[Damage pattern caused by high pressure water jets and high pressure water abrasive jets to the hand]. / Schädigungsmuster von Hochdruck-Wasserstrahlen und Hochdruck-Wasser-Abrasivstrahlen an der Hand.

Water and abrasive water jets have been developed as efficient tools for different purposes in industrial manufacturing, cleaning and dismantling, and--experimentally--in drilling and milling. In contrast to other high pressure techniques, these machines produce power densities up to 250 kW/mm2. In order to assess the range of destruction caused by water as well as abrasive water jets in human hands, cadaveric forelegs of pigs were targeted with constant nozzle geometry and working distance between cadaver and nozzle. Variable parameters investigated included pressure and time of exposure. Reproducible injury patterns were found in the forefoot of the pig, allowing for conclusions to be drawn with respect to damage assessment in the human hand.

Deepithelialized vertical rectus abdominis flap in calf augmentation.

This is the first report of a case of aesthetic calf augmentation with microvascular transferred autologous material. The technique regarding to calf augmentation using silicon prostheses is described and the advantages and disadvantages of this method are discussed. This should incite discussion on the use of free-flap technique in aesthetic operations.

[Anterior interosseus syndrome from the surgical viewpoint]. / Das Interosseus-anterior-Syndrom aus chirurgischer Sicht.

An isolated lesion of the anterior interosseus nerve has different causes and may be difficult to differentiate preoperatively. However, an exact diagnosis is necessary before starting immediate operative therapy or waiting for a change. One case of denervation of the flexor pollicis longus muscle is reported. The problems involved in clinical and instrumental diagnostic procedures and therapy are shown and discussed with reference to the literature.

[Free tissue transplantation for correction of calf asymmetry. A case report]. / Die freie Gewebetransplantation zur Korrektur der Wadenasymmetrie. Ein Fallbericht.

A case of aesthetic calf augmentation by a microsurgical free deepithelialized VRAM-flap is reported. As a result of poliomyelitis infection in childhood and atrophy of the m. gastrocnemius medialis sinister, the contour of the left calf was deformed. The reconstruction by autologous material was performed by use of the free VRAM-flap. The indications, advantages, and disadvantages of this method compared to calf augmentation by silicon prostheses are discussed.

[Therapy of thumb tip injuries]. / Die Therapie der Daumenkuppenverletzungen.

Thump-tip lesions are the most common occupational and non-occupational injuries to the hand. Our fingers and especially the thumb are the integral part of any manual activity and, at the same time, are the most exposed. In this report we illustrate the possibilities of treating thumb-tip injuries. Depending on the kind of injury, the extent of tissue loss and the length of the remaining part of the thumb, the different methods of treatment are shown. Their advantages and disadvantages are discussed and the recommendations in the literature are listed. Our own results in treating 86 thumb-tip injuries during the passed 10 years are demonstrated.

[Isolated denervation of the flexor pollicis longus muscle as a rare sequela of anterior interosseus syndrome]. / Die isolierte Denervation des Musculus Flexor Pollicis Longus als seltene Folge eines Interosseus-Anterior-Syndroms.

Isolated lesion of the anterior interosseus nerve is very uncommon. One case of a denervation of the flexor pollicis longus muscle is reported. The problems of clinical and instrumental diagnostic and therapy of the interossus anterior syndrome are shown and discussed with the literature.

Free vascularized mesentery transfer for closure of wide peritoneal wall defects.

The repair of large abdominal defects can often present problems related to the availability of local tissues adequate for filling the gap without creating high abdominal tension and pressure. The use of a free vascularized mesentery flap for restoration of the abdominal wall, in a case of an infiltrating carcinoid of the right upper and middle abdomen, is reported. After anastomosing the mesentery donor vessels to the deep inferior epigastric artery and vein, the subcutaneous and cutaneous layers were sutured primarily. Closure of the peritoneal cavity by means of vascularized undamaged visceral peritoneum should avoid infection and the formation of adhesions.

[Treatment strategy in explosion and gunshot injuries of the upper extremity]. / Behandlungsstrategie bei Explosions- und Schussverletzungen an der oberen Extremität.

Explosion and gunshot injuries represent a challenging problem with regard to preserve optimal hand function. These wounds exhibit a spectrum of complexity and mostly include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and concomitant trauma. To gain maximal restoration of hand function the use of microsurgical technique, grafting of nerves, vessels and soft tissue as an acute free flap to cover a large defect immediately is necessary. The experience in treatment of 38 cases of blast and gunshot injuries of the hand are reported. The results are discussed in relation to literature, complication, indication and technique.

[Value of heterotopic finger replantation]. / Sinn und Zweck heterotoper Fingerreplantationen.

Multidigital amputations represent a challenging problem with regard in restoring optimal sensomotoric hand function. Often orthotopic finger stumps or the separated digits are unfit for conventional replantation. This condition is an imperative indication for transpositional replantation. Among 24 heterotopic replantations the survival rate was 82 percent. The favorable finger transfer was a pollizisation, followed by a substitution of the middle finger and finally creating an expanding opposite grip on the ulnar site of the hand. Secondary corrective procedures have been performed in 37.5 percent. To evaluate the global hand function score systems according to Millesi or Tamai have been applied. 65 percent presented a "good" subjective and objective hand function as to Tamai. However the regain of hand function has to be aspired much more in the single and individual case of transpositional replantations when compared to the Millesi-score system.

[Primary reconstruction of the left hand by heterotopic replantation of the right mid-hand]. / Primäre Rekonstruktion der linken Hand durch heterotope Replantation der rechten Mittelhand.

A case of heterotopic replantation of the metacarpus is demonstrated. This procedure shows the successful primary reconstruction of a severely injured hand. The result seventeen months after the injury is shown. The patient is rehabilitated and is able to manage basic activities of daily living.

[Genesis and treatment of hand para-articular, painful tendon and tendon sheath changes]. / Genese und Behandlung handgelenksnaher, schmerzhafter Sehnen- und Sehnenscheidenveränderungen.

Many patients suffer from wrist disorders caused by tendon- and tendon-sheath-affections. Apart from this the successful treatment of these affections is an important implication concerning national economy. In Lower Saxony 2.3% of all RVO-insured patients have these disorders. Most tendon- and tendon-sheath-affections are due to chronic stress which is generally treated by a non-operative therapy. Only some need be treated by a surgical intervention. In this paper the most frequent painful tendon- and tendon-sheath-diseases are listed, their clinical appearance is shown and the different methods of treatment are discussed.

Male reduction mammoplasty in serious gynecomastias.

This article is a report on long-term followup of a total of 44 serious gynecomastia cases in the stages I-III (according to Deutinger). The treatment consisted of either a semicircular incision and subcutaneous mastectomy or a superiorly or an inferiorly based nipple transposition while performing male reduction mammoplasty. Aesthetically pleasing results could be obtained by a periareolar approach and mastectomy. This inconspicuous procedure is feasible even in massive gynecomastia cases (stage III) or in cases of male breast asymmetry. On the other hand, all cases with breast reduction plasty and nipple transposition resulted in wing-shaped, mainly broad scars, and subjectively unfavorable results. Consequently, we favor the semicircular approach in male reduction mammoplasty in treating serious gynecomastias. With regard to possible male breast cancer etiology, the histological specimen of the mammary gland in gynecomastia is excised prior to any additional liposuction for supplementary body contouring.

[Functional rehabilitation of the upper extremity after compartment syndrome]. / Funktionswiederherstellung an der oberen Extremität nach Kompartmentsyndrom.

In established compartment syndrome discrimination between the different forms of flexion contracture, i.e., manifest Volkmann's contracture and intrinsic contracture is necessary. A combination of both is also possible. Classification is essential for determination of whether reconstruction is indicated and what procedure should be selected. Shortening osteotomies of the ulna and radius are now of historical interest only, as is carpalectomy. Lengthening of the flexor tendons is indicated only in mild and localized limited contracture of only some of the long fingers, but there is a danger of possible further adhesions limiting the range of motion. Thus, cases of stage I and II according to Tsuge with persisting partial flexor motor function are treated mainly by muscle sliding operation (Scaglietti) combined with microsurgery for internal neurolysis of the median and ulnar nerves. The latter is anteriorly transposed. In cases of solitary intrinsic contracture we prefer the Littler release procedure. The most useful repair in advanced compartment syndrome, however, consists in free microsurgical tissue transfer. The non-contractile, degenerated scarred flexor muscle remnants are excised and substituted orthotopic by transfer of free, neurovascular muscle, with salvage of flexor motor function in the forearm.