[Vacuum assisted closure for the treatment of sternal wound infections -- rapid infection control and bridging to reconstructive surgery]. / Vakuumtherapie bei sternaler Wundinfektion -- Initiale Therapie zur Infektkontrolle und Uberbrückung zur plastisch chirurgischen Rekonstruktion.

Vacuum Assisted Closure (V.A.C.) is a sound strategy to control severe post-sternotomy infection. Secondary re-wiring of the sternal bone or reconstructive surgery may be required later to achieve complete wound closure. Ten patients with severe sternal bone infection underwent initial V.A.C. therapy and delayed surgery for wound closure. Complete wound healing was achieved in all cases. As a case report we describe a patient with right-sided mastectomy and irradiation for breast cancer, who developed severe post-sternotomy infection and sternal bone necrosis following CABG. A combination of V.A.C. therapy and surgical reconstruction using a pedicled latissimus dorsi musculocutaneous flap led to complete wound closure.

[Vascular complications in free tissue transfers]. / Vaskuläre Komplikationen bei der freien Gewebeübertragung.

The causes of vascular complications after 306 cases of free vascularized tissue transfers were examined. The technique and success of the explorative operations were determined. The results show that 22 flaps were lost because of failures in indication, technique and monitoring. A no-reflow phenomenon was not observed.

[Clinical aspects and surgical treatment of Dupuytren contracture]. / Klinik und chirurgische Therapie der Dupuytren-Kontraktur.

The etiology of Dupuytren's contracture is still not clear. Many theories have been proposed, but no basic data are currently available that would make it possible to treat Dupuytren's contracture by other methods than surgical intervention. The surgical technique used in our clinic is described, and a postoperative treatment is also outlined. This paper is designed to propose an acceptable technique for practicing trauma and hand surgeons.

Muscle transfers in brachial plexus lesions.

The concept of reconstruction to regain lost function after brachial plexus lesions has to be as broad and complex as possible. We have been exploring wider and more novel clinical concepts at the Clinic of Plastic, Hand, and Reconstructive Surgery at the Medical School of Hannover. Our ideas are supported by experience in 160 patients. We have attempted to combine the use of a vascularized nerve graft and a microvascularly-transferred autologous muscle. Patients undergoing the procedures have included those with late complete root avulsions and no functional return, as well as previously operated cases with poor recovery of biceps, wrist, and forearm function. The surgery is divided into two stages. In the first stage, the ulnar nerve is prepared as a vascularized nerve graft and is sutured to intercostal nerves 3 to 5 or 6. In stage 2, when the Tinel sign reaches the distal ends of the ulnar nerve graft (about six to eight months later), the latissimus dorsi muscle is harvested. The muscle is then placed as far distally as possible in the forearm and sutured to the deep finger flexors and flexor pollicis longus. Proximally, the insertion is performed similarly to Steindler's method. The vessels are connected to the brachial artery and vein and the thoracodorsal nerve is sutured to the graft. This method provides flexion of both the fingers and the elbow.

[Criteria for amputation, reconstruction and replantation of extremities in multiple trauma patients]. / Kriterien der Amputation, Rekonstruktion und Replantation von Extremitäten bei Mehrfachverletzten.

The paper defines indications for amputation, reconstruction and replantation of severely injured extremities of multiple traumatised patients using the trauma score PTS (Hannover Polytrauma Score) and the fracture grading for open and closed fractures.

[Indications for primary wound closure in bite injuries of the face]. / Zur Indikation des primären Wundverschlusses bei Bissverletzungen im Gesicht.

Because of high infection rats and because of possible deformities after radical débridement there is still some restraint in primary wound closure in facial bite injuries. Today the sophistication of facial reconstructive surgery provides the possibility even with injuries with significant skin defects to gain primary healing with satisfactory results from a cosmetic point of view as well as from a functional one.

[Initial treatment of amputation injuries]. / Erstbehandlung von Amputationsverletzungen.

Emergency treatment of an amputation injury is based on the correct assessment of the extent and functional loss of the amputated part. In addition to choosing the best treatment for the patient and amputated part, timely organization of transport and early contact with the replantation center are of utmost importance. We present the results of our experience based on replantations in 323 patients.

[Surgical treatment of tumor-induced destruction of the spine]. / Chirurgische Behandlung tumoröser Wirbelsäulendestruktionen.

Surgery for treatment of destructions of the spine varies depending on localization and tumour status. If the body of the vertebra is affected, the ventral approach allows radical tumour resection as far as possible. The following stabilization is effected by filling the defect and carrying out osteosynthetical fusion. Of 38 patients, three had benign tumours, whereas ten patients had primary malignant and 25 had metastatic tumours. The results show that surgical treatment is justified also in palliative indications; although survival time is not prolonged, the quality of life can be improved.

[Results of the surgical treatment of distal femoral fractures]. / Ergebnisse nach operativer Behandlung von distalen Femurfrakturen.

In a follow-up of 97 operated distal femoral fractures good and satisfactory results were found in 64% of the cases. 22% unsatisfactory and 14% poor findings attribute mainly to the comminuted supracondylar fracture types. More than half of the patients were multiple injured. In 83% of the cases the internal fixation was obtained by the use of the condyle buttress plate.

[The accessory brachial tendon--a rare cause of pronator teres syndrome]. / Die akzessorische Brachialissehne--seltene Ursache des Pronator teres-Syndroms.

The pronator syndrome is caused by a compression of the median nerve at the level of the elbow. In the case presented bizonal compression of the nerve was seen, first by the lacertus fibrosus, second by an isolated abnormal tendon of the brachialis muscle. The treatment, therefore, includes the early and extensive operative exploration of the nerve, the resection of all compressive structures and sometimes interfascicular neurolysis and transposition of the nerve anterior to the pronator teres, when the nerve is in a badly scarred bed.

[Management of complex pelvic injuries]. / Management der komplexen Beckenverletzung.

Compound pelvic fractures can be mastered only by means of an active surgical procedure. If the shock cannot be controlled by conservative treatment, early angiography followed by embolisation should be done. Alternatively to embolisation, control of haemorrhage can be achieved by specific ligation, reconstruction of the vessels or tamponade with mandatory laparotomy. Septic complications can be prevented by a liberal indication of derivative colostomy with irrigation of the rectal segment by copious amounts of saline solution, by suprapubic urinary drainage and meticulous "debridement" of soft tissue. The procedure is presented in detail.

Treatment of disordered and ordered systems of polymer chains by lattice methods.

Classical lattice theories of systems of long-chain molecules provide estimates of the number Z of random configurations to the exclusion of ordered ones. The decrease of Z thus estimated to values [unk]1 with decrease in chain flexibility at high densities is genuine, but it does not take account of eligible ordered configurations; the latter are not a subset of the configurations whose numbers are estimated by classical lattice methods. Failure to recognize this fact and the fundamental distinction between disordered and ordered states has engendered misinterpretations and has cast doubt on the validity of lattice-statistical methods. In a system at equilibrium, the decline of Z (disordered) with decrease in chain flexibility must be arrested by a first order transition to an ordered state. The inference that approach of Z (disordered) to values <1 presages a thermodynamic transition of second order is tenable only if the array of ordered configurations, not comprehended by theories in which the mean field of unoccupied lattice sites is random, can be ignored.