[Intercarpal and radiocarpal resection arthroplasty and arthrodesis]. / Interkarpale und radiokarpale Resektionsarthroplastiken und Arthrodesen.

Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBOCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis. Implant resection arthroplasty of the lunate and scaphoid or total wrist implants are still causing multiple problems regarding heavy load. Therefore this implants should be confined to rheumatoid patients. Of the limited carpal arthrodeses the scaphotrapezium-trapezoid arthrodeses is the most frequent performed procedure. It can be indicated for STT-osteoarthritis, KIEHNBOCK's disease, scapho-lunate instability and scaphoid pseudarthrosis if other surgical procedures had failed presuming there are no signs of arthrosis in the radiocarpal joint. Persisting pain especially in heavy work is quite frequent after limited arthrodesis but can be greatly relieved by simultaneous wrist denervation. In advanced cases of osteoarthritis total wrist arthrodesis is still the best choice for the patient.

Intercarpal and radiocarpal resection arthroplasty and arthrodesis.

Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBÖCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis. Implant resection arthroplasty of the lunate and scaphoid or total wrist implants are still causing multiple problems regarding heavy load. Therefore this implants should be confined to rheumatoid patients. Of the limited carpal arthrodeses the scaphotrapezium-trapezoid arthrodeses is the most frequent performed procedure. It can be indicated for STT-osteoarthritis, KIEHNBÖCK's disease, scapho-lunate instability and scaphoid pseudarthrosis if other surgical procedures had failed presuming there are no signs of arthrosis in the radiocarpal joint. Persisting pain especially in heavy work is quite frequent after limited arthrodesis but can be greatly releaved by simultaneous wrist denervation. In advanced cases of osteoarthritis total wrist arthrodesis is still the best choice for the patient.

Ilizarov distraction-lengthening in congenital anomalies of the upper limb.

Nine patients underwent Ilizarov distraction-lengthening for congenital anomalies. All were late cases and had undergone other procedures. In five radial club hand patients with very short forearms, we achieved an average 5.8 cm increase in length with each distraction cycle. In two patients with symbrachydactyly of the cleft hand type, we achieved pinch grip between a radial and an ulnar digit by lengthening the short ray. Another case of the monodactyly type in which we tried to lengthen three transplanted proximal toe phalanges ended in failure. A soft tissue distraction was attempted in a case of camptodactyly but failed. We report the problems we encountered and suggest some solutions.

[Donor site defect after removal of free and pedicled forearm flaps: functional and cosmetic results]. / Der Hebedefekt nach Entnahme freier und gestielter Unterarmlappen: Funktionelle und kosmetische Ergebnisse.

The donor-site defect poses a special problem in free and pedicled forearm flaps. A multi-center-study of seven departments for Hand and Plastic Surgery in Germany and Switzerland studied the problem and showed the functional and cosmetic results. 342 questionnaires were checked. 267 patients came for a follow-up examination. 83.9% of them were satisfied with the result of the operation. Restrictions of movement in the wrist, forearm, and elbow appeared to be very rare. Half of the patients considered the donor-site defect to be ugly. Nearly the same number objected to preoperative information about the appearance of the donor-site defect. Based on the results of this study, we can still recommend the radial forearm flap for small and medium size soft-tissue defects, delicate technique of closure of the donor site defect provided.

[High voltage accidents, characteristics and treatment]. / Hochspannungsunfälle, Besonderheiten und Behandlung.

High-voltage injuries cause localised entrance and exit burns, extensive arc, flame and flash burns and, even more dangerous, necrosis of the underlying muscles on the pathway of the current through the body. Therefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be judged by the percentage and depth of the skin burn. Diagnostic fasciotomies, radical debridement, and in many cases early amputation are necessary to prevent life-threatening complications. Over a period of 10 years, 43 patients with high-voltage injuries have been treated at the Hamburg Burn Center, 36 of them in primary care. Common causes of injury were accidents in railway areas (28%), using portable aluminium ladders near overhead power lines (9.3%), and working on electrical equipment (30.2%). Six of the primary care patients died (16.6%), and 34.9% had an amputation of one or more extremities. Nearly all patients underwent several debridement and split-skin graft procedures. In 30% of cases additional free and pedicled flaps were needed to cover soft tissue defects. Ten patients (23.3%) sustained fractures and other injuries from falls, seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics were diagnosed in 16.6% of the primarily treated patients. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these caused solely by the electric current.

[Covering skin-soft tissue defects with a free forearm flap in exposed osteosynthesis material in the area of the lower leg]. / Deckung von Haut-Weichteildefekten mit dem freien Unterarmlappen bei freiliegendem Osteosynthesematerial im Unterschenkelbereich.

Soft tissue defects in the lower leg with exposed internal fixation plates frequently pose problems to the surgeon. Substantial defects in the distal lower leg should be covered by free tissue transplantation. Very good results can be achieved in such cases using the radial forearm flap. This flap can be used for covering exposed internal fixation plates in selected patients. The authors present four such cases. The flaps healed well in all cases and fracture healing was without delay. Bone fixation procedure did not have to be changed.