[The impact of the VAC-treatment for locally advanced malignancy of the scalp]. / Stellenwert der V.A.C.(R)-Therapie beim fortgeschrittenen Kopfhautmalignom.

Locally advanced cutaneous malignancy of the scalp is a disease that requires an aggressive approach to resection and reconstruction. In cases where the pericranium is intact a split-thickness skin graft is a simple treatment, since direct closure often fails because due to the lack of elasticity of the scalp. If there is a loss of periosteum or a skull defect local or free flaps are necessary for sufficient coverage. Increasing geriatric and polymorbid patients with impaired wound healing require surgical treatment, considering pros and cons for general anaesthesia. A simple method of both, combining radicality of tumor resection with outer table bone and skin grafting as a two stage procedure, while minimizing perioperative risk using local anaesthesia and analgo-sedation, using the vacuum assisted closure device, is presented.

Salvage of an ischaemic lower limb and a free flap with an arterial Y-graft. Case report.

A defect of the lower limb was treated with a scapular free flap. An end-to-side anastomosis was made to the posterior tibial artery, which was the single perfusing artery of the foot. When it thrombosed, the problem was solved successfully with an arterial Y-graft.

[Reconstruction of nose defects by combined multiple flap-plasties and stabilization with cartilage transplants]. / Die Rekonstruktionen von Nasendefekten durch Kombination mehrerer Lappenplastiken und Stabilisierung mit Knorpeltransplantaten.

In the reconstruction of nasal defects, the method of choice involves flaps from the immediate surroundings (nose, cheek, forehead), because of their superior skin colour and texture match. In defects involving all layers of the nose, the inner lining and the nasal skeleton must also be reconstructed. These procedures are often performed in several steps, with incision and elevation of flaps, implantation of cartilage and skin-grafting of the donor site (prefabricating). By using one flap to replace the missing skin and a second flap for inner lining, a stabilizing cartilage graft can be inserted primarily. Using this "sandwich-technique", subtotal nose reconstructions can be performed in a single stage as well. Between 1986 and 1996, 23 patients underwent nasal reconstructions using local flaps. Our reconstructive concept is demonstrated by means of several clinical cases.

Reconstruction of a complex defect on the foot with an osteotendofasciocutaneous lateral arm free flap. Case report.

A one-stage reconstruction of a complex defect of the dorsum of the foot was undertaken with an osteotendofasciocutaneous lateral arm free flap in a 21 year old man. A vascularised strip of the triceps tendon with the adjacent part of the olecranon was used to reconstruct a missing tibialis anterior tendon with the insertion into the medial cuneiform bone. Recovery was uneventful and he was discharged from hospital after two weeks.

Procel burn cover used as a total body dressing in burns.

A 26-month-old boy sustained a scald injury covering 83 per cent of his total body surface area (TBSA). He also developed sepsis and multiorgan failure (MOF). Locally he was treated with Procel burn cover and silver sulphadiazine cream (SSD) for 23 days. By using Procel, the dressing-change time was shortened significantly. Procel burn cover controlled core and skin temperature more effectively compared to conventional dressing, and the staff acceptance increased because of its easy and fast use. Based on our observation, this material can be used successfully as a total body dressing with children with extensive partial thickness burns or temporarily in full thickness burns until wound excision can be performed.

[Scar tissue cancer: observations and results of 23 cases]. / Narbenkarzinom: Beobachtungen und Ergebnisse in 23 Fällen.

The scar tissue carcinoma is a rare disease which arises from the floor of unstable scars, chronic fistulae, ulcera and radiation injuries. The clinical pictures of 23 cases between 1976 and September 1990 have been elucidated. Compared to earlier findings it must now be stated that the development of cancer in stasis ulcera is more frequent than in burn scars or X-ray cancer. Generally, the number of scar tissue carcinomas seems to decrease. Since surgical and adjuvant therapies are--like in any other cancers--limited, prevention and early diagnosis have become of major importance. Though the cancer grows mainly on the body surface and could, therefore, be easily recognised, we still found tumours of remarkable dimension and disturbance, which were either shown to the physician too late or remained unrecognised by the diagnostician.

Successful replantation of a totally amputated penis by using microvascular techniques.

A rare case of successful replantation of a totally amputated penis is reported. By using microvascular techniques a superior result was achieved. Not only were all tissue preserved, but also urination, sensation and erection returned to normal. Specific points to be considered in penile replantation are discussed.

The osteomusculocutaneous musculoperitoneal groin flap in head and neck reconstruction.

The anatomy of the ascending branch of the deep circumflex iliac vessels is reported. This vasculature allows the design of a musculoperitoneal flap, not exceeding 7 cm x 14 cm, together with an osteomusculocutaneous groin flap. The procedure is particularly useful, if resection of an intraoral carcinoma has included such structures as bone and the outer skin of the head and neck. The flap can be harvested with or without the internal oblique muscle. Most common composite defects after resection can be replaced by an osteomusculoperitoneal flap. Clinical applications are also described and one case report is included.

[Complications and failures in free-flap transplantations]. / Komplikationen und Misserfolge bei freien Lappentransplantationen.

Complications and failures in nine cases of free flap transfer are reported. With increasing experience the number of failures declines. In six of seven cases with total flap necrosis technique and tactics in microsurgical procedure were responsible for the disaster. The failure in the other case was due to thrombosis of an axillary vein and thoracodorsal vein leading to necrosis of a latissimus dorsi flap. A dorsalis pedis flap was saved by arterial inflow through a flap vein. The fact that not one flap could be saved by revision is accounted for by the circumstance that the monitoring looks at capillary filling alone. It is possible that the Laser-Doppler-flowmetry is a useful and practical method for objective monitoring.

[Compartment syndrome as a complication of surgical position in penis replantation]. / Kompartmentsyndrome als Lagerungskomplikation bei Penisreplantation.

A case report of a penis- and scrotum amputation in a 28-year old patient, caused by a moped accident, is presented. The penis replantation is discussed as are the postoperative problems.

[Resorbable suture material in cardiovascular surgery?]. / Resorbierbares Nahtmaterial im Rahmen der Herz- und Gefässchirurgie?

The examination of a new, fully resorbable suture material (polydioxanon) in case of artery sutures is reported. Smaller tissue reactions are found than in all suture materials examined. Exceptional long durability for fully resorbable suture material seems in case of anastomoses in vessels very usefull.