Scaphoid pseudarthrosis is defined and the most common techniques are described (Matti-Russe, Geissend6rfer-Obermuth, Corticalis splinter, Enders bookplate, the AO screw). Four of our own cases are discussed and the good results (43 of 48 patients) prove the superiority of the "sandwich" grafting technique in scaphoid reconstruction using the Herbert screw. The indication, contraindications, and suitable alternative procedures are also discussed. Other advantages are that the patient is disabled for a shorter period of time and that a second operation is unnecessary.
A 3.5-year-old girl suffered from a thermal injury affecting 37% of the body surface area. The parents, being Jehovah's witnesses, refused permission for their child to receive blood transfusions. As the haemoglobin level was only 7.5% and a necrectomy was planned, the patient was likely to need blood transfusions. Indications for transfusion were defined as clinical signs of hypoxia and/or cardiovascular instability. A judicial declaration was proposed. Hb decreased during the therapy. To stimulate the erythropoiesis erythropoietin and iron were administered. During the clinical course the anaemia worsened. First, a conservative treatment with polyvidoniodine ointment for tanning was started, to avoid an operation during the acute phase after the injury, as in this case it was thought a blood transfusion would definitely be necessary. On the 19th day after the injury a necrectomy of 10% of the body surface was necessary because of fever and leucocytosis not responding to antibiotics. The most likely cause of the symptoms was an infection of the burned area. Hb was 4.6 g/dl%. General anaesthesia was performed with midazolam, ketamine and vecuronium and mechanical ventilation. No blood transfusion was required during the operation. Vital signs were stable during the preoperative period, during anaesthesia and following the operation. There were no signs of tissue hypoxia. Peripheral oxygen saturation ranged between 98% and 100%, lactate and arterial blood gas samples were normal, and the child was awake and cooperative before and after anaesthesia. The lowest Hb was 3.3 g/dl on the 22th day after injury (3rd postoperative day). In this phase the patient was still playing and riding a tricycle. On the 45th day after injury the child was discharged home with Hb of 10.9 g/dl and reticulocytosis of 33%.
In a comparison of two groups of patients (identical according to age, sex and number of simultaneous injuries) we tried to evaluate radical and planned debridement (debridement every 48 h with removal of all avascular and badly perfused tissue) in patients with open fractures of the lower leg. We could demonstrate a correlation between adequate debridement and the frequency of posttraumatic osteitis, septic-toxic reactions and the incidence of amputation. "Unscrupulous" and planned debridement leads to a significant reduction of post-traumatic osteitis, a decrease in the frequency of amputation, shortening of the duration of hospitalization and, therefore, to a diminished loss of social and familial interaction.Summary. Breast reconstruction with the use of an upper rectus flap utilizes perforating cutaneous branches of the superior epigastric artery. Flap necrosis of various degrees, which occurred in our series of 26 patients at a rate of up to 30 %, prompted repeated dissection and perfusion studies. In 35 fixed and 12 fresh cadavers, 1 to 3 perforators with an average diameter of 0.5 mm were found in every specimen. Between 8 and 21 cm (average 13.5 cm) lateral to the median line, extensions of the perforators could be demonstrated. Clinical investigation showed a high risk of flap necrosis in irradiated patients and in those undergoing simultaneous prosthesis implantation.
Zusammenfassung. Zum nichtinvasiven Nachweis isch~.mischer Muskelnekrosen wurde bei 26 Patienten und 20 Kontrollpersonen eine computerassistierte Funktionsanalyse nach Injektion von 15 mCi Tc-99m M DP i. v. durchgeffihrt. Die Bestimfiaung der arteriellen FlieBgeschwindigkeit und der integralen Durchblutung in den Extremit/iten sowie der Nachweis einer Speicherung des Tc-99 m MDP Komplexes in der Muskulatur lassen die Existenz und Ausdehnung ischiimischer Muskelnekrosen erkennen und erleichtern in klinisch fraglichen Fallen die Indikationsstellung ffir oder wider ein operatives Vorgehen. Sehliisselwiirter: Kompartment-Syndrom -Speicherung yon Tc-99m MDP in Muskelnekrosen -nicht invasive Funktionsanalyse.Summary. The hind legs of 18 dogs were amputated and replanted. Of three experimental groups, group 1 was the control, in which the limbs were immediately replanted. In groups 2 and 3, the limbs were exposed to warm ischemia at room temperature for 3 h, after which those of group 2 were refrigerated (+ 4 ° C) dry for another 3 h and replanted. The limbs from group 3 were, however, perfused for 3 h with room-temperature cell-free hemoglobin solution and replanted. All animals in group 3 showed good washout of potassium and myoglobin and maintained stable cardiovascular status. In group 2, two animals died of hyperkalemia (up to 7 mval/l), tachycardia, and shock, following the declamping phenomenon. At 16 months following replantation, irreversible tissue damage and loss of limb function were found only in animals from group 2.Zusammenfassuug. 18 Hunde wurden oberschenkelamputiert mit Knochendurchtrennung. 6 Extremit~iten (Gruppe I) wurden sofort replantiert, w/ihrend die restlichen Extremit/iten ffir 3 h bei Zimmertemperatur gelagert wurden. Vor Replantation wurdenje 6 Extremitfiten weitere 3 h bei + 4 ° C trocken gelagert (Gruppe II) oder ffir 3 h mit stromafreier H/imoglobinl6sung (Gruppe III)perfundiert. Die Tiere der Gruppe III zeigten einen guten Auswascheffekt von Kalium und Myoglobin bei stabilen Kreislaufverh/iltnissen nach der Replantation. In Gruppe II war nach Replantation ein Anstieg des Serumkaliums auf 7 mval/l bei Druckabfall und tachykarden Krisen zu erkennen, wobei 2 Tiere an diesem Declamping-PhS.nomen verstarben. Bei einer Nachbeobachtung bis 16 Monaten waren deutliche irreversible Zellsch~iden nur in Gruppe II nachweisbar bei Funktionsverlust der Extremit~iten.Sehliisselwiirter: Postisch/imie-Syndrom -Declamping-PhS.nomen -stromafreie H/imoglobinperfusion. Summary.A report is given of 45 operations of the carPal and 15 of the tarsal tunnel. Both nerve-compression syndromes can often be found post-traumatically. The clinical diagnosis and necessary neurological examination (EMG) are demonstrated. The therapy of choice is perineural decompression; the operative technique is described. None of the patients examined at follow-up had any complaints. Zusammenfassung. Es wird fiber 45 Operationen beim Carpaltunnel-Syndrom und fiber 15 Operationen beim Tarsaltunnel-Syndrom berichtet. Beide Nervenkompress...
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