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Brix E, Prantl L, Anker A, Klein S, Kehrer A. Free neurovascular toe-(joint)-transfers compared to alternative reconstructive procedures for amputation injuries of two and tripartite fingers with substance loss. Clin Hemorheol Microcirc 2024; 86:71-88. [PMID: 37742630 DOI: 10.3233/ch-238114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Complex injuries of the hand frequently result in loss of essential functional features. Common reconstructive procedures for soft tissue defects of the thumb or phalanges are locoregional flaps like Moberg-, Foucher-, Cross-Finger- or Littler flaps. Microneurovascular toe (joint-) transfers complete the arsenal of operative reconstructive procedures and allow for most detailed reconstructions. Our experiences with free toe transplants are reported and diversely discussed regarding contending procedures. METHODS From 2010 until 2019 14 patients who received emergency or elective partial or complete toe transfers were compared with a control group (n = 12) treated with contending reconstructive procedures. Aim of the reconstructions was to cover the defect with well-vascularized, sensate tissue, while preserving length and range of motion in a reliable manner. RESULTS The Kapandji score showed a significant difference (p- value = 0.04) with a score of 9.8 in comparison to control group (Kapandji index = 8.0). CONCLUSION In our heterogenic patient collective free toe transplants have proven to achieve comparable functional results for reconstruction of two and tripartite phalanxes as opposed to common local reconstructive procedures.
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Affiliation(s)
- E Brix
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Klein
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Department of Plastic and Reconstructive Surgery, Ingolstadt Hospital, Ingolstadt, Germany
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Wenzel C, Brix E, Heidekrueger P, Lonic D, Lamby P, Klein SM, Anker A, Taeger C, Prantl L, Kehrer A. A favorable donor site in microsurgery: Nerve and vein graft harvest from the dorsum of the foot. Clin Hemorheol Microcirc 2021; 83:1-10. [PMID: 34719482 DOI: 10.3233/ch-211135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES In complex hand traumas nerves and vessels are often destructed without the possibility for primary repair. For bridging defects of nerves, veins and arteries grafts are necessary. Commonly nerve and vein grafts from adjacent donor sites as the wrist, forearm or cubital region are harvested. METHODS This study is a retrospective cohort study. Between 2017 and 2019, 10 patients with complex hand injuries were treated. There were 8 males and 2 females, with an average age of 39 years (range 8-63 years). In all cases grafts were used of the dorsum of the foot for reconstructing of the severed digital nerves and arteries. All donor sites could be closed primarily. RESULTS In 100% of cases nerves and veins of the dorsum of the foot showed a good size match as well as adequate length for a sufficient repair. The overall Hand Injury Severity Score (HISS) was determined with a median of 86 (range 57 to 286). In the area of the donor site no relevant complications were seen. CONCLUSIONS In complex hand injuries the dorsum of the foot is a favorable donor site for nerve and vein graft harvest.
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Affiliation(s)
- C Wenzel
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - E Brix
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Heidekrueger
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - D Lonic
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Lamby
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - S M Klein
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Anker
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C Taeger
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Kehrer
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Plastic and Reconstructive Surgery, Ingolstadt Hospital Ingolstadt, Ingolstadt, Germany
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Moellhoff N, Prantl L, Fritschen U, Germann G, Giunta RE, Kehrer A, Aung T, Zeman F, Broer PN, Heidekrueger PI. Uni-vs. bilateral DIEP flap reconstruction - A multicenter outcome analysis. Surg Oncol 2021; 38:101605. [PMID: 34022504 DOI: 10.1016/j.suronc.2021.101605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Over the past decade numbers of bilateral mastectomy have increased steadily. As a result, bilateral breast reconstruction is gaining popularity. The presented study compares complications and outcomes of unilateral and bilateral DIEP free-flap breast reconstructions using the largest database available in Europe. METHODS Female breast cancer patients (n = 3926) receiving DIEP flap breast reconstructions (n = 4577 free flaps) at 22 different centers were included in this study. Free flaps were stratified into two groups: a unilateral- (UL) and a bilateral- (BL) breast reconstruction group. Groups were compared with regard to surgical complications and free flap outcome. RESULTS Mean operative time was significantly longer in the BL group (UL: 285.2 ± 107.7 vs. BL: 399.1 ± 136.8 min; p < 0.001). Mean ischemia time was comparable between groups (p = 0.741). There was no significant difference with regard to total (UL 1.8% vs. BL 2.6%, p = 0.081) or partial flap loss (UL 1.2% vs. BL 0.9%, p = 0.45) between both groups. Rates of venous or arterial thrombosis were comparable between both groups (venous: UL 2.9% vs. BL 2.2%, p = 0.189; arterial: UL 1.8% vs. BL 1.2%, p = 0.182). However, significantly higher rates of hematoma at the donor and recipient site were observed in the UL group (donor site: UL 1.1% vs. BL 0.1%, p = 0.001; recipient site UL 3.9% vs. BL 1.7%, p < 0.001). CONCLUSIONS The data underline the feasibility of bilateral DIEP flap reconstruction, when performed in a setting of specialized centers.
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Affiliation(s)
- N Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - L Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany.
| | - Uv Fritschen
- Department of Plastic and Esthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, Berlin, Germany
| | - G Germann
- Department of Plastic, Reconstructive, Esthetic and Handsurgery, ETHIANUM Klinik Heidelberg, Germany
| | - R E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - A Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - T Aung
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - P N Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - P I Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Germany
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Abstract
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
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Affiliation(s)
- V M Hösl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - A Kehrer
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - L Prantl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Engelmann S, Ruewe M, Geis S, Taeger CD, Kehrer M, Tamm ER, Bleys RLAW, Zeman F, Prantl L, Kehrer A. Author Correction: Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves. Sci Rep 2020; 10:6865. [PMID: 32300183 PMCID: PMC7162972 DOI: 10.1038/s41598-020-63860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
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Affiliation(s)
- V M Hösl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - A Kehrer
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - L Prantl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Engelmann S, Ruewe M, Geis S, Taeger CD, Kehrer M, Tamm ER, Bleys RLAW, Zeman F, Prantl L, Kehrer A. Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves. Sci Rep 2020; 10:1935. [PMID: 32029860 PMCID: PMC7005293 DOI: 10.1038/s41598-020-58917-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/20/2020] [Indexed: 11/09/2022] Open
Abstract
We developed a time-efficient semi-automated axon quantification method using freeware in human cranial nerve sections stained with paraphenylenediamine (PPD). It was used to analyze a total of 1238 facial and masseteric nerve biopsies. The technique was validated by comparing manual and semi-automated quantification of 129 (10.4%) randomly selected biopsies. The software-based method demonstrated a sensitivity of 94% and a specificity of 87%. Semi-automatic axon counting was significantly faster (p < 0.001) than manual counting. It took 1 hour and 47 minutes for all 129 biopsies (averaging 50 sec per biopsy, 0.04 seconds per axon). The counting process is automatic and does not need to be supervised. Manual counting took 21 hours and 6 minutes in total (average 9 minutes and 49 seconds per biopsy, 0.52 seconds per axon). Our method showed a linear correlation to the manual counts (R = 0.944 Spearman rho). Attempts have been made by several research groups to automate axonal load quantification. These methods often require specific hard- and software and are therefore only accessible to a few specialized laboratories. Our semi-automated axon quantification is precise, reliable and time-sparing using publicly available software and should be useful for an effective axon quantification in various human peripheral nerves.
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Affiliation(s)
- S Engelmann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Ruewe
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C D Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - E R Tamm
- Institute of Human Anatomy, University of Regensburg, Regensburg, Germany
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
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Anker AM, Miranda BH, Prantl L, Kehrer A, Strauss C, Brébant V, Klein SM. 50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery. Aesthetic Plast Surg 2019; 43:608-615. [PMID: 30903252 DOI: 10.1007/s00266-019-01345-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding. METHODS A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003-2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs. RESULTS Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons. CONCLUSIONS This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- A M Anker
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - B H Miranda
- Plastic and Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, NW3 2QG, UK
| | - L Prantl
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Kehrer
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C Strauss
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - V Brébant
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Klein
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Heine-Geldern A, Broer P, Prantl L, Brebant V, Anker A, Kehrer A, Thiha A, Lonic D, Ehrl D, Ninkovic M, Heidekrueger P. Impact of intraoperative use of vasopressors in lower extremity reconstruction: Single centre analysis of 437 free gracilis muscle and fasciocutaneous anterolateral thigh flaps. Clin Hemorheol Microcirc 2019; 71:193-201. [DOI: 10.3233/ch-189411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Heine-Geldern
- Department of Plastic, Hand, and Reconstructive Surgery, BG Unfallklinik, Frankfurt, Germany
| | - P.N. Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM - Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
| | - L. Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - V. Brebant
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A.M. Anker
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A. Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A. Thiha
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - D. Lonic
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - D. Ehrl
- Department of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians University Munich, Campus Großhadern, Munich, Germany
| | - M. Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM - Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
| | - P.I. Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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Guimarães B, Bandow C, Amorim MJB, Kehrer A, Coors A. Mixture toxicity assessment of a biocidal product based on reproduction and avoidance behaviour of the collembolan Folsomia candida. Ecotoxicol Environ Saf 2018; 165:284-290. [PMID: 30205330 DOI: 10.1016/j.ecoenv.2018.08.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
Biocidal products represent mixtures that might be released into the environment at application and continuously during service life. Concentration addition (CA) has been proposed as default model to calculate theoretical mixture toxicity. However, the suitability of CA for chronic toxicity towards soil organisms has so far rarely been evaluated and therefore needs further experimental evidence. The present study investigated the toxicity of a wood preservative product and the individual active substances (tebuconazole and IPBC) therein with the aim to evaluate the compliance with the CA prediction for the product. Folsomia candida was selected as test organism for this purpose using the endpoints reproduction and avoidance behaviour. Both endpoints were increasingly impacted by increasing concentrations of the wood preservative product as well as its active substances tested individually. The chronic effects of the product could be predicted by CA with less than 4-fold deviation, while the assessment for avoidance behaviour indicated a strong underestimation. This underestimation could not be attributed to the one known formulation additive, an organic solvent. Overall, the present study provides some more evidence that CA could be applied as default model for standard endpoints of soil organisms, but warns against using CA for behavioural responses.
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Affiliation(s)
- B Guimarães
- ECT Oekotoxikologie GmbH, Böttgerstr. 2-14, 65439 Flörsheim a.M., Germany; University of Aveiro, Department of Biology & CESAM, 3810-193 Aveiro, Portugal
| | - C Bandow
- ECT Oekotoxikologie GmbH, Böttgerstr. 2-14, 65439 Flörsheim a.M., Germany
| | - M J B Amorim
- University of Aveiro, Department of Biology & CESAM, 3810-193 Aveiro, Portugal
| | - A Kehrer
- German Environment Agency, Wörlitzer Platz 1, 06844 Dessau, Roßlau, Germany
| | - A Coors
- ECT Oekotoxikologie GmbH, Böttgerstr. 2-14, 65439 Flörsheim a.M., Germany.
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Aung T, Taeger C, Geis S, Schiltz D, Brix E, Wenzel C, Lamby P, Kehrer A, Prantl L, Brebant V. WITHDRAWN: The use of integrated indocyanine green fluorescence microscope camera for intraoperative lymphography of supermicrosurgery. Clin Hemorheol Microcirc 2018:CH189311. [PMID: 30347608 DOI: 10.3233/ch-189311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- T Aung
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - C Taeger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - S Geis
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - D Schiltz
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - E Brix
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - C Wenzel
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - P Lamby
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - L Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - V Brebant
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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Kehrer A, Engelmann S, Ruewe M, Geis S, Taeger C, Kehrer M, Tamm ER, Bleys RLAW, Prantl L, Mandlik V. Perfusion maintains functional potential in denervated mimic muscles in early persistent facial paralysis which requires early microsurgical treatment - the histoanatomic basis of the extratemporal facial nerve trunk assessing axonal load in the context of possible nerve transfers. Clin Hemorheol Microcirc 2018; 70:1-13. [PMID: 30010114 DOI: 10.3233/ch-189905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684±1884 axons (range, 2655- 12457) were counted for the entire group (n = 87). Right facial halves showed 6364±1904 axons (n = 43). Left facial halves demonstrated 6996±1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247±2230 (n = 22), male showed 6769±1809 axons (n = 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012). CONCLUSIONS No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen.
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Affiliation(s)
- A Kehrer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Engelmann
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Ruewe
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Taeger
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Germany
| | - E R Tamm
- Institute of Human Anatomy, University of Regensburg, Germany
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, The Netherlands
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - V Mandlik
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
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Kauffmann P, Troeltzsch M, Cordesmeyer R, Heidekrueger PI, Schliephake H, Canis M, Wolff HA, Rave-Fraenk M, Stroebel P, Kehrer A, Prantl L, Aung T. Presentation of a variation of the chorioallantoic membrane set up as a potential model for individual therapy for squamous cell carcinoma of the oropharynx. Clin Hemorheol Microcirc 2018; 67:453-457. [PMID: 28885213 DOI: 10.3233/ch-179226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The chorioallantoic membrane of fertilized chicken eggs in an early phase of breeding presents an approved test situation for the growth and treatment of human cancer cells.These models work due to the inoculation of cells into the membrane that stays within the egg shell during the time of investigation. In this study a modification of this model is presented. Samples of native tumors, rather than cell lines, are transplanted into the membrane and the body of the egg is taken out of the shell and placed in a plastic bowl. These modifications lead to an enhanced accessibility to the chorioallantoic membrane and the surrounding vessels thus facilitating intra venous access and application of pharmaceuticals and a focused radiotherapy. With the current modifications the embryo was kept alive and additionally, the vascularized tumor environment was preserved.
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Affiliation(s)
- P Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Göttingen, Göttingen, Germany
| | - M Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Göttingen, Göttingen, Germany
| | - R Cordesmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Göttingen, Göttingen, Germany
| | - P I Heidekrueger
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich, Munich, Germany
| | - H Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Göttingen, Göttingen, Germany
| | - M Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - H A Wolff
- University Medical Center Göttingen, Present Address: Department of Radiotherapy and Radiation Oncology, Radiologie München, Munich, Germany
| | - M Rave-Fraenk
- University Medical Center Göttingen, Present Address: Department of Radiotherapy and Radiation Oncology, Radiologie München, Munich, Germany
| | - P Stroebel
- Institute of Pathology, University Medical Centre, Göttingen, Germany
| | - A Kehrer
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - T Aung
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
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Ranieri M, Wohlgemuth W, Müller-Wille R, Prantl L, Kehrer A, Geis S, Klein S, Lamby P, Schiltz D, Uller W, Aung T, Dolderer JH. Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment. Clin Hemorheol Microcirc 2018; 67:355-372. [PMID: 28885203 DOI: 10.3233/ch-179216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.
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Affiliation(s)
- M Ranieri
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Wohlgemuth
- Department of Radiology, University Hospital Regensburg, Germany.,Institute of Radiology, University Hospital Halle, Germany
| | - R Müller-Wille
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany
| | - L Prantl
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - A Kehrer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Geis
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Klein
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - P Lamby
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - D Schiltz
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - T Aung
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - J H Dolderer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
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Kehrer A, Engelmann S, Bauer R, Taeger C, Grechenig S, Kehrer M, Prantl L, Tamm ER, Bleys RLAW, Mandlik V. The nerve supply of zygomaticus major: Variability and distinguishing zygomatic from buccal facial nerve branches. Clin Anat 2018; 31:560-565. [PMID: 29322603 DOI: 10.1002/ca.23044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/14/2017] [Accepted: 01/08/2018] [Indexed: 11/11/2022]
Abstract
The zygomaticus major (ZM) is important for the human smile. There are conflicting data about whether the zygomatic or buccal branches of the facial nerve are responsible for its motor innervation. The literature provides no precise distinction of the transition zone between these two branch systems. In this study, a definition to distinguish the facial nerve branches at the level of the body of the zygoma is proposed. In the light of this definition, we conducted an anatomical study to determine how the source of innervation of the ZM was distributed. A total of 96 fresh-frozen cadaveric facial halves were dissected under loupe magnification. A hemiparotidectomy was followed by antegrade microsurgical dissection. Any branch topographically lying superficial to the zygoma or touching it was classed as zygomatic, and any neighboring inferior branch was considered buccal. The arborization of the facial nerve was diffuse in all cases. In 64 out of 96 specimens (67%, 95% CI: 56% to 76%), zygomatic branches innervated the ZM. Buccal branches innervated ZM in the other 32 facial halves (33%, 95% CI: 24% to 44%). There were no differences in respect of sex or facial side. All facial halves displayed additional branches, which crossed the muscle on its inner surface without supplying it. In 31 specimens, a nerve branch ran superficial to ZM in its cranial third. According to our classification, the zygomaticus major is innervated by zygomatic branches in 67% of cases and by buccal branches in 33%. Clin. Anat. 31:560-565, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- A Kehrer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
| | - S Engelmann
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
| | - R Bauer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
| | - C Taeger
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
| | - S Grechenig
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - M Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Germany
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
| | - E R Tamm
- Institute of Human Anatomy, University of Regensburg, Germany
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, The Netherlands
| | - V Mandlik
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Germany
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Mandlik V, Kehrer A, Jiga L, Hoinoiu B, Ionac M, Jung F, Staudenmaier R, Prantl L. Prefabrication and free transfer of a tissue engineered composite flap - An experimental model in the rat. Clin Hemorheol Microcirc 2016; 64:319-331. [PMID: 27935552 DOI: 10.3233/ch-168120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The technique of flap-prefabrication has been successfully established in tissue engineering: missing intrinsic vascularisation of engineered tissue can be generated in vivo by microsurgical vesselloop construction. It is possible to move engineered tissue into a defect with microsurgery. In the literature, the combination of engineered tissue covered with skin is not widely reported. OBJECTIVE Aim of this study was to establish a model to investigate scaffold prefabrication with full thickness skin graft coverage with subsequent free tissue transfer. METHODS 8 Wistar rats were operated in 2 separate steps: 1) after creating an arteriovenous loop with the femoral vessels, a porous scaffold was placed on the loop and covered with an inguinally based skin flap. A control was implanted without loop into the contralateral groin. 2) 6 weeks later the prefabricated composite flaps were microsurgically transferred to the cervical region. Skin-island monitoring was performed with Laser Doppler-scanner after the transfer. RESULTS Continuous loss of the skin islands was observed within 72 hours. Complications included wound-dehiscence, thrombosis and death from anaesthesia; in spite of consistent loop viability. CONCLUSION Evaluation showed that modifications are necessary to maintain the skin-island cove.
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Affiliation(s)
- V Mandlik
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - A Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - L Jiga
- Division of Microsurgery, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - B Hoinoiu
- Division of Microsurgery, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - M Ionac
- Division of Microsurgery, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburger Centre for Regenerative Therapies (BCRT), Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | | | - L Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Germany
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Gohla T, Kehrer A, Holle G, Megerle K, Germann G, Sauerbier M. Funktionelle und ästhetische Gesichtspunkte bei der Defektdeckung der Streckseite an Hand und distalem Unterarm mit freien Lappenplastiken. Unfallchirurg 2007; 110:5-13. [PMID: 17124616 DOI: 10.1007/s00113-006-1203-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Free coverage of exposed functional structures of the hand and distal forearm can be achieved using a variety of free flaps. However, there is a lack of data in the literature which tissue components are best used for defect coverage of this specific area regarding aspects such as tendon gliding and tissue elasticity. The purpose of this retrospective study was to compare and to evaluate the functional and aesthetical results using free cutaneous, fascial and muscle flaps. PATIENTS AND METHODS Between 1994 and 2002, a total of 56 patients underwent free flap coverage at the dorsal side of the hand and forearm at our institution. Of these patients, 20 with 21 free flaps met the study criteria and were available for follow-up examination. Depending on the tissue component used patients were allocated into three different groups. In group 1 eight patients received a fascial flap, in group 2 eight a cutaneous flap and in group 3 five a muscle flap. The mean follow-up was 50 months (range: 4-103 months). At follow-up examination the patients answered the Client Satisfaction Questionnaire (CSQ 8) and the DASH questionnaire. RESULTS Regarding range of motion of the wrist and fingers, fascial flaps clearly showed the best results. Concerning grip strength and pinch grip, fascial and cutaneous flaps demonstrated the same results. Patients with cutaneous flaps showed the best DASH score. Regarding the overall aesthetical outcome, fascial and cutaneous flaps were far better than muscle flaps. Donor site morbidity was lowest for fascial flaps followed by muscle flaps and was highest for cutaneous flaps. CONCLUSION Cutaneous and fascial flaps had the best functional and aesthetical results. Fascial flaps achieved the best aesthetical outcome of the donor site. We recommend free fascial flaps and cutaneous flaps as the first choice due to their advantages in the specific area of the dorsal site of the hand and distal forearm which requires pliable and thin tissue coverage.
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Affiliation(s)
- T Gohla
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie der Universität Heidelberg, 67071 Ludwigshafen.
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Abstract
PURPOSE Coverage of exposed functional structures such as tendons, bones, vessels or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. Free fascial flaps are possible alternatives to cutaneous, fasciocutaneous and muscle flaps. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free serratus fascial flaps in our department. METHOD AND CLINICAL MATERIAL From 1994 to 2002, ten patients underwent free fascial flap coverage of the hand with eleven serratus fascial flaps. Six patients could be re-examined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was after 34 months. RESULTS Average active range of motion of the hand, functional improvement and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. CONCLUSION We recommend the use of free serratus fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps since the functional results are excellent; no additional procedures were necessary and the aesthetical results are appealing.
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Affiliation(s)
- A Flügel
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie -- Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen
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Abstract
Coverage of exposed functional structures such as tendons, bones, vessels, or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free fascial flaps. From 1994-2002, 14 patients underwent free fascial flap coverage of the hand with 4 tempo-parietal fascia flaps and 11 serratus fascia flaps. Eight patients could be reexamined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was 41.7 months. Average active range of motion of the hand, functional improvement, and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. We recommend the use of free fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps, since the functional results are excellent, no additional procedures were necessary, and the aesthetic results are appealing.
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Affiliation(s)
- A Flügel
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany
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Dou SQ, Kehrer A, Ofial AR, Weiss A. N-trichloro- and dichloroacetyl amino acids and compounds of amino acids with halogeno acetic acids. 35Cl nuclear quadrupole resonance spectroscopy; crystal structure of N-trichloroacetyl-glycine, - DL-alanine and - L-alanine. Acta Crystallogr A 1993. [DOI: 10.1107/s0108767378088716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Georgiev J, Georgieva R, Kehrer A, Weil S. [Relationship between environmental temperature, humidity and energy conversion in the Göttinger miniature pig]. Berl Munch Tierarztl Wochenschr 1977; 90:392-6. [PMID: 921725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Kehrer A, Starke P. [Experience on breeding, rearing, and keeping of cats for experimental purposes under conventional conditions]. Berl Munch Tierarztl Wochenschr 1975; 88:101-7 concl. [PMID: 1120064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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23
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Kehrer A, Starke P. [Experience on breeding, rearing and keeping of cats for experimental purposes under conventional conditions]. Berl Munch Tierarztl Wochenschr 1975; 88:94-7 contd. [PMID: 1120063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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24
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Kehrer A. [Chorionic development and structure of the placenta zonaria in the cat, dog and fox (author's transl)]. Z Anat Entwicklungsgesch 1973; 143:25-42. [PMID: 4789566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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25
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Kehrer A. [Copper deficiency diseases of sheep in Turkey]. Berl Munch Tierarztl Wochenschr 1970; 83:371-8. [PMID: 5528591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bronsch K, Lörcher K, Kehrer A. [Calcium metabolism in poultry. 2. Resorption of dietary calcium and endogenous calcium excretion in laying hens]. Z Tierphysiol Tierernahr Futtermittelkd 1967; 22:349-54. [PMID: 4924983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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