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Fuchsberger T, Gonser P, Boesch CE, Tonagel F, Fischborn T, Schaller HE, Haerle M. Corrigendum to ``Patient-rated long-term results after complete denervation of the wrist'' [Journal of Plastic, Reconstructive & Aesthetic Surgery Volume 71 Issue 1 (2018) 57-61]. J Plast Reconstr Aesthet Surg 2018; 71:1381. [PMID: 30017672 DOI: 10.1016/j.bjps.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T Fuchsberger
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - P Gonser
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - C E Boesch
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - F Tonagel
- Department for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany
| | - T Fischborn
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - H E Schaller
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - M Haerle
- Clinic for Hand- and Plastic Surgery, Orthopedic Hospital Markgroeningen (OKM), Kurt-Lindemann-Weg 10, 71706 Markgroeningen, Germany
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Fuchsberger T, Boesch CE, Tonagel F, Fischborn T, Schaller HE, Gonser P. Patient-rated long-term results after complete denervation of the wrist. J Plast Reconstr Aesthet Surg 2017; 71:57-61. [PMID: 28882490 DOI: 10.1016/j.bjps.2017.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 07/20/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to examine the long-term results after the denervation of the wrist. Between 1977 and 2001, we treated 375 patients in our clinic. The mean age was 43.5 years; 81% were male and 19% female. The long-term results were assessed by a questionnaire assessing pain on a visual analog scale and patient satisfaction and by the DASH questionnaire. After a mean follow-up of 12.23 years, we found an overall pain reduction of 52.1%. In 67.7% of the patients, we found a relief of pain: of these, 44% are free of pain until today and 56% were temporarily asymptomatic. Patients with a painful osteoarthritic condition without dynamic instability and good range of motion are ideal candidates to benefit from the denervation. The complete denervation of the wrist is an effective treatment option in patients with painful wrist conditions to reduce pain and improve the overall function.
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Affiliation(s)
- T Fuchsberger
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - C E Boesch
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - F Tonagel
- Department for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany
| | - T Fischborn
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - H E Schaller
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - P Gonser
- Clinic for Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
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Petersen W, Rothenberger J, Schaller HE, Rahmanian-Schwarz A, Held M. Experiences with Osteoligamentoplasty According to Weiss for the Treatment of Scapholunate Dissociation. J INVEST SURG 2017; 31:313-320. [PMID: 28829651 DOI: 10.1080/08941939.2017.1330907] [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: 10/19/2022]
Abstract
BACKGROUND In post-traumatic, dynamic, or static scapholunate (SL) instability, an SL ligament reconstruction is advisable to avoid long-term complications. However, a sufficient primary reconstruction is best achieved in acute injuries. For chronic SL dissociation, there is still no satisfying standard surgical technique. In this context, we evaluated the clinical outcome of Weiss's osteoligamentoplasty as a treatment option. METHODS Over a three-year period, 16 patients with chronic and symptomatic SL dissociation Grade-II and III, without the signs of osteoarthrosis were, surgically treated using a bone-retinaculum-bone autograft from the distal radius. All patients underwent prior wrist arthroscopy. The clinical outcome was measured using the Mayo-Wrist, Krimmer, and DASH score. In addition, radiological measurements were also performed. RESULTS The postoperative clinical outcome successfully increased the Mayo-Wrist score: 32 to 64 points, Krimmer score: 30 to 53 points and DASH score: 41 to 30 points. The radiological follow-up demonstrated no evidence of an SL gap or significant loss of reposition in the SL angle in 13 of the 16 cases. Till date, two patients had to be revised to an arthrodesis. CONCLUSIONS The autogenous osteoligamentary span from the distal radius improves a chronic SL dissociation and, therefore, presents a suitable option to anatomically reconstruct the SL ligament. It leads to a proper realignment of the carpus and could help to prevent arthritic changes of the wrist. Nevertheless, in patients with postoperative high occupational physical strain, the procedure should be performed with reservations. As long as there is no satisfying standard surgical treatment, Weiss's osteoligamentoplasty is a convincing technique.
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Affiliation(s)
- W Petersen
- a BG Trauma Center, Department of Plastic, Reconstructive, Hand and Burn Surgery , Tuebingen , Baden Wuerttemberg , Germany
| | - J Rothenberger
- a BG Trauma Center, Department of Plastic, Reconstructive, Hand and Burn Surgery , Tuebingen , Baden Wuerttemberg , Germany
| | - H E Schaller
- a BG Trauma Center, Department of Plastic, Reconstructive, Hand and Burn Surgery , Tuebingen , Baden Wuerttemberg , Germany
| | - A Rahmanian-Schwarz
- b Clinic Traunstein, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery , Traunstein , Bavaria , Germany
| | - M Held
- a BG Trauma Center, Department of Plastic, Reconstructive, Hand and Burn Surgery , Tuebingen , Baden Wuerttemberg , Germany
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Giunta RE, Horch RE, Prantl L, Fuchs PC, Germann G, Infanger M, Jakubietz R, Kneser U, Langer S, Lehnhardt M, Machens HG, Mailänder P, Pallua N, Reichert B, Schaefer DJ, Schaller HE, Stark GB, Steinau HU, Vogt PM. [Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2015/2016]. HANDCHIR MIKROCHIR P 2016; 48:370-373. [PMID: 28033627 DOI: 10.1055/s-0042-121417] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRÄC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.
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Affiliation(s)
- R E Giunta
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - R E Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen
| | - L Prantl
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität, Regensburg, Caritas-Krankenhaus St. Josef, Regensburg
| | - P C Fuchs
- Klinik für Plastische, Wiederherstellungs- und Handchirurgie - Schwerstverbranntenzentrum, Campus Köln-Merheim Kliniken der Stadt Köln gGmbH, Lehrstuhl der Universität Witten-/Herdecke, Köln
| | | | - M Infanger
- Klinik für Plastische, Wiederherstellungs- und Handchirurgie, Otto-von-Guericke-Universität, Magdeburg
| | - R Jakubietz
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie/Sektion Plastische & Ästhetische Chirurgie / Universitätsklinikum Würzburg, Würzburg
| | - U Kneser
- Klinik für Hand-, Plastische & Rekonstruktive Chirurgie/Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen, Ludwigshafen
| | - S Langer
- Abteilung für Plastische-, Ästhetische- und spezielle Handchirurgie, Universitätsklinikum Leipzig - AöR, Leipzig
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Universitätsklinik Bergmannsheil, Bochum
| | - H G Machens
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie/Klinikum rechts der Isar, Technische Universität München, München
| | - P Mailänder
- Sektion Plastische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - N Pallua
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie Universitätsklinikum - RWTH Aachen, Aachen
| | - B Reichert
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg-Süd, Nürnberg
| | - D J Schaefer
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz
| | - H-E Schaller
- Plastische Chirurgie, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls Universität/BG Unfallklinik, Tübingen
| | - G B Stark
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Freiburg
| | - H-U Steinau
- Universitätsklinik für Allgemein- und Transplantationschirurgie, Sektion Sarkomchirurgie, Westdeutsches Tumorzentrum, Plastische Chirurgie, Essen
| | - P M Vogt
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Hannover
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Lotter O, Hoefert S, Micheel M, Gonser P, Schaller HE, Rothenberger J. [Analysis of Diagnosis Related Groups and their Impact on Health Care in Post Massive Weight Loss Surgery]. HANDCHIR MIKROCHIR P 2016; 48:226-32. [PMID: 27547931 DOI: 10.1055/s-0042-110568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Diagnosis Related Groups (DRG) were introduced in Germany as a medico-economic classification system in 2004. In this analysis, we looked at restorative surgery after massive weight loss, focusing on reimbursement of this fee-per-case system in comparison to costs to deduce possible effects on health care over time. MATERIAL AND METHODS First we analysed the algorithms for the relevant DRGs including data about length of stay and reimbursement. Furthermore, we integrated cost data from German reference hospitals of the last 5 years as well as single-centre data from a university hospital. RESULTS Due to a diagnosis-related algorithm, coding will constantly lead to DRG K07Z. In 2016, a new diagnosis code specific to massive weight loss was introduced, which now leads to DRG J10B. As a result, reimbursement is reduced by more than half. In the cost matrix, staff, general ward, operation theatre and anaesthesia were identified as the main cost drivers. As expected, there was a statistically significant correlation between general ward costs and time of stay in hospital as well as operation theatre costs and incision-suture time. Considering the cost data of the reference hospitals, there was an average excess of EUR 781 per case whereas our own cost data revealed a deficit of EUR 1 700 to 2 700 per case. This is mainly due to the fact that approximately one third of our patient cohort underwent highly elaborate circular body lifts. CONCLUSION It has to be questioned whether a newly introduced main diagnosis code can be applied as such without any underlying cost data having been collected in previous years. Given unchanged treatment measures, the main cost drivers identified by us remain the same, which means that there is no rationale for a drop in revenue. In addition to providing incentives for an efficient use of resources and quality optimisation, this system should offer medical service providers a sustainable and realistic possibility to break even.
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Affiliation(s)
- O Lotter
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Klinikum Landkreis Tuttlingen
| | - S Hoefert
- Klinik für Mund-, Kiefer- und Gesichtschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen
| | - M Micheel
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen
| | - P Gonser
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen
| | - H-E Schaller
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen
| | - J Rothenberger
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen
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Fuchsberger T, Jaminet P, Gonser P, Manoli T, Schaller HE, Aszmann O. [Decompression of Peripheral Nerves in the Treatment of Diabetic Polyneuropathy]. HANDCHIR MIKROCHIR P 2015; 47:190-5. [PMID: 26084859 DOI: 10.1055/s-0035-1550043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Polyneuropathy causing ulceration and amputation as a long-term consequence of diabetes mellitus is analysed for its pathophysiology, socioeconomic and medical relevance. Outcomes of decompression of peripheral nerves on the lower extremity regarding sensation, pain, development, and recurrence of ulceration, and amputation is evaluated by a systematic literature review in pubmed, medline and embase. Decompression of peripheral nerves in diabetic peripheral neuropathy seems to be a good treatment option for restoring sensation, decreasing pain, as well as for avoiding the development and recurrence of ulceration and amputation.
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Affiliation(s)
- T Fuchsberger
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Tübingen
| | - P Jaminet
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Tübingen
| | - P Gonser
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Tübingen
| | - T Manoli
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Tübingen
| | - H-E Schaller
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Tübingen
| | - O Aszmann
- Zentrum für Extremitätenrekonstruktion und Rehabilitation, Abteilung für Plastische und Wiederherstellende Chirurgie, Medizinische Universität Wien, Wien
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Medved F, Schubert M, Held M, Notohamiprodjo M, Lotter O, Schaller HE. [Technique of Autologous Chondrocyte Implantation for Severe Radiocarpal Arthrosis: Status Quo after 24 Months]. HANDCHIR MIKROCHIR P 2015; 47:164-70. [PMID: 26084855 DOI: 10.1055/s-0035-1550041] [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: 10/23/2022] Open
Abstract
We illustrate the operative technique of autologous chondrocyte implantation (ACI) to restore a 4° cartilage damage of the radius surface in the case of a 22-year-old patient, and report on the clinical and radiological results at 6 and 24 months postoperatively.
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Affiliation(s)
- F Medved
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - M Schubert
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - M Held
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - M Notohamiprodjo
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen
| | - O Lotter
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - H-E Schaller
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
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Esfahani BJ, Faron A, Roth KS, Schaller HE, Medved F, Lüers JC. [Systematic analysis of the readability of patient information on the websites of clinics for plastic surgery]. HANDCHIR MIKROCHIR P 2014; 46:369-74. [PMID: 25412241 DOI: 10.1055/s-0034-1385936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The Internet is becoming increasing-ly important as a source of information for patients in medical issues. However, many patients have problems to adequately understand texts, especially with medical content. A basic requirement to understand a written text is the read-ability of a text. The aim of the present study was to examine texts on the websites of German -plastic-surgical hospitals with patient information regarding their readability. MATERIALS AND METHODS In this study, the read-ability of texts of 27 major departments of plastic and Hand surgery in Germany was systematically analysed using 5 recognised readability indices. First, texts were searched based on 20 representative key words and themes. Thereafter, texts were assigned to one of 3 major themes in order to enable statistical analysis. In addition to the 5 readability indices, further objective text parameters were also recorded. RESULTS Overall, 288 texts were found for analyzation. Most articles were found on the topic of "handsurgery" (n=124), less were found for "facial plastic surgery" (n=80) and "flaps, breast and reconstructive surgery" (n=84). Consistently, all readability indices showed a poor readability for the vast majority of analysed texts with the text appearing readable only for readers with a higher educational level. No significant differences in readability were found between the 3 major themes. CONCLUSION Especially in the communication of medical information, it is important to consider the knowledge and education of the addressee. The texts studied consistently showed a readability that is understandable only for academics. Thus, a large part of the intended target group is probably not reached. In order to adequately deliver online information material, a revision of the analysed internet texts appears to be recommendable.
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Affiliation(s)
- B Janghorban Esfahani
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - A Faron
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - K S Roth
- Deutsches Seminar, Abteilung Linguistik, Universität Zürich, Zuerich, Switzerland
| | - H-E Schaller
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - F Medved
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - J-C Lüers
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Uniklinik Köln, Köln
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Siegel-Axel D, Guthoff M, Nadalin S, Rittig K, Schaller HE, Königsrainer A, Heyne N, Häring HU. Perihiläres Fett: ein weiteres funktionell aktives, perivaskuläres Fettgewebe mit hohem angiogenetischem Potential, das sich von anderen Fettgeweben unterscheidet. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374884] [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: 10/25/2022]
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Medved F, Janghorban-Esfahani B, Manoli T, Faron A, Rahmanian-Schwarz A, Schaller HE. [Traumatic rupture of a hydrogel-filled breast implant - a case for the Employer's Liability Insurance Association?]. HANDCHIR MIKROCHIR P 2014; 46:113-5. [PMID: 24408326 DOI: 10.1055/s-0033-1361099] [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: 10/25/2022] Open
Abstract
Today textured breast implants for augmentation and reconstruction are commonly used to reduce the incidence of capsular contractures. Despite modified surfaces, capsular contracture may occur as result of traumatic or iatrogenic ruptures of the implant along with discharge of filling material.We report the interesting case of a female patient with traumatic rupture of one prosthesis in an industrial accident 14 years after implantation of hydrogel-filled breast prostheses. As it was a work related accident, the Employer's Liability Insurance Association is responsible for covering the treatment. The patient history and the histological exam have proven that the accident was work related.
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Affiliation(s)
- F Medved
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität -Tübingen, Tübingen
| | - B Janghorban-Esfahani
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität -Tübingen, Tübingen
| | - T Manoli
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität -Tübingen, Tübingen
| | - A Faron
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität -Tübingen, Tübingen
| | | | - H-E Schaller
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität -Tübingen, Tübingen
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Gonser P, Medved F, Schaller HE, Lotter O. [Economic profit of different injuries in a centre for hand surgery - replantation vs. amputation]. HANDCHIR MIKROCHIR P 2013; 45:350-3. [PMID: 24357480 DOI: 10.1055/s-0033-1361117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The Institute for Reimbursements in Hospital (InEK) annually provides an updated DRG system to ensure the medical service providers with a cost-covering remunera-tion. However, the underlying cost data are often opaque and disclosure of the basis of calculation does not take place. On the basis of cost and revenue data from our clinic between 2010 and 2012, a profit statement for amputations and replantation of one or more fingers was employed and compared with the nationwide data of the calculation clinics. MATERIALS AND METHODS Inpatient days, the revenue and the costs incurred in our clinic based on the cost matrix of InEK costing manual [4] were determined for amputation (DRG X05B), replantation of one (DRG X07B) and several fingers (DRG X07A). The profit was calculated as the difference between revenues and costs. Further-more, a comparison of our data with the nationwide data of InEK was applied. RESULTS For each of the 3 DRGs the actual costs in our clinic were higher than the costs generated by InEK. Only amputation appeared profitable, while all limb-preserving interventions were associated with losses for our hospital. There was a clear discrepancy between the data of cost of InEK GmbH to the data of our clinic. CONCLUSION In order not to create any monetary disincentives at the expense of quality of care of individual patients, a cost-covering patient care for all case groups mentioned above should be ensured. The general distrust in the InEK's data that results from such a discrepancy in the cost data can only be rebutted by increasing transparency and disclosure of the calculation basis.
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Affiliation(s)
- P Gonser
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen
| | - F Medved
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen
| | - H-E Schaller
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen
| | - O Lotter
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen
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Rothenberger J, Held M, Jaminet P, Stahl S, Rahmanian-Schwarz A, Schaller HE. [Benign subcutaneous emphysema caused by a bellows mechanism of the first interdigital space]. HANDCHIR MIKROCHIR P 2013; 45:311-3. [PMID: 24089310 DOI: 10.1055/s-0033-1357135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We report 2 cases of subcutaneous emphysema after stab wounds of the first interdigital space. The first diagnosis of a gas gangrene was not confirmed. We hypothese an air incorporation caused by a bellows mechanism. An escape of the air may not be possible due to an one-way valve mechanism. The aim of this report is to describe criteria to distinguish benign emphysema from emphysema caused by infection.
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Affiliation(s)
- J Rothenberger
- Klinik für Hand-, Plastische-, Rekonstruktive und Verbrennungschrurgie, BG Unfallklinik Tübingen, Eberhard-Karls -Universität Tübingen
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13
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Medved F, Gonser P, Lotter O, Albrecht D, Amr A, Schaller HE. Severe posttraumatic radiocarpal cartilage damage: first report of autologous chondrocyte implantation. Arch Orthop Trauma Surg 2013; 133:1469-75. [PMID: 23880842 DOI: 10.1007/s00402-013-1821-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Case report. CLINICAL QUESTION Traumatic articular cartilage defects predispose to secondary osteoarthritis accompanied by impairment or complete loss of function in the corresponding joint. On this account, the timely and correct diagnosis as well as the selection of an appropriate therapy for reconstruction of articular cartilage defects is important. METHODS A 22-year-old healthy male patient with history of traumatic intra-articular distal radius fracture is presented with in the course detectable 4° cartilage damage in the fovea scaphoidea and into the fovea lunata. For the first time, autologous chondrocyte implantation by the use of an in situ polymerizable albumin-hyaluronic acid gel was performed to restore the articular cartilage. RESULTS The assessment 6 months after autologous chondrocyte implantation using the standard DASH questionnaire for upper extremity pointed out an improvement in the patient outcome (DASH score pre-operative: 10.8 and 6 months post-operative: 7.5). The clinical examination also showed an improvement in the range of movement of the wrist without pain. The radiological control investigation (MRI- examination) of the wrist 6 months after implantation also revealed a good integration of the implant. CONCLUSION The case presented here demonstrates the first use of autologous chondrocyte implantation for cartilage reconstruction using an in situ polymerizable albumin-hyaluronic acid gel after traumatic cartilage lesion with 4° cartilage damage of the wrist in a 22-year-old non-smoking, active and healthy man. Initial results are promising in terms of mobility, pain and patient outcome. However, further clinical studies have to be performed with larger number of cases.
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Affiliation(s)
- F Medved
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany,
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Horch RE, Vogt PM, Schaller HE, Stark GB, Lehnhardt M, Kneser U, Giunta RE. [Strategies to ensure careers of young academics in plastic surgery - analysis of the current situation and future perspectives]. HANDCHIR MIKROCHIR P 2013; 45:193-9. [PMID: 23881363 DOI: 10.1055/s-0033-1347195] [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: 10/26/2022] Open
Abstract
Recruitment problems in surgical disciplines have become an increasingly debated topic. On the one hand current career prospects appear to be less attractive than those were seen for the previous generation. On the other hand the demands for a so-called "work-life balance" have changed and the proportion of female students and colleagues in medicine has risen and will continue to increase. Although Plastic Surgery currently seems to be less affected by these problems than other surgical disciplines, securing a qualified supply of young academics in Plastic Surgery is a prerequisite for the further development of this discipline. The traditional model of mentoring is discussed and the role of coaching in a sense of helping the mentorees examine what they are doing in the light of their intentions and goals is reflected. The present article tries to analyze the current status of academic Plastic Surgery from the viewpoint of German university senior surgeons in academic plastic surgery, and aims to highlight the specific prospects for young academics against the backdrop of an often one-sided and superficial perception of this profession.
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Affiliation(s)
- R E Horch
- Plastisch und Handchirurgische Klinik, Universitätsklinikum Erlangen, -Friedrich Alexander Universität Erlangen-Nürnberg.
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15
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Gonser P, Lotter O, Schaller HE, Jaminet P. [Development of length of stay and reimbursement in elective hand surgery after the introduction of DRGs in Germany]. HANDCHIR MIKROCHIR P 2012; 44:306-9. [PMID: 23027336 DOI: 10.1055/s-0032-1323712] [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: 10/27/2022] Open
Abstract
BACKGROUND Since its introduction in Germany, the DRG (Diagnosis-Related Groups) system is often fraught with negative connotations. Frequent points of criticism are a deterioration of patient care by decreasing length of stay (LOS) in hospital and a decline in reimbursement. The following investigation analyzes and compares the development of length of stay and reimbursement in hand surgery based on the 3 most common elective procedures. MATERIAL AND METHODS The main diagnoses scaphoid nonunion (PSA), Dupuytren's contracture (DK) and rhizarthrosis (RIA) were evaluated for number of cases, length of stay, reimbursement per day and total reimbursement in 2000 as well as 2010 based on the data of our clinic. Patients covered by the Employers' Liability Insurance were not included. Only inpatient cases were considered. RESULTS In PSA and RIA an increase in the number of cases is reported (PSA: +11 cases; RIA: +26 cases) and a decrease in DK ( - 7 cases). The sum of the total hospital days declined despite rising case numbers predominantly between 65 (RIA) and 260 days (DK). The average LOS decreased by 3.1 days at DK (48.4%) to 4.1 days at PSA (52.6%). Average revenues per day in 2000 amounted to 379 €, which corresponds to 442 € adjusted for inflation in 2010. Average revenue per day in 2010 was 755 € (RIA), 797 € (PSA) and 876 € (DK). Revenue per case in 2010 were only higher than in 2000, when 5 (RIA) or 6 hospital days (DK and PSA) were not exceeded. CONCLUSION With declining revenue per case, the average income per day increased by a reduction in hospital days. A positive or at least equivalent revenue situation can thus only be achieved by a distinct concentration of labor and reduction of hospital days under the DRG-system.
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Affiliation(s)
- P Gonser
- Abteilung für Hand-, Plastische, rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen.
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Jaminet P, Schäufele M, Geuna S, Schaller HE, Rosenberger P, Köhler D. [Scope and limitations of the median nerve mouse model in research on peripheral nerve regeneration]. HANDCHIR MIKROCHIR P 2012; 44:204-8. [PMID: 22878893 DOI: 10.1055/s-0032-1321771] [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: 10/28/2022] Open
Abstract
INTRODUCTION Peripheral nerve regeneration is usually studied in rat animal models (N. medianus or N. ischiadicus). In this article, we further evaluate the mouse median nerve model with its advantages and possible pitfalls. MATERIALS AND METHODS 24 mice (C57BL/6) were operated. The median nerve was exposed in the left axilla. After transection, immediate microsurgical repair followed using 11/0 sutures. In the contralateral axilla, 1 cm of median nerve was resected. After the operation, functional regeneration of the median nerve was assessed using the grasping test. Histological analysis was performed after staining with toluidine blue. RESULTS All animals survived the procedure. Grip strength increased starting at day 10 and reached its maximum at day 35. Myelinated fibres in the regenerated nerves showed a smaller diameter and a thinner myelin sheath and the typical microfasciculation of regenerated nerve fibres in comparison to the uninjured nerve. CONCLUSION The mouse median nerve model is technically demanding but opens a wide field of possible research options using genetically modified mice.
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Affiliation(s)
- P Jaminet
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen.
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Siegel-Axel D, Rittig K, Dolderer J, Stefan N, Schaller HE, Stock U, Häring HU. Fetuin-A beeinflusst das erhöhte angiogenetische Potential humaner perivaskulärer Fettzellen. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314574] [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: 10/28/2022]
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Rittig K, Dolderer JH, Balletshofer B, Machann J, Schick F, Meile T, Küper M, Stock UA, Staiger H, Machicao F, Schaller HE, Königsrainer A, Häring HU, Siegel-Axel DI. The secretion pattern of perivascular fat cells is different from that of subcutaneous and visceral fat cells. Diabetologia 2012; 55:1514-25. [PMID: 22327346 DOI: 10.1007/s00125-012-2481-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS We have previously found that the mass of perivascular adipose tissue (PVAT) correlates negatively with insulin sensitivity and post-ischaemic increase in blood flow. To understand how PVAT communicates with vascular vessels, interactions between perivascular, subcutaneous and visceral fat cells with endothelial cells (ECs) were examined with regard to inflammatory, metabolic and angiogenic proteins. To test for possible in vivo relevance of these findings, circulating levels of the predominant secretion product, hepatocyte growth factor (HGF), was measured in individuals carefully phenotyped for fat distribution patterns. METHODS Mono- and co-cultures of human primary fat cells with ECs were performed. mRNA expression and protein production were studied using Luminex, cytokine array, RealTime Ready and ELISA systems. Effects of HGF on vascular cells were determined by WST assays. In patients, HGF levels were measured by ELISA, and the mass of different fat compartments was determined by whole-body MRI. RESULTS In contrast with other fat cell types, PVAT cells released higher amounts of angiogenic factors, e.g. HGF, acidic fibroblast growth factor, thrombospondin-1, serpin-E1, monocyte chemotactic protein-1 and insulin-like growth factor-binding protein -3. Cocultures showed different expression profiles from monocultures, and mature adipocytes differed from pre-adipocytes. HGF was preferentially released by PVAT cells and stimulated EC growth and smooth muscle cell cytokine release. Finally, in 95 patients, only PVAT, not visceral or subcutaneous mass, correlated independently with serum HGF levels (p = 0.03; r = 0.225). CONCLUSIONS Perivascular (pre-)adipocytes differ substantially from other fat cells with regard to mRNA expression and protein production of angiogenic factors. This may contribute to fat tissue growth and atherosclerotic plaque complications. Higher levels of angiogenic factors, such as HGF, in patients with increased perivascular fat mass may have pathological relevance.
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Affiliation(s)
- K Rittig
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tübingen, Otfried-Müller Str 10, 72076 Tübingen, Germany
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Abstract
Diagnosis-Related Groups (DRG) were introduced in Germany in 2004 as a medico-economic classification system. In this analysis, we looked at reconstructive surgery after breast cancer, focusing on changes of the fee-per-case system in the last 6 years. Immediate, delayed, pedicle and free flaps as well as alloplastic reconstructive methods were analysed using data from German reference hospitals. We analysed the length of stay, reimbursements, costs and profits. The biggest profit margin was found in free perforator flaps. These were up to 3 times higher than in alloplastic reconstruction and pedicle flaps. Due to the fact that the underlying costs for the calculation of reimbursement are always retrospective, we accounted for the rate of price increase. In spite of increasing mean profits, foregone profits of up to €574 per case due to inflation were not taken into consideration. Contrary to actual guidelines, neither the immediate reconstruction of the breast by autologous tissue, nor the bilateral reconstruction is taken into account economically. Although a more differentiated reimbursement of breast reconstruction by DRG has taken place in the last years, the subject still remains a classical example for insufficient mapping of new medical standards in our DRG system. As the choice of surgical therapy is increasingly influenced by free market mechanisms, the risk for economic selection in contradiction to clinical recommendations becomes a real problem. Even 9 years after its introduction, the German DRG system is far from being a learning or quick adapting system.
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Affiliation(s)
- O Lotter
- Klinik für Hand-, Plastische Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität Tübingen, Berufsgenossenschaftliche Unfallklinik.
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20
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Rahmanian-Schwarz A, Spetzler V, Willkomm LM, Eisenschenk A, Bernhard H, Schaller HE. [A composite osteomusculocutaneous free flap from the medial femoral condyle: anatomic characteristics, clinical aspects, new applications]. HANDCHIR MIKROCHIR P 2012; 44:67-74. [PMID: 22495956 DOI: 10.1055/s-0032-1306360] [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: 10/28/2022] Open
Abstract
Advances in plastic and reconstructive surgery allow an almost complete functional and aesthetic reconstruction after severe injuries. However, particularly the treatment of complex defects involving different tissue components is still challenging. The reconstruction requires a combined flap consisting of different tissues from an adequate donor area. In this context, we focused on anatomical and clinical aspects of transplants from the area of the medial femoral condyle. In this study, the anatomical characteristics and potentials of various flaps from the region of this region are described. Moreover, previous literature on this subject is put in context with both the results of our own anatomical study and our clinical experience. The supplying vessel is the descending genicular artery with its branches. In addition to the consistency in vessel length and diameter, the descending genicular artery has a continuous distribution in a periosteal, cutaneous and muscular branch. Due to this anatomical characteristic, this donor site offers the possibility for several customized transplants. Thus, the distal medial thigh is a versatile and reliable donor site for plastic surgical procedures.
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Affiliation(s)
- A Rahmanian-Schwarz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Eberhard Karls University Tuebingen, BG-Trauma Center, Tübingen.
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Abstract
Complicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III-V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.
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Affiliation(s)
- O Lotter
- Berufsgenossenschaftliche Unfallklinik, Klinik für Plastische, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland.
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Lotter O, Stahl S, Hohenstein C, Schaller HE, Jaminet P. [Comparison of pedicle and free tissue transfers in the German DRG system]. HANDCHIR MIKROCHIR P 2012; 43:384-92. [PMID: 22241521 DOI: 10.1055/s-0031-1291247] [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: 10/14/2022] Open
Abstract
Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. The mean value of the average length of stay was higher in free flaps as compared to pedicle flaps (15 vs. 9 days) and the mean reimbursement in free flaps was almost twice as high as in pedicle flaps (8 936 € vs. 4 582 €). Regarding the diagnosis, third-grade open fractures in pedicle flaps and full-thickness burns in free flaps are in the vanguard of reimbursement. Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort.
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Affiliation(s)
- O Lotter
- Klinik für Plastische , Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
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Schley M, Topfner S, Wiech K, Schaller HE, Konrad CJ, Schmelz M, Birbaumer N. Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees. Eur J Pain 2012; 11:299-308. [PMID: 16716615 DOI: 10.1016/j.ejpain.2006.03.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Revised: 03/26/2006] [Accepted: 03/28/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hyperexcitability of N-methyl-d-aspartate acid (NMDA) receptors may play an important role in the development of phantom limb pain (PLP). AIM OF THE STUDY To investigate whether early treatment with the NMDA antagonist memantine attenuates phantom pain memory formation in traumatic amputees. METHODS In a randomized, double-blind, controlled trial 19 patients with acute traumatic amputation of the upper extremity were investigated. All patients received postoperative analgesia by continuous brachial plexus anesthesia (ropivacaine 0.375% 5 ml/h) for at least 7 days. In addition, the patients received either memantine (20-30 mg daily, n=10) or placebo (n=9) for 4 weeks. RESULTS Memantine treatment reduced the number of requested ropivacacine bolus injections during the first week and resulted in a significant decrease of PLP prevalence and intensity at 4 weeks and 6 months follow up, but not at 12 months follow up. CONCLUSIONS We conclude that memantine can reduce intensity of phantom limb pain and might also prevent the development of PLP. However, despite the very early begin of treatment; no long-term effect on established PLP was evident.
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Affiliation(s)
- M Schley
- Department of Anaesthesiology and Intensive Care Medicine, Experimental Pain Research/Pain Centre, University of Heidelberg, Faculty of Clinical Medicine, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Lotter O, Stahl S, Beck M, Loewe W, Schaller HE. [Development of diagnosis-related groups in different surgical disciplines]. Zentralbl Chir 2011; 139 Suppl 2:e109-15. [PMID: 21688237 DOI: 10.1055/s-0031-1271532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Since the introduction of Diagnosis-Re-lat-ed Groups (DRGs) in Germany, the variables of remuneration have continuously changed. Subjectively, reimbursement by DRG has a negative connotation among all specialities. We analysed the development of reimbursement and length of stay in different surgical specialties. MATERIAL AND METHODS By grouping the top-10-diagnoses and therapies in hand surgery, trauma surgery, general surgery as well as cardiothoracic and vascular surgery between 2004 and 2010, DRGs were obtained, compared and the data deduced. RESULTS While the lower threshold of length of stay remained almost the same, mean value and upper threshold became shorter in most of the top-10-diagnoses. During the observation period, total reimbursement increased by 30 % in hand surgery, 20 % in general surgery and 17 % in cardiothoracic and vascular surgery, while in trauma surgery it decreased by 1 %. This corresponds to mean annual growth rates of 4.47 %, 3.08 %, 2.68 % and - 0.15 %, respectively. No correlation was found between the 4 disciplines and macro-economic parameters. CONCLUSION Reductions of mean and upper thresholds of length of stay are present in all surgical disciplines. Total reimbursements developed partially in a contradictory manner. Negative growth involves the danger that hospital investments cannot be realised, especially in the presence of high personnel costs.
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Affiliation(s)
- O Lotter
- Klinik für Plastische, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, BG Unfallklinik, Tübingen, Deutschland
| | - S Stahl
- Klinik für Plastische, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, BG Unfallklinik, Tübingen, Deutschland
| | - M Beck
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie und Universitätsklinik für Thorax-, Herz- und Gefäßchirurgie an der Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - W Loewe
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität Tübingen, BG Unfallklinik, Tübingen, Deutschland
| | - H-E Schaller
- Klinik für Plastische, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, BG Unfallklinik, Tübingen, Deutschland
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Valina S, Lotter O, Schaller HE, Rahmanian-Schwarz A. [Abscess formation after puncture of a thyroid cyst--a case report]. Zentralbl Chir 2011; 138 Suppl 2:e108-9. [PMID: 21667445 DOI: 10.1055/s-0031-1271477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Valina
- Klinik für Plastische, Hand-, -Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Berufsgenossenschaftliche Unfallklinik, Tübingen, Deutschland
| | - O Lotter
- Klinik für Plastische, Hand-, -Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Berufsgenossenschaftliche Unfallklinik, Tübingen, Deutschland
| | - H-E Schaller
- Klinik für Plastische, Hand-, -Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Berufsgenossenschaftliche Unfallklinik, Tübingen, Deutschland
| | - A Rahmanian-Schwarz
- Klinik für Plastische, Hand-, -Rekonstruktive und Verbrennungschirurgie an der Eberhard Karls Universität Tübingen, Berufsgenossenschaftliche Unfallklinik, Tübingen, Deutschland
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Vogel D, Lotter O, Stahl S, Pfau M, Schaller HE. [Operative technique for the rupture of the deep flexor tendon close to the insertion]. Unfallchirurg 2011; 114:528-31. [PMID: 21660510 DOI: 10.1007/s00113-011-2038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Vogel
- Berufsgenossenschaftliche Unfallklinik, Klinik für Plastische, Hand-, Rekonstruktive und Verbrennungschirurgie, Eberhard-Karls-Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland.
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Jaminet P, Werdin F, Pfau M, Götz M, Manoli T, Rahmanian-Schwarz A, Schaller HE. [Treatment algorithm for scaphoid nonunion : retrospective case-control study of 208 patients]. Unfallchirurg 2011; 115:994-9. [PMID: 21465239 DOI: 10.1007/s00113-011-1956-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION We present a retrospective study on different treatment options for scaphoid nonunion. The results are compared to the literature and a treatment algorithm is proposed. MATERIALS AND METHODS Based on a retrospective case-control study, 208 patients suffering from scaphoid nonunion were treated between 2000 and 2006. The patients were grouped depending on the localization of the nonunion: proximal (n=10), middle (n=105), or distal (n=93) third. In the presence of a small avascular proximal fragment, a vascularized bone graft from the distal radius was added (n=53). The determination of scaphoid healing was achieved by conventional radiographs or CT scans. RESULTS Overall scaphoid healing occurred in 89.9% (n=187). For small proximal scaphoid fragments (n=93), we could show healing rates up to 83% (n=77). Using a vascularized bone graft from the distal radius, scaphoid consolidation was achieved in 81% for avascular proximal fragments and recurrent scaphoid nonunion (n=53). CONCLUSION Using sophisticated treatment options, the prognosis of scaphoid nonunions is very good.
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Affiliation(s)
- P Jaminet
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Eberhard-Karl-Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland.
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Abstract
Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their corresponding operative treatment in our clinic in 2009 were processed using a DRG grouper. The underlying data were transferred to the Italian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The latter was adjusted and corrected by the purchasing power of each country. The mean of the upper threshold of length of stay was 10 days in the German as well as the Italian system whereas the median was 2 times higher in Italy (6 vs. 12 days). Fifteen out of 19 cases showed higher reimbursement in Germany. The case mix index (CMI) of 0.917 in Germany represents a mean payment of 2,676 € per case. In Italy the hypothetical CMI of 0.635 resulted in a mean reimbursement of 1,853 € per case. The biggest difference in remuneration could be found for replantation of multiple fingers. For this service the German health-care system pays 12,320 € more than the Italian. Total proceeds of the top 15 diagnoses applying the number of cases treated in our clinic revealed 1.7 million € in the German and 1.2 million € in the Italian DRG system. Considering the purchasing power utilizing consumer prize parities, the difference of reimbursement between the countries decreased to 300,000 €. There is no mean length of stay per DRG in Italy, only the upper threshold of length of stay is determined. In most cases the latter is higher in Italy compared to Germany. The consumption of resources for finger replantation is not adequately represented in the Italian DRG system compared to finger amputation. Reimbursement of inpatient care is influenced by multiple factors not being subject to the free market economy. For this reason only descriptive comparison is feasible.
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Affiliation(s)
- O Lotter
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik/Eberhard-Karls-Universität Tübingen, Tübingen.
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Werdin F, Jaminet P, Rennekampff HO, Sinis N, Nusche A, Schaller HE. [Does additive spongiosaplasty improve outcome after surgical therapy for solitary enchondroma in the hand?]. HANDCHIR MIKROCHIR P 2010; 42:299-302. [PMID: 20734283 DOI: 10.1055/s-0030-1254087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The necessity of spongiosaplasty in the treatment of solitary enchondroma in the hand has been a subject of controversial discussions for several years. Over a period of 10 years the authors performed single curettage without spongiosaplasty. The aim of this study was to investigate our results and to compare these findings with those of other studies. PATIENTS AND METHOD Over the last 10 years we have treated 106 patients with solitary enchondroma of the hand by single curettage without bone grafting. All patients underwent postoperative radiological examination. The mean follow-up was 34 months. The results of the X-ray investigation were examined retrospectively concerning the recurrence rates and the Hasselgren score. RESULTS Two patients (1.9%) have experienced radiological changes according to Hasselgren score IV. One patient (0.8%) demonstrated radiological III° changes according to score of Hasselgren. Including the patient with the radiological changes according to Hasselgren score III, the overall recurrence rate was 2.8%. DISCUSSION After comparing our results with those of other studies, we conclude that additional bone-grafting does not improve the recurrence rate of solitary enchondromas of the hand.
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Affiliation(s)
- F Werdin
- Klinik für Hand-, Plastische-, Rekonstruktive- und Verbrennungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karls Universität, Tübingen.
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Sinis N, Kraus A, Papagiannoulis N, Werdin F, Schittenhelm J, Meyermann R, Haerle M, Geuna S, Schaller HE. Concepts and developments in peripheral nerve surgery. Clin Neuropathol 2009; 28:247-262. [PMID: 19642504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Nerve injuries may result in sensory and motor deficits when not treated appropriately. Especially the surgical management of nerve defects still represents a challenge for the surgeon. In these cases the grafting of autologous nerves represents the only reasonable approach. Due to the side effects associated with this method (sacrifice of donor nerves, neuroma formation in the harvesting area, limited availability of donor nerves, etc.), numerous alternatives were proposed in order to avoid the transplantation of autologous tissue. This review provides a general view on the state of the art of how to supply gaping injuries in the peripheral nerve. Furthermore new approaches emphasizing tubulization techniques for the reconstruction of lost nerve tissue are described with a special focus on various materials with their advantages and disadvantages.
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Affiliation(s)
- N Sinis
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Germany.
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Abstract
BACKGROUND The relevance of subcutaneous transposition of the ulnar nerve in the therapy of cubital tunnel syndrome is still under debate. The aim of this study was to compare the results after decompression to additional transposition in cases of intraoperative luxation. METHODS A total of 54 cases after surgery of cubital tunnel syndrome between 2000 and 2006 were analyzed. Nerve transposition was performed in cases of intraoperatively apparent nerve luxation. RESULTS Of the patients 12 were treated by decompression alone and 42 by additional subcutaneous transposition. There was no significant difference concerning symptom amelioration, usage properties of the hand, sensation impairment and duration of disability. Force measurements of grip strength and pinch strength revealed no significant differences between either hand in both groups. The 2-point discrimination ability of the 8th to 10th finger nerves was not significantly different between the groups either. CONCLUSION Nerve transposition revealed no benefits in the treatment of cubital tunnel syndrome when performed in cases of intraoperative nerve luxation.
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Affiliation(s)
- A Kraus
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Eberhard-Karls-Universität Tübingen, Deutschland.
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Abstract
Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand's ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. Also sensibility can be compromised from tendon injury without direct injury to the nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain temperature and touch or pressure recognition, in addition to the tendon injury. However, the outcome after operative treatment of these"minor" injuries of the hand is horrible. Therefore, we try to summarize practical consequences for the repair of combined flexor tendon and nerve injuries which will improve operative outcome. These guidelines are based on current scientific knowledge and our own experience.
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Affiliation(s)
- F Werdin
- Klinik für Hand-, Plastische-, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Universitätsklinik Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Deutschland.
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Werdin F, Sinis N, Schaller HE, Coerper S. [Recurrence rates of venous leg ulcers and the special importance of its surgical treatment]. HANDCHIR MIKROCHIR P 2008; 40:94-9. [PMID: 18437667 DOI: 10.1055/s-2007-965722] [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: 10/22/2022] Open
Abstract
BACKGROUND Venous insufficiency may lead to recurrent leg ulcers. The reason for this observation remains still unclear. In this study we tried to underline the influence of surgical treatment on recurrence rate of venous leg ulcers. PATIENTS AND METHODS In this study 69 patients were treated in a special wound care centre. Before treatment the angiological status was evaluated using phlebography or duplex scan. Afterwards, patients were scored according to the "Venous Clinical Severity Score" of the American Venous Forum. During the observation period compression therapy was performed and wounds were treated with moist dressings. Necroses were removed by radical debridement and large ulcers were covered by mesh graft tissue transfer. When indicated incompetent veins were treated surgically. RESULTS The follow-up revealed an overall recurrence rate of 21 % after 30 months. Ulcers treated by radical wound debridement or mesh graft tissue transfer demonstrated a significant lower recurrence rate (p = 0.02 and p = 0.03). According to duplex sonography a correlation was evident among severity of venous insufficiency, the "clinical scoring" (p = 0.04), and the recurrence rate (p = 0.023). After surgical intervention by venous stripping, the insufficiency was improved but the recurrence rate was comparable to that of patients treated without venous surgery (p = 0.44). CONCLUSION Surgical treatment of venous leg ulcers in modern wound care centres can reduce its recurrence rates. Herein this study a correlation among venous insufficiency evidenced by duplex scan and recurrence rate for leg ulcers could be demonstrated.
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Affiliation(s)
- F Werdin
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Universität Tübingen.
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Ateschrang A, Eisenbarth I, Schaller HE, Weise K. [Arrosion of flexor tendons after palmar plate osteosynthesis of the distal radius: three case reports]. HANDCHIR MIKROCHIR P 2007; 39:418-22. [PMID: 18058673 DOI: 10.1055/s-2007-964880] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Indication of palmar plate osteosynthesis of the distal radius has steadily broadened over recent years. The reason for this has been the introduction of angle stable implants. In addition, advantages were attributed to the palmar plate over the dorsal plate position on the distal radius through the covering of the M. pronator quadratus as a means of preventing the occurrence of arrosion of the tendon. Over a period of 12 months we treated 3 patients with varying degrees of flexor tendon rupture after palmar plate osteosynthesis, indicating that the incidence of flexor tendon arrosion occurring through palmar plate osteosynthesis is possibly greater than previously assumed.
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Affiliation(s)
- A Ateschrang
- Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Germany.
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Sinis N, Schaller HE, Schulte-Eversum C, Schlosshauer B, Doser M, Dietz K, Rösner H, Müller HW, Haerle M. [Tissue engineering of peripheral nerves]. HANDCHIR MIKROCHIR P 2007; 38:378-89. [PMID: 17219321 DOI: 10.1055/s-2006-924739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] Open
Abstract
BACKGROUND In spite of considerable progress in microsurgical techniques, the treatment of long distance defects in peripheral nerves remains challenging for the surgeon. Autologous nerve grafting has been the only applicable procedure to overcome such defects in the past. Due to the known disadvantages of this procedure (neuroma formation and sensory deficits at the donor-site, limited availability of donor-material, etc.) and impaired regenerative results, different tubulisation techniques are discussed more frequently as alternatives to the autologous nerve grafts. AIM OF THE STUDY In this work, the authors summarise their experiences and results with different synthetically developed materials, cellular and acellular tubes and venous conduits for the reconstruction of peripheral nerve defects. MATERIAL AND METHODS To analyse peripheral nerve regeneration, we utilised a median nerve model in rats. In these studies nerve gaps up to 40 mm were induced. Guiding tubes of various materials (trimethylene carbonate-epsilon-caprolactone, polyethylene, veins, and collagen) were employed. Furthermore, we introduced Schwann cells as cellular elements into some of the trimethylene carbonate-epsilon-caprolactone tubes. The longest postoperative observation period was nine months. RESULTS The results demonstrated that only in the case of cellular filled tubes (syngenic Schwann cells) did regeneration occur across the 20 mm gap. This regeneration was comparable to that induced after autologous grafting. Across a 40 mm gap the autologous graft demonstrated the best results.
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Affiliation(s)
- N Sinis
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Sinis N, Schaller HE, Schulte-Eversum C, Lanaras T, Schlosshauer B, Doser M, Dietz K, Rösner H, Müller HW, Haerle M. Comparative neuro tissue engineering using different nerve guide implants. Acta Neurochir Suppl 2007; 100:61-64. [PMID: 17985547 DOI: 10.1007/978-3-211-72958-8_13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
At the moment autologous nerve grafting remains the only reasonable technique for reconstruction of peripheral nerve defects. Unfortunately, this technique has a lot of complications and disadvantages. These problems are related to the autologous nerve that is harvested for this procedure. Donor site morbidity with loss of sensitivity, painful neuroma formation and of course the restricted availability of autologous nerves stimulates the idea for alternative techniques on that field. In this paper we describe our experience with different graft materials for reconstruction of a 2 cm nerve gap in a median nerve model in rats. After implantation of various materials (biological/synthetic) the main experiments were conducted with a synthetic, biodegradable nerve conduit seeded with autologous Schwann cells. With this material we were able to reconstruct successfully a 2 cm gap in the rat median nerve. Regeneration with this material was found to be equally to an autologous nerve graft.
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Affiliation(s)
- N Sinis
- Klinik für Hand-, Plastische-, Rekonstruktive- und Verbrennungschirurgie, Universität Tübingen, BG-Unfallklinik, Tübingen, Germany.
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Sinis N, Birbaumer N, Schwarz A, Gustin S, Unertl K, Schaller HE, Haerle M. Memantine und komplexes regionales Schmerzsyndrom (CRPS): Behandlungseffekte und kortikale Reorganisation. HANDCHIR MIKROCHIR P 2006; 38:164-71. [PMID: 16883501 DOI: 10.1055/s-2006-924180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/24/2022] Open
Abstract
BACKGROUND In recent studies a central nervous system involvement in the pathogenesis of Complex Regional Pain Syndrome (CRPS) was suggested, stimulating the introduction of central acting drugs. Animal studies have demonstrated an increased expression of the N-methyl-D-aspartate (NMDA) receptors in experimental neuropathic pain. PURPOSE The aim of this study was to investigate the relationship between NMDA receptor blockers and CRPS. METHOD Three patients suffering from CRPS of one upper extremity where treated with oral NMDA antagonist Memantine for eight weeks. Patients expressed their pain levels with a visual analog scale ranging from zero to ten at rest and after fist clenching. Furthermore, the range of movement of the fingers and the wrist were documented. To assess force, a pinchmeter and a dynamometer were used. Cortical reorganisation was studied with functional Magnetic Resonance Imaging (fMRI) and Magnetoencephalography (MEG). RESULTS Six months after treatment with Memantine no rest pain was present in any of the patients. Furthermore, an increase in finger movement was observed after six-month follow-up with no deficits and free movement ranges. Additionally, wrist movement was improved and an increase of force was measured after six months with the dynamometer and the pinchmeter. Moreover the functional impairment, cortical reorganisation was observed in all patients before treatment. These changes returned to a normal pattern after eight weeks of treatment with Memantine. CONCLUSION These first results demonstrate central nervous system involvement in the development and maintenance of CRPS. The results (functional, pain, fMRI, MEG) after treatment with Memantine indicate the importance of the NMDA receptor system in neuropathic pain syndromes and provide a promising approach for the treatment of CRPS.
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Affiliation(s)
- N Sinis
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Rein S, Weindel S, Schaller HE, Mittelbronn M, Schmidt G. [Peroneal nerve palsy caused by a recurrent proximal tibiofibular joint ganglion--a case report and review of the literature]. HANDCHIR MIKROCHIR P 2005; 37:267-75. [PMID: 16149036 DOI: 10.1055/s-2005-865896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/25/2022] Open
Abstract
PURPOSE/BACKGROUND Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete. MATERIAL AND METHODS We report a case of a 60-year-old man with peroneal nerve palsy caused by recurrent proximal tibiofibular joint ganglion. RESULTS Within the context of the current literature, clinical symptoms, diagnostics, differential diagnosis with regard to imaging methods, neurology, pathology and the broader spectrum of operative and non-operative treatment are discussed. The cyst was completely resected, but a recurrent cyst developed eight years later. At reoperation, a communication of the cyst with the tibiofibular joint was demonstrated. Despite complete resection of the cyst and ligation of the ganglion stem, a routine postoperative MRI disclosed a second recurrence of the cyst nine months later. On the last clinical examination, twelve years after onset of the symptoms, a complete paresis of the peroneal nerve was seen. CONCLUSION This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.
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Affiliation(s)
- S Rein
- Berufsgenossenschaftliche Unfallklinik, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen.
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Abstract
UNLABELLED Significant trauma, severe bacterial infections and tumour resections of the hand are often complicated by primary or secondary soft-tissue defects. The Posterior Interosseous Artery Flap (PIA), described by Zancolli and Angrigiani in 1985 offers one possibility for soft-tissue coverage. In this abstract, we present the results of 35 patients who were treated with distally based PIA flap reconstructions during the years 1998 to 2003. 24 patients were available for one-year follow-up and beyond. RESULTS Long-term follow-up demonstrates excellent colour and texture match with reliable soft-tissue coverage. Two of the 33 flaps were lost because of ischemic necrosis. The incidence of distal local ischemia was predictable when the flaps were extended to the level of the PIP joint or beyond. CONCLUSION The PIA flap affords a very durable and aesthetic option for soft-tissue coverage of the dorsum of the hand. The flap donor site can usually be closed primarily with little to no morbidity. In comparison to other local and distally based flaps such as the radial forearm flap, major blood vessels are spared. In summary, the PIA flap should be considered as a reliable and judicious alternative to free microvascular transfer procedures for soft-tissue defects of the hand proximal to the level of the PIP joint.
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Affiliation(s)
- C Zwick
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik an der Eberhard-Karls-Universität, Tübingen.
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Lenk S, Schmidt G, Lichy M, Schlemmer H, Schaller HE, Claussen CD. 3.0T-MRT des Handgelenkes: Nutzen von hochauflösenden 3D-T2-gewichteten Turbospinecho- und Gradientenecho-Sequenzen zur Diagnostik von TFCC-Läsionen. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867731] [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: 10/19/2022]
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Pfau M, Hamprecht K, Schaller HE, Rennekampff HO. Die Bedeutung der Cytomegalievirus-Infektion in deutschsprachigen Verbrennungszentren. HANDCHIR MIKROCHIR P 2004; 36:392-6. [PMID: 15633084 DOI: 10.1055/s-2004-830489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/26/2022] Open
Abstract
Due to immunosuppression, burn patients are at risk for CMV-infection. By means of a retrospective questionnaire we evaluated the clinical rating and management of CMV-infection in German-speaking burn centers. 41 % of the participating burn centers considered the role of CMV-infection of overall minor importance, 41 % of importance only in intensive care burn patients, 18 % of overall great importance. 70 % of the participating burn centers do not perform CMV-screening at admission. More than 50 % of the participating burn centers consider application of CMV-negative human blood-derived products in CMV-seronegative individuals as essential. At present clinical importance of CMV-infection in burn patients can not be clearly determined. But further prospective studies utilizing recently developed diagnostics seem warranted to the potential influence of CMV-infection on morbidity and mortality in burn patients.
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Affiliation(s)
- M Pfau
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Eberhard-Karls-Universität Tübingen, Schnarrenbergstrasse 95, 72076 Tübingen, Germany
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Abstract
We studied the forearm vessels and the palmar carpal arch in 41 fresh cadaver upper limbs injected with colored latex solutions. In one case, we found a complete occlusion of the radial artery. Collateralization was evident through the anterior interosseous artery, its palmar branch and the radial part of the palmar carpal arch. The diameters of these vessels were significantly enlarged. The dissections of the remaining 40 arms demonstrated that these vessels offer a possible collateralization pathway via the anterior interosseous artery. One hypothesis for the formation of such collateralization might be a dominant blood flow of the radial artery to the hand. Therefore, it seems sensible to preserve the communication between the anterior interosseous and the radial arteries through the palmar carpal arch, raising the radial artery for surgery.
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Affiliation(s)
- M Haerle
- Department of Hand and Plastic Surgery, Burn Center, BG Trauma Center, University of Tuebingen, 72076 Schnarrenberg 95, Germany.
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Wisser D, Rennekampff HO, Schaller HE. Skin assessment of burn wounds covered with a collagen based dermal substitute in a 2 year-follow-up. Burns 2004; 30:399-401. [PMID: 15145202 DOI: 10.1016/j.burns.2003.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2003] [Indexed: 10/26/2022]
Affiliation(s)
- D Wisser
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG-Unfallklinik, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
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Rennekampff HO, Rabbels J, Pfau M, Schaller HE. [Evaluating scar development with objective computer-assisted viscoelastic measurement]. Kongressbd Dtsch Ges Chir Kongr 2003; 119:749-55. [PMID: 12704925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
In a prospective study we compared the subjective scar assessment by the Vancouver Scar Scale with an objective viscoelastic measurement. Donor sites from the thigh primarily dressed with vaseline gauze (F), biobrane or occlusive dressing(O) were evaluated 0.5 years postoperatively by VSS and with the Cutometer (Courage and Khazaka). VSS of donor sites was 2.74 +/- 0.91 (F), 4.25 +/- 0.77 (B) and 2.57 +/- 0.72(O) (mean +/- sem). All ratings were significant compared to normal mirror-sided skin. Viscoelastic measurements by the Cutometer were near normal compared to uninjured skin. No correlation was found between subscale VSS pliabilty rating and Cutometer readings.
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Affiliation(s)
- H O Rennekampff
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Universität Tübingen, Schnarrenbergstrasse 95, 72076 Tübingen
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Haerle M, Schaller HE, Mathoulin C. Vascular anatomy of the palmar surfaces of the distal radius and ulna: its relevance to pedicled bone grafts at the distal palmar forearm. J Hand Surg Br 2003; 28:131-6. [PMID: 12631484 DOI: 10.1016/s0266-7681(02)00279-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The potential for harvesting vascularized bone grafts from the palmar surface of the distal radius has been studied in 40 arms of fresh cadavers which had previously been injected with coloured latex solution. It was found that vascularized grafts can be pedicled on the radial part of the palmar carpal arterial arch. If a longer pedicle is required, the bone graft can be pedicled on the anterior branch of the anterior interosseous artery with retrograde flow occurring from the palmar carpal arch.
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Affiliation(s)
- M Haerle
- Department of Hand- and Plastic Surgery, Burn Centre, University of Tübingen, Germany.
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Abstract
We studied the patterns of dominance in the palmar digital arteries of the fingers in 39 fresh cadaver arms which had been injected with coloured latex solution. We also performed photoplethysmographic studies in 20 hands. The ulnar digital artery in the index finger and the radial digital artery of the little finger were usually dominant, and their counterparts were slim and often hypoplastic. The findings are relevant to digit revascularization and might influence the planning of digital island-flaps or toe transfers.
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Affiliation(s)
- M Haerle
- Department of Hand- and Plastic Surgery, Burn Centre, University of Tübingen, Germany. maxhaerle@-online.de
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Pfau M, Ruck P, Schaller HE. [Plexiform fibrohistiocytic tumour - case report of a rare low-malignant tumour with frequent localisation at the upper limb]. HANDCHIR MIKROCHIR P 2002; 34:201-4. [PMID: 12203157 DOI: 10.1055/s-2002-33686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/27/2022] Open
Abstract
A male child aged nine months was admitted due to a slow growing, painless resistance at the palmar aspect of the proximal phalanx of the index finger. The intraoperative aspect of the tumour showed a yellow to white soft tissue mass with signs of infiltration. After special histopathological stainings, the diagnosis of a plexiform fibrohistiocytic tumour was confirmed. In literature almost 100 cases were reported since first description by Enzinger and Zhang in 1988. In this paper, 41 of 65 described cases showed tumour localization in the upper limb. This is the second case ever published in Germany and the first with localisation to the hand. There is very little clinical experience with this tumour entity. Local recurrence, lymphatic and pulmonal metastases with lethal outcome in rare cases are described. In the presented case, after secondary radical excision of the tumour, the patient has been free of local recurrence and actually in complete remission for 14 months.
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Affiliation(s)
- M Pfau
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Plastische, Rekonstruktive, Hand- und Verbrennungschirurgie, an der Universität Tübingen, Germany
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Diesch E, Preissl H, Haerle M, Schaller HE, Birbaumer N. Multiple frequency steady-state evoked magnetic field mapping of digit representation in primary somatosensory cortex. Somatosens Mot Res 2001; 18:10-8. [PMID: 11327566 DOI: 10.1080/0899022002002060] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 10/17/2022]
Abstract
Magnetic source imaging of multiple frequency steady-state somatosensory evoked responses was examined using a 151-channel magnetoencephalography (MEG) system and a dual-channel electrical stimulator. Somatotopy of digit representation was studied in healthy subjects and effects of injury-related cortical plasticity in patients with unilateral transections of the median or the ulnar nerve. Dipole source locations exhibited somatotopic order with overlap between neighboring digits. In two of three nerve injury patients evidence for cortical reorganization was found. The location of sources related to digits neighboring deafferented digits was changed and their dipole moments were enlarged by comparsion with the sources related to contralateral homologue control digits. As a basis for magnetic source imaging, the recording of multiple frequency somatosensory steady-state evoked responses may be a viable and time saving alternative to the recording of transient evoked responses.
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Affiliation(s)
- E Diesch
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
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Wiech K, Preissl H, Lutzenberger W, Kiefer RT, Töpfner S, Haerle M, Schaller HE, Birbaumer N. Cortical reorganization after digit-to-hand replantation. J Neurosurg 2000; 93:876-83. [PMID: 11059672 DOI: 10.3171/jns.2000.93.5.0876] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/06/2022]
Abstract
Functional recovery after digit-to-hand replantation depends on the interaction of various factors. In addition to peripheral mechanisms, cortical and subcortical reorganization of digit representation may play a substantial role in the recovery process. However, cortical processes during the first months after replantation are not well understood. In this 25-year-old man who had traumatically lost digits II to V (DII-V) on his right hand, the authors used magnetoencephalographic source imaging to document the recovery of somatosensory cortical responses after tactile stimulation at four sites on the replanted digits. Successful replantation of DIV and DV was accomplished at the original position of DIII and DIV with mixed innervation. Cortical evoked fields could be recorded starting from the 10th week after digit-to-hand replantation. Initially, signals from all sites showed decreased amplitudes and prolonged latencies. In the subsequent six recordings obtained between the 12th and 55th week postreplantation, a continuous increase in amplitude but only a slight recovery of latencies were observed. Components of the recorded somatosensory evoked fields were localized in the primary somatosensory cortex (SI). The localizations of the replanted DIV showed a gradual lateral-inferior shift in the somatosensory cortex over time, indicating cortical reorganization caused by altered peripheral input. The authors infer from this shift that the original cortical area of the missing finger (DII) was taken over by the replanted finger. From these data the authors conclude that magnetic source imaging might be a reliable noninvasive method to evaluate surgical nerve repair and that cortical reorganization of SI is involved in the regeneration process following peripheral nerve injury.
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Affiliation(s)
- K Wiech
- Institute of Medical Psychology and Behavioral Neurobiology, Department of Anesthesiology, University of Tübingen, Germany.
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Schaller HE, Berger A. [Initial muscle operations in brachial plexus paralysis]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:554-9. [PMID: 9931678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Regeneration after surgical treatment of fresh or delayed brachial plexus injuries is often incomplete, with remaining sensory and motor loss. The aim of reconstructive surgery for these patients is to regain subordinate motor function. Therefore, reconstructive surgery should emphasize the restoration of elevation abduction and external rotation of the shoulder, elbow flexion and flexion of the fingers for basic grasping.
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Affiliation(s)
- H E Schaller
- Abteilung für Plastische, Hand- und Verbrennungschirurgie, Eberhard-Karls-Universität Tübingen
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