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Steinheber J, Kanz KG, Biberthaler P, Flatz W, Bogner-Flatz V. [Head injuries and their wound treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:391-402. [PMID: 38619616 DOI: 10.1007/s00113-024-01430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Head injuries are frequent occurrences in emergency departments worldwide and are notable for the fact that attention must be paid to the sequelae of intracranial and extracranial trauma. It is crucial to assess potential intracranial injuries and to strive for both medically sound and esthetically pleasing extracranial outcomes. The aim of this continuing education article is to provide a refresher on knowledge of head injuries and the associated nuances for wound care.
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Affiliation(s)
- Jakob Steinheber
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Sportmedizin, Kreisklinik Ebersberg, Ebersberg, Deutschland
| | - Karl-Georg Kanz
- Zentrale Notaufnahme, Klinikum rechts der Isar der Technischen Universität München und Ärztlicher Bezirksbeauftragter Rettungsdienst Oberbayern West, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Wilhelm Flatz
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland
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Wachtel N, Heidekrueger PI, Brenner C, Endres M, Burgkart R, Micheler C, Thon N, Ehrl D. Finding the Optimal Surgical Incision Pattern-A Biomechanical Study. J Clin Med 2022; 11:2600. [PMID: 35566724 PMCID: PMC9099478 DOI: 10.3390/jcm11092600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
The closure of wounds and subsequent optimal wound healing is essential to any successful surgical intervention. Especially on parts of the body with limited possibilities for local reconstruction, optimal distribution of load is essential. The aim of the present study was therefore to examine three different incision patterns, conventional straight, Lazy-S and Zigzag, with regard to their biomechanical stability and mode of failure on a porcine skin model. Our results demonstrate the superior biomechanical stability of Lazy-S and Zigzag incision patterns with perpendicular suture placement. This holds true, in particular, for Zigzag incisions, which showed the highest values for all parameters assessed. Moreover, the observed superior stability of Lazy-S and Zigzag incision patterns was diminished when sutures were placed in tensile direction. The conventional straight incision represents the standard access for a large number of surgical procedures. However, we were able to demonstrate the superior biomechanical stability of alternative incision patterns, in particular the Zigzag incision. This is most likely caused by an improved distribution of tensile force across the wound due to the perpendicular placement of sutures. Moreover, this technique offers additional advantages, such as a better overview of the operated area as well as several cosmetic improvements. We therefore advocate that the surgeon should consider the use of a Zigzag incision over a conventional straight incision pattern.
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Affiliation(s)
- Nikolaus Wachtel
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (C.B.); (M.E.); (D.E.)
| | - Paul I. Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany;
| | - Carolin Brenner
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (C.B.); (M.E.); (D.E.)
| | - Maximilian Endres
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (C.B.); (M.E.); (D.E.)
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (R.B.); (C.M.)
| | - Carina Micheler
- Department of Orthopaedics and Sports Orthopaedics, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (R.B.); (C.M.)
- Institute for Machine Tools and Industrial Management, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
| | - Niklas Thon
- Department of Neurosurgery, Hospital of the University of Munich, 81377 Munich, Germany;
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (C.B.); (M.E.); (D.E.)
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[Autologous tissue reconstruction of the lower extremity-indications and technique]. Chirurg 2022; 93:1007-1018. [PMID: 35089367 DOI: 10.1007/s00104-021-01566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Autologous tissue reconstruction for defect coverage of lower extremity wounds describes a broad interdisciplinary spectrum of conservative, surgical and interventional treatment options. The goals of reconstruction are a resilient and function-preserving but also esthetically acceptable wound closure, which should enable rehabilitation and the return to participation in social and working life for those affected. Depending on the wound conditions as well as on potentially occurring concomitant injuries and comorbidities, the timing and method of defect coverage is selected in an individualized approach for each patient. It is essential that the plastic surgeon is involved as early as possible in the preparation of a treatment plan and can then select the most appropriate and least invasive reconstructive procedure from the armamentarium, depending on the localization and etiology of the soft tissue defect. These vary from secondary wound closure to skin grafts up to local and free flaps.
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Affiliation(s)
- Andrea Baczako
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Tatjana Fischer
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Alexander Konstantinow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Thomas Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland.
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