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Moog P, Dozan M, Betzl J, Sukhova I, Kükrek H, Megerle K. WALANT-Epinephrine injection may lead to short term, reversible episodes of critical oxygen saturation in the fingertips. Arch Orthop Trauma Surg 2021; 141:527-533. [PMID: 33484301 PMCID: PMC7900334 DOI: 10.1007/s00402-020-03744-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although the WALANT technique's long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur. METHODS Seventeen patients, who were scheduled for different procedures in WALANT technique, were injected with 5-7 ml of 1% Articain containing 1:200,000 epinephrine at the finger base. Capillary-venous oxygen saturation, hemoglobin volume in the capillaries, and relative blood flow in the fingertips were recorded once per second by white light spectrometry and laser Doppler flowmetry before, during and after injection for an average of 32 min. RESULTS Clinically, no persistent tissue malperfusion was observed, and there were no postoperative complications. Capillary-venous oxygen saturation was reduced by ≥ 30% in seven patients. Critical levels of oxygen saturation were detected in four patients during 13 intervals, each lasting for 132.5 s on average. Oxygen saturation returned to noncritical values in all patients by the end of the observation period. Blood flow in the fingertips was reduced by more than 30% in nine patients, but no critical levels were observed, as with the hemoglobin. Three patients demonstrated a reactive increase in blood flow of more than 30% after injection. CONCLUSIONS Injection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.
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Affiliation(s)
- P. Moog
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany ,Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum Rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - M. Dozan
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - J. Betzl
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - I. Sukhova
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - H. Kükrek
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - K. Megerle
- Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Moog P, Buchner L, Cerny MK, Schmauss D, Megerle K, Erne H. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:1471-1477. [PMID: 31367843 DOI: 10.1007/s00402-019-03247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.
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Affiliation(s)
- P Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - L Buchner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - M K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Lugano, Switzerland
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
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Cerny M, Schmauss D, Reidel M, Machens HG, Megerle K. [Persistent Symptoms after Carpal Tunnel Release: the Challenge of Preoperative Planning - a Case Report]. HANDCHIR MIKROCHIR P 2016; 48:310-2. [PMID: 27560099 DOI: 10.1055/s-0042-109864] [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: 10/21/2022] Open
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Schmauss D, Pöhlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K. Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 2016; 136:873-80. [PMID: 26969464 DOI: 10.1007/s00402-016-2441-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The diagnostic value of clinical tests and magnetic resonance (MR) imaging for the investigation of triangular fibrocartilaginous complex (TFCC) lesions is not clear due to a lack of clinical data. MATERIALS AND METHODS We retrospectively analyzed 908 patients who underwent clinical tests and arthroscopy for suspected TFCC lesions at our institution. Further, MR imaging findings concerning the TFCC were gathered. We correlated clinical tests and MR imaging findings with those obtained during arthroscopy, and we calculated sensitivity, specificity, as well as positive and negative predictive values. RESULTS In the whole cohort, the positive predictive values of all clinical tests were low, ranging from 0.53 to 0.55. The ulna grinding test had the highest sensitivity, but lowest specificity. Sensitivity and specificity of the ulnar fovea sign and magnetic resonance imaging were similar, ranging from 0.73 to 0.76, and from 0.41 to 0.44, respectively. To some degree, the diagnostic value seemed to depend on the Palmer class of TFCC lesion. CONCLUSIONS According to this study, clinical tests and MR imaging findings are of very limited diagnostic value for the diagnosis of TFCC lesions.
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Affiliation(s)
- D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - S Pöhlmann
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany
| | - J A Lohmeyer
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - G Germann
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany.,Clinic for Plastic, Reconstructive and Aesthetic Surgery, ETHIANUM, Heidelberg, Germany
| | - B Bickert
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. .,Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Heidelberg, Germany.
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Mobargha N, Esplugas M, Garcia-Elias M, Lluch A, Megerle K, Hagert E. The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study. J Hand Surg Eur Vol 2016; 41:374-9. [PMID: 26253421 DOI: 10.1177/1753193415597114] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/25/2015] [Indexed: 02/03/2023]
Abstract
Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak® motion tracking device was used to assess the effects of individual isometric muscle loading on the base of the thumb metacarpal relative to the radius and to the base of the middle finger metacarpal. We found that the first dorsal interosseous muscle caused the least dorsoradial translation and highest distal migration of the base of the first metacarpal, whereas abductor pollicis longus was the primary destabilizer, increasing dorsoradial misalignment. The findings show different impacts of these muscles on joint alignment and stability, which suggests that treatment should be targeted to enhance the action of the primary stabilizing muscle, the first dorsal interosseous muscle.
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Affiliation(s)
- N Mobargha
- Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway
| | | | - M Garcia-Elias
- Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut Kaplan, Barcelona, Spain
| | - A Lluch
- Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut Kaplan, Barcelona, Spain
| | - K Megerle
- Clinic for Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany
| | - E Hagert
- Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden Hand & Foot Surgery Center, Stockholm, Sweden
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Schmauss D, Finck T, Lohmeyer JA, Reidel M, Machens HG, Megerle K. [Primary adaptive vs. secondary wound closure in hand infections - differences and benefits]. HANDCHIR MIKROCHIR P 2014; 46:56-60. [PMID: 24481692 DOI: 10.1055/s-0033-1363980] [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
BACKGROUND Hand infections are common surgical emergencies. There are still controversial opinions regarding the ideal timing of wound closure after radical débridement of the infection. The aim of this retrospective study was to compare the outcome of primary adaptive and secondary wound closures after operative débridement in patients with hand infections. METHODS We retrospectively analysed all infections of the hand treated operatively in our hospital in the years 2011 and 2012 with a follow-up of at least 6 months. We included 16 patients with primary adaptive wound closure (PWC) and 12 patients with secondary wound closure (SWC) in this study. The evaluated parameters were the need for re-operations, the length of hospital stay, the overall satisfaction with the treatment, the characteristics of the scar and the mobility of the hand. RESULTS No patient had to be re-operated after PWC or SWC, respectively. Patients in the PWC group were kept significantly shorter as inpatients in comparison to patients in the SWC group (3.0 days vs. 5.1 days; p=0.048). Overall patient satisfaction with the treatment and the scar was comparable for both groups, as was the re-establishment of the mobility of the treated hand to preoperative levels. CONCLUSION This study shows that wounds after radical débridement for infection of the hand can be closed primarily adaptive without disadvantages for the patient. The length of hospitalisation is significantly shorter if the wound is closed primarily adaptive, a fact that is important for patient comfort and the socio-economic system. Both, primary adaptive and secondary wound closures generally have good outcomes with possible advantages for primary adaptive wound closures concerning the characteristics of the scar.
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Affiliation(s)
- D Schmauss
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - T Finck
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - J A Lohmeyer
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - M Reidel
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - H-G Machens
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - K Megerle
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
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Megerle K, Bertel D, Germann G, Lehnhardt M, Hellmich S. Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability. ACTA ACUST UNITED AC 2012. [DOI: 10.1302/0301-620x.94b12.30007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to assess the clinical and radiological outcomes of dorsal intercarpal ligament capsulodesis for the treatment of static scapholunate instability at a minimum follow-up of four years. A total of 59 patients who underwent capsulodesis for this condition were included in a retrospective analysis after a mean of 8.25 years (4.3 to 12). A total of eight patients underwent a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were excluded. The mean range of extension/flexion was 88° (15° to 135°) and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up. The mean Disabilities of the Arm Shoulder and Hand (DASH) score and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively. After significant improvement immediately post-operatively (p < 0.001 and p = 0.001, respectively), the mean scapholunate and radiolunate angles deteriorated to 70° (40° to 90°) and 8° (-15° to 25°), respectively, at final follow-up, which were not significantly different from their pre-operative values (p = 0.6 and p = 0.4, respectively). The mean carpal height index decreased significantly from 1.53 (1.38 to 1.65) to 1.48 (1.29 to 1.65) indicating progressive carpal collapse (p < 0.001); 40 patients (78%) had radiological evidence of degenerative arthritis. Capsulodesis did not maintain carpal reduction over time. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist.
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Affiliation(s)
- K. Megerle
- Clinic for Plastic Surgery and Hand Surgery,
Klinikum rechts der Isar, Technical University of Munich, Ismaninger
Str. 22, 81675 Munich, Germany
| | - D. Bertel
- Department for Hand, Plastic and Reconstructive
Surgery – Burn Centre, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str.
13, 67071 Ludwigshafen, Germany
| | - G. Germann
- Department for Hand, Plastic and Reconstructive
Surgery – Burn Centre, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str.
13, 67071 Ludwigshafen, Germany
| | - M. Lehnhardt
- Department for Hand, Plastic and Reconstructive
Surgery – Burn Centre, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str.
13, 67071 Ludwigshafen, Germany
| | - S. Hellmich
- Department for Hand, Plastic and Reconstructive
Surgery – Burn Centre, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str.
13, 67071 Ludwigshafen, Germany
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Megerle K, Harenberg PS, Germann G, Hellmich S. Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury 2012; 43:306-10. [PMID: 21903213 DOI: 10.1016/j.injury.2011.08.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 02/02/2023]
Abstract
Scaphoid malunion and carpal malalignment can result after scaphoid reconstruction, if the two fragments are not properly reduced before fixation. However, currently there is no information about which degree of deformity or malalignment can be tolerated without impairing clinical function. The purpose of this study was to investigate the influence of the scaphoid morphology and carpal alignment on clinical outcomes after scaphoid reconstruction. A total of 65 patients with an average age of 29 years were followed-up after a mean period of 45 months. In all patients, osseous union after a first-time scaphoid reconstruction in the middle third had been confirmed. Scapholunate (SL) and radiolunate (RL) angles were obtained on plain radiographs as were intrascaphoid (ISA) and dorsal cortical (DCA) angles and the height/length (H/L) ratio of the reconstructed scaphoid on computed tomography (CT) scans. These parameters were correlated with clinical outcome measures. RL angles correlated significantly with wrist range of motion, grip strength and pain levels, whilst SL angles, ISA, DCA and H/L ratio failed to show significant correlations. Our data suggest that clinical outcome is correlated with correct restoration of bone morphology and carpal alignment. After reconstruction, the RL angle should not exceed 10°.
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Affiliation(s)
- K Megerle
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwig-Guttmannstr. 13, 67071 Ludwigshafen, Germany.
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Abstract
The purpose of this prospective study was to correlate preoperative gadolinium-enhanced MRI scans with intraoperative bleeding of the proximal fragment and postoperative union in a series of consecutive patients with established scaphoid nonunions. In 60 patients (6 females, 54 males) with a mean age of 29 years, scaphoid perfusion was judged preoperatively as normal, impaired or absent using a gadolinium-enhanced MRI scan. Scaphoid reconstruction was performed using a nonvascularized bone graft and screw fixation. Perfusion of the proximal fragment was assessed intraoperatively in 49 of 60 patients; compromised or absent vascularity was predicted with a specificity of 90% by contrast-enhanced MRI. However, there was no significant correlation between preoperative MRI assessment of vascularity and subsequent union of the scaphoid.
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Affiliation(s)
- K Megerle
- Clinic for Hand Surgery, Salzburger Leite 1, Institute for Diagnostic and Interventional Radiology Bad Neustadt/Saale and Handcenter Ravensburg Germany, Ravensburg, Germany.
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Hellmich S, Kolbenschlag J, Germann G, Megerle K. Prognosefaktoren und chirurgische Sanierbarkeit von sternalen Wundinfektionen nach kardiochirurgischen Eingriffen. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238139] [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: 10/20/2022]
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Megerle K, Kolbenschlag J, Germann G, Hellmich S. Funktionelle Ergebnisse nach freier Lappentransplantation zum Erhalt der unteren Extremität bei Patienten mit kompromittiertem Gefäßstatus. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238151] [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: 10/20/2022]
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Behr B, Megerle K, Germann G, Kloeters O. Neue Konzepte in der Oberflächentherapie bei Verbrennungswunden. HANDCHIR MIKROCHIR P 2008; 40:361-6. [DOI: 10.1055/s-2008-1039062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Megerle K, Przybilski M, Sauerbier M, Germann G, Giessler G. Die frühaktive Nachbehandlung nach Extensor indicis-Sehnentransposition - Eine prospektiv randomisierte Studie. HANDCHIR MIKROCHIR P 2008; 40:156-9. [DOI: 10.1055/s-2007-965140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gohla T, Kehrer A, Holle G, Megerle K, Germann G, Sauerbier M. Funktionelle und ästhetische Gesichtspunkte bei der Defektdeckung der Streckseite an Hand und distalem Unterarm mit freien Lappenplastiken. Unfallchirurg 2007; 110:5-13. [PMID: 17124616 DOI: 10.1007/s00113-006-1203-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Free coverage of exposed functional structures of the hand and distal forearm can be achieved using a variety of free flaps. However, there is a lack of data in the literature which tissue components are best used for defect coverage of this specific area regarding aspects such as tendon gliding and tissue elasticity. The purpose of this retrospective study was to compare and to evaluate the functional and aesthetical results using free cutaneous, fascial and muscle flaps. PATIENTS AND METHODS Between 1994 and 2002, a total of 56 patients underwent free flap coverage at the dorsal side of the hand and forearm at our institution. Of these patients, 20 with 21 free flaps met the study criteria and were available for follow-up examination. Depending on the tissue component used patients were allocated into three different groups. In group 1 eight patients received a fascial flap, in group 2 eight a cutaneous flap and in group 3 five a muscle flap. The mean follow-up was 50 months (range: 4-103 months). At follow-up examination the patients answered the Client Satisfaction Questionnaire (CSQ 8) and the DASH questionnaire. RESULTS Regarding range of motion of the wrist and fingers, fascial flaps clearly showed the best results. Concerning grip strength and pinch grip, fascial and cutaneous flaps demonstrated the same results. Patients with cutaneous flaps showed the best DASH score. Regarding the overall aesthetical outcome, fascial and cutaneous flaps were far better than muscle flaps. Donor site morbidity was lowest for fascial flaps followed by muscle flaps and was highest for cutaneous flaps. CONCLUSION Cutaneous and fascial flaps had the best functional and aesthetical results. Fascial flaps achieved the best aesthetical outcome of the donor site. We recommend free fascial flaps and cutaneous flaps as the first choice due to their advantages in the specific area of the dorsal site of the hand and distal forearm which requires pliable and thin tissue coverage.
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Affiliation(s)
- T Gohla
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie der Universität Heidelberg, 67071 Ludwigshafen.
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Megerle K, Worg H, Krimmer H, Christopoulos G, Schmitt R, Lanz U. Die präoperative Kernspintomographie als Prognoseparameter bei Skaphoidrekonstruktionen. HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2004-862403] [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] Open
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Liberles A, Greenberg A, Megerle K. Semiempirical calculations on the ring opening of α-lactones. Tetrahedron 1975. [DOI: 10.1016/0040-4020(75)80066-4] [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: 10/18/2022]
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Borowitz I, Liberles A, Megerle K, Rapp R. On the conformation of 6-ketononanolide and 1,4-cyclohexanedione in solution by dipole moment studies. Tetrahedron 1974. [DOI: 10.1016/s0040-4020(01)97408-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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