1
|
Ma Y, Taylor L, Swift C, Mitchell S, Thyagarajan M, Jester A, Al-Ani S. Ultrasonography in the assessment of hand injuries in children: A systematic review. ANN CHIR PLAST ESTH 2023; 68:260-269. [PMID: 36967309 DOI: 10.1016/j.anplas.2023.02.004] [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] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 06/14/2023]
Abstract
Despite the frequency of paediatric hand injuries, recommendations for diagnostic investigations are limited due to paucity of published guidelines. This has led to inappropriate diagnoses and therefore inappropriate management. Ultrasonography is a portable, non-ionising imaging modality that allows rapid real-time evaluation of anatomical structures at a low cost and without sedation. In the adult population, ultrasonography has already been shown to improve accuracy in hand injury diagnoses. However, in the paediatric population, only one narrative review focuses on the application of ultrasonography to diagnose hand injury. A systematic search using PubMed, Google Scholar, EMBASE, Scopus, Cochrane database of systematic reviews and University Library of York, Keele, Edinburgh and King's College London was conducted to assess literature surrounding use of ultrasonography as a diagnostic tool for paediatric hand injuries. The literature search yielded 11,860 articles and 21 studies were identified with a total of 30 patients. Ultrasonography was observed to be an accurate tool for diagnosing bone, tendon, ligament and nerve injuries in children. The results of our study suggest that ultrasonography should be considered as an early diagnostic step for paediatric hand injuries.
Collapse
Affiliation(s)
- Y Ma
- Royal Stoke University Hospital, ST4 6QG Stoke-on-Trent, United Kingdom.
| | - L Taylor
- King's College London, WC2R 2LS London, United Kingdom
| | - C Swift
- University of Keele, ST5 5BG Keele, United Kingdom
| | - S Mitchell
- University of Keele, ST5 5BG Keele, United Kingdom
| | - M Thyagarajan
- Birmingham Women's and Children's Hospital, B4 6NH Birmingham, United Kingdom
| | - A Jester
- Birmingham Women's and Children's Hospital, B4 6NH Birmingham, United Kingdom
| | - S Al-Ani
- Aston University, B4 7ET Birmingham, United Kingdom
| |
Collapse
|
2
|
Jing SS, Jester A. Myth in hand surgery: When is an opponensplasty an abductorplasty? JPRAS Open 2020; 24:40-42. [PMID: 32337331 PMCID: PMC7177157 DOI: 10.1016/j.jpra.2020.03.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- S S Jing
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - A Jester
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| |
Collapse
|
3
|
Vermaak PV, Southwood TR, Lindau TR, Jester A, Oestreich K. Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications. J Wrist Surg 2018; 7:186-190. [PMID: 29922493 PMCID: PMC6005783 DOI: 10.1055/s-0038-1639508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
Introduction Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition in children and frequently affects the wrist. The roles for wrist arthroscopy and arthroscopic synovectomy (AS) in JIA are unclear. Our aim was to find the current evidence supporting its use. Methods Systematic literature review of relevant publications from 1990 to present in the Cochrane Library, Clinical Knowledge Summaries, DynaMed, PEMSoft, NICE Guidance, MEDLINE, EMBASE, and PubMed. Results We found no publications detailing the use of arthroscopy or AS specifically in patients with JIA involving the wrist. There is evidence that AS reduces pain, improves function, and induces remission in patients with rheumatoid arthritis resistant to medical management. Discussion and Conclusion Although there is paucity in evidence for the use of AS in the wrists of patients with JIA, studies suggest it to be safe and effective, and could be applied to patients with refractive JIA. It is possible that early identification of patients suffering from JIA with extensive joint destruction and little symptoms could benefit from AS, delaying joint destruction and preserving function.
Collapse
Affiliation(s)
- P. V. Vermaak
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - T. R. Southwood
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | | | - A. Jester
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - K. Oestreich
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
4
|
Jester A, Harth A, Wind G, Germann G, Sauerbier M. Disabilities of the Arm, Shoulder and Hand (Dash) Questionnaire: Determining Functional Activity Profiles in Patients with Upper Extremity Disorders. ACTA ACUST UNITED AC 2016; 30:23-8. [PMID: 15620487 DOI: 10.1016/j.jhsb.2004.08.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2003] [Accepted: 08/31/2004] [Indexed: 11/19/2022]
Abstract
The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients’ own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients’ needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients’ requirements and have relevance to their daily activities.
Collapse
Affiliation(s)
- A Jester
- Department of Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
| | | | | | | | | |
Collapse
|
5
|
Aslam R, Hendriksz CJ, Jester A. Objective results of median nerve decompression and tenosynovectomy for carpal tunnel syndrome in patients with mucopolysaccharidoses Types I and II. J Hand Surg Eur Vol 2015; 40:216-8. [PMID: 24554690 DOI: 10.1177/1753193414523356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R Aslam
- Department of Hand Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - C J Hendriksz
- Department of Inherited Metabolic Disease, Birmingham Children's Hospital, Birmingham, UK
| | - A Jester
- Department of Hand Surgery, Birmingham Children's Hospital, Birmingham, UK
| |
Collapse
|
6
|
Jester A, Harth A, Rauch J, Germann G. DASH-Daten nicht-klinischer versus klinischer Personengruppen – eine Vergleichsstudie mit T-Normen für die klinische Praxis. HANDCHIR MIKROCHIR P 2010; 42:55-64. [DOI: 10.1055/s-0030-1247500] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
7
|
Abstract
This study evaluated the effectiveness of a patient-oriented, hand rehabilitation programme compared to a standard programme regarding functional outcomes, return to work, patient satisfaction and costs. Patients were recruited in two consecutive cohorts. One cohort received the standard treatment programme (n = 75) and the other a programme based on principles of patient orientation (n = 75). Data were collected at the beginning and end of rehabilitation and 6 months after discharge. Clinical variables included range of motion, grip and pinch strength. Self-reported measures included pain, upper extremity functioning, health status, satisfaction and job situation. Analysis of variance for repeated measurements was used to calculate the main effects. The patient-oriented group showed more favourable results with respect to DASH scores (P <.05), pain (P <.001) and patient satisfaction (P <.0001). More patients returned to their former jobs and time off sick was reduced. We concluded that the patient-oriented approach was more effective and cost-saving.
Collapse
Affiliation(s)
- A Harth
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen Department of Plastic and Hand Surgery, University of Heidelberg, Germany.
| | | | | |
Collapse
|
8
|
Loukas M, Tubbs RS, El-Sedfy A, Jester A, Polepalli S, Kinsela C, Wu S. The clinical anatomy of the triangle of Petit. Hernia 2007; 11:441-4. [PMID: 17492342 DOI: 10.1007/s10029-007-0232-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hernias through the triangle of Petit (TP) are uncommon. The anatomy of the TP is known to be variable, yet quantitative data are scant. MATERIALS AND METHODS The triangle was observed in 80 adult cadavers and its dimensions and surface area were measured. RESULTS On the basis of surface area we classified the triangles into four types. Type I or small TP, with a surface area of <8 cm2, accounted for 43.7% of our specimens. Type II (26.2%) were intermediate in size, with a surface areas of 8-12 cm2. Type III (12.5%) were large triangles with surface areas >12 cm2. Finally, Type IV (17.5%) were not triangles. In these, the latissimus dorsi was covered by the external abdominal oblique muscle. CONCLUSIONS We hope these data will help prediction of which patients are at greater risk of herniation through the TP.
Collapse
Affiliation(s)
- M Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Since 1948, closed reduction and osteosynthesis for supracondylar humeral fractures using two K-wires from the medial and lateral side has been performed on a regular basis. Although this procedure is used routinely, many authors have described paralysis of the ulnar nerve after blindly inserting the medial K-wire. Only very few publications describe the treatment options after iatrogenic paralysis of this nerve. The patients described showed progressive paralysis of the ulnar nerve after K-wire osteosynthesis. Intraoperatively, all patients showed scarring but intact continuity. After surgical revision and neurolysis, all four patients showed complete restitution after 1 year. If patients show progressive paralysis of the ulnar nerve early operative revision after 3 months should be performed.
Collapse
Affiliation(s)
- A Jester
- Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Plastische und Handchirurgie der Universität Heidelberg, BG-Unfallklinik Ludwigshafen, Ludwigshafen, Germany.
| | | | | | | |
Collapse
|
10
|
Oestreich K, Flügel A, Raab N, Germann G, Jester A. Der Einsatz des Ballondissektors in der Expanderchirurgie: Zehn Jahre Erfahrung in der plastischen und rekonstruktiven Chirurgie. HANDCHIR MIKROCHIR P 2006; 38:240-5. [PMID: 16991044 DOI: 10.1055/s-2006-924418] [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: 10/24/2022] Open
Abstract
BACKGROUND The use of the balloon dissector ("space maker") for the implantation of soft tissue expanders is illustrated and technical aspects and advantages are compared to the conventional method. PATIENTS AND METHODS Over a 10-year period a group of 90 patients with evaluation records (m = 34, f = 56) was analysed retrospectively. The mean age was 23 years (range: 5 to 62 years). Overall, 164 expanders were implanted and in 73 cases (44.5%) a balloon dissector was used. RESULTS The mean intraoperative expander filling was increased up to 27% of the volume of the tissue expander after using the balloon dissector; in contrast it was 15% after conventional dissection. The mean duration of expansion was decreased by 9.8% after space maker dissection. CONCLUSION The use of the space maker is a scar-sparing technique. Time of operation and overall duration of expansion are reduced. Patient comfort is clearly improved. The negligible costs of a space maker are compensated by the cost reduction due to shorter operating time, fewer outpatient contacts and a low complication rate. The indications for the use of balloon dissectors are the expansion of skin (scar correction after burns, trauma, tumour), breast reconstruction and augmentation, and the prefabrication and rapid intraoperative expansion of musculocutaneous flaps.
Collapse
Affiliation(s)
- K Oestreich
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie-Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen.
| | | | | | | | | |
Collapse
|
11
|
Oestreich K, Jester A, Ohlbauer M, Schröter B, Germann G, Pelzer M. Überlebensstrategie der Schwerbrandverletztenzentren im Kontext der Y-DRG: Budgetsicherung. Unfallchirurg 2006; 109:505-10. [PMID: 16773327 DOI: 10.1007/s00113-006-1092-7] [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: 11/26/2022]
Abstract
BACKGROUND The system of German diagnosis-related groups (G-DRG) has undergone modifications for burn cases (Y-DRG) since 2003. The DRG catalog includes two of seven Y-DRGs without a case weight. METHODS The BG Trauma Center in Ludwigshafen could demonstrate that the cost of burn care treatment could not be reimbursed through Y-DRGs in 2004. RESULTS By being accredited as a so-called "individual hospital-based unit" for burn care (Besondere Einrichtung), it was possible to agree to an "all-inclusive" contract. The daily rate is reimbursed with 2792 Euros/day. The reimbursement of the treatment of burn patients is thus cost covering. CONCLUSION In summary the budget for 2006 should be calculated by an individualized hospital rate for all Y-DRGs, especially as it was shown that the additional payments (Zusatzentgelte) for selected therapies did not cover the costs of special treatments in burn care in 2005 and 2006. The problem has been recognized and published internationally. The special and cost-intensive treatment of burn patients is difficult to calculate in a system of diagnosis-related groups due to the low number of cases.
Collapse
Affiliation(s)
- K Oestreich
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG-Unfallklinik, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen.
| | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Germann G, Waag KL, Selle B, Jester A. Extremity salvage with a free musculocutaneous latissimus dorsi flap and free tendon transfer after resection of a large congenital fibro sarcoma in a 15-week-old infant. A case report. Microsurgery 2006; 26:429-31. [PMID: 16924620 DOI: 10.1002/micr.20266] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A case of complex microsurgical reconstruction of the dorsum of the foot, including tendon transfer following tumor resection, in a 15-week-old male infant is presented. After birth, a 5.5 x 4 cm large tumor was observed on the dorsum of the right foot. Biopsy showed a congenital malignant fibro sarcoma. After initial chemotherapy a radical excision of the tumor at the age of 14 weeks was followed. To cover the defect a musculocutaneous latissimus dorsi flap was taken, the cutaneous part being large enough to cover the defect. Extensor tendons were reconstructed with free tendon transplants. Amputation is usually indicated in these cases. To the best of our knowledge, microsurgical reconstruction in infants at this age with congenital malignant tumors has not yet been reported. The case shows that Plastic surgery can play an important role in pediatric oncology and should routinely be integrated into the multi-modal treatment concepts.
Collapse
Affiliation(s)
- G Germann
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center, Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
| | | | | | | |
Collapse
|
14
|
Jester A, Harth A, Wind G, Germann G, Sauerbier M. Ersetzt der Disability of Arm, Shoulder and Hand Questionnaire (DASH-Fragebogen) die Erfassung von Bewegungsausmaß und Kraft bei der Bewertung von Ergebnissen? HANDCHIR MIKROCHIR P 2005; 37:126-30. [PMID: 15877274 DOI: 10.1055/s-2004-821279] [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: 10/25/2022] Open
Abstract
Scoring systems currently used to evaluate functional disabilities in upper extremity conditions frequently combine so-called "objective" parameters such as grip strength and range of motion with "subjective" parameters such as pain. Since its introduction, the Disabilities of Arm, Shoulder and Hand Questionnaire has proven useful in the pre- and postoperative evaluation of functional limitations of the upper extremity. This study examines the relationship between DASH scores, the so-called "objective" parameters of grip strength and range of motion and those of "mixed scores" such as Krimmer and Cooney Scores. Based on the data of six diagnostic groups, Spearman's correlation coefficients were calculated. There was no correlation between DASH scores and range of motion, however, some of the diagnostic groups showed a moderate correlation between DASH scores and grip strength. Both the Krimmer and Cooney scores showed a significant correlation with the DASH scores, indicating that these "mixed-scores" can be replaced by the DASH. Since it has been shown that grip strength and range of motion do not capture patients' functional limitations adequately, their continued use in the evaluation of upper extremity conditions should be the topic of further discussion.
Collapse
Affiliation(s)
- A Jester
- Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Plastische und Handchirurgie der Universität Heidelberg, Berufsgenossenschaftliche Unfallklinik Ludwigshafen.
| | | | | | | | | |
Collapse
|
15
|
|
16
|
Jester A, Harth A, Wind G, Germann G. [The "Shoulder, Arms and Hand Disability Questionnaire" as a scale for identification of the diagnosis-specific activity profile]. Unfallchirurg 2004; 106:834-8. [PMID: 14652726 DOI: 10.1007/s00113-003-0632-7] [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: 11/29/2022]
Abstract
Functional disabilities of the upper extremities have a considerable social and economic impact so that interest was aroused in developing a valid and reliable instrument suitable for international use. The Disabilities of the Arm, Shoulder, and Hand questionnaire is a self-report measure recording functional limitations in the upper extremity. A German version is now available in German-speaking countries. Previous studies have been concerned with the evaluation of DASH scores. Based on the data of four diagnostic groups, this study explores DASH's ability to identify diagnosis-specific limitations at the item level. The data were pooled and examined with regard to significant differences within the groups. Diagnosis-specific limitations could be identified within all groups, indicating that DASH is capable of expressing diagnostic entities as well as summed scores. Consideration of the individual profiles opens the possibility of using DASH as a prognostic tool to anticipate functional problems arising during rehabilitation following surgical interventions.
Collapse
Affiliation(s)
- A Jester
- Klinik für Rekonstruktive, Plastische und Handchirurgie, Schwerbrandverletztenzentrum, Ludwigshafen.
| | | | | | | |
Collapse
|
17
|
Baumeister S, Dragu A, Jester A, Germann G, Menke H. Stellenwert der Plastischen Chirurgie im interdisziplinären Therapiekonzept diabetischer Ulzera am Fuß. Dtsch Med Wochenschr 2004; 129:676-80. [PMID: 15026963 DOI: 10.1055/s-2004-821369] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept. PATIENTS AND METHODS In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results. RESULTS Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients. CONCLUSIONS Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.
Collapse
Affiliation(s)
- S Baumeister
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg.
| | | | | | | | | |
Collapse
|
18
|
Abstract
This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher's and Kleinert and Verdan's evaluation systems, the results were graded as "excellent" and "good" in more than 94%, and as "satisfactory" in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.
Collapse
Affiliation(s)
- S Brüner
- Department for Hand, Plastic and Reconstructive Surgery, Burn Centre, Plastic and Hand Surgery University of Heidelberg, BG--Trauma Centre, Ludwigshafen, Germany.
| | | | | | | | | |
Collapse
|
19
|
Abstract
This retrospective study examines the use and advantages/disadvantages of glycerol preserved human allograft skin in our burn care facility between February 1997 and December 1999. Three hundred and twenty patients were included into the study, 85 of whom were treated with human cadaver skin. The usage of allograft slightly increased the number of operative procedures per percent of the total body surface area burn. There were no adverse effects noted from the use of allograft. The group of patients with allograft use had a significantly larger burn size, ABSI score and length of ICU stay. Demographically the groups were comparable. The considerably easier handling and storage of glycerol preserved allograft skin make it preferable to cryopreserved allograft skin in all indications where it is used as a temporary wound closure. We recommend the usage of cryopreserved skin in cases where the integration of a dermal component as a permanent part of wound closure is desired.
Collapse
Affiliation(s)
- S Blome-Eberwein
- Clinic for Plastic, Reconstructive and Hand Surgery, Burn Center, University of Heidelberg, BG Unfallklinik Ludwigshafen, Ludwig Guttmannstrasse 13, 67071 Ludwigshafen, Germany
| | | | | | | | | | | |
Collapse
|
20
|
Jester A, Waag KL, Germann G, Bickert B. Sequential microsurgical flap reconstruction following purpura fulminans during infancy and childhood. J Reconstr Microsurg 2002; 18:17-22. [PMID: 11917951 DOI: 10.1055/s-2002-19704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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
Purpura fulminans is a potentially lethal complication of meningococcal septicemia, characterized by progressive hemorrhagic skin lesions, which can result in extensive necrosis and mummification of all the extremities. With improving survival rates in infancy and childhood, plastic surgeons are challenged more often to provide sufficient and stable soft-tissue coverage. Usually, conservative methods, such as skin grafting or amputation, are favored by many pediatric surgeons, since further specialized departments and training are not required. Often secondary reconstructive procedures to improve soft-tissue coverage have to be performed to achieve proper prosthetic fitting. Microsurgical techniques are used only in selected cases, after failure of other procedures for defect coverage. In two cases of post-acute purpura fulminans, two free flaps and three microsurgically dissected flaps were used as primary measures for defect coverage and preservation of stump length. Despite the presence of vasculitis, all flaps survived. In a third case, secondary reconstructive measures had to be performed 1 year after purpura fulminans due to insufficient soft-tissue coverage after lower leg amputation. This patient also had contractures on both hands and no grip function after complete finger loss. Several microsurgical procedures were performed to improve grip function and soft-tissue coverage. The primary use of microsurgical techniques prevents lengthy secondary reconstructive measures.
Collapse
Affiliation(s)
- A Jester
- Department of Hand, Plastic and Reconstructive Surgery-Burn Centre-BG-Trauma Center Ludwigshafen, Germany
| | | | | | | |
Collapse
|