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Vetter M, Föhn M, Oehy K, Wedler V. [Displaced pain pump because of a pendulous abdomen - dermatolipectomy as solution of the problem]. HANDCHIR MIKROCHIR P 2010; 42:263-5. [PMID: 20425693 DOI: 10.1055/s-0030-1252005] [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: 10/19/2022] Open
Abstract
A female patient with a chronic pain syndrome after multiple operation on her muskuloskeletal system presented with a displaced pain pump in her lower left abdominal region. After an excessive weight loss due to gastric banding the patient developed a massive pendulous abdomen causing the complication. An interdisciplinary dermatolipectomy together with a refixation of the pump was performed. Since this operation a recurrence of the displacement has not been observed and consecutively the filling of the pump could be accomplished without radiological investigations. This rare case demonstrates the significance of interdisciplinary treatment in which a primarily aesthetic intervention was necessary for a successful therapeutic outcome.
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Affiliation(s)
- M Vetter
- Abteilung für Plastische, Rekonstruktive und Asthetische Chirurgie, Switzerland.
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2
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Woodfield TBF, Guggenheim M, von Rechenberg B, Riesle J, van Blitterswijk CA, Wedler V. Rapid prototyping of anatomically shaped, tissue-engineered implants for restoring congruent articulating surfaces in small joints. Cell Prolif 2009; 42:485-97. [PMID: 19486014 DOI: 10.1111/j.1365-2184.2009.00608.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preliminary studies investigated advanced scaffold design and tissue engineering approaches towards restoring congruent articulating surfaces in small joints. MATERIALS AND METHODS Anatomical femoral and tibial cartilage constructs, fabricated by three-dimensional fibre deposition (3DF) or compression moulding/particulate leaching (CM), were evaluated in vitro and in vivo in an autologous rabbit model. Effects of scaffold pore architecture on rabbit chondrocyte differentiation and mechanical properties were evaluated following in vitro culture and subcutaneous implantation in nude mice. After femoral and tibial osteotomy and autologous implantation of tissue-engineered constructs in rabbit knee joints, implant fixation and joint articulation were evaluated. RESULTS Rapid prototyping of 3DF architectures with 100% interconnecting pores promoted homogeneous distribution of viable cells, glycosaminoglycan (GAG) and collagen type II; significantly greater GAG content and differentiation capacity (GAG/DNA) in vitro compared to CM architectures; and higher mechanical equilibrium modulus and dynamic stiffness (at 0.1 Hz). Six weeks after implantation, femoral and tibial constructs had integrated with rabbit bone and knee flexion/extension and partial load bearing were regained. Histology demonstrated articulating surfaces between femoral and tibial constructs for CM and 3DF architectures; however, repair tissue appeared fibrocartilage-like and did not resemble implanted cartilage. CONCLUSIONS Anatomically shaped, tissue-engineered constructs with designed mechanical properties and internal pore architectures may offer alternatives for reconstruction or restoration of congruent articulating surfaces in small joints.
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Affiliation(s)
- T B F Woodfield
- Institute for Biomedical Technology, University of Twente, Enschede, The Netherlands.
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Handschin A, Jung F, Guggenheim M, Moser V, Wedler V, Contaldo C, Kuenzi W, Giovanoli P. Die chirurgische Behandlung von Hochspannungsverletzungen. HANDCHIR MIKROCHIR P 2007; 39:345-9. [DOI: 10.1055/s-2007-965721] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wedler V, Farshad M, Sen M, Koehler C, Hanschin A, Graetz K, Kuenzi W. Retrospective analysis and clinical evaluation of mandible reconstruction with free fibula flap. Eur J Plast Surg 2007. [DOI: 10.1007/s00238-006-0081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wedler V, Farshad M, Sen M, Koehler C, Handschin A, Graetz K, Kuenzi W. Retrospective analysis and clinical evaluation of mandible reconstruction with a free fibula flap. Eur J Plast Surg 2007. [DOI: 10.1007/s00238-006-0105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schneider NK, Koehler C, Wedler V, Kuenzi W. [Oropharyngeal reconstruction with a free jejunum graft after tumour and stenosis resection: an analysis of 53 cases]. HANDCHIR MIKROCHIR P 2007; 38:398-402. [PMID: 17219323 DOI: 10.1055/s-2006-955893] [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: 10/23/2022] Open
Abstract
The surgical therapy of oropharyngeal carcinoma by means of a free jejunum graft is an established procedure. The application of a monitor segment for postoperative flow control turned out to be a reasonable modification. In this study, we examine the results over a period of 16 years retrospectively. Between 1988 and 2004, 53 patients underwent oropharyngeal reconstructions by means of 58 free jejunum grafts at the clinic for reconstructive surgery in cooperation with the clinic for otorhinolaryngology. All patients were examined postoperatively with the help of a small jejunum loop in the function of a monitor segment to survey flap vitality. Between the 7th and 11th postoperative day the patients were administered Gastrografin to evaluate oesophagojejunal anastomoses. The survival ratio of the transplants in this series amounted to 90.6 %. All anastomoses were initially passable and leak-proof. After a complete loss of the first graft, five patients were successfully reconstructed with a second jejunum graft. In one patient, the vessel anastomoses had to be revised. In two patients, newly formed stenoses were postoperatively treated with a bougie during hospitalisation. In four patients, fistula formation was detected in the follow-up examination. Substantial advantages of the free jejunum graft compared to other alternative free or local tissue transfers are the excellent functional results, the simple local tumour monitoring and the low complication rate.
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Affiliation(s)
- N Krügel Schneider
- Klinik für Wiederherstellungschirurgie, Universitätsspital Zürich, Schweiz.
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Koehler C, Farshad M, Sen M, Scholz T, Kuenzi W, Wedler V. Clinical outcome and long-term follow-up after liposuction procedures. Eur J Plast Surg 2006. [DOI: 10.1007/s00238-006-0080-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koehler C, Niederbichler AD, Scholz T, Bode B, Roos J, Jung FJ, Hoerstrup SP, Hellermann JP, Wedler V. Should human chondrocytes fly? The impact of electromagnetic irradiation on chondrocyte viability and implications for their use in tissue engineering. Bioprocess Biosyst Eng 2006; 29:415-20. [PMID: 17051394 DOI: 10.1007/s00449-006-0094-8] [Citation(s) in RCA: 2] [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] [Received: 09/21/2006] [Accepted: 09/29/2006] [Indexed: 11/30/2022]
Abstract
A significant logistic factor as to the successful clinical application of the autologous tissue engineering concept is efficient transportation: the donor cells need to be delivered to tissue processing facilities which in most cases requires air transportation. This study was designed to evaluate how human chondrocytes react to X-ray exposure. Primary cell cultures were established, cultured, incubated and exposed to different doses and time periods of radiation. Subsequently, quantitative cell proliferation assays were done and qualitative evaluation of cellular protein production were performed. Our results show that after irradiation of chondrocytes with different doses, no significant differences in terms of cellular viability occurred compared with the control group. These results were obtained when chondrocytes were exposed to luggage transillumination doses as well as exposure to clinically used radiation doses. Any damage affecting cell growth or quality was not observed in our study. However, information about damage of cellular DNA remains incomplete.
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Affiliation(s)
- C Koehler
- Division of Plastic, Hand and Reconstructive Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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Moron M, Contaldo C, Wedler V, Künzi W. Experience in Using the Radial Forearm Free Flap Over the Last Nine Years. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-949095] [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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Hug U, Jung FJ, Guggenheim M, Wedler V, Burg D, Künzi W. ["True neurologic thoracic outlet syndrome" -- anatomical features and electrophysiological long-term follow-up of lateral thenar atrophy]. HANDCHIR MIKROCHIR P 2006; 38:42-5. [PMID: 16538571 DOI: 10.1055/s-2006-923941] [Citation(s) in RCA: 3] [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: 10/24/2022] Open
Abstract
Atrophies of the intrinsic muscles of the hand are considered to be a typical symptom of the "true neurologic" form of thoracic outlet syndrome (TOS). The classical form of this entity was described as early as 1970, consisting of a cervical rib or a prolonged transverse process of C7, complete with a fibrous band to the first thoracic rib, resulting in atrophy of the intrinsic muscles of the hand. All our TOS patients presenting with such atrophy displayed anatomical findings consistent with this definition. Based on this observation, the TOS classification currently in clinical use, which differentiates between "disputed" and "true neurologic" subgroups of the neurologic form, is reviewed. In all cases of "true neurologic TOS" with atrophy of the intrinsic muscles of the hand, the lateral thenar muscles are affected first. We present the electrophysiological long-term results of such thenar atrophies of seven patients with eight operated extremities after brachial plexus decompression. The amplitude of the neurographically measured potential over the opponens pollicis and the abductor pollicis brevis muscle, respectively, was defined as quantitative parameter for muscles atrophy. Neither distinct reinnervation nor progressive denervation was evident in any of the cases after a follow-up period, on average, of more than five years post surgery. These findings are in conflict with clinical observations reporting a major postoperative improvement of the motor deficits.
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Affiliation(s)
- U Hug
- Klinik für Wiederherstellungschirurgie, Departement Chirurgie, Universitätsspital Zürich, Schweiz.
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Labler L, Wedler V, Mica L, Trentz O. [Entrapment of the anterior tibial artery in a distal tibial fracture after intramedullary nailing]. Unfallchirurg 2006; 109:156-9. [PMID: 16391935 DOI: 10.1007/s00113-005-1033-x] [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: 10/25/2022]
Abstract
We present a patient with a closed displaced distal tibia fracture with entrapment of the anterior tibial vessels in the fracture after tibial nailing. This complication was initially not recognised. After several debridements of the forefoot on the same side due to open metatarsal fractures and severe soft tissue injury, a free latissimus dorsi flap was used for covering the dorsum pedis. Preoperative angiography showed occlusion of the anterior tibial artery at the fracture line which was interpreted as a secondary occlusion due to an intima lesion of the vessel after injury. The entrapment in the fracture line was recognised intra-operatively during the preparation of the anterior tibial vessel.
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Affiliation(s)
- L Labler
- Departement Chirurgie, Universitätsspital Zürich, Schweiz.
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Abstract
Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was linked to a breast implant have been published. Whether there is an etiological relation to the silicone implant or if it is pure coincidence is not evident at this time. We present the case of a 24-year-old female with congenital asymmetric breasts who underwent breast augmentation in our division on the left side and 15 months later had a breast reduction on the other side. Nine years after the first operation we found a suspicious lesion on the side of the breast implant. The histological result of the excisional biopsy showed an aggressive fibromatosis "arising from" the capsule around the silicon implant. We discuss the possible association of breast implant and desmoid tumor of the breast and evaluate the diagnostic and therapeutic options for desmoid tumors of the breast.
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Affiliation(s)
- A R Jandali
- Klinik für Wiederherstellungschirurgie, Departement Chirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091 Zurich, Switzerland.
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Wedler V, Meuli-Simmen C, Guggenheim M, Schneller-Gustafsson M, Künzi W. Laparoscopic Technique for Secondary Vaginoplasty in Male to Female Transsexuals Using a Modified Vascularized Pedicled Sigmoid. Gynecol Obstet Invest 2004; 57:181-5. [PMID: 14752211 DOI: 10.1159/000076476] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2003] [Accepted: 11/26/2003] [Indexed: 11/19/2022]
Abstract
Between 1995 and 2002, 53 primary sex reassignments in male to female transsexuals were performed at our division. The objective of this procedure is to mimic the female external and part of the internal genitalia both esthetically and functionally. In 11 of the 53 patients, a secondary vaginal lengthening had to be performed due to a short neovagina. This was achieved using a pedicled sigmoid segment, with an open approach in the first 2 patients and using a laparoscopic method in the following 9. This paper focuses on the laparoscopic technique, its benefits and potential complications. Where a primary vaginoplasty, combining inversion of the penile and scrotal skin flaps, yields unsatisfactory functional results, a secondary vaginoplasty using the pedicled sigmoid represents an elegant means to achieve functional improvement. Furthermore, we report a modified surgical approach to the conventional sigmoid transition.
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Affiliation(s)
- V Wedler
- Division of Plastic, Reconstructive and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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Wedler V, Meuli-Simmen C, Künzi W, Giovanoli P, Meyer VE. [Necrotising fasciitis caused by streptococcal toxic shock syndrome]. HANDCHIR MIKROCHIR P 2002; 34:108-14. [PMID: 12073187 DOI: 10.1055/s-2002-32302] [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: 10/14/2022] Open
Abstract
Between 1994 and 1997, sixteen patients suffering from necrotising soft tissue infection were treated at the burn centre of the Division of Reconstructive Surgery, University of Zurich. The case of a 47 year old man is presented: He suffered from a necrotising fasciitis caused by Streptococcal induced Toxic Shock Syndrome (STSS). This example emphasizes the necessity of early diagnosis, priority of surgical intervention, and the antibiotic strategy. Necrotising fasciitis is a serious disease, caused by a variety of bacteria, which shows a high mortality rate, and its frequency was increasing over the last years.
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Affiliation(s)
- V Wedler
- Abteilung für Brandverletzte der Klinik für Wiederherstellungschirurgie, Universitäts-Spital Zürich, Switzerland.
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Abstract
The compression syndrome of the posterior circumflex humeral artery is an infrequent vascular compression syndrome and differential diagnosis of the thoracic outlet- and the hypothenar-hammer-syndrome. The diagnosis includes a complete interview and a transfemoral armarteriography. Our report is about an affected volleyball player, the possible pathomechanism that can lead to this syndrome and the current literature.
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Affiliation(s)
- K Stänz
- Institut für diagnostische Radiologie, Universitätsspital Zürich, Schweiz
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Loss M, Wedler V, Künzi W, Meuli-Simmen C, Meyer VE. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA. Burns 2000; 26:644-52. [PMID: 10925189 DOI: 10.1016/s0305-4179(00)00045-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [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: 11/27/2022]
Abstract
Despite refinements in burn shock resuscitation, improvements in surgical techniques, advances in intensive care medicine and the presence of very expert surgeons, the treatement of patients with severe burns exceeding 60% TBSA remains a big challenge. A major problem in the treatment of severe burn injuries is the lack of autologous skin. In selected cases cultured epidermal autograft (CEA) may be used. However, they are available only 2-3 weeks after biopsy, thus requiring a temporary wound closure after necrosectomy. A new option is Integra(TM), an artificial skin consisting of a bilayer membrane system. The three-dimensional porous matrix from bovine tendon collagen and a glycosaminoglycan layer is covered by a silicon sheet. The latter prevents fluid loss from the wounds and serves as a barrier against germ invasion. After adequate vascularisation of the dermal template, the silicon layer is removed and replaced by a thin autograft. We present a 26-year old male who sustained a 93% TBSA burn injury (60% full-thickness burn, 33% partial-thickness burn). He was treated with artificial skin, split-thickness autograft and CEA in combination. The clinical history and the follow-up of approx. 1 year are presented and the results discussed. We consider the survival of this patient being a result of the therapeutic progress of the recent decades.
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Affiliation(s)
- M Loss
- Division of Hand, Plastic and Reconstructive Surgery, University Hospital, CH-Zurich, Switzerland.
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Abstract
There is no detailed information about the care of burns victims, in Europe, in the case of a fire disaster. Several countries have discussed how to treat burn victims, but only a little is known of their capacity to offer space to other countries in the event of a fire disaster outside the country in question. In Europe, most countries are dependent on England, France and Germany in such cases. Since "Los Alfaques", "Ramstein" and other examples of such disasters, we know how important it is to focus more on burn victims in Europe with respect to national and international cooperation.
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Affiliation(s)
- V Wedler
- Burns Centre, Clinic for Reconstructive Surgery, University Hospital, Zürich, Switzerland
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