From 1985 to 1991, we performed 58 trapezium implantations using porous proplast surrounded by a silastic cylinder. This stemless proplast prevents proximalisation of the thumb as well as the diminution of strength after removal of the trapezium. Contrary to the Swanson-implants, we did not find a radio-dorsal dislocation in our patients. The operative technique is very simple. With the tissue growing into the proplast, a secondary dislocation, especially while loading, is avoided. So far, all patients are satisfied with the result of the operation. Our youngest patient is 31 years old. Ten weeks after bilateral trapezium-implantation he went back to his full-time job as a construction worker.
From unsatisfactory results in fractures in the hand treated with K-wires or other osteosynthesis we felt the need to develop new material for osteosynthesis. Our goal was to simplify the operative procedure, to enable exact anatomical reposition to avoid or reduce splinting in order to prevent adhesions and secondary operations. Further more to be able to reduce and stabilise small fragments. After more than 4 years of experience with our material in more than 200 osteosynthesis we can conclude, that our goal has been accomplished to a great deal. We would like to present this procedure.
A flap of loose connective tissue based on the thoracodorsal vein and artery and lying between the latissimus dorsi and serratus lateralis can be raised and transferred as a local or free flap. This flap has been used to reconstruct the gliding mechanism in block adhesions of the flexor tendons at wrist level. It has also been used for staged tendon and nerve reconstruction at the same site. Technical details for raising the flap are described and other flaps for similar purposes are suggested. Results of five hands in four cases, including one failure, are detailed.
In order to investigate late results in cases with mamma-augmentations, we have controlled cases which have been operated between 1970 and 1980. From a total number of 70 cases 34 have appeared for control. In spite of the problems of capsular contracture the interest for mamma-augmentation has rather increased during this period of time. We have mainly used 3 types of implants: 1. gelfilled silicon prosthesis, 2. inflatable prosthesis, 3. gelfilled prosthesis with polyurethan coating (Aeshly). In most of the inflatable prosthesis (5) spontaneous perforations occurred so that they had to be exchanged. In 41 cases a simple augmentation was performed. Out of these 16 have been controlled. In 4 cases an augmentation was combined with mastopexy. All of these appeared for control. 13 out of 17 cases of subcutaneous mastectomy with augmentation mammaplasty were controlled. In all cases of subcutaneous mastectomy the prosthesis were placed retropectoral. In 18 cases the prostheses were exchanged either because of leakage or when the prosthesis was injured during a capsulotomy. In 2 cases the prosthesis was removed, in 1 case because of problems with the skin and in another case because of repeated severe capsular contracture even after two capsulotomies. The classification of Baker was used to express the severity of capsular contracture. Prosthesis which was placed retropectorally showed significantly less problems with capsular contracture than prosthesis which was placed subglandular.(ABSTRACT TRUNCATED AT 250 WORDS)
A flap of loose connective tissue based on the thoracodorsal vein and artery and lying between the latissimus dorsi and serratus lateralis can be raised and transferred as a local or free flap. This flap has been used to reconstruct the gliding mechanism in block adhesions of the flexor tendons at wrist level. It has also been used for staged tendon and nerve reconstruction at the same site.
Using the anterior iliac crest as donor-site for free osseous, osseomuscular, and osseomyocutaneous flaps has proven itself an important reconstructive instrument both in maxillofacial and in orthopaedic surgery. We present a long-term retrospective evaluation of the donor-site situation after vascularized free anterior iliac crest transfer. The study is based in 95 cases from the years 1985 to 1993 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined, looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Herniation developed in 3% of cases, loss of sensibility in the region of the N. cutaneous femoris lateralis occurred in 9.5% and was in 6% reversible. Scars were in 7% aesthetically not satisfying with no keloids or hypertrophic scarring after all wounds healed per primam intentionem. Mostly minor alteration of the outer surface of the donor site was notable in 20 to 25% of the patients. Pain was a problem for an average of 7% of cases. Impairment in private life was named in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases. Not content with the donor-site situation were 13.5%, not content with the preoperative information were 12% of the patients. Nonetheless were 98.8% of the patients willing to, if necessary, undergo the same operation again. Surprisingly, there is a negative correlation between objective and subjective results: Merely 25% of the patients with sensibility loss were not content with the donor-site result of the operation and vice versa only 1% of the dissatisfied patients had objectively measurable minor complications.
Our experiences in eight radial forearm flaps as free flaps or island flaps are shown. Indications for the use of these flaps in the hand are shown and advantages and disadvantages mentioned. Since 1980, when Mühlbauer and others brought the idea of this flap from China to Europe, its use as an island or as a free flap has been mentioned repeatedly. Generally the safety of this flap and the ease of harvesting are stressed. Other advantages are the long vascular pedicle and the large size of the vessels. These advantages are a temptation to use this flap for indications where it is not really suitable and where other methods are better. It has to be stressed that the donor site is not without problems from an esthetic and functional point of view. The removal of the radial artery, even when replaced by a venous graft may have some drawbacks.
We present in this paper the multicentric study of donor-site morbidity in free flaps, conducted under the auspices of the Deutschsprachige Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefässe (DAM). To have a basis for evaluation of this and future research, we summarize previous results of literature.
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