[Immediate breast reconstruction following mastectomy for carcinoma]. / Uberlegungen zur sofortigen Wiederherstellung nach Mammaamputation wegen Karzinom.

Analysis of the psychic situation of the women after mastectomy. Most surgeons are against an immediate reconstruction of the breast, because the comparison to conditions before the amputation is usually too negative. The main argument against immediate reconstruction is the local recurrence which occurs in the first 6 postoperative months in 75% of the cases. In stage 0, no local recurrences were observed. If a mastectomy is performed in this stage, immediate reconstruction can be done. In stage 1 the number of local recurrences is 5% in the first postoperative months. In elected cases, if it is the expressed wish of the patient immediate reconstruction can be discussed. In stage 2 the local recurrence rate is already 13,8%. In this stage, an immediate reconstruction is out of the question.

[Severe blast injury of both hands]. / Schwere Explosionsverletzung beider Hände.

A report is presented of a case of an officer, both of whose hands were injured severely by an explosion. On the right side amputation was followed by fitting of a myo-electrical prosthesis. On the left side treatment with an inguinal flap plasty, a two stage tendon graft, transposition of flexor profundus IV-tendon to the thumb, a tendolysis of the second finger, Z-plasty of skin of the thumb in order to ensure a good grip. The functional result was good.

[Evaluating occupational stress on the hand]. / Uber die Messbarkeit beruflicher Beanspruchung der Hand.

In order to achieve objective data to eventually measure the dexterity of hands, we examined 210 hands in 105 persons. These persons were divided into two groups: one group of people with jobs demanding unusual dexterity (musicians, typists, etc.), and another group with average occupational demands on the hand. As expected, we found that hand length and breadth and wrist circumference are always greater in the dominant hand of any individual. The thumb and small finger are always longer in the dominant hand. Joints' active range of motion are significantly higher in individuals whose occupations were particularly demanding.

[Local reconstructive possibilities following infections of the lower leg and foot]. / Ortsgebundene rekonstruktive Möglichkeiten nach Infektionen an Unterschenkel und Fuss.

Basic rule: slough removal, treatment of infection, closure of the defect. Already existing infection: antiseptic solutions, rarely or never antibiotics. Measurement of wound pH (pH 6-8). According to indications, split thickness skin graft, in large defects mesh-graft. Reverdin grafts only in poorly healing wounds. For preparation of defect closure, silicone foam is very effective. If bone is exposed, we still use cross leg flaps and myocutaneous flaps besides more modern methods of plastic surgery. Distant flaps, like tube flaps from the abdomen have only historical interest.