[Various possibilities of reconstruction of the thoracic wall in radiation defects]. / Verschiedene Möglichkeiten der Thoraxwandrekonstruktion bei Bestrahlungsdefekten.

Reconstruction of the thoracic wall is often necessary after cancer surgery of the breast or irradiation. The resulting large defects often cause an instable thoracic wall. To reconstruct stability, we can use fascia or dura mater. The large defects can be closed either by latissimus flap, or, if the thoracodorsal artery is destroyed, which is often the case by rotating flaps according to the technique of Schrudde or Bohmert, in very rare cases by distant flaps from the neighbouring upper arm.

[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.

[Limitations of rehabilitation possibilities in lye burns of the face]. / Grenzen der Rehabilitationsmöglichkeit bei Laugenverätzung des Gesichtes.

Acute management of lye burns of the face has to include continuous irrigation and earliest possible necrectomy. Wound coverage by split thickness skin grafts was quite often found to be problematic for frequent occurrence of secondary necroses. Loss of eyelids is difficult to tackle, since complicated transposition flaps would then be required, with no guarantee of satisfactory cosmetic result.

[Limits in the possibilities for rehabilitation of lye burns of the face]. / Grenzen der Rehabilitationsmöglichkeit bei Laugenverätzung des Gesichtes.

Several cases of lye burns of the face are presented. The most common causes are explosions. Primary treatment includes continuous irrigation, debridement by dermabrasion and split-thickness skin grafts. The problems resulting from deep burns with loss of the eyelids and exposure of the alar cartilages, can be solved satisfactorily only with distant pedicled flaps.

[Pathogenesis of Dupuytren's disease]. / Untersuchungen zur Genese der Dupuytrenschen Erkrankung.

Liver studies performed in 47 patients with Dupuytren's contracture revealed a high level of hepatitis A contamination; in addition, procollagen III levels were distinctly lowered as compared to normal values, and liver enzyme values were pathologic in 32%. A disturbance of collagen metabolism must, therefore, be considered as a possible cause of Dupuytren's contracture.

[Management of an explosion injury of the face]. / Versorgung einer Explosionsverletzung des Gesichtes.

A 19 year old soldier suffered an explosion injury of the face. He lost the left cerebral hemisphere, the left eye and ear and the majority of the facial musculature on the left side. Primary surgery with rotational flap and mesh graft. Further local flaps and revision of wound area followed. Inspite of nearly complete destruction of the left cerebral hemisphere the patient could walk with only slight hemiparesis. He learned to write with his left hand, he could read from the lips and stand. An understandable speech could not be obtained. Fitting of an epithesis.

[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.

[First aid at the accident site--immediate measures at the hospital in burn cases]. / Erste Hilfe am Unfallort--Sofortmassnahmen im Krankenhaus bei Verbrennungen.

First aid on the scene of the accident consists in case of burns in removal of clothing, cooling with water (20 degrees C) and wrapping in metallic sheet dressing or sterile linen. Hands are dressed with non-adherent gauze and immobilized on splints in a functional position. No application of burn ointment, powder or cream. I.v. pain therapy with morphine derivates. Intravenous infusion (30 ml Ringer's lactate/kg bodyweight/h) tetanus prophylaxis. Hospitalization of all burn wounds of 15% of the body surface or more. Continuation of infusion therapy according to the exact balancing of water and electrolyte metabolism.

[Silicone rubber dressing in wound healing disorders]. / Silikonschaumverband bei Wundheilungsstörungen.

This report deals with new dressing method using silastic foam which was used on 55 patients with good success. Silastic foam dressings are indicated in cases of badly healing and infected wounds, especially caused by diabetes and arteriosclerosis. On account of the physical quality of the silastic foam the wounds were cleaned and healed quickly. The treatment with silastic foam dressing is a good alternative to conservative dressing methods. Two cases will demonstrate the success of the silastic foam dressing in surgery.

[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.

[Unspecific tissue reactions caused by glove powder]. / Unspezifische Gewebsreaktionen durch Handschuh-Puder.

Macro- and histopathological examinations were performed on 200 Wistar rats of both sexes which had been intraperitoneally treated with either Brauns resorbable surgical glove powder or Bio-sorb surgical glove powder; control animals were injected with talcum powder. Talcum resulted in the well known foreign body granuloma along with adhesions. The amylaceous powders induced an initial inflammatory reaction with a subsequent non-reactive interval and thereafter solitary foreign body granulomas were formed. After terminating the experiment (12 weeks), no adhesions could be detected in animals treated with starch containing powder. A resorption of the powder was assumed in that the number of powder crystals was greatly reduced by the end of the experiment. The granulomas which developed after the 12th week were regarded as resorption granulomas. The development of adhesions was minimal with both types of amylaceous powder.

[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.

[A new method for correction of clubhands (author's transl)]. / Eine neue Methode zur Korrektur von Klumphänden.

A 17 year old patient is presented who had aplasia of the radius for clubhand described by Clodius. The ulnar was divided at the wrist and the distal fragment was rotated by 90 degrees. Tendons were elongated by z plasties. Results can be described as satisfactory.

[A new treatment method for hydrochloric acid burns of the hand]. / Eine neue Behandlungs-methode von Flusssäure-Verätzungen der hand.

The progression of hydrofluoric acid corrosion on the hands, which cannot be arrested by other means and leads to crippling or amputation, can be stopped by one single or several repeated intra-arterial perfusions of 10 ml 20% calcium-gluconate solution in 40 ml normal saline over 4 hours as close to the defect as possible via the brachial artery or one of the forearm arteries. In 4 patients, with corrosion of a severity judged to be between first and third degree, spontaneous healing resulted after this treatment. Based on our experience we advise the use of intra-arterial perfusion and show its advantages over subcutaneous injections or intravenous infusion of calcium.

[A new treatment method of hydrofluoric acid burns of the extremities]. / Eine neue Behandlungsmethode von Flusssäureverätzungen an den Extremitäten.

A new method to arrest the unremitting progression of hydrofluoric acid burns, which occurs in the absence of appropriate therapy, is described. The treatment consists of repeated perfusions of calcium gluconate into one of the arteries supplying the affected areas. To date 11 patients have been treated in the described manner, and the therapy brought about recovery in all cases, with little loss of tissue or function.

[Multiple enchondromas of both hands with ulna hypoplasia and radius dysplasia on the left]. / Multiple Enchondrome an beiden Händen mit Ulnahypoplasie und Radiusdysplasie links.

A 33 year old patient with multiple enchondromas of both hands, ulna hypoplasia and radial dysplasia is described. In addition, a deformity of ulna and radius was present on the left side. The first signs of the disease appeared in 1949. The diagnosis, made by biopsy and X-ray was the indication for surgery. The result was very satisfactory. The differences of this undescribed syndrome from Morbus Ollier disease are discussed.