[Complex Regional Pain Syndrome (CRPS) - State of the Art in Diagnostics and Therapy]. / Complex Regional Pain Syndrome (CRPS).

The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2-5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no "CRPS personality", instead there are factors that negatively influence the course. The prognosis is generally good ("rule of thirds"), but remaining limitations are common. The diagnosis is clinically possible according to the "Budapest criteria". Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are "graded exposure" (GEXP) in the case of dominant anxiety and, e.g., "graded motor imagery" (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure.

[Moschella island flap for coverage of thumb defects]. / Homodigitaler Insellappen nach Moschella zur Defektdeckung am Daumen.

OBJECTIVE: The homodigital island flap according to Moschella is used to cover palmar and radiodorsal soft tissue defects of the thumb. INDICATIONS: Soft tissue reconstruction of the thumb with exposed bone and/or tendon if reconstruction of the soft tissue is required. CONTRAINDICATIONS: Extensive scars in the harvesting area of the flap; vascular occlusions of the radial artery. SURGICAL TECHNIQUE: After Doppler sonographic imaging of the origin of the vessel radially at the thumb, the pivot point is determined. The flap is then cut from ulnar to radial, including the dorsoradial artery of the thumb. Removal of the origin of the vessel from the radial artery in the tabatiére and preparation from proximal to distal to the pivot point of the flap at the junction of the artery with the palmar vessels. If necessary, a part of the skin can remain palmar to the pivot point to improve venous drainage. The donor site of the flap can primarily close defect sizes up to 5â€¯× 4 cm. POSTOPERATIVE MANAGEMENT: Until wound healing, soft cotton dressing should protect the vascular pedicle from pressure; immobilisation on a palmar splint may be helpful. RESULTS: In 9 men, sufficient soft tissue reconstruction of thumb defects could be achieved with the described Moschella flap. Eight patients had additional injuries to the fingers and hand.