[Aging and the appearance of the hand]. / Alterung und ideale Asthetik der Hand.

The appearance of the hand is clearly secondary to its function. Nonetheless, aging changes on the hands are of considerable importance to many patients. Although rejuvenation of the hand has attracted increased interest in plastic surgery recently, the dermatologists have dealt with this problem for a longer time. Successful rejuvenation requires thorough analysis of the underlying pathophysiology. Hand aging is characterized by dermal and subcutaneous volume loss resulting wrinkle formation. Aging is also associated with increased visibility of tendons and veins as well as age spots and precancerous lesions. Hand rejuvenation aims at successfully reversing this three-dimensional process. The majority of treatment options address only partial aspects of the aging process. Topical treatments are the mainstay of therapy as these changes are most obvious. As patients will mainly seek advice from dermatologist, this field requires increased attention.

A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO C-type fractures of the distal radius in the elderly.

Current surgical treatments for distal radial fractures include dorsal and palmar plate fixation. We report results of a randomised study comparing these methods for AO C1-3 fractures. The emphasis was placed on the early postoperative functional recovery within the first 6 months as this interval is of decisive importance for elderly patients. Thirty patients with unilateral AO C1-3 fractures were enroled, 15 were treated with a palmar plate and 15 received a dorsal Pi-plate. Results were assessed 6 weeks, 3 months and 6 months postoperatively focusing on functional recovery. The palmar plate group demonstrated significantly better results in range of motion, grip strength and pain.

[Soft tissue coverage of the distal third of the tibia with fasciocutaneous propeller flaps]. / Die Defektdeckung des distalen Unterschenkeldrittels mit perforatorbasierten 180 degrees -Propellerlappen.

BACKGROUND: The distal third of the tibia is often only amenable to free tissue transfer to cover exposed bone, tendons and neurovascular structures. Using relatively constant perforators of the tibial and peroneal vessels, soft tissue coverage can be achieved with so-called propeller flaps. METHODS: 8 patients presenting with post-traumatic defects over the lateral malleolus and the Achilles tendon were included in this study. A propeller flap based on perforators from the peroneal or tibial artery was used to cover the defect. RESULTS: One case of partial flap necrosis was encountered in a diabetic patient. Transient venous congestion of the flap tip was witnessed in two instances, which resolved without further intervention. No other complications occurred. All patients were fully ambulatory within 8 weeks, except for 1 patient, who required a below-knee amputation. CONCLUSION: The propeller flap has proven to be a versatile and elegant method to obtain soft tissue coverage with local tissue. Contrary to conventional rotation flaps, direct closure of the donor site is possible. Patients are not impaired by bulky flaps and may wear normal shoes. Even in the elderly, this flap was successful.