Collagen polymorphism in pathologic human scars.

The collagen type composition of normal and pathologic scars was examined in comparison with normal skin from the same individual. Particular care was taken to separate scar tissue from adjacent normal dermis. After urea extraction, the tissue specimens were cleaved with cyanogen bromide. The presence of the dermal collagen types I and III was deduced from the electrophoretic distribution patterns of the CNBr peptides in 12% SDS-polyacrylamide gels. The intensity of the type III specific peptide bands correlates with the type III content of the samples. Using this method, the presence of both type I and III collagen can be proved in normal as well as pathologic scars. The type III content in older normal scars is slightly increased, whereas the type III content of pathologic scars is significantly increased in comparison with the type III content of normal skin. The electrophoretic CNBr peptide distribution pattern of pathologic scar tissue is almost the same as that of fetal skin. Both are clearly different from the peptide pattern of normal adult skin.

[Stable soft tissue reconstruction using an autochthonous muscle flap transposition and simultaneous bone reconstruction in post-traumatic and osteitis defects of the lower extremity]. / Stabile Weichteilwiederherstellung durch autochthone Muskellappentransposition und simultanen Knochenaufbau bei posttraumatischen und osteitischen Defekten an der unteren Extremität.

Posttraumatic soft tissue and bone defects can pose problems for the surgeon. Autogenous bone from the iliac crest may be used to fill bone defects. To achieve bone healing, a well vascularized recipient site for the graft is important. Local muscle flaps or distant microvascular flaps improve vascularity by introducing a fresh blood supply. Cellular and humoral antibodies are more effective and allow quicker revascularisation of the transplanted graft. 49 soft tissue defects were treated by local muscle flaps. In 14 cases the soleus, in 28 the gastrocnemius, in three the tibialis anterior, in two the abductor hallucis, and in two the gracilis muscle was transposed. 38 cases had posttraumatic osteitis, in eight the defect was merely a soft tissue defect and in three due to tumour excision. In 24 patients a combination of soft tissue repair and cancellous bone grafting was performed. Four flaps failed because of total or partial necrosis. In all cases full weight bearing on the leg with good soft tissue cover was achieved.

[Compression neuropathy of the median nerve at the wrist joint caused by chondroma]. / Kompressionsneuropathie des N. medianus am Handgelenk durch ein Chondrom.

The case is reported of a 75-year old patient with diabetes, who suffered from a typical carpal tunnel syndrome, which was diagnosed by a neurologist. On the X-rays of hand and wrist there were no pathological findings. A small, clinically almost inapparent induration at the palmar and radial side of the wrist was found. Ultrasonography and CT-scan showed a tumor with compression of the median nerve. At operation the authors excised a tumor which on histological investigation was compatible with a soft tissue chondroma. Full recovery followed local excision with decompression of the median nerve. Soft tissue chondromas localised to the hand and wrist are extremely rare. A few cases have been described in the literature which led to a nerve compression.

[Surgical treatment of distal fractures of the radius (author's transl)]. / Operative Behandlung distaler Radiusfrakturen.

We report 25 follow-up-examinations of 26 patients with operated fractures of the distal radius. After explanation of the op. indications by means of the preoperative x-ray-result the used operation-procedures and results are shown with regard to exact x-ray-anatomic position and function. Instable osteosynthesis should only be used in cases without violation of the joint or in cases with only 2-3 fragments. Decisive advantages of a single procedure of stable osteosynthesis cannot yet be demonstrated. But the relatively good functional results and the possibility of early mobilisation of T-plate-osteosynthesis justify a wider application, even if exact roentgenological anatomic position could not always be achieved. In conclusion operative procedures should be taken only in irreducible and prognostic disadvantageous fractures of the distal radius because even by operative procedures the late results of severe injuries of the wrist joint can only be slightly improved.

[Surgically treated carpal tunnel syndrome--clinical and electrophysiologic follow-up]. / Das operierte Karpaltunnelsyndrom--eine klinische und elektrophysiologische Nachuntersuchung.

The carpal tunnel syndrome is described as a compression of the N. medianus under the retinaculum flexorum with the causes for this syndrome being of the most varied nature. The aetiology is multifactorial with frequent alterations of the connective tissue being observed in the histological specimen, i.e. chronic inflammatory proliferations or fibrotic degenerations. Direct pressure measurements have shown that the pressure is markedly higher both at rest and extension or flexion as compared to normal healthy subjects. An exact diagnosis requires a measurable prolongation of the distal motorial latency. Surgery is the treatment of choice to ensure perfect recovery. For this purpose the retinaculum flexorum must be entirely split, and our experiments have shown that the splitting of the epineurium yields good results. The microsurgical interfascicular neurolysis, however, should be considered in special cases only. Complaints tend to disappear fairly quickly in the majority of cases, i.e. pain recedes by 90%, sensitivity disorders by more than 70% and muscle atrophy by 50%. The operation enables a measurable improvement of the distal motorial latency. The incidence of postoperative complications is relatively low, and if they do occur, then they are negligible and without any bearing on the final surgical result. Persistent residual complaints are very often due to other accompanying diseases such as cervical vertebral column syndrome, cervical ribs etc.

[Animal experiments on the stability of small fragment screws]. / Tierexperimentelle Untersuchungen von Lösemomenten an Kleinfragmentenschrauben.

Animal experiments reveal that stability may be achieved in small metaphyses also by "small-fragment" screws if applied correctly. Although the bone fixation of lag screws is greater than that of positioning screws the latter still make internal fixation stable enough for early mobilization. With continuing bone healing there is decreasing screw stability though it is not lost completely. The forces exerted by the screws on bone or plate, respectively, therefore seem to provide enough stability for the osteosynthesis on the operating day as well as for the entire duration of the healing. If the screws ever come loose it is usually due to faulty operating technique.

[Therapy of old carpal dislocations and dislocation-fractures and its results]. / Therapie veralteter Luxationen und Luxationsfrakturen der Handwurzel und deren Ergebnisse.

Carpal fractures and dislocations are rare. Pitfalls in the diagnosis of these injuries are quite common failures. A follow up study in 10 patients with carpal injuries was done. Good results were found in five patients. These had been treated within 2-3 weeks. Another 5 patients had not been operated earlier than 2-17 months after the injury. In these cases the results were poor, because either the lunate must be removed or replaced by a prosthesis or was destroyed by avascular necrosis. The possibilities of early diagnosis and the methods of therapy are discussed.

[Local therapy in a case of intravenous mercury injection]. / Lokale Therapie bei intravenöser Quecksilberinjektion.

Intravenous injection of metallic mercury is very rare. It may induce pulmonary and renal complications. Locally serious abscess formation may occur. Radical dissection and excision of affected venous system may result in a satisfactory outcome.

[Injuries to the tibial plateau (author's transl)]. / Tibiakopffrakturen.

Conservative management of considerably displaced tibial head fractures tends to stretch the ligaments and damage the soft tissue. Plateau steps impair mobility and lead to secondary osteoarthritis. Therefore operative procedures are prefered: A buttressing plate supports the displaced condyle after exposure and immaculate reduction. Impacted fragments call for elevation and underlining by cancellous graft. Postoperatively, early active motion and late weight bearing is the rule. Operative procedures will only produce satisfactory results when performed by an experienced surgeon.

[Results of screw fixation of the scaphoid pseudarthrosis]. / Ergebnisse der Verschraubung von Kahnbeinpseudarthrosen.

MATTI-RUSSE's cancellous graft is successful in the management of scaphoid pseudarthrosis. The necessity of post-operative immobilization of the wrist, usually previously immobilized, for up to 16 weeks is its disadvantage. Screw fixation including radial styloidectomy and a small cancellous graft is an alternative abbreviating immobilization to only 2 to 6 weeks. the follow-up of 26 patients thus operated revealed osseous union in 19 cases. The failures were due to lack of proper indication or faulty technique. In spite of the correct position of the scaphoid screw one pseudarthrosis did not heal, the clinical result being satisfactory. The procedure described permits early remobilization of the wrist. Failures, also described by other authors, can be avoided by proper indication and technique.

[Determination of the course of surface arteries by means of Doppler ultrasonics]. / Ermittlung des Verlaufes oberflächlicher Arterien durch Doppler-Ultraschalluntersuchung.

In order to trace the arterial circulation in areas with axial pattern of blood supply, the application of a Doppler-Ultra Sound examination is described by which a precise picture of the circulation can be obtained in a short time and using simple technical means.