[Amputation of the Lower Limb - Treatment and Management]. / Amputation und Prothesenversorgung ­ die untere Extremität.

Despite modern conservative and surgical procedures, the number of amputations of the lower limb remains at a consistently high level. With the demographic changes and the consequent prevalence of atherosclerosis and diabetes mellitus, there is a steady increase of the risk factors that can lead to an amputation. The cause, which ultimately leads to the loss of the affected limb is therefore a symptom of the underlying disease. Primarily, the purpose of any medical treatment is the prevention of any amputation. If the preservation of the limb is not achievable, the surgical procedure follows. In principle the preparation of the stump should be as peripheral as possible. The actual prosthetic fitting starts with the dimension and the impression (negative-copy) of the prosthesis a few weeks following surgery. The technical requirements of a prosthesis will depend on the degree of mobility and the medical history of the patient. Prosthetic adjustments are available for all amputation levels and activities. The essential basic modules of a modern prosthesis can be combined and exchanged freely, so as to allow a change of function, form and axis. The aim of rehabilitation is the full reintegration into daily life. Especially young patients can provide amazing professional and athletic achievements.

[Factitious disorder and self-mutilation in hand and plastic surgery]. / Artifizielle Störungen und selbstverletzendes Verhalten in der Hand- und Plastischen Chirurgie.

Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented.

[Münchhausen's syndrome--a diagnosis to remember]. / Münchhausens syndrom--en diagnose vi ikke må glemme.

We hereby report a case of self mutilation against the right upper extremity in a 26-year-old male. The condition started after a minor trauma. After a few days the diagnosis compartment syndrome was suspected and a fasciectomy of the forearm was performed. The patient subsequently claimed that he had experienced further symptoms. Despite countless investigations, it was not possible to identify the course of the patient's symptoms. It has become clear that the patient suffers from >>Münchhausen's syndrome<<.

Self-amputation of a healthy hand: a case of body integrity identity disorder.

A case report is presented of self-amputation of a healthy hand. We have reviewed the literature and seek to broaden the scope of understanding of Body Integrity Identity Disorder. This rare condition can constitute a pitfall for the unsuspecting hand surgeon.

[Self-induced injuries--surgical aspects]. / Selbstverletzungen--Chirurgische Aspekte.

So far, psychiatric-psychoanalytic theories have been able to explain the phenomenon "self-injury" only unsatisfactorily. Moreover, the patients do not turn to a psychiatrist in the first place, but to surgeons, dermatologists, gynecologists or general practitioners. This is therefore an interdisciplinary problem. Since general medical knowledge is relatively unhelpful in diagnosing self-inflicted disease and its treatment, these patients often do not receive adequate psychiatric co-management or further care or indeed often get the chance to delegate the act of self-injury to the physician. In view of the sustained tendency for the disorder to chronify, this frequently results in severe, partly irreversible and sometimes iatrogenically co-induced physical impairments. In the final analysis, it also leads to enormous financial burdens for the agencies which bear the costs.

Munchausen syndrome: hospital hobo of the 1990s.

Munchausen Syndrome is an unusual subset of symptoms experienced by patients who self-inflict artificial illness. Caring for Munchausen patients, who are frequently finding their way into plastic surgery practices, is very time consuming because they often fail to respond to standard modalities of treatment. They abuse the medical system by seeking care from one or more caregivers at the same time and appear to relish repeating expensive diagnostic procedures. Four case studies are presented in this article along with suggestions for treating these patients.

["Hospital tourism". Case report of Munchausen syndrome]. / "Krankenhaustourismus". Fallbericht zu einem Münchhausen-Syndrom.

We report on a 29-year old patient, who was treated as an inpatient in 95 different hospitals (altogether 173 times) within 7 years. The gynaecologist can suspect Münchausen's syndrome, if the following aspects are recorded: dramatic clinical admissions patterns, (frequently out of the normal consultation time); a history of several operations and many short stays in different hospitals. Special care in diagnostics should be taken to avoid further unnecessary surgical interventions.

A case of Munchausen syndrome masquerading as unstable angina.

The authors report the case of a man who presented with unstable angina and who, at different hospitals over a period of several months, underwent two heart catheterizations, intra-aortic ballon counterpulsation, and eventual bypass surgery despite essentially normal coronary arteries.