[Dorsal plate arthrodesis of the thumb metacarpophalangeal joint]. / Die Arthrodese des Daumengrundgelenks durch Plattenosteosynthese.

OBJECTIVE: Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. INDICATIONS: Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. CONTRAINDICATIONS: Local infection of the thumb metacarpophalangeal joint area. SURGICAL TECHNIQUE: Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K­wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. POSTOPERATIVE MANAGEMENT: Splint for 3 weeks. Full load after 6-8 weeks. RESULTS: The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.

Compression plate arthrodesis for osteoarthritis of the first carpometacarpal joint: A retrospective study of 77 cases.

Osteoarthritis of the first carpometacarpal joint (CMCJ1) is a common, painful condition with positive radiological findings in up to 32% of people over 50 years of age and up to 91% of people over 80 years of age. Currently, there is insufficient evidence to recommend one surgical treatment option over the others. We conducted a retrospective review of 77 patients treated for CMCJ1 osteoarthritis with plate arthrodesis between 1979 and 1996. The review included physical examination, including range of motion (ROM) of the thumb interphalangeal joint, metacarpophalangeal joint and CMCJ1, pinch grip, key grip and power grip strength, and a questionnaire on subjective outcomes (appearance, dexterity, load bearing, pain, strength, subjective overall result and if patients would choose the procedure again). The complication rate was 26%. However, the general patient satisfaction was high with 88% of patients saying they would choose to have the procedure done again. There was a significant decrease (side-to-side difference) in the ROM for palmar and radial abduction as well as opposition when compared to the opposite hand. Furthermore, there was a significant reduction (side-to-side difference) in pinch, key grip and power grip strength. ROM did not seem to have any influence on pain (and vice versa), load bearing, and the subjective overall result. No gender differences were noted. Despite the high complication rate, CMCJ1 arthrodesis remains a viable option for the treatment of CMCJ1 osteoarthritis in select patients requiring good thumb stability.

[Ten Cases of Cryptotia Corrected using Ono's Technique]. / Zehn Fälle von Kryptotie, korrigiert mit der Ono Technik.

Cryptotia is a very rare condition of ear deformity found in Europe which is more common in Asian populations. The upper ear portion is hidden and fixed in a pocket of skin of the mastoid. Conservatively, this deformity can be treated by molding of the posterior sulcus starting early after birth. Various surgical procedures are described in the literature. We successfully operated on a total of 10 ears of 9 patients with the technique described by Ichiro Ono in 1995. Here, a triangular flap is raised above the ear to reconstruct the posterior sulcus together with a rhomboid-shaped flap in the anterior part of the ear in order to elongate the helix. Among all patients, regular contours and a stable and successful outcome was observed.

[Osteoconductive behaviour of beta-tricalcium phosphate ceramics in osteoporotic, metaphyseal bone defects of the distal radius]. / Osteokonduktive Eigenschaften von Beta-Trikalzium-phosphat in osteoporotischen, metaphysären Radiusdefekten.

BACKGROUND: Surgical treatment of osteoporotic distal radius fractures with locking plates does not completely prevent loss of reduction. Additional bone deficit stabilisation with the use of bone substitute materials is receiving increased attention. Most knowledge on the in vivo behavior of bone substitutes originates from a small number of animal models after its implantation in young, good vascularized bone. PURPOSE: This paper investigates the osteoconductivity, resorption and biocompatibility of beta-tricalcium phosphate as a temporary bone replacement in osteoporotic type distal radius fractures. PATIENTS AND METHODS: 15 bone samples taken from the augmented area of the distal radius of elderly people during metal removal were examined. RESULTS: The material was found to be osteoconductive, good degradable, and biocompatible. Degrading process and remodelling to woven bone seem to require more time than in available comparative bioassays. CONCLUSIONS: The material is suitable for temporary replacement of lost, distal radius bone from the histological point of view.

[Propeller flaps: the reliability of preoperative, unidirectional Doppler sonography]. / Propeller-Lappenplastiken: die Reliabilität der präoperativen, unidirektionalen Dopplersonografie.

BACKGROUND: Propeller flaps represent an elegant and reliable method for soft-tissue reconstruction of the extremities and trunk, obviating the need for free tissue transfer. Preoperative localisation of perforators adjacent to the defect is important regarding the pivot point and length of the flap. Most commonly unidirectional Doppler sonography is used. The reliability of this method regarding propellerflaps has not thoroughly been evaluated. The aim of this study is to assess the positive predictive value of this method for planning propeller flaps. PATIENTS AND METHOD: In a total of 68 patients, soft-tissue reconstruction using propeller flaps was planned with unidirectional Doppler sonography. Defects were located on the lower extremity in 48 cases, the buttock area in 15 cases and the trunk in 5 cases. RESULTS: In 12 cases no adequate perforators were located intraoperatively despite a positive Doppler signal. In the lower extremity Doppler produced a false-positive result in 21% of the cases, whereas in the buttock region only 13% false positives result were found. The positive predictive value overall was 82%. When no perforator was located, flap coverage was achieved using the reverse sural artery flap in 6 cases, the free peroneal artery perforator flap in 3 cases, local advancement flaps in 2 cases and skin grafting in 1 case. DISCUSSION: The reliability of unidirectional Doppler sonography is inadequate for localisation and selection of the dominant perforator when planning propeller flaps. A high rate of false-positive results needs to be anticipated especially distally in the extremities. In 18% of cases an alternative surgical plan was required to achieve soft tissue coverage. We recommend using colour duplex sonography for a more reliable preoperative localisation of perforators.

[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.

[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.

[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.

[Tumors of the hand -- results of a long-term study]. / Tumoren der Hand -- Ergebnisse einer Langzeitstudie.

This is a report of a long-term study at the Friedrich-Alexander University of Erlangen-Nurnberg, Germany from 1936 to 1994. We divided tumors into three categories, i.e. skin, soft tissue and bone tumors. 4612 tumors were included in the study. Over the course of the study, a dramatic change in the occurrence of single tumors was noticed. While tumor-like lesions have been on the decline, other types of tumors, especially malignant tumors as well as more advanced stages of tumors have become a common occurrence. We will show that particularly larger institutions experience an ever increasing number of advanced tumors requiring individual approaches.

[A new technique of subdermal flap dissection for reconstruction of the ala of the nose]. / Eine neue Technik der subdermalen Lappendissektion zur Wiederherstellung des Nasenflügels.

There are different techniques for reconstruction of the ala of the nose. Nasolabial flaps are commonly used. With these techniques nasolabial and perialar skin is subdermally dissected and turned over into the defect to create both the inner and outer lining of the ala. If there is also loss of the perialar and nasolabial skin, such techniques become impossible. With a modification it is still possible to reconstruct both the ala of the nose and the perialar/nasolabial skin in one operation. A V/Y sliding flap from the cheek with a side extension from the lower nasolabial fold used as a turn-over flap is dissected. With this technique it is also possible to reconstruct isolated loss of the ala of the nose.