[Results of follow-up of Matti-Russe surgical treatment of scaphoid pseudarthroses]. / Nachuntersuchungsergebnisse von operativ nach Matti-Russe behandelten Kahnbeinpseudarthrosen.

Sixty patients after Matti-Russe procedures for scaphoid non-union were investigated. In 85%, autologous corticocancellous bone grafting was successful. Wrist function was good in 65% of the cases. 68% of the patients were satisfied with the result of the operation. Patients younger than 30 years at the time of the operation and with the diagnosis of scaphoid non-union not older than two years showed the best results. In cases with long-time follow-up investigation after Matti-Russe procedure (more than nine years), wrist function as well as the patient's self-estimation become significantly poorer.

The 1990 Everett Idris Evans memorial lecture: the inhalation injury.

The most important question that had to be answered from our animal data was whether a significant difference existed between the two groups. It could be observed that the resuscitation with Ringer's lactate did not lead to any increased lymph flow or total transcapillary protein flow in spite of the drop in protein and oncotic pressure in plasma. With Ringer's lactate there was a lower lymph to plasma protein ratio, which might be significant. No negative difference could be observed either in the pulmonary capillary wedge pressure or pulmonary vessel resistance. All animals survived throughout the experiment, and in all experiments no advantages regarding the vital parameters could be ascertained with the administration of albumin; however, several factors must be borne in mind. The inhalation injury was from a heat source alone and no toxic substances were involved. Only inhalation trauma was induced in the absence of a surface burn wound. The duration of the observation was for only 36 hours. Thus some caution must be observed in applying these findings to a clinical situation. In our evaluation of the clinical results, we have seen that no differences could be established in regard to pulmonary capillary wedge pressure and extravascular lung water between the Ringer's lactate and the albumin group. In spite of a 50% drop in oncotic pressure, however, this is only valid for the first 24 to 36 hours, after which one could assume that a further protein drop coupled with a still raised hydrostatic filtration coefficient would lead to interstitial edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of ticarcillin/clavulanate in severely burned patients.

A pharmacokinetic trial with ticarcillin/clavulanate was undertaken in patients with severe burns. Timentin 5.2 g (ticarcillin 5 g + clavulanate 200 mg) was administered by iv infusion over 20 min, two or three times daily. Fifteen patients with varying amounts of total body surface (TBS) burned could be evaluated for pharmacokinetic calculations (group A, greater than 20% TBS, n = 7; group B, less than 10% TBS, n = 8). Both groups presented similar pharmacokinetic behaviour. Compared with healthy volunteers, the volume of distribution for both ticarcillin and clavulanate was increased 2.5 times. For ticarcillin the mean elimination half-lives in serum were 95.1 (A) and 86.1 min. (B), respectively; for clavulanate, the half-lives were 144.0 (A) and 132.1 min (B), respectively. The 0-8-h urine recovery of ticarcillin was 84% (A) and 83% (B), and for clavulanate it was 86% (A) and 88% (B) of the administered dose. As a consequence of the increased distribution volumes and the increased AUC's in severely burned patients the highest recommended dose of ticarcillin/clavulanate appears suitable.

[Procedures in reconstructive interventions in the area of the face and neck after burn injuries]. / Verfahren bei rekonstruktiven Eingriffen im Gesicht- und Halsbereich nach Brandverletzungen.

Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck of burn patients. For reconstructive surgery full-thickness or split thickness skin grafts are preferred. Pedicled flaps or free flaps are mostly used to correct contractures in the neck. The transplantation of bone or cartilage and tissue expansion are also used for special indications.

[Initial treatment of burns]. / Erstbehandlung von Verbrennungen.

Burns, scalds and caustic burns all bring about an increase in microvascular permeability, with volume losses into the interstitium and at the surface of the body. The first aid measures to be taken include removal of the source of heat, maintenance of the vital functions, institution of infusion therapy with Ringer's lactate, and sterile covering of burn wounds, followed by rapid transportation of the victim to the nearest hospital. The crucial immediate step to be taken at the hospital, when large-area burn wounds are present, is rapid parenteral administration of fluid. Local management of the burns must be effected under sterile conditions. If an inhalation injury is suspected careful diagnostic procedures must be carried out. Therapeutic measures depend on the diagnosis. Finally, reasons for transferring victims to a burns unit are given.

[Primary measures in facial burns]. / Primäre Massnahmen bei Verbrennungen des Gesichts.

In regard to the good regeneration of the skin in the facial area surgical therapy in burns can be postponed up to the 2nd week. By then deep 2nd degree burns are healed. The flap procedures are rarely indicated, they are necessary only if bone is exposed. Meshgraft is contraindicated. It is mandatory not to delay escharotomy of the ears in regard to the problem of chondritis. The same approach should be followed in 3rd degree damage of the eye lids.

[Malignant melanoma of the nailbed under a skin graft]. / Malignes Melanom des Nagelbetts unter einem Hauttransplantat.

The authors report on a case of subungual malignant melanoma, which developed beneath a split-skin graft. The patient had an accident which caused a pathologic growth of the nail. Eleven years later the patient removed the nail, because it became moist, and a surgeon grafted the nail-bed with a split-thickness skin. Six years later we saw a 2 X 2 cm tumor under the skin graft and histologic examination showed a nodular malignant melanoma. Diagnostic and therapeutic guidelines for subungual and acral melanomas are discussed.

Soft tissue reconstruction of the anterior surface of the lower leg in burn patients using a free latissimus dorsi muscle flap.

The primary treatment of extensive, deep 3 degrees burn injuries of the lower leg can lead to adhesion of the split-thickness graft with the anterior tibial shaft. Chronic recurring defects with correlative soft-tissue infection can be the consequences, which complicate the patient's rehabilitation. In most cases large defects are involved, so that the secondary reconstructive measures must be planned on accordingly generous scale. The transfer of a latissimus dorsi free flap enables the surgeon to cover defects of almost the entire anterior aspect of the lower leg as well as the ventral circumference. We covered the muscle surface with mesh graft. All patients on whom this technique was practiced achieved an adequate, stable skin coverage without further recurrence of infection. A description of the technique is given based on case reports and their subsequent follow-up.

[Changes in iodine metabolism in patients with burns treated topically with PVP-iodine]. / Jodstoffwechselveränderungen bei Brandverletzten unter PVP-Jod Oberflächentherapie.

Under exposure treatment of 33 burn patients with povidone-iodine (polyvinylpyrrolidon-iodine) preparations (Betaisodona ointment and solution) massive absorption of the iodine by the body and temporary changes in the thyroid hormones (T3 and T4 lowered, TSH raised) were found. No other clinical or laboratory-chemical side effects were observed in the patients. TRH stimulation test was carried out on 18 patients 3-6 months after ceasing povidone-iodine application. The results showed normoreaction of the hypothalamus-pituitary regulation. Povidone-iodine topical treatment of the burn patients involves them in substantial exposure to iodine, but offers no additional risk to the patients.

Povidone-iodine in the treatment of burn patients.

The improvement in infusion therapy of burn patients in the last decades has led to a marked reduction of the early mortality rate and to an increase in the importance of severe wound infection and septicaemia. For the control of infection, detailed bacteriological monitoring is recommended. The main therapeutic fields for prevention of infection are: immunotherapy, antisepsis, aseptic techniques, and rapid restoration of the destroyed body surface. The most important part of antisepsis in burns is topical treatment. The good bacteriological and clinical results with povidone-iodine (PVP-I), in combination with open treatment are described. A possible disadvantage of this therapy was the extensive iodine resorption. However, no disorders of thyroid function were revealed, and the TRH test indicated no abnormal reactions of the hypothalamus-pituitary axis. The high serum and urine iodine levels returned rapidly to normal after discontinuing the PVP-I application.

[The burned hand]. / Die verbrannte Hand.

The treatment of the burned hand is part of the care of the burned patient and is not an isolated problem. Second degree injuries present no difficulties because any therapy will be successful. The deep dermal burn is treated in different ways, some authors preferring early tangential necrectomy, while others had good results with secondary reconstructions. In the case of the third degree burn, necrectomy will in any case be mandatory. The preservation of the scar with Betadine gives the opportunity to choose the best timing for the operation in relation to the general condition of the patient. Skin grafting can be performed without any dressing by using the "hayrake" splint. Postoperative treatment is important, splints and pressure dressings are successful. In electrical burns, early necretomy is mandatory. Defects should be closed with flaps. In the area of the secondary reconstruction, the treatment of functional disability has priority over aesthetic corrections.

[Results of surgically treated scaphoid pseudarthrosis using the Matti-Russe method]. / Ergebnisse operativ behandelter Kahnbeinpseudarthrosen nach Matti-Russe.

For the treatment of scaphoid pseudarthrosis which is recognized sufficiently soon after an accident and where are no arthritic changes, the best method is that described by Matti-Russe; in our series we found healing in 95%. By grafting an autologous cortico-cancellous bone from the ilium we had no failures when we diagnosed and operated on the pseudarthrosis in the first five years after injury. We, therefore, now operate also on fractures with delayed union. The resection of the radial styloid process in combination with the Matti-Russe method has shown no advantages, and we have abandoned this modification.

[Complications in face lifting]. / Komplikationen bei der Gesichtsstraffung.

There is a considerable rate of complications in face lift procedures. Especially those examiners who have included the dissatisfaction of patients found a rate of complications up to 40%. The article brings a conclusion of the most in the literature described complications and also hints from different authors to avoid them.

[Pedicle flap plastic surgery in the primary care of large skin and soft tissue defects of the upper extremity]. / Gestielte Lappenplastik bei der Primärversorgung grosser Haut- und Weichteildefekten an der oberen Extremität.

Pedicle flaps from the chest or abdomen are still most suitable to cover large skin and soft tissue defects on the upper extremity. Compared to free tissue transfer with microvascular anastomosis, the conventional techniques ave advantages with regard to size, technical execution, technical differentiation and rate of healing in. Every skin and soft tissue defect on the upper extremity, however large it is, can be primarily treated by means of a pedicle flap.

[Isolated loss of function of the flexor pollicis longus muscles in moderate polyneuropathy]. / Isolierter Ausfall der Flexor pollicis longus-Funktion bei geringer Polyneuropathie.

A 60 year old female patient was referred to us with the diagnosis of a traumatic rupture of the flexor pollicis longus tendon. Because of disturbances in sensitivity in the superficial branch of the radial nerve, we carried out a neurological examination. A mild polyneuropathy was found, but there was no evidence against the presence of a trauma-induced rupture of the flexor pollicis longus tendon. In the surgical revision, a rupture could not be detected. However, the musculature of the flexor pollicis longus differed markedly in color and consistency from the other flexors and the histological examination showed atrophy patterns of the muscle fibers which are typical for polyneuropathy of the distal type.