[Differential therapeutic Approaches in congenital Malformations of the Hand]. / Differentialtherapeutische Zugänge bei kongenitalen Fehlbildungen an der Hand.

With the same clinical picture, different pathological changes must be expected in congenital malformations of the hand. Therefore, knowledge of these pathologies is crucial for planning the surgical approach. The approaches to common malformations are dealt with as examples. These include the double thumb and the syndactyly.In the case of the double thumb with an asymmetrical contour, the result is improved by augmenting parts of the redundant double thumb. In this case, a different incision is required than in simple resection.In the frequently performed syndactyly separations, there are many techniques that have been proven to achieve a good result. But only if principles such as local displacement flap plasty for commissure formation, tension-free wound closure, no longitudinal incisions and no bilateral preparation of a finger are observed here too. If it can be assumed preoperatively that a good surgical result cannot be achieved with the conventional technique of syndactyly separation, pre-treatment using an external fixator for transverse soft tissue distraction is the method of choice.The timing of surgery takes into account not to disturb the motor development of the affected person.

Comparison of Two Clinical Protocols for Total Intravenous Anesthesia (TIVA) for Breast Surgery Using Propofol Combined With Either Sufentanil or Alfentanil.

BACKGROUND: Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for total intravenous anesthesia (TIVA) in combination with propofol. OBJECTIVES: We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia. PATINETS AND METHODS: Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. During anesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesia care unit, pain scores, nausea and vomiting as well as medications were recorded. RESULTS: Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04). CONCLUSIONS: Both protocols provide excellent anesthesia, but patients receiving sufentnail had more stable anesthesia and less postoperative pain.