-
[show abstract]
[hide abstract]
ABSTRACT: Necrotising fasciitis (NF) and Fournier's gangrene are still a source of high morbidity and mortality and a significant health-care resource consumption. These difficult cases are increasingly being referred to burn centres for specialised wound and critical care issues. Besides the total body surface area (TBSA) affected, location, co-morbidities, age and an immediate surgical treatment are important prognostic factors. The treatment of these patients is challenging and best performed by prompt diagnosis, immediate radical surgical debridement and aggressive critical care management. Referral to a major burn centre may help provide optimal surgical intervention, wound care and critical care management.As soon as the patient is stabilised, reconstruction of the injured areas becomes the main focus. As often seen, complete loss of dermal structures needs a depth adjusted--'multilayer'--reconstruction especially in critical areas. In modern reconstructive surgery, concepts of layer-specific reconstruction, including dermal substitution have to be considered. In this article, we present our recent experiences of five patients with NF who underwent dermal reconstruction with Matriderm® not only for better skin quality but also in some cases as an alternative to flap surgery when joint capsules or tendons were exposed.
Burns: journal of the International Society for Burn Injuries 04/2010; 36(7):1107-11. · 1.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Kapandji-Sauvé procedure is a salvage operation for the treatment of painful arthrosis of the distal radioulnar joint (DRUJ). It should be performed if an anatomical reconstruction of the DRUJ is not longer possible. The present study was designed to evaluate mid-term results by means of objective parameters (strength, range of motion, Krimmer and Mayo wrist scores) and subjective self-assessment of patient disabilities (DASH, pain) after the Kapandji-Sauvé procedure.
Fifteen patients (8 female, 7 male, average age 49 years) underwent Kapandji-Sauvé procedure and were retrospectively reviewed 55 months after the operation (range, 6 months to 8 years). As a reason for DRUJ arthrosis we found fractures of the distal radius in 7 patients, severe contusion and distorsion trauma (5), luxation of the DRUJ (2) and a Madelung deformity (1). For evaluation of grip strength the Jamar dynamometer was used. Pain assessment was performed with a visual analogue scale (VAS 0 - 100) pre- and postoperatively, before and after physical load was used. The DASH questionnaire was used in all patients for subjective outcome assessment.
Forearm rotation improved by 59,7 % (89,3 to 142,7 degrees) as well as grip strength by 63,6 % (13 to 20,7 kg) compared preoperative to postoperative. Pain reduction was significant (p = 0,003) before physical load by 48,6 % and after physical load by 63,1 % compared with the preoperative values. The mean DASH score was 41,6 points, Krimmer and Mayo-Wrist scores were 61 and 63 respectively. Radioulnar impingement occurred in 14 patients after an X-ray under load. Because of the improvement of forearm rotation and grip strength 12 patients would undergo the procedure again, three patients were not satisfied with their results.
Our clinical findings show good improvement of forearm rotation, grip strength and reduction of pain after Kapandji-Sauvé procedure. However midrange DASH, Mayo and Krimmer-Wrist scores suggest that the Kapandji-Sauvé procedure is not able to provide a solution for every complex, non-reconstructable DRUJ disorder.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 01/2008; 39(6):403-8. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24 h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5 ml/kg per h and 1 ml/kg per h and mean arterial pressures of >70 mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.
Der Chirurg 07/2004; 75(6):599-604. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Eine adquate Primrversorgung sowie eine ausreichende, an die individuellen Anforderungen des Patienten angepasste Flssigkeitstherapie in der Frhphase nach Verbrennung gelten als wesentliche Voraussetzungen fr die erfolgreiche chirurgische und intensivmedizinische Therapie des Brandverletzten. Die Flssigkeitstherapie Schwerverbrannter erfolgt bevorzugt mit isotonen kristalloiden Lsungen. Kolloidale Lsungen sollten, wenn mglich, whrend der ersten 24h nach Trauma vermieden werden. Die Therapie kann anhand des mittleren arteriellen Drucks (MAD) und einer bilanzierten Flssigkeitssubstitution gesteuert werden. Die Ausscheidung sollte zwischen 0,5 und 1,0ml/kg/h und der MAD>70mmHg eingestellt werden. Wenn die Flssigkeitstherapie, gesteuert anhand dieser Vitalzeichen, nicht den gewnschten Effekt erzielt, liefert ein erweitertes hmodynamisches Monitoring wertvolle zustzliche Informationen. Hierfr knnen der Swan-Ganz-Katheter oder weniger invasive transkardiopulmonale Indikatordilutions-Methoden eingesetzt werden. Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5ml/kg per h and 1ml/kg per h and mean arterial pressures of >70mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.
Der Chirurg 05/2004; 75(6):599-604. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical procedures, minor trauma, trivial scratches, in the setting of a chronic wound, or even in apparently intact skin. The age of the patient is not relevant for the prognosis of NF. As it is shown in this reported case, a young and previously healthy patient died after aesthetic liposuction in the course of a NF. Necrotizing fasciitis is a rare disease, therefore, it is important to review its diagnostic and clinical features, because only early diagnosis and prompt, radical surgery improves the survival rate.
Aesthetic Plastic Surgery 08/2000; 24(5):344-7. · 1.41 Impact Factor
