-
[show abstract]
[hide abstract]
ABSTRACT: EPO is an autologous hormone, which is known to regulate erythropoiesis. For 30 years it has been used for the therapy of diverse forms of anaemia, such as renal anaemia, tumour-related anaemias, etc. Meanwhile, a multitude of scientific publications were able to demonstrate its pro-regenerative effects after trauma. These include short-term effects such as the inhibition of the "primary injury response" or apoptosis, and mid- and long-term effects for example the stimula-tion of stem cell recruitment, growth factor production, angiogenesis and re-epithelialisation. Known adverse reactions are increases of thromboembolic events and blood pressure, as well as a higher mortality in patients with tumour anaemias treated with EPO. Scientific investigations of EPO in the field of plastic surgery included: free and local flaps, nerve regeneration, wound healing enhancement after dermal thermal injuries and in chronic wounds.Acute evidence for the clinical use of EPO in the field of plastic surgery is still not satisfactory, due to the insufficient number of Good Clinical Practice (GCP)-conform clinical trials. Thus, the initiation of more scientifically sound trials is -indicated.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2013; 45(2):108-19. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Breast augmentation is one of the most frequent surgical procedures performed by plastic surgeons. Furthermore, in the majority of breast reconstructions implants are still in use. With the focus on surface modifications and biomaterials, the article provides an overview of the latest trends and concepts in increase of implant biocompatibility and reduction of capsular contracture. Because of the recent events regarding PIP® implants, a short report on this topic is presented as well.
The literature was searched for experimental and clinical studies, as well as meta-analysis and reviews, using the databases PubMed, Embase and Cochrane Collaboration. Based on the title, year of publication and abstracts, thematically relevant and recent publications in English or German were selected and full text articles were studied.
According to the classification, 4-5 generations of breast implants have been developed since the 1960s. Modifications affected diverse areas including various surface textures as well as coatings with polyurethane or titanium. Some of these changes were able to reduce capsular contracture, however, without resolving the issue sufficiently. Recent experimental studies mostly evaluated different surface coatings with antifibrotic and antibacterial substances. For the local drug release various carrier substances were used. Furthermore, drugs were covalently bonded to the implant surface or applied by surface impregnation. In different approaches biocompatibility could be increased by biomimicry or nanotechnologically modified biomaterials, which could additionally contribute to the reduction of capsular contracture.
The development of coating technologies for the locally controlled sustained drug release using the implant surface as drug delivery system could potentially enable the local administration of drugs, which were orally delivered in clinical trials, and effectively reduced capsular contracture. This kind of application could potentially minimize the risk of adverse side effects. However, there are still some questions concerning controlled drug release systems for implant surfaces, as well as long-term results and possible side effects of drugs in a continuous local administration to be answered in further studies.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 08/2012; 44(4):240-53. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Von Februar 1996 bis April 1999 wurden in unserer Klinik 9 Patienten mit primären Verbrennungswunden und 13 Patienten mit
sekundären instabilen Narben mit Integra – artificial skin – gedeckt. Dieser künstliche Hautersatz, bestehend aus einer Kollagen/Glykosaminoglykanmatrix
und einer Silikonschicht wurde 1980 erstmalig in den USA eingesetzt. Durch seine mechanischen und biologischen Eigenschaften
dient er in der Akutphase nach Verbrennungen dem Schutz vor Flüssigkeitsverlust und Bakterieninvasion. Langfristig wird durch
integra-induzierte körpereigene Produktion einer Neodermis eine in funktioneller und ästhetischer Hinsicht bessere Narbenbildung
erreicht. Wir berichten über unsere klinischen Erfahrungen mit dem Einsatz von Integra in Akut- und Langzeitverlauf und über
Langzeitbeobachtungen.
We report on our experience with Integra application in 22 patients treated from February 1996 through April 1999. Nine patients
suffered a primary burn injury and 13 patients had secondary unstable scars. Integra is artificial skin that consists of a
collagen/glycosaminoglycane matrix and a silicon layer. It was first used by Burke and Yannas in 1980 in the USA. The mechanical
and biological features of Integra protect the tissue from fluid loss and bacterial invasion in the acutely burned patient.
The integra-induced formation of a neodermis leads to functionally and aesthetically highly acceptable scar formation. We
present our clinical experience with Integra in long-term follow-up.
Der Chirurg 05/2012; 71(5):558-563. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Innerhalb der biotechnologischen Forschung der letzten 10 Jahre hat die Gentechnologie besonders im Bereich der Gefäßchirurgie
eine zunehmend bedeutende Rolle entwickelt. In letzter Zeit haben insbesondere die Nachrichten zur erfolgreichen Gensequenzierung
des menschlichen Erbguts dieser Entwicklung weiteren Auftrieb gegeben. Die Anzahl laufender und angemeldeter gentherapeutischer
Studien in der Gefäßchirurgie hat in Deutschland und vor allem in den USA seit 1998 massiv zugenommen. Die dabei verwendeten
Techniken sind teilweise sehr unterschiedlich, was den jeweiligen Anwendungsbereich und die Interpretation der erbrachten
experimentellen Ergebnisse entsprechend beeinflusst.
Dieser Beitrag gibt einen Überblick über Techniken, bisherige Ergebnisse und gegenwärtige Anwendungsmöglichkeiten der Gentherapie
in der Gefäßchirurgie.
Advances in biotechnological research have enhanced gene therapy strategies in many different medical fields with vascular
surgery playing a pivotal role in this new and exciting therapeutic mode. The recently announced progress in deciphering the
gene sequence of the human genome has lent support to these developments. Since 1998, the number of gene therapeutic studies
for vascular surgery has greatly increased both in Germany and the United States of America. The gene therapeutic techniques
employed, however, differ very much, making it difficult to correctly identify the suitable mode of use and to interpret the
experimental results reported.
This paper gives an overview of techniques, results reported, and current possibilities for applying gene therapy in vascular
surgery.
Gefässchirurgie 04/2012; 6(2):72-80. · 0.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Geriatrische Patienten stellen hinsichtlich Pathogenese, Pathophysiologie und therapeutischem Vorgehen eine gesonderte Gruppe
in der Behandlung Schwerbrandverletzter dar. Altersabhängige Veränderungen der Haut, steigende Komorbiditäten und verminderte
Reaktionsfähigkeit im Rahmen des Traumas können zu schwerwiegenderen Verläufen führen.
Im Zeitraum von 1990 bis 2001 wurden auf der Intensiveinheit für Schwerbrandverletzte am Universitätsklinikum Schleswig-Holstein,
Campus Lübeck 53 Patienten mit einem Lebensalter von mehr als 60 Jahren stationär behandelt. Das Durchschnittsalter der 27
Frauen und 26 Männer betrug 76 Jahre (60–102 Jahre), im Mittel waren 33,2% der Körperoberfläche (5–95%) betroffen, 25 Patienten
wiesen ein bronchoskopisch gesichertes Inhalationstrauma auf. 77,4% der Patienten erlitten drittgradige thermische Verletzungen.
Bei Aufnahme wurde ein durchschnittlicher ABSI-Score (Abbreviated burn severity index) von 12 errechnet. Als relevante Begleiterkrankungen
fanden sich koronare Herzerkrankung (n=32), Herzinsuffizienz NYHA III-VI (n=27), arterieller Hypertonus (n=25), COPD (n=11),
Adipositas mit BMI>30 (n=14) und chronischer Alkoholabusus (n=9).
Bei 22 Patienten konnte ein frühzeitiger operativer Eingriff, die sog. Frühnekrektomie (0–4 Tage nach Unfall) durchgeführt
werden, 13 dieser Patienten überlebten im Verlauf. Bei 17 Patienten konnte der Ersteingriff erst zu einem späteren Zeitpunkt
erfolgen, 14 Schwerbrandverletzte wurden aufgrund früher Letalität nicht operiert. 26 Patienten (49%) entwickelten im Verlauf
eine Pneumonie. Die Gesamtmorbidität betrug 26 von 53. 19 Schwerbrandverletzte mit einem Verbrennungsindex >80 überlebten.
Von diesen 19 Überlebenden hatten 9 Patienten einen Index von >100. Es zeigte sich, dass die gängigen Indizes wie Zellweger-
Index und der ABSI-Score (Abbreviated burn severity score) nicht adäquat sind, um eine valide Prognose für den schwerbrandverletzten
älteren Patienten zu erheben.
Geriatric patients represent a separate group in the treatment of burn injury regarding pathogenesis, pathophysiology and
therapeutic procedure. Age-dependent changes of the skin, rising comorbidity and decreased reactivity in the context of trauma
can lead to more serious processes. In the period from 1990 to 2001 in the burn unit of the University Hospital Schleswig-
Holstein, Campus Luebeck, 53 patients with an age of more than 60 years were treated. The mean age of the 27 women and 26
men was 76 years (60–102 years), with on average 33.2% of the body surface (5–95%) being concerned by thermal injury, 25 patients
had severe inhalation injury, 77.4% of the patients suffered third degree burn injuries. At the time of admission, the mean
ABSI Score (Abbreviated Burn Severity Index) was 12. Relevant additional diseases were coronary heart disease (n=32), heart
insufficiency NYHA III-VI (n=27), arterial hypertonus (n=25), COPD (n=11), adiposity with BMI>30 (n=14) and chronic alcoholism
(n=9).
Twenty-two patients were treated by early operative intervention (early necrectomy: 0–4 days following the accident), 13 of
these patients survived. In 17 cases, the first operative procedure could take place only at a later date; 14 patients were
not operated due to early death. Twenty-six patients (49%) developed pneumonia. The total morbidity amounted to 26 of 53 patients.
A total of 19 injured with a burn index more than 80 survived. From these 19 survivors 9 patients had an index of more than
100. Usual indices as the Zellweger Index and the ABSI Score are not adequate to determine prognosis about thermal injuries
in the elderly.
Intensivmedizin + Notfallmedizin 04/2012; 44(8):507-514.
-
Der Chirurg 08/2011; 82(8):674. · 0.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Phalloplasty in female-to-male transsexuals is a very demanding procedure concerning preoperative planning and surgical implementation and many operative techniques have been described in the past. Here we illustrate the phalloplasty by means of a pedicled anterolateral-thigh-flap ("ALT-flap") in a patient who underwent unsuccessful groin-flap-phalloplasty alio loco. The sensible innervation was constituted via coaptation to a branch of the pudendal nerve. The technique presented here shows an aesthetically appealing result 6 months postoperatively with a 2-point discrimination of 2.5 cm and ongoing reinnervation. The operative time was reasonable with 360 min. The benefit of a pedicled transposition vs. a free transplantation becomes obvious especially as a salvage procedure in a preoperated situs with altered vascular anatomy. Additionally the shortened operating time and the lack of possible complications of microvascular anastomoses bear advantages. In conclusion we consider this technique for phalloplasty concerning operating time and effort, complications, donor site morbidity and aesthetic result as an appropriate alternative to established methods in selected patients.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2011; 43(4):227-31. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Preoperative Doppler ultrasonography for planning free perforator flaps is widely established to identify preoperatively perforators. The method allows one to localise the penetrating point of the perforator through the abdominal fascia. By this means it is not possible to see the intramuscular course or the position of the perforator in relation to the inferior epigastric artery. Lately the technique of computed tomographic angiography provides an opportunity for visualising the course of perforator vessels in these tissues. This paper summarises our experience with the preoperative CT angiography in our breast centre. Since spring 2009 we have reconstructed the breasts of 44 female patients by using free flaps from the lower abdominal wall. 6 of these were bilateral. In a total number of 50 breast reconstructions we used 23 deep inferior epigastric perforator (DIEP) flaps and 27 muscle-sparing transverse rectus abdominis muscle (TRAM) flaps. In addition to the preoperative ultrasonography, a CT angiography of the lower abdomen was conducted in 29 patients. On average they showed at least 2 perforators on the left as well as right abdominal sides, which could be used as flap vessels based on their signal intensity. Based on their estimated microsurgical dissection complexity, the perforator vessels could be classified into 3 groups: 1) direct perforators of category A with short intramuscular course (39%), 2) perforators with long intramuscular course of category B (50%) and 3) "turn around" perforators of category C, which pass medially around the rectus abdominis (11%). The technique of CT angiography permits a reliable preoperative visualisation of perforators in their entire course and facilitates the selection of the supplying perforator as well as the intraoperative procedure for the surgeon. The suggested classification of perforators into 3 groups simplifies the preoperative assessment of the microsurgical dissection effort. Compared to the commonly used Doppler ultrasonography there are disadvantages like the additional cost factor and the radiation exposure. However, in our experience the more detailed planning increases the safety of flap raising and reduces surgery time, so that we consider CT angiography a positive tool to facilitate free perforator flaps.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2011; 43(2):88-94. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most cases of obstetrical brachial plexus palsies are mild traction injuries which resolve under physical therapy within several weeks or months. Severe ruptures or avulsion injuries of the plexus can lead to lifelong impairment of the upper extremities. Hence, in severe brachial plexus injuries the indications for brachial plexus reconstruction should be evaluated, early. At the age of about 3 months, the infant should be presented in a centre specialised in obstetrical brachial plexus palsies. In almost all cases intensive physical therapy is performed. In addition, many patients require splinting in order to gain function as part of the conservative therapy or for postoperative fixation. Depending on the type of splint, different demands are made on design, material and strategy of adjustment. Many different natural and synthetic materials are available for orthopaedic constructions. Because of its good adjustment options, the use of low temperature thermoplastic is steadily increasing. This contribution presents an overview of our currently used splints, new technical developments in our experience with more than 200 patients with obstetrical brachial plexus palsy. We present our experience with the most common splints for the use in fixation after birth-related brachial plexus surgery, subscapularis release, trapezius muscle transfer and functional improvement of hands with a lack of wrist extension.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2011; 43(2):105-11. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Injection injuries of the hand are often underestimated because the full extent of the injury often only emerges after a delay. Flap coverage is often needed to avoid amputation.
In the case presented an epoxy resin injection trauma to the left index finger occurred. A critical blood circulation resulted and after demarcation of the injury a radical débridement was carried out. A heterodigital island flap was used to reconstruct the dorsum of the finger and 3 years after the trauma the patient has no impairments in daily activities.
The extent of the injury and the carcinogenic properties of the injected material are crucial for adequate treatment of injection injuries. Patients should be referred to specialized hand centers at an early stage.
Der Unfallchirurg 03/2011; 114(3):263-7. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the treatment of esophageal cancer neoadjuvant radiotherapy often leads to vascular damage of the usual recipient arteries for free jejunal transfer. End-to-side anastomosis to the carotid artery could be a potential alternative.
A total of 70 patients with locally advanced carcinoma of the esophagus underwent esophagectomy after neoadjuvant radiochemotherapy. In all patients reconstruction was carried out with a free jejunal transfer. Smaller vessels could be used for anastomoses in 54 of these patients and in 16 cases the jejunal flap artery was attached to the carotid artery.
Out of 54 patients 9 (17%) with microvascular anastomoses to the smaller vessels needed surgical intervention for ischemia. In 16 patients with anastomosis to the carotid artery no significant failure of perfusion occurred.
The carotid artery as recipient vessel in free jejunal transfer seems to be a safe therapeutic option for intestinal reconstruction of preradiated esophageal cancer with good functional results.
Der Chirurg 01/2011; 82(8):670-4. · 0.70 Impact Factor
-
H-O Rennekampff,
K Reimers,
C J Gabka,
G Germann,
R E Giunta,
K Knobloch, H G Machens,
N Pallua,
K Ueberreiter,
D von Heimburg,
P M Vogt
[show abstract]
[hide abstract]
ABSTRACT: One hundred years after the first description of autologous fat transplantation, this technique is receiving renewed attention. Initially, critically reviewed by plastic surgery societies, particularly those in the United States, the transfer of autologous fat was recently addressed at the September 2009 annual meeting of the German Society of Plastic Reconstructive and Aesthetic Surgeons in Hannover. In this consensus meeting, the panel reviewed both the current status of autologous fat transfer as well as established data concerning this evolving practice. In Germany, autologous fat transplantation is regulated by the Law on Tissue Transfer and Processing (Gewebegesetz). In an effort to facilitate future comparisons it is mandatory to describe harvesting, processing and reinjection techniques in detail. The consensus panel concluded that fat should be harvested using low vacuum settings and then transplanted in thin layers (Evidence V). Quantification of transplanted fat can best be performed by MRI (Evidence level III). Limited clinical studies are available with only some reaching a level of evidence II. At present, risk associated with autologous fat transplantation is considered to be minor. Tumor induction by autologous fat grafting is not proven. New techniques like stem cell enriched fat grafts may offer new promise for the Plastic and Reconstructive Surgeon.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2010; 42(2):137-42. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In parallel with aging, increasing skin laxity and subcutaneous atrophy occur in many regions of the human body. Apart from the most obvious facial region, where most aesthetic operations for rejuvenation are done, also the dorsum of the hand is continuously visible in daily life. This region exhibits skin laxity, subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Autologous transplantation of fatty tissue (structural fat grafting, lipofilling) enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process. This paper illustrates the special operative technique on the hand in the form of a case report. Furthermore, 3D surface laser scanning permits an objective evaluation of the permanent volume effect over time. In the presented case a volume effect of 69% of the injected volume was measured after 6 months follow-up time. This amount of injected tissue seems to be integrated as a graft and results in a reduction of subcutaneous atrophy in terms of a true regeneration. Structural fat grafting of the dorsum of the hand is thus a method of regenerative medicine. Together with other methods which reduce the age-related pigmentations, it plays a key role in our treatment concept for rejuvenation of the hand.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 04/2010; 42(2):143-7. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Osseous craniofacial defects are commonly seen problems after operative treatment of craniosynostoses. This case report describes a calvarial reconstruction by means of computer-aided fabrication of a customised implant. Three-dimensional imaging is followed by computer-aided design and fabrication of a medical grade PCL-TCP biodegradable scaffold using the rapid prototyping technology fused deposition modelling (CAD/CAM). After six months the implant was well integrated, no defect area could be palpated any more and a beginning bony consolidation could be detected via CT.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 03/2010; 42(6):369-73. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Adenoviral transduction of the VEGF gene in an oversized skin flap increases flap survival and perfusion. In this study, we investigated the potential of magnetofection of magnetic lipospheres containing VEGF(165)-cDNA on survival and perfusion of ischemic skin flaps and evaluated the method with respect to the significance of applied magnetic field and ultrasound. We prepared perfluoropropane-filled magnetic lipospheres ('magnetobubbles') from Tween60-coated magnetic nanoparticles, Metafectene, soybean-oil and cDNA and studied the effect in an oversized random-pattern-flap model in the rats (n = 46). VEGF-cDNA-magnetobubbles were administered under a magnetic field with simultaneously applied ultrasound, under magnetic field alone and with applied ultrasound alone. Therapy was conducted 7 days pre-operative. Flap survival and necrosis were measured 7 days post-operatively. Flap perfusion, VEGF-protein concentration in target and surrounding tissue, formation and appearance of new vessels were analysed additionally. Magnetofection with VEGF-cDNA-magnetobubbles presented an increased flap survival of 50% and increased flap perfusion (P < 0.05). Without ultrasound and without magnetic field, the effect is weakened. VEGF concentration in target tissue was elevated (P < 0.05), while underlying muscle was not affected. Our results demonstrate the successful VEGF gene therapy by means of magnetobubble magnetofection. Here, the method of magnetofection of magnetic lipospheres is equally efficient as adenoviral transduction, but has a presumable superior safety profile.
Journal of Cellular and Molecular Medicine. 01/2010; 14(3):587-599.
-
[show abstract]
[hide abstract]
ABSTRACT: Plastic surgery has passed through a very positive evolution in the last decades on the solid fundament of constantly developing academic plastic surgery. Aim of this paper is an objective evaluation of the current status of academic plastic surgery regarding research topics, currently available ressources and scientific outcome based on a questionnaire. The return rate of the questionnaire in academic departments was 92%. Main topics in research besides wound healing were topics from regenerative medicine such as tissue engineering, biomaterials, genetherapy and angiogenesis with the main focus on skin and fat tissues. In the past five years a total of 25 million Euros of third party research grants were raised. Research relied mainly on interdisciplinary research facilities. Regarding the scientific outcome more than 200 scientific papers were published in basic science research journals having an impactfactor higher than two. These results clearly demonstrate that plastic surgery is scientifically highly productive in academic surroundings where independent departments are established. Considering that independent units of plastic surgery exist in a relatively small number of all 36 university hospitals in germany, it has to be claimed for further independent departments so to provide adequate research facilities for further evolution of academic plastic surgery.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 12/2009; 41(6):359-63. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: It has been shown that Pancreatic Stem Cells (PSCs) share many features with skin stem cells. Yet, their potential role in skin regeneration remains to be elucidated. 5x10(5) PSCs from male Rattus norwegicus were seeded on Matriderm scaffold overnight. Cells survival and proliferation were then tested in vitro showing the survival of the cells and their homogenous distribution in the scaffolds. Afterwards, scaffolds were used to replace bilateral full-thickness skin wounds made on the dorsum of Nu/Nu mice. A control group of nude mice received the Matriderm scaffolds without cells. Two weeks after transplantation, wound areas were harvested and analyzed with respect to epithelialization, vascularization and wound closure. The healing area and regeneration rate were significantly increased in the group used the PSCs-seeded scaffolds (factor of 2.1). Vascularization rate showed a significant increase in the PSCs-seeded scaffolds(factor of 1.5). Morphology and immunohistochemistry showed new skin-like structures positive to epidermal markers in the healing wound bed. PSCs were detected in the regenerated tissues. This study showed that the combined use of PSCs with the Matriderm as a scaffold for dermal regeneration significantly increased the epidermalization, vascularization and healing in full-thickness wounds.
Biomaterials 01/2009; 30(5):789-96. · 7.40 Impact Factor
-
H-G Machens
[show abstract]
[hide abstract]
ABSTRACT: From July 25 through to July 26, 2008, after many years of preparation, the world-wide first transplantation of complete arms was carried out at the Klinikum rechts der Isar, Technische Universität München. The patient is as well as can be expected under the circumstances. The Clinic for Plastic Surgery and Hand Surgery (head: Hans-Günther Machens) was responsible for the operation. The operation in which a team of 40 members participated was headed by Christoph Höhnke (head of the transplantation team) and Edgar Biemer (former long-standing head of the Department for Plastic Surgery).
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 09/2008; · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Adjuvant therapies may improve the outcome after nerve reconstruction. We analyzed the influence of recombinant human Erythropoietin (rHuEpo), which has proven angiogenic and neuroprotective effects, on the quality of peripheral nerve regeneration.
Thirty two female Lewis rats underwent nerve reconstruction by means of tubulization (groups I and II) or autologous sciatic nerve grafting (groups III and IV). Groups I and III received daily subcutaneous rHuEpo injections over 2 weeks (1,000 U/kg bw) with normal saline injections as controls (groups II and IV). Data on histology and muscle weight were collected after 7 weeks. Axon count and diameter were assessed by a new method based on digital segmentation.
Atrophy of the tibial muscle was less severe in the rHuEpo-treated group compared to controls resulting in significant higher muscle weight quotients (p = 0.006). The same trend was found in the gastrocnemius muscle, but without being statistically significant. No significant differences in axon count or axon diameter were detected in the presence of rHuEpo treatments.
Our findings give evidence for a positive effect of Erythropoietin on functional recovery after nerve grafting. Muscle recovery benefited from rHuEpo administration despite absence of improved neural morphology. Semi-automated axon detection facilitated accurate morphometrical assessment.
Langenbeck s Archives of Surgery 06/2008; 393(3):317-23. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In avulsion-type injuries of the fingers recovery of blood circulation is one of the major obstacles. The indication for finger reconstruction is discussed controversely, being influenced by the patient's needs, the degree of damage to the soft tissue and the prospects of success of the healing process. In this study we present our results after reconstruction of avulsion-type injuries of the fingers. Indications for finger reconstruction will be assessed in consideration of the expected outcome.
From 1999 to 2006 we treated 18 patients with finger level avulsion injuries. 15 casualties were caused by rings and three by ropes looped around a digit. The median age at injury was 23 (12 - 66) years. All patients were examined by an independent observer, who did not participate in the operation. Criteria were functional outcome and patient's complaints and satisfaction. Sensibility was evaluated by 2-point discrimination applying the Greulich star. Finger mobility was assessed with the Buck-Gramcko goniometer.
According to the classification of Urbaniak as modified by Kay, 2 patients ranked in class II, 3 in class III and 13 suffered from complete avulsion-amputations (class IV). Of the latter, 8 allowed primary reconstruction of the blood circulation. Two fingers required early or late secondary amputation. After finger reconstruction, patients spent a median time of 18 (12 - 32) days in hospital while primary amputation resulted in a shorter stay of 4 (2 - 5) days. Active motion after replantation in the proximal interphalangeal joint was reduced on average to 64 (25 - 100) degrees. The distal interphalangeal joint nearly ankylosed in all patients following replantation except for one case with an active motion of 40 degrees . Good sensibility could be achieved in one case, protective sensibility in three and none in two patients. All patients with preserved fingers would again decide in favour of finger replantation.
In specialised centres replantation of complete avulsion-type finger amputations can be achieved. The decision for or against replantation should only be made after microsurgical assessment of the severed soft tissue and in consideration of the patient's specific demands. With the right indication for reconstruction, the patient's satisfaction often outweighs even poor functional outcomes.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 01/2008; 39(6):396-402. · 0.88 Impact Factor
