S Kessler

Schön Klinik München Harlaching, München, Bavaria, Germany

Are you S Kessler?

Claim your profile

Publications (22)16.2 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The treatment of charcot arthropathy in the hindfoot is a challenging problem. Loading of a deformed charcot foot leads to increased deformities and ulceration around the ankle. The surgical technique depends on the location, the extent of the deformity and the ability of the patients to unload the extremity. The aim of the treatment should be a bony consolidation through an adequate and stable arthrodesis.
    Fuß & Sprunggelenk 09/2010; 8(3):196–201.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Infections are the typical complications of ulcers related to the neuropathic diabetic foot. There is a high risk for amputation or sepsis. Therefore prophylaxis of ulcer formation with footcare and adequate shoes are of high importance. Clinical findings, laboratory parameter and imaging help to determine the severity of the infection according to the PEDIS classification. The treatment of local soft tissue infections is unloading and antibiotics. Severe infections; especially abscesses are treated with incisions, preceded with repeated debridement of necrotic bone and soft tissue. After the infection is controlled and the soft tissues are closed, bony prominences and instability of the hind foot are treated with bump resection, tenotomies or tendon transfers as well as fusions. Following these principles, a lot of amputations can be avoided.
    Fuß & Sprunggelenk. 09/2010; 8(3).
  • [Show abstract] [Hide abstract]
    ABSTRACT: The diabetic foot syndrome is defined by ulceration and gangrene due to diabetes related structural changes, neuropathy and/or angiopathy. The Charcot́s foot is a special entity of the neuropathic diabetic foot syndrome. Neuropathic changes lead to an increased vulnerability and cause typical deformities. These deformities are the main reason for ulceration often followed by infection and amputation. The diagnostics consists of the history of the patient, physical and radiological examination. Decreasing the high rate of amputation is the aim of the conservative and surgical therapy.
    Fuß & Sprunggelenk. 09/2010; 8(3).
  • [Show abstract] [Hide abstract]
    ABSTRACT: The charcot arthropathy of the midfoot causes progressive destruction of the foot without any treatment. Because of the concomittant neuropathy the patients do not have any warning signs of increasing overload and progressive damage of the foot. In consequence patients may develop complications like ulcers, infections, osteitis, osteomyelitis and may need amputations. Due to the epidemiological development in the industrialized nations it is expected that the charcot arthropathy with its problems will aggravate in the future. For this reason, promising therapeutic approaches are needed. The primary therapy of charcot arthropathy of the midfoot is stage dependent. At the beginning of the disease, conservative treatment is indicated, with no-weight-bearing and immobilization. In case of bony deformity, instability and ulceration, the treatment is more difficult and often less successful. Beside conservative measures the surgical treatment with reconstruction of an unstable, deformed and destroyed midfoot plays a more important role. The early elective surgery is increasingly favoured in the literature. Nevertheless an algorithm has not yet developed. There is only little consensus in the surgical treatment. The complexity of Charcot-related fractures often requires a customized surgical treatment. The postoperative treatment seems to be a bit more standardized, immobilization in a “total contact cast” or an external fixator – application are used. We normally perform the open reduction and arthrodesis with internal plates for reconstruction (3.5 mm plates or special interlocking plates) in combination with an “Ilizarov” - ring fixator (“neutral frame technique”). In the first 30 patients limb-salvage could be obtained in 94%, regardless to infection. In 70% a fusion of the arthrodesis was achieved and all patients are currently able to walk. In charcot arthropathy of the midfoot reconstruction of the collapsed, fragile foot is the goal of treatment. Because of the neuropathy with unnoticed overloading failure of internal fixation device is seen frequently. This leads to complications. The combination of internal fixation with the application of an external ring fixator has not reached full acceptance yet. The postoperative partial to full weight bearing allows more flexibility and mobility and protects the internal fixation and arthrodesis. Patients, who can not guarantee a post-operative non-weight-bearing, have to be treated with an additional ring fixator.
    Fuß & Sprunggelenk. 09/2010; 8(3).
  • Sigurd Kessler, Christoph Volkering
    MMW Fortschritte der Medizin 09/2010; 152(34-35):45-8.
  • C. Volkering, S. Kessler
    [Show abstract] [Hide abstract]
    ABSTRACT: The high amputation rate in patients with diabetic foot syndrome is still an unsolved problem. Infection caused by trauma or neuropathic ulceration is the main reason for these amputations. Beside conservative therapy surgery becomes more important. While the number of amputations decrease, reconstructive surgery becomes important to prevent ulceration by adressing the underlying foot deformity.
    Fuß & Sprunggelenk. 09/2010; 8(3).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.
    Der Unfallchirurg 07/2010; 113(7):594-7. · 0.64 Impact Factor
  • S Kessler, P Delhey, C Volkering
    [Show abstract] [Hide abstract]
    ABSTRACT: Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.
    Der Orthopäde 11/2009; 38(12):1215-21. · 0.51 Impact Factor
  • MMW Fortschritte der Medizin 04/2009; 151(10):37.
  • S. Kessler, P. Delhey, C. Volkering
    [Show abstract] [Hide abstract]
    ABSTRACT: Infektionen am diabetisch neuropathischen Fuß sind die typischen Komplikationen der Fußulzera. Sie stellen ein erhebliches Risiko zum Verlust des Fußes bzw. zur Sepsis dar, deshalb sind umfangreiche konservative und operative Maßnahmen zur Vermeidung und zur Heilung der Ulzera erforderlich. Wenn Infektionen eingetreten sind, erfordern sie ein gezieltes Vorgehen zunächst mit Entlastung und Antibiotikagabe. Abszesse und Phlegmonen lassen sich durch klinischen Befund, Sonographie, Röntgenaufnahme, Computer- (CT) und Magnetresonanztomographie (MRT) lokalisieren. Sie müssen durch Inzisionen drainiert werden. Nach Abklingen des akuten Stadiums werden die infizierten Nekrosen an Knochen und Weichteilen durch Débridements entfernt. Die Hautdefekte sind durch geeignete Verfahren zu verschließen. Störende Fehlstellungen und Instabilitäten sind durch Korrekturen an den Sehnen, durch Knochenresektionen oder durch Fusionsoperationen zu beseitigen. Auf diese Weise lässt sich eine Vielzahl von Amputationen verhindern bzw. das Ausmaß der Amputation deutlich einschränken. Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.
    Der Orthopäde 01/2009; 38(12):1215-1221. · 0.51 Impact Factor
  • S. Kessler, S. Sommerey
    Fuß & Sprunggelenk. 12/2008; 6(4).
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the literature, the association between chronic complaints of the cervical spine and sustained"whiplash trauma" is a matter of controversy. Whiplash trauma is identified as contusion, compression, and/or sprain without definite imaging proof of injury to the bone, disk, or ligaments.However, complex chronic complaints leading to permanent and significant functional limitations in daily living and work may develop. Besides the diagnostic and therapeutic challenges for the treating physician, the expert confronted with compensation claims very often must decide whether whiplash trauma of the spine may lead to significant and permanent functional limitations or loss with chronic disorders. The data from the literature dealing with this topic are contradictory and deficient. In this article, based on the present available data from the literature, we critically examine the causality between spinal whiplash trauma and possible permanent chronic complaints in order to support the process of decision making in cases of litigation and controversial compensation claims.
    Der Orthopäde 05/2008; 37(5):414-23. · 0.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Zusammenfassung In der Literatur wird der Zusammenhang zwischen chronischen Beschwerden der Halswirbelsäule (HWS) und „Bagatellverletzungen“ kontrovers diskutiert. Als solche wird meist die Beschleunigungsverletzung der HWS interpretiert, ohne frische, sichere bildgebende nachweisbare Verletzungsfolgen an knöchernen und diskoligamentären Strukturen. Dennoch können nach „Bagatellverletzungen“ der Wirbelsäule komplexe chronische Beschwerden mit maßgeblichen dauerhaften funktionellen Einschränkungen auftreten, die die Leistungsfähigkeit bei den Betroffenen im Privat- und Erwerbsleben langfristig erheblich mindern. Neben der diagnostischen und therapeutischen Herausforderung für den Behandelnden sieht sich der Gutachter dabei oftmals mit der Fragestellung konfrontiert, ob eine Beschleunigungsverletzung der HWS zu maßgeblichen und dauerhaften Funktionseinschränkungen mit chronischen Beschwerden führen kann. Die Datenlage in der wissenschaftlichen Literatur ist hierzu widersprüchlich. Basierend auf der derzeitig verfügbaren internationalen Literatur wird in dem vorliegenden Artikel die Kausalität zwischen Unfallereignis mit Beschleunigungsverletzung der HWS und in der Folge auftretendem chronischen Beschwerdebild kritisch untersucht, um die Entscheidungsfindung des Gutachters in strittigen Fällen zu erleichtern und argumentativ zu untermauern.
    Der Orthopäde 01/2008; 37(5):414-423. · 0.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Impaired wound healing is a frequent event in inguinal surgery and very common after lymphadenectomy for penile cancer. Although vacuum therapy has been reported to expedite the healing of complex wound failures, vacuum-assisted closure (VAC) has been reported to be contraindicated in malignancy. In the present study we evaluated the use of VAC in the treatment of complex wound failures following inguinal lymphadenectomy for penile cancer in comparison to conventional wound care (CWC) implying debridement and saline-soaked gauze. We retrospectively identified six inguinal wounds following inguinal lymphadenectomy for penile cancer and subsequent use of VAC from 2003 to 2006 at our institution. Data on surgical interventions, complications, length of time required for closure, and outcome were compared to 10 inguinal defects treated with CWC between 2000 and 2003. Wound volume was comparable for both groups. Wound breakdown occurred at a median of 7.4 d after inguinal lymphadenectomy and was treated by CWC for a mean of 69.8 d. In the VAC group, the median duration until complete closure was 38.9 d. Thus, VAC was shown to result in complete wound healing in less time (p<0.001). No local recurrence in the VAC group was noted despite positive lymph nodes. VAC therapy is effective in complex inguinal wound failures following lymphadenectomy for penile cancer and appears to be superior to CWC. VAC seems to offer adequate safety concerning local recurrence.
    European Urology 06/2007; 51(5):1320-5. · 10.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful. All other courses indicate a multifactorial pathology and belong in the hands of an experienced specialist.
    MMW Fortschritte der Medizin 04/2007; 149(10):27-30.
  • S Sommerey, C Volkering, S Kessler
    [Show abstract] [Hide abstract]
    ABSTRACT: Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.
    MMW Fortschritte der Medizin 04/2007; 149(10):36-7.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vacuum-assisted closure (VAC) is an acknowledged method of treating wound healing disorders, but has been viewed as a contraindication in therapy of intraabdominal fistulas. We present the case of an 83-year old patient with ureteroileal anastomotic insufficiency following cystectomy and urinary diversion by Bricker ileal conduit due to urothelial bladder cancer. After developing an open abdomen on the 16th postoperative day a leakage of the ureteroileal anastomosis appeared that cannot be managed by surgical means. To stop the continued leakage we tried a modified VAC therapy with a silicon covered polyurethane foam under a suction of 125 mmHg. After 32 days with regularly changes of the VAC foam under general anesthesia the fistula resolved without further problems of ureteroileal leakage. We present the first report of VAC therapy successfully performed in urinary tract leakage after surgical treatment of bladder cancer. VAC therapy of such disorders requires greater care than of superficial application to avoid mechanical alterations of internal organs but opens new opportunities in cases without surgical alternatives.
    World Journal of Surgical Oncology 02/2007; 5:41. · 1.09 Impact Factor
  • B A Leidel, S Kessler, W Mutschler
    [Show abstract] [Hide abstract]
    ABSTRACT: In the literature, the association between chronic pain syndromes of the spine and sustained "trifle trauma" is a matter of controversy. "Trifle trauma" is identified as a contusion, compression and/or sprain without a definite, acute imaging sign of injury to the bone, the disk or the ligaments of the spine. Most of the time, striking isolated changes to the intervertebral disks are interpreted as preexisting without relevance to an acute injury. However, complex chronic pain syndromes causing permanent and significant functional limitations in daily life and work may occur. Besides the diagnostic and therapeutic challenge for the treating physician, the expert confronted with compensation claims very often has to answer questions as to whether "trifle trauma" of the spine may lead to significant and permanent functional limitations or loss with chronic pain syndromes, and what the importance of possible isolated changes in intervertebral disks is. The data from literature dealing with this topic is contradictory and deficient. In this article, we critically examine the causality between "trifle trauma" to the spine and possible permanent chronic complaints based on currently available data from the literature in order to support the process of decision making in questions of litigation and controversial compensation claims.
    Der Unfallchirurg 01/2007; 109(12):1109-16. · 0.64 Impact Factor
  • B. A. Leidel, S. Keßler, W. Mutschler
    [Show abstract] [Hide abstract]
    ABSTRACT: In der Literatur wird der Zusammenhang zwischen chronischen Schmerzsyndromen der Wirbelsäule und ,,Bagatellverletzungen“ kontrovers diskutiert. Als solche gelten Prellung, Stauchung und/oder Distorsion ohne frische, sichere bildgebend nachweisbare Verletzungsfolgen an knöchernen und diskoligamentären Strukturen der Wirbelsäule. Isolierte Auffälligkeiten der Bandscheiben werden dabei meist als vorbestehende, vom Unfall unabhängige Veränderungen interpretiert und ein Zusammenhang mit dem Unfallereignis abgelehnt. Dennoch können nach ,,Bagatellverletzungen“ der Wirbelsäule komplexe chronische Schmerzsyndrome mit maßgeblichen funktionellen Einschränkungen auftreten, die die Leistungsfähigkeit bei den Betroffenen im Privat- und Erwerbsleben dauerhaft erheblich mindern.Neben der diagnostischen und therapeutischen Herausforderung für den Behandelnden sieht sich der Gutachter dabei oftmals mit der Fragestellung konfrontiert, ob ,,Bagatellverletzungen“ der Wirbelsäule zu maßgeblichen und dauerhaften Funktionseinschränkungen mit chronischen Schmerzsyndromen führen können und welche Bedeutung dabei ggf. isolierten Auffälligkeiten der Bandscheiben zukommt. Die Datenlage in der wissenschaftlichen Literatur ist hierzu widersprüchlich und insgesamt mangelhaft.Basierend auf der derzeitig verfügbaren internationalen Literatur wird in dem vorliegenden Artikel die Kausalität zwischen Unfallereignis ,,Bagatellverletzung“ der Wirbelsäule und eventuellem chronischen Beschwerdebild kritisch untersucht, um die Entscheidungsfindung des Gutachters in strittigen Fällen zu erleichtern und argumentativ zu untermauern.
    Der Unfallchirurg 01/2006; 109(12). · 0.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic plantar forefoot ulcers together with peripheral neuropathy are mostly associated with diabetes mellitus. To avoid the development of a systemic infection, therapeutic treatment has to be performed rapidly. We have investigated the effect of Achilles tendon lengthening on the healing of chronic plantar forefoot ulcers that were resistant to other therapies. Ten patients were included into the study. The clinical findings as well as the forefoot-pressure patterns during standing or walking were documented immediately before and 8 weeks after the operation. In all patients, complete healing of the forefoot ulcers could be achieved. In two cases we had to carry out additional osseous resections. In three patients with prolonged wound healing, soft tissues healed within 8 weeks. Achilles tendon lengthening is an effective procedure to treat chronic plantar forefoot ulcers. It should be indicated widely, i. e., in combination with other surgical procedures.
    Fuß & Sprunggelenk. 01/2005; 3(4).

Publication Stats

23 Citations
16.20 Total Impact Points

Institutions

  • 2010
    • Schön Klinik München Harlaching
      München, Bavaria, Germany
  • 2004–2010
    • Ludwig-Maximilian-University of Munich
      • Cardiac Surgery Clinic
      München, Bavaria, Germany
  • 2007–2008
    • University Hospital München
      München, Bavaria, Germany