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Biomedical subjects

B D Partecke

Publications and source records attributed to B D Partecke.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Lengthening osteotomy with the Ilisarow fixator].

From 1991 to 1993, 23 distraction lengthenings were performed using the Ilisarow external fixator. It could be demonstrated that significant lengthening was possible without bone transplantation with the exception of two cases. In one further case, non-union resulted. Further complications were five pin infections, four loosenings of the apparatus, and in one case difficulties with the scar on the amputation site. The Ilisarow external fixator demonstrated stability and variability in its possible applications.

Adolescent↗
PubMed1995

[Basic comments on differential surgical therapy of severe burns].

The life of severely burned patients nowadays is endangered especially by infections and septic complications deriving from the wounds. This danger can be obviated only by early excision of all deep necrotic areas and immediate wound closure, ideally with autografts. The correct estimation of the depth of burn is decisive for effective local surgical therapy, which is guided mainly by visible criteria. Conservative treatment is employed for first-degree and superficial second-degree burns, while operative therapy is needed for deep second-degree and third-degree burns. The required immediate wound closure with autografts is problematic after necrectomy of burns larger than 40% TBSA. To extend the limited skin reserves, autografts are meshed or combined with homografts. Defects can be covered temporarily with vital or non-vital homografts until donor sites for split-thickness skin grafts are healed. Cultured epithelial autografts at present are not suitable for routine use. After deep burns, no matter what kind of operative treatment is used, scars are left. The scars raise difficulties with regard to aesthetics and function. Permanent pressure in the early stages of aftercare is an effective method of accelerating the maturation of scars and improving their appearance.

Burns↗
PubMed1995

[Therapy of the severely burned child from the pediatric intensive care viewpoint].

All burn injuries involving more than 10% of the total body surfaces in children necessitate immediate fluid replacement. Such patients should be admitted to a hospital with an intensive care unit specialized in dealing with such accidents. Fluid replacement should be started, with administration of an isotonic electrolyte solution, such as lactated Ringer's, to avoid severe burn shock. Several other fluid replacement protocols have been proposed. Controversy exists as to whether a hypertonic or hypotonic solution should be used and whether or not colloid should be added to these solutions. The findings of controlled studies have not shown any differences with regard to morbidity or mortality. Dextran solution helps to stabilize the circulation during the first few hours. In addition, albumin should be given from 8 to 24 h post-injury. Most burned children require central venous catheters for intravenous fluid supplementation. The adequacy of fluid replacement must be assessed by a variety of clinical parameters, beginning with urinary excretion of above 0.5-1.0 ml/kg per hour. Acute management of burned children includes adequate analgesia with potent drugs. Opioids or ketamine should be given to avoid pain and pain-related depression of the circulation. Adequate intensive care of inhalation trauma, sepsis, prevention of multi-organ failure, early enteral feeding and limited prophylactic use of antibiotics can reduce mortality in these severely ill children.

Body Surface Area↗
PubMed1995

[Surgical therapy in the second stage after burn injuries with special reference to reconstruction of face and hands].

Surgical reconstruction in the second stage after burn injury requires an individual approach. The possibilities are determined primarily by the extent of the injury. The timing of the surgery is very important, and functional, aesthetic and psychological aspects must be taken into consideration in each case. Plastic surgery is only one part of the rehabilitation of the burn patients. Examples are given of possible reconstructive procedures for the face and hands.

Adolescent↗
PubMed1995

[High voltage accidents, characteristics and treatment].

High-voltage injuries cause localised entrance and exit burns, extensive arc, flame and flash burns and, even more dangerous, necrosis of the underlying muscles on the pathway of the current through the body. Therefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be judged by the percentage and depth of the skin burn. Diagnostic fasciotomies, radical debridement, and in many cases early amputation are necessary to prevent life-threatening complications. Over a period of 10 years, 43 patients with high-voltage injuries have been treated at the Hamburg Burn Center, 36 of them in primary care. Common causes of injury were accidents in railway areas (28%), using portable aluminium ladders near overhead power lines (9.3%), and working on electrical equipment (30.2%). Six of the primary care patients died (16.6%), and 34.9% had an amputation of one or more extremities. Nearly all patients underwent several debridement and split-skin graft procedures. In 30% of cases additional free and pedicled flaps were needed to cover soft tissue defects. Ten patients (23.3%) sustained fractures and other injuries from falls, seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics were diagnosed in 16.6% of the primarily treated patients. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these caused solely by the electric current.

Adolescent↗
PubMed1995

[In vitro and in vivo studies of a temporary absorbable dressing].

The major advantage of biodegradable synthetic wound dressings compared to other synthetic materials and biological tissue derivatives is avoidance of the necessity to change the dressing. The copolymer films used in this study were made of lactic and caproic acid. They pose no problems concerning immunology or transmission of diseases. Moreover, the substances released by degradation may possibly influence the process of wound healing. The material proved to be non-toxic and was used successfully as a carrier for cell culture with keratinocytes. The permeability for bacteria is determined by degradation. Evaluation of the bacteriological studies indicates secure protection against secondary contamination of the films for at least 15 days, however. Concerning application, dressing properties, wound healing and wound retraction, no disadvantages were found in comparison with the results of the competition's film Opsite. Based on these findings, the films are now used in a clinical study as a wound dressing for split-skin donor sites.

Animals↗
PubMed1994

[Follow-up and gait study in patients with plastic-surgery-treated foot sole defects].

A long-term follow-up study on 20 patients with soft-tissue coverage of sole defects analysing "sensitivity", "stability" and "function" is presented. The dynamic motion of walking was recorded using an EMED sensor plate. Patients with free flap coverage of the sole only walk over the remaining original plantar skin if at all possible. Patients with transposition flaps, however, were found to have normal gait motion. In spite of these results, the better stability of free flaps than split-thickness skin grafts and the high acceptance by the patients makes the free neurovascular forearm flap a good donor for larger sole defects not suitable for transposition flaps. A new scoring system for free flaps on the sole of the foot is proposed.

Adult↗
PubMed1992

[Initial experiences with the Ilisarov method on the hand bones].

From 1 July 1991 to 1 July 1992, 23 patients were treated using an Ilisarov distraction apparatus. The apparatus was used for callus distraction in 13 patients, and for closed fracture treatment, for generating longitudinal pressure in the treatment of fractures, for corrective osteotomy and for soft tissue distraction in 10 patients. Callus distraction in the hand has advantages over conventional techniques. Furthermore, the Ilisarov technique has its merits in certain fractures of the hand.

Adult↗
PubMed1986

[Resorbable PDS splints in fracture stabilization and for arthrodeses of the hand].

Small rods of resorbable Polydioxanon (PDS-splints) are suitable for stabilizing fractures of a phalanx, either near the base or the head, be the fracture transverse or comminuted. Such internal splints are especially useful in replantation of clean amputations. Used in combination with intraosseous wiring, osteosynthesis can be achieved that is stable for exercise in all cases. Another use is in arthrodesis of the distal interphalangeal joints and the metacarpophalangeal joint of the thumb. Disadvantages that accompany Kirschner wire fixation are thus avoided. Case descriptions and results are presented.

Adult↗
PubMed1985

[Antithrombin III--an important factor in long-lasting microvascular operations].

Antithrombin III is an important factor in preventing thrombosis in the normal coagulation system. The antithrombotic effect of heparin is closely related to the presence of Antithrombin III (AT III) as cofactor. It is also known that the concentration of AT III decreases considerably during long-lasting gynaecological procedures and in visceral surgery. We have found that the serum concentration of AT III also decreases during long-lasting microvascular procedures as in free flap or toe transfers. The crucial points are the duration of the operation, the duration of ischaemia of the extremity and the preoperative concentration of AT III which heavily depends on the general condition of the patient. In ten cases the AT III concentration decreased by an average of 21.7%. In three patients the AT III factor decreased below the critical level of 80%. In these cases levels between 60 and 65% were measured at the end of long microvascular operations. This decrease of AT III can be avoided by application of the AT III factor in an active form during the procedure (AT III in solution with heparin). To avoid thrombosis of the anastomosed vessels the local application of AT III in its active form before anastomosis has proved very effective. In practice, measuring of the AT III level has proved to be very useful in long microvascular procedures before the operation and at intervals of two to four hours. Nevertheless, in spite of AT III application careful microsurgical anastomosis has to be made.

Administration, Topical↗
PubMed1985

[Technic and results of tendon interposition arthroplasty of the lunate and scaphoid bones].

Between 1971 and 1982 tendon interposition arthroplasty in combination with denervation of the wrist joint was performed on 55 patients with either Kienböck's disease, irreducible lunate dislocations with or without scaphoid dislocation, or scaphoid non-union with a small proximal fragment. Follow-up was possible on 38 patients (69%). In two third of the cases good and very good results are achieved with this operative technique. The significant points were the arthrosis in the wrist joint and the complete obliteration with tendon material of the cavity left by the extirpated carpal bone. Ulnar styloidectomy produced not only a painfree wrist but also better ulnar movement.

Adolescent↗
PubMed1984

Free forearm flap for reconstruction of soft tissue defects concurrent with improved peripheral circulation.

The free forearm flap is an accepted procedure for covering defects due to osteitis in the lower leg. End-to-end anastomoses have usually been preferred, if the diameters of the donor and recipient arteries are more or less equal. However, if one or more arteries of the lower leg are absent, end-to-end anastomosis is not indicated, because further disturbances of blood circulation will ensue. We present a procedure in which the flap vessels act as an arterial and venous bypass, thus improving the circulation in the lower leg, while concurrently perfusing the flap. Following full thickness skin graft, cosmetic results at the donor site are not especially pleasing. Results can be improved by a split skin graft (used as a mesh graft), and by situating the donor site on the upper third of the forearm. At the recipient site, the flap can be infolded and connected in anatomic right or reverse directions, depending on the required length of the flap vascular pedicle needed for reconstruction. This can lead to a reverse blood flow in he vessels of the transferred free forearm flap. The radial artery can be restored by vein graft from the same forearm. In 25 free forearm flaps to the lower leg, arterial bypass was performed in 14 cases, venous bypass as well in four cases, with reverse blood flow in three cases.

Adult↗
PubMed1984

[Covering of tissue defects of the lower extremities using free cutaneous or myocutaneous flaps and island flaps].

The problems of covering soft tissue defects associated with osteitis in the lower leg are discussed. Not only is absolute bone stabilisation necessary to restore such cases, but also good soft tissue cover. In the middle and distal part of the lower leg the free latissimus dorsi flap is ideal. For the sole of the foot and for the heel a sensible flap should be transferred. If the dorsalis pedis artery is present, shown by arteriogram, a dorsalis pedis island flap can be used. Otherwise a free neurovascular flap must be done, in which case the free forearm flap based on the radial artery is recommended. Some cases and problems are presented and discussed.

Foot Injuries↗