Search PubMed⌕ Search

Biomedical subjects

D Buck-Gramcko

Publications and source records attributed to D Buck-Gramcko.

At least 55 records · Page 3Linked to original sources
PubMed1985

Radialization as a new treatment for radial club hand.

"Radialization," a new technique for operative treatment of the radial club hand, is presented. It has been successfully used in 30 hands (23 patients) since 1979. It is named "radialization" because after all fibrotic tissues are excised, the hand and radial carpal bones are placed over the distal end of the ulna; the hand is fixed with a Kirschner wire in a position of moderate ulnar deviation. Usually, no carpal bones need to be removed. The improved mechanical forces are further stabilized by transposition of the radial wrist extensor and flexor to the ulnar side; this favors a better muscle balance. The optimal age for surgery is between 6 and 12 months.

Child, Preschool↗
PubMed1985

Cleft hands: classification and treatment.

"Atypical" cleft hand should be classified under symbrachydactyly because its etiology and clinical and radiologic findings are quite different from those of typical cleft hand. The operative treatment also differs considerably. For severe forms of cleft hand, the procedure described by Snow and Littler is recommended.

Congenital Abnormalities↗
PubMed1985

[Improvement of suture technic in flexor tendon injuries. Clinical and experimental study].

Multiple causes for the rupture of sutured tendons have been reported. At the time of exploration, loosening of the knot and breakage of the suture have been found to explain failure. A knot with four throws is frequently mentioned in various series as the smallest secure knot which can be made when employing a braided polyester suture material. Experiments have shown that the distance between the ends of the tendons affects the healing process and the tensile strength of the injured tendons. In order to avoid increasing the gap between the sutured ends of the tendons with the thick knot, it can be placed away from the cut surface of the tendons and displaced into the proximal or distal end of the tendons with a small additional incision. Through a longitudinal incision, the suture is easily passed in a criss cross fashion through the tendon and the knot can be buried in the tendon. This technique assures a very delicate and exact coaptation of the tendon ends. Almost 100% of the tendons remain intact during the healing phase. According to this experience, the risk of tendon rupture is reduced as a result of an increase in the tensile strength of the suture and the displacement of the knot away from the cut surface of the tendon.

Finger Injuries↗
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

[Problems in the surgical technic used in free toe transfer].

Based on the experiences of sixteen toe-to-hand transfers (nine for thumb reconstruction, seven for finger replacement), some technical problems of the operation are discussed. On the foot the incision should be planned in such a way that the wound can be closed directly to achieve a better aesthetic result The excision of the distal third of the second metatarsal bone marrows the foot, which improves the later appearance. On the hand deeper skin defects with exposed bone are easily closed by a forearm-island flap based on the distal radial artery. The rotation of the head of the transferred metatarsal into hyperextension gives the MP-joint much more excursion in flexion. If the great toe is used for thumb reconstruction and a new basal joint is necessary, this can be reconstructed with the dorsal half of the head of the first metatarsal, while its plantar half remains in the foot for weight bearing. The mobility of the new thumb was excellent following this procedure.

Adolescent↗
PubMed1985

[Severe skin burns caused by a photochemotherapeutic agent].

By uncontrolled application without indication of a photoactive drug methoxypsoralen (Meladinine) which is sold only on prescription a 20-year-old man sustained a large burn injury of 71% of body surface. Because he was admitted to the hospital relatively late, a life-threatening condition developed as it is well known after large body burns. Adequate intensive care including artificial respiration and proper local treatment to prevent infection were decisive for successful treatment.

Adult↗
PubMed1985

[Carpal instabilities].

The ligaments of the wrist and the bony configuration--beside muscles and tendons--are responsible for stability in the wrist joint, which is impaired in certain pathological conditions: unstable fractures of the scaphoid, scapholunate dissociations, perilunate fracture-dislocations, malunited Colles' fractures, Kienböcks disease, rheumatoid arthritis and posttraumatic laxity of ligaments. The differentiation between dorsal and palmar instability is made by radiological examination and measuring of the scapholunate, capitolunate and radiolunate angles. The understanding of normal anatomy and (post-)traumatic conditions is facilitated by the concept of dynamic action of the ligaments and the bones of the wrist as articular and extraarticular slings.

Arthritis, Rheumatoid↗
PubMed1985

[Scapholunate dissociation].

Scapholunate dissociation is a rotatory subluxation of the scaphoid with widening of the gap between the scaphoid and lunate. It is caused by rupture of the ligaments between radius, scaphoid, lunate and capitate bones. The scaphoid has lost its stabilizing function as a bridge between the proximal and distal carpal row, so that the wrist shows the typical "concertina" deformity of dorsal instability. The scapholunate angle measures about 100 degrees (more than 70 degrees). The subluxation of the scaphoid and lunate with the wide gap between these bones is best treated by primary repair of the ruptured ligaments. However, most cases are seen late and a ligament reconstruction by a free or pedicled tendon graft becomes necessary. The results are often unsatisfactory radiologically, but cause the patient minimal disability. An alternative to the ligament reconstruction is the scapho-trapezio-trapezoid arthrodesis. By this procedure the scaphoid regains its stabilizing function to the "link system" of the carpus.

Arthrodesis↗
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↗
PubMed1984

[Free forearm flap as a possibility for simultaneous reconstruction of damaged peripheral circulation and skin].

The free forearm flap has become an accepted procedure for cover of defects in the lower leg due to osteitis. Because the diameter of the donor and recipient artery is equal, end-to-side anastomosis is not without problems and in such cases end-to-end anastomosis is preferred. However, if one or more arteries of the lower leg are absent it may be dangerous to do an end-to-end anastomosis because of the further disturbance of circulation. A new method is shown in which the flap vessels act as an arterial and venous bypass, which improves the circulation in the lower leg, while still perfusing the flap. In 18 free forearm flaps to the lower leg, arterial bypass was performed seven times and venous bypass in three cases. One case is demonstrated.

Adult↗
PubMed1983

[Interposition arthroplasties in the area of the proximal carpal row (lunate and scaphoid replacement/partial replacement].

Prostheses are recommended for replacement of the scaphoid. Results of tendon interposition after resection of small proximal fragments are unpredictable. Therefore alternative procedures like liquid silicone casts or replacement by a lunate prosthesis (or part of the prosthesis of the scaphoid) have to be evaluated. If after removal of the lunate a prosthesis does not fit into the cavity we recommend filling this cavity with liquid silicone.

Arthrodesis↗
PubMed1982

Secondary operations after replantation.

104 secondary operations after 76 successful replantations in the upper limb in 49 patients have been evaluated. Of 150 successful replantations in 106 patients this represents an incidence of secondary procedures of 50.6%. 28.5% for skin cover, 18.6% on nerves, 17.6% on joints, 7.4% on bones and 3.9% on vessels. 1.5% of secondary operations were for removal of materials used for bone fixation. The most frequent operations on the individual structures in relation to level of amputation and the interval after replantation have been described. The inference that the number of reconstructed vessels influences the number of secondary operations can at least be drawn from the figures for skin cover for the finger as a whole, but not for the other structures. From the metacarpus proximally, no relationship could be demonstrated between vessels anastomosed and secondary procedures. An association between type of injury and incidence of secondary operations could be demonstrated. The so-called "unfavourable" slicing injuries. It was remarkable that circular saw and crush injuries, usually regarded as "unfavourable", necessitated fewer further operations than slicing injuries. Equally unexpected was the finding that secondary operations were most frequent not in the oldest age groups but in the group aged between 10 and 20. The type of injury can be excluded as a reason for this. No satisfactory explanation can be given.

Adolescent↗
PubMed1982

[Indications and results of arthrodesis of the wrist].

Between 1966 and 1980, fusion of the wrist joint was performed on 113 patients. Follow-up was possible on 98 (86,6%). Stable fixation with a plate using a corticocancellous bone graft from the ilium improved the technique. Particularly striking was the reduction of postoperative immobilisation from an average of four months between 1966 and 1972 (before the introduction of the plate) to three weeks between 1973 and 1980. This improvement and the increased incidence of permanent wrist joint damage after injury have broadened the indications for wrist joint fusion. In 57 of the 113 cases (58,2%), good and excellent results were obtained. 92 patients (93,9%) pronounced themselves satisfied with the result compared to the preoperative situation. The one exception was wrist joint fusion in childhood, even though the growing epiphyses of the radius was protected.

Adolescent↗
PubMed1981

[Thumb reconstruction after amputation injuries].

Reconstruction of the thumb following amputation injuries: In this review of the different methods of thumb reconstruction following traumatic amputation, the procedures applicable in the primary care of the hand are first mentioned and demonstrated: replantation of a thumb, cover of a distal amputation with a neurovascular flap and salvage of a thumb with intermediate segmental loss. In most instances the thumb reconstruction is performed as a secondary procedure. The indication and the selection of the method depend upon the level of amputation, the dominance of the injured hand, and the presence of other injuries to the same hand as well as age, sex, occupation, and intelligence of the patient. There are several different operative methods: 1) Deepening of the first web space (phalangisation of the first metacarpal) by means of a Z-plasty with proximal transposition of the insertion of the adductor pollicis muscle. 2) Lengthening of the first metacarpal with a bone graft either as Gillies cocked hat procedure or as interposition following distraction of the osteotomized two parts of the metacarpal in one stage or as continuous distraction (Matev). --Both methods are performed often in combination and are indicated in loss of the thumb at the base of the proximal phalanx or at the MP-joint in the non-dominant hand or in unskilled workmen. 3) Osteoplastic methods with bone graft, tube pedicle and neurovascular island flap have the risk of absorption of the bone graft and therefore more limited indications. These are given in unskilled manual workers with no other injured digits and in multiple loss of digits where toe transfer is not appropriate. 4) Transposition of another intact or partially amputated digit on a neurovascular pedicle. The two different operative techniques depend upon the presence or loss of the first metacarpal and the thenar muscles. The indication is given in amputations at any point proximal to the base of the proximal phalanx in either hand of most women, children and skilled workers. 5) Free toe transfer is indicated if there is not any other finger or part of a finger available and the first metacarpal is preserved. In exceptional cases a free transfer of a digit of the contralateral hand is possible.

Amputation, Traumatic↗