[A comment on perforator flaps].
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Arteries↗
Biomedical subjects
E Biemer
Publications and source records attributed to E Biemer.
[Subcutaneous "wash-out" in extravasations].
Extravasations of chemotherapeutic drugs may lead to large soft-tissue losses in the hand and forearm and necessitating surgical excision with secondary flap coverage. Unfortunately, a delayed referral to a hand and plastic surgical unit with an already established soft-tissue defect is most common. Nevertheless, in our unit the method of choice is early emergency subcutaneous "wash-out", which facilitates dilution and reduction of concentration of the extravasation and therefore reliably avoids the development of soft-tissue defects. The aim of this paper is to present the surgical technique.
Anesthesia, Conduction↗
Reorganization of human motor cortex after hand replantation.
In 10 patients, reorganizational changes of the motor cortex contralateral to a replanted hand (MCreplant) were studied one to 14 years after complete traumatic amputation and consecutive successful replantation of the hand. The organizational state of MCreplant was assessed for the deafferentated and peripherally deefferentated hand-associated motor cortex and the adjacent motor representation of the proximal arm. For this, response maps were established for the first dorsal interosseus and biceps brachii muscle using focal transcranial magnetic stimulation (TMS) on a skull surface grid. Characteristics of the maps were center of gravity (COG), number of effective stimulation sites, amplitude sum, and amplitudes and response threshold at the optimal stimulation point. The COG is defined by the spatial distribution of response amplitudes on the map and lies over the cortex region with the most excitable corticospinal neurones supplying the recorded muscle. The COG of the biceps map in MCreplant was shifted laterally by 9.8 +/- 3.6 mm (range 5.0-15.7 mm). The extension of the biceps map in MCreplant was increased and the responses were enlarged and had lowered thresholds. For the muscles of the replanted hand, the pattern of reorganization was different: Response amplitudes were enlarged but thresholds, COG, and area of the cortical response map were normal. The different reorganizational phenomena observed for the motor cortical areas supplying the replanted hand and the biceps brachii of the same arm may be influenced by a different extent of deafferentation and by their different role in hand motor control.
Adolescent↗
Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction.
Female-to-male transsexuals have been treated by the authors since the 1970's, using different operative methods. Since 1981, these patients have received neophallus construction with free sensate osteofasciocutaneous forearm flaps and, since 1993, with free sensate osteofasciocutaneous fibula flaps. In order to evaluate the usefulness of these flaps, the authors performed, in 24 patients (12 with forearm and 12 with fibula flaps), the following examinations: clinical and radiologic evaluations of the neophallus and its donor site, as well as patient questionnaires. In all patients, subjective findings and clinical examinations showed no significant variations in neophallus size and form. Patients with fibula flaps had better sexual intercourse, although their neophallus sensibility was minor, when compared to the forearm flap patients. Donor-site morbidity was moderate in both groups. On radiologic examination, robust, calcified bone structure, and no fracture of the neophallus bone and its donor site, as well as no instability of the ankle joint (in the fibula flap patients) were found. These findings further support the use of these free sensate osteofasciocutaneous flaps for neophallus construction. In the authors' opinion, it is the patient who must decide which method should be used for neophallus construction.
Female↗
[Color comparison of donor sites of free flaps and the face].
Microsurgical reconstructions of the face using free flaps from the body and the extremities often lead to imperfect aesthetic results. In order to find the optimal free-flap donor site with respect to its colour we compared the colour of the face and of typical free-flap donor sites. In a study of 19 healthy, untanned subjects with skin type II-III (Fitzpatrick 1988), we measured the colour of four facial areas and of ten common free-flap donor sites and compared them statistically. Measurements were carried out with a Minolta CR-300 chromameter and the CIELAB colour system. We found that the face itself can be divided into two statistically significant different colour regions. The forehead-, cheek- and mandible areas have a distinctly different colour than the nose. The donor sites showing the best colour match with the forehead-, cheek- and mandible area were pectoralis, lateral upper arm, radialis, fibula, and latissimus. The nose area is clearly darker and less colourful. For this reason the colour match of all the free-flap donor sites in our investigation is poorer. Here the best suited donor site area is still the dorsalis pedis area.
Face↗
[Aspects of quality assurance in plastic surgery. Subjective well-being and satisfaction of 420 plastic surgery patients with preoperative counseling, surgical intervention and after-care].
The aim of quality assurance should be the improvement of medical treatment. Beside quality assurance measures, which are mainly based on clinical parameters and medical ratings, subjective opinions of patients gain more and more in importance. In the present study results of an inquiry of 420 plastic-surgical patients with preoperative consultation, plastic surgery, and postoperative consultation are shown. The priority weakness on the wards was a high dissatisfaction of the patients with the lounges, the sanitary facilities, equipment and size of the rooms. Information about treatment after discharge was often not quickly and completely passed on, besides, there was in many cases a delay in the recommended physiotherapy after discharge. As a consequence of this study, improvements based on the results shown are required.
Adolescent↗
[Free microvascular rectus abdominis muscle flap for soft tissue reconstruction of the lower leg and foot: results and donor site defect].
The free rectus abdominis muscle flap is now a routine procedure for the reconstruction of soft tissue defects in the lower extremity. We present the follow-up of 21 out of 27 patients operated in our clinic between 1986 and 1994. The recipient leg always showed a stable soft-tissue coverage. Clinical or radiological signs of osteitis were not found. In many of the cases, where the transplantion was to the ankle region, the muscle bulk led to an alteration of the shape of the leg, without impairment of function. When harvested through a low transverse abdominal incision, the aesthetic results in the donor site are convincing. The functional donor site defect is negligible as long as only a segment of the muscle is used. Abdominal muscle tests showed good results when only a segment of the muscle was used. The patients reported no impairment in daily life. Abdominal wall weakness was present only when the entire muscle was harvested. There was one hernia after postoperative wound infection and secondary wound healing. In all other cases, the abdominal wall was stable. In the segmental use of the free rectus abdominis muscle flap, the good results obtained in our examination correlate to the high degree of patient satisfaction.
Adult↗
Role of vein grafts in reconstructive microsurgery.
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Anastomosis, Surgical↗
Donor-site morbidity of the segmental rectus abdominis muscle flap.
The donor-site morbidity of the segmental rectus abdominis muscle flap was evaluated in 20 patients with an average follow-up time of 47 months. Our criteria were based on static and dynamic functional results including relaxation and hernia of the abdominal wall, aesthetic outcome and patient satisfaction. The dynamic functional tests of the abdominal wall showed good results corresponding to the reported minimal impairment of quality of life. There was one abdominal hernia after wound infection and secondary healing. There was no evidence of abdominal wall instability in any of the other patients. The aesthetic outcome was excellent when a transverse lower abdominal incision, asymmetrically elongated to the donor site, was used and moderate in the case of a paramedian vertical incision. Ninety-five per cent of the patients were completely satisfied or satisfied with the result at the donor site. In the segmental use of the free rectus abdominis flap a high degree of subjective patient satisfaction reflects the favourable outcome of our examinations. On the other hand there is a clinically significant functional donor-site defect of this flap. As this procedure is still widely used, and as its indication is closely linked to its absolute and relative donor-site defect, comparisons with the alternatives, e.g. the partial latissimus dorsi muscle flap, the extended gracilis muscle flap or the serratus anterior muscle flap will have to be made.
Abdominal Muscles↗
[Information exchange via internet--possibilities, limits, future].
Today, the exchange of information in the Internet is dominated by the WWW and e-mail. Discussion groups like mailing lists and newsgroups also permit communication in groups. Information retrieval becomes a crucial challenge in using the Internet. In the field of medicine, three more aspects are of special importance: privacy, legal requirements, and the necessity of transferring large amounts of data. For these problems, today's Internet doesn't provide a sufficient solution yet. Future developments will not only improve the existing services, but also lead to fundamental changes in the transfer technologies: Safer data transfer is to be ensured by new encrypting software together with the planned transfer protocol IPv6. Introducing the new transfer mode ATM will lead to better and resource saving transmission. Computer, telephone and TV networks will grow together, resulting in convergence of media.
Forecasting↗
Expression of CD44-v6-containing isoform on breast tissue adjacent to silicone breast implants.
Although a variety of studies exists, the silicone controversy is still going on. In the present study we investigated the expression of the activation markers CD44-v6, intracellular adhesion molecule 1 (ICAM-1), and HLA class II molecules on breast epithelia adjacent to a silicone gel-filled breast implants (SGBI). Using an indirect immunoperoxidase procedure 12 tissue samples from implant recipients were investigated and 6 tissue samples from patients with slight breast hyperplasia were used as controls. Expression of CD44-v6 was found on ductal epithelia in all specimens from implant recipients, HLA-DR was expressed in all specimens, HLA-DQ in 3 of 10, and ICAM-1 in 8 of 12. In contrast, neither CD44-v6 nor HLA-DQ nor ICAM-1 were expressed on ductal epithelia from patients with slight breast hyperplasia, and HLA-DR was only weakly expressed in 2 of 6 patients. These data show that CD44-v6 can be expressed by benign cells under certain conditions, which may indicate an abnormal state of activation in breast tissue adjacent to an SGBI.
Breast↗
[Neovascularization of pre-formed tissue flaps in relation to arteriovenous blood flow of the implanted vascular pedicle. Experimental study in the rabbit].
In 45 Chinchilla-Bastard rabbits, a skeletonised arterio-venous pedicle was implanted on the subsurface of a 15 x 8 cm abdominal skinflap to create a neovascularised axial prefabricated flap. In order to evaluate the potency of neovascularisation in relation to the blood flow of the pedicle, we compared minimal blood flow by distal ligation (model 1) with maximal blood flow by distal microvascular arteriovenous shunt anastomoses (model 2) of the implanted vascular pedicle. The results show that 8 and 12 days after pedicle implantation, tissue flap perfusion in model 2 is significantly earlier and better in comparison to model 1.
Anastomosis, Surgical↗
Temporary ectopic implantation for salvage of amputated digits.
Temporary ectopic implantation for salvage of amputated parts is a fascinating idea. The first successful case, to our knowledge, of preserving digits by means of temporary ectopic implantation to the contralateral forearm is presented and this treatment concept is discussed. The indication for temporary ectopic implantation is an amputation injury with associated extensive soft tissue damage in which immediate replantation with either adequate shortening or preservation of length does not seem feasible, although the amputated part itself is uninjured and should therefore be salvaged. The groin, axilla and lower arm are compared as possible recipient sites for ectopic implantation. Early replantation of the ectopic implanted parts will provide superior functional results although replantation may be technically more demanding. The function of a replanted extremity after ectopic implantation will probably always be inferior to a comparable, immediately replanted extremity.
Adult↗
Increase of immunologically relevant parameters in correlation with Baker classification in breast implant recipients.
A variety of studies have suggested a possible immune reaction to silicone implants, although an increased frequency of rheumatic disorders among implant recipients could not be established. Several immunologically relevant humoral parameters were investigated in 239 breast implant recipients. The following parameters were determined: immunoglobulin G and M, complement C3 and C4, rheumatoid factor, C-reactive protein, antinuclear antibodies, antimitochondrial antibodies, and antithyroglobulin and antimicrosomal antibodies of the thyroid gland. Levels of complement C3 were elevated in 42.5% of the patients. No difference could be observed between silicone gel-filled and saline-filled implant recipients. Complement C4 was increased in 21.3% of the patients and a parallel relationship was observed between elevated C4 and C3 levels (p < 0.0015). In 28% of the patients, the antithyroglobulin titer was elevated > 200 U/ml. No difference was found between silicone gel-filled and saline-filled implant recipients. Elevation of antimicrosomal antibodies existed in 14.3% of the patients and was correlated significantly with antithyroglobulin antibodies (p < 0.0347). In accordance with the classification developed by Baker, we observed a significant correlation between capsule fibrosis types Baker I and II, and elevated C3 values (p < 0.0004) in silicone gel-filled but not in saline-filled implant recipients. Additionally, a correlation was found between increased antithyroglobulin titers (< 200 U/ml) and capsule fibrosis types Baker I and II (p < 0.0001) in this group. In the study presented here, an increase of several humoral parameters could be demonstrated in breast implant recipients, although we failed to correlate these findings with any clinical symptoms.
Adult↗
[Comment on the contribution: 202 toe transplants to the hand].
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Adult↗
Insulin-like growth factor binding protein 2 is differentially expressed in leukaemic B- and T-cell lines.
Production of insulin-like growth factor binding protein (IGFBP)-2 and accumulation of IGFBP-2 mRNA was determined in six leukaemic T-, B- or promyelocytic cell lines. Cell growth was compared in serum free medium M-3 and in medium M-9 containing 5% FCS. In both media, high amounts of IGFBP-2 as measured by radioimmunoassay were detectable in culture supernatant of T-cell lines and promyelocytic HL-60 cells, whereas only small amounts of IGFBP-2 were secreted by the B-cell lines. Production of IGFBP-2 in M-9 was approximately 20-fold higher (up to 195 ng ml-1) than in M-3, partially reflecting higher proliferation. However, quantitative reverse transcriptase polymerase chain reaction analysis revealed that, independent of the culture medium 10(6) T-cells contained between 30 and 48 units IGFBP-2 mRNA relative to the glycerol aldehyde phosphate dehydrogenase control gene, but B-cells contained less than 1 unit. Since IGF-II is known to be a major regulator of IGFBP-2, its influence on IGFBP-2 expression has to be investigated.
Base Sequence↗
[Endoscopic forehead lift].
Indications for the endoscopic frontal lift are the same as for the conventional open procedure: (a) ptosis of the eyebrow; (b) laxation of the frontal skin; (c) frowning of the glabella in the frontal area. While the conventional open procedure requires a coronal incision from ear to ear, the endoscopic procedure requires only four to six 1-cm incisions in the hair area. From there we lift the frontal skin subperiosteally up to the orbital rim where we incise the periosteum. Here the corrugator and procerus muscle are incised and the necessary portion of frontal skin can be elevated. Technical details, as well as the instruments needed are described in over 30 procedures.
Adult↗