Search PubMed⌕ Search

Biomedical subjects

G Germann

Publications and source records attributed to G Germann.

At least 19 recordsLinked to original sources
PubMed2000

[Therapeutic options in treatment of heel defects. Presentation of an algorithm for therapeutic strategy].

INTRODUCTION: The treatment of soft tissue defects of the foot and ankle region remains a challenge, because special anatomical and physiological properties have to be considered. PATIENTS AND METHODS: The data of 52 patients, who were treated between 1994 and 1998, were analyzed. 48% were posttraumatic defects and were located in the weight bearing zone in 37%. RESULTS: Fifty-nine procedures were used, including skin transplantation in 16 patients, local flaps in 3 cases, regional flaps in 14 cases, and microvascular procedures in 17 cases. Amputation was required in 4 patients. The overall success rate was 92%. Complications occurred in 18 patients. CONCLUSIONS: Using these data and evaluation of the actual literature lead to the development of an algorithm for the treatment of defects in this area. The modern armamentarium of plastic surgery offers the possible different treatment modalities.

Adolescent↗
PubMed2000

[Treatment strategy in complex hand injuries].

There are no clear definitions of serious or complex hand injuries in the literature. Multistructural injuries involving a vital risk to the affected part of the body part are usually classified as complex. The quality of the reconstruction, based on sound management principles, determines the aesthetic and functional outcome for the patient. The strategies basically consist of: Careful radical dbridement, thorough analysis of the defect and evaluation of lost functions, injury classification, Patient oriented reconstructive procedures, careful and realistic explanation of perspectives and risks to the patient. Following these principles will most likely achieve the planned objectives of treatment, such as, best possible restoration of form and function, cost-effective therapy, and early professional and social reintegration. Algorithmic approaches are an important aid in the clinical approach to these kinds of problems, making it possible to reach clear reproducible decisions that are amenable to standardization. Despite all individual decisions necessary to achieve optimal care, this standard theoretical framework will be able to improve the quality of care.

Algorithms↗
PubMed2000

[Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)].

Longstanding and untreated scaphoid fractures and scapholunate dissociations lead to painful destruction of the wrist with carpal collapse. The severity of degenerative arthrosis is classified in three stages and can be treated adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) after failed fusion of the scaphoid and SLAC wrist (scapholunate advanced collapse) after scapholunate dissociation should be differentiated. The reconstruction of the scaphoid or scapholunate ligament in stage II and III is no reasonable option. Motion preserving procedures such as proximal row carpectomy or midcarpal arthrodesis are preferable in this situation. Thirty-one male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined, the mean follow-up was 15 months. Grip strength was measured with the Dexter-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activities and general quality of life were estimated with the DASH-questionnaire. Pain was reduced to 50% compared to the preoperative situation. Grip strength improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39.0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in total wrist arthrodesis. 80% of the patients returned to their original occupation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed. The DASH-score reflects the subjective impressions of the patients in daily life and justifies the choice of a salvage procedure preserving wrist mobility. Total wrist fusion represents the last line of defense.

Adult↗
PubMed2000

Functional outcome with scaphotrapeziotrapezoid arthrodesis in the treatment of Kienböck's disease stage III.

Scaphotrapeziotrapezoid (STT) arthrodesis for the treatment of Kienböck's disease is recommended as a wrist salvage procedure since the publication by Watson and colleagues in 1985. Stage IIIa/b of the Lichtman classification is the specific indication for this operative-procedure. This study reviews the results of 26 patients with stage III of Kienböck's disease treated with STT arthrodesis during a 6-year period. From 1993 to 1998, 26 patients (16 men, 10 women) were treated with STT arthrodesis for Kienböck's disease in stage IIIa/b. The mean follow-up was 35 months. Two-rung grip strength was measured by using an electronic computerized JAMAR-Dynamometer. Pain was evaluated pre- and postoperatively using a visual analog scale. Patients' activities of daily living and general quality of life were estimated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Also two established wrist scores (Mayo wrist score and Krimmer wrist score) including objective and subjective parameters were used. Fusion was established in 25 patients after an average period of 7 weeks. Pain was reduced substantially to 72% of the preoperative values under resting conditions and 60% under stress. Eight patients claimed complete pain relief. Grip strength improved to 60% of the opposite side. Active range of motion was 65% of extension/flexion and 50% of radial/ulnar deviation on average compared with the contralateral hand. Twenty of the 26 patients were satisfied with the final result and would undergo the operation again. A total of 80% of the patients returned to their original occupation. The average DASH score was 24.8, the Mayo and Krimmer wrist scores averaged 66 and 67.8 points respectively. The procedure combines the advantages of decreasing load to the lunate and maintaining carpal height. Pain was markedly reduced, grip strength improved, and functional wrist mobility was preserved. The data support increasing confidence that STT fusion will stand the test of time.

Adult↗
PubMed1999

[Long-term outcome of reconstruction of proximal scaphoid pseudarthroses with Matti-Russe-plasty].

Thirty-two patients who were treated with Matti-Russe grafts between 1985 and 1995 after a fracture of the proximal scaphoid pole were examined in a retrospective study. The purpose of the study was the evaluation of the long-term results of functional outcome, radiological results, and postoperative quality of life. Main object of the study was to clarify whether the development of carpal collapse is inevitable or if it is correlated to the persistence of bony nonunion. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale from 0 to 100 (VAS). The analysis of the X-rays was carried out with a special wrist-score that was developed for the 1997 meeting of the German Speaking Society for Surgery of the Hand (DAH). The functional outcome was evaluated with the DASH-questionnaire. Twenty-nine patients were male, three were female. In 22 patients the right hand was involved, in ten patients the operation was performed on the left hand. The average follow-up period was 66 months. Bony union was achieved in 26 cases, six patients still demonstrated a persistent nonunion. The mean postoperative pain score was 1.8 (non-stress) and 42.5 (stress) in patients with scaphoid union. Active range of motion and grip strength were 90% compared to the contralateral side, the DASH-score reached 12.73. Only in persistent nonunion an advanced carpal collapse could be detected. The results show the reliability of the Matti-Russe graft in nonunion of fractures of the proximal pole of the scaphoid. Alternative treatment options have no advantages in bony union. The disadvantage of the Matti-Russe graft is the long period of immobilisation.

Adult↗
PubMed1999

[Initial results of treatment with the new AO wrist joint arthrodesis plate].

Although diagnosis and therapeutic options for post-traumatic, idiopathic, and degenerative wrist arthropathies have improved during recent years, total wrist fusion is still frequently regarded as a popular option of treatment. Fourty-one patients underwent wrist arthrodesis between May 1994 and April 1996 using the recently introduced new AO-plate after earlier wrist trauma or Kienböck's disease. Thirty-five patients were examined. The average follow-up time was 15 months. Hand function and active digital range of motion (ADROM) was assessed clinically, grip strength was measured using a Jamar-Dynamometer and the Dexter-Computer-System. Patient's daily activities and general postoperative quality of life were estimated with the new DASH-questionnaire. It can be concluded from our data, that the widely claimed complete pain relief after total wrist fusion does not match reality. Eighty percent of the patients complained about reduction of postoperative quality of life with impaired personal hygiene and functional deficits; however, the majority would undergo the procedure again. Seventy percent of the patients returned to their original occupation. The DASH-questionnaire proved to be a very useful and sensitive tool for evaluating the patient's problems at the upper extremity.

Adult↗
PubMed1999

[Chronic compartment syndrome of the first dorsal interosseous muscle: 2 case reports].

Chronic exercise-induced compartment syndrome of the first dorsal interosseous muscle of the hand is a rare condition. The presented complaint is a dull muscle pain which can be increased by hyperextension of the index metacarpo-phalangeal joint and by repetitive key grip. Two patients complaining of these symptoms could successfully be treated by simple fasciotomy of the first dorsal interosseous compartment.

Adolescent↗
PubMed1999

[The DASH(Disability of Arm-Shoulder-Hand) Questionnaire--a new instrument for evaluating upper extremity treatment outcome].

The paper presents the translation of a new measurement tool, the DASH Questionnaire. The DASH (Disability of Arm--Shoulder--Hand) is an outcomes data collection instrument which has been developed by the "American Academy of Orthopaedic Surgeons", the Council of the "Musculoskeletal Specialty Societies", and the "Institute for Work and Health", in order to assess outcomes among patient groups with musculoskeletal disorders. Using a self-report system, patients attribute scores of 1 to 5 on 30 items relating to functional activities and symptoms; a further optional module contains four items relating to disability levels among musicians and athletes. The raw score is then transformed to a 0 to 100 scale, whereby 0 reflects minimum and 100 maximum disability. The subjective nature of this instrument makes it suitable for both postal or in situ clinical surveys. The instrument is in the process of validation for use with a German population.

Arm↗
PubMed1999

Combined pedicle and free-tissue transfer to improve functional restoration of the foot: the "backpack principle".

Reconstruction of weight-bearing areas of the foot remains a challenging problem for the reconstructive surgeon. The principle described involves the combination of an innervated regional pedicle flap providing sensate, durable coverage of the weight-bearing heel, and a microvascular fascia flap for thin, pliable coverage of a large surface defect, based on the same vascular bundle. This provides excellent long-term stability and minimizes the disruption of blood supply to the foot. The result after 3 years demonstrates that this concept may represent an interesting solution for these particular problems.

Adenocarcinoma, Clear Cell↗
PubMed1999

Two modifications of the radial forearm flap for reconstruction of complex facial defects.

The free radial forearm flap has been one of the most common free flaps of recent decades. This flap is employed predominantly in head and neck reconstruction. The possibility of combining bone, muscle, and nerves with the fasciocutaneous flap greatly enhanced reconstructive options. However, the frequently unsightly donor site and the development of other readily available free flaps have led to a decline in the use of the radial forearm flap. Nevertheless, for reconstruction in head and neck surgery, with the need for thin, pliable tissues and a long vascular pedicle, the radial forearm flap still remains a prime choice. Two modifications of the standard forearm flap are presented. The first patient had two large defects at the nose and mental area after radical resection of a basal-cell carcinoma. Soft-tissue reconstruction was achieved with a conventional forearm flap and a second additional skin island based on a perforator vessel originating proximally from the pedicle. Both skin islands were independently mobile and could be sutured tension-free into the defects after tunneling through the cheek, with vascular anastomosis to the facial vessels. The second patient required additional volume to fill the orbital cavity after enucleation of the eye due to an ulcerating basal-cell carcinoma. In this case, the body of the flexor carpi radialis muscle was included in the skin flap to fill the defect. The skin island was used to reconstruct the major soft-tissue defect.

Aged↗
PubMed1999

Versatility and reliability of combined flaps of the subscapular system.

One-stage reconstructions of complex or unusually large defects frequently require composite tissue transfers. The various components of these "chimeric" flaps facilitate three-dimensional reconstructions or the coverage of large surface defects. Data from 36 combined flaps from the subscapular arterial system are demonstrated in this series. Defect locations were evenly distributed between the upper and lower extremities. Eighty-three percent were two-component flaps, and 17 percent contained three or more various tissue components. Overall flap survival was 97 percent. Major complications included vascular revisions in four patients and seven secondary skin transplantations. Five cases contained osseous components. The independent mobility of skin, muscle, and bone proved to be a major advantage in the reconstruction of compound defects. Donor-site morbidity was acceptable; the most frequent donor-site complication was persistent seroma in 9 of 36 patients (25 percent). Patient satisfaction was high. Ninety-one percent were satisfied with the operative result and would undergo the operation again. Eighty-six percent accepted the aesthetic appearance of the donor site. The data demonstrate that these complex flap procedures are extremely reliable and versatile, thus avoiding multiple reconstructive procedures and achieving excellent reconstructive results with acceptable donor-site morbidity.

Adolescent↗
PubMed1998

[Reconstruction of severe facial defects due to noma].

Noma is an ulcerative-necrotizing gingivo-stomatitis eventually leading to severe destruction of the midface, including lips and cheek, maxilla/mandible, nose and rarely the orbit. The defects are usually unilateral. Children from economically underdeveloped countries are predominantly affected. Medically untreated the disease has a high mortality rate, which can be dramatically lowered by adequate antibiotic therapy started in time. Predisposing factors include malnourishment, immunosuppression, and poor oral hygiene. Forty-eight noma patients were surgically treated in Sokoto, Nigeria during October 1997 by an Interplast Germany team sponsored by AWD Stiftung Kinderhilfe. Interdisciplinary surgical strategies and results, e.g. ankylosis release, local flap coverage and 12 pedicled musculocutaneous latissimus dorsi island flaps, as well as a noma classification (NOMAC), are presented.

Adolescent↗
PubMed1998

[Prefabricated flaps, a new reconstructive concept].

Microsurgery has entered its third generation. Functional and aesthetic requirements have been steadily increased with the refinements of microsurgery. The new principle of prefabricated flaps are another step to match these requirements. These prefabricated flaps can either be created by expanding known flap donor sites or creating entirely new flaps by implanting AV-loops or vascularized fascia. Principles and indications of this new technique will be elucidated by clinical examples.

Facial Neoplasms↗
PubMed1998

The radial forearm fascial flap as a salvage procedure for chronic tuberculosis of the hand and wrist.

A patient with tuberculous infection of the hand and wrist developed a recurrent draining wound of the right forearm. After recurrent failure of surgical debridement and wound closure under antituberculous therapy, wound closure was established by means of a radial forearm fascial flap with an excellent functional and cosmetic result. Extra-pulmonary tuberculosis must be kept in mind in the diagnosis of slowly growing tumours and chronic wounds in the upper extremity.

Adult↗
PubMed1998

The partial gluteus maximus musculocutaneous turnover flap. An alternative concept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall.

Three cases with posterior perineo-sacral defects are presented. One is a 57-year-old white female following amputation of her rectum for carcinoma, radiation and chemotherapy with a significant residual sacral/perineal defect and loss of the posterior vaginal wall. The two other patients had radical pelvic exenteration after recurrent rectum carcinoma. A new myocutaneous turnover flap as a modification of the conventional gluteus maximus flap was designed to solve the particular reconstructive problems. The flap is based on branches of the inferior gluteal artery. The posterior cutaneous femoral nerve and the motor branches of the inferior gluteal nerve not leading into the muscle portion of the flap are left intact. The skin island can be used for vaginal reconstruction or can be de-epithelialised to fill perineal cavities. This new flap eventually enabled the successful reconstruction of the posterior vaginal wall and appropriate sacral/perineal soft tissue coverage in the first case. In the other patients the flap was used to achieve closure of the deep through-and-through defect acutely in one case, and after a 3-week interval in the other.

Aged↗
PubMed1998

[Mid-term results of scapho-trapezio-trapezoid arthrodesis in aseptic semilunar bone necrosis stage IIIa/b].

The mid-term results of 20 cases of Kienböck's disease treated with scaphotrapezio-trapezoid arthrodesis with an average follow-up period of 25 months between 1993 and 1997 are presented. Clinical results were good with regard to pain, grip strength and range of motion; the results with regard to the DASH questionnaire were very good. It can be concluded from this study that STT arthrodesis is a useful procedure for the treatment of Kienböck's disease in stage III.

Adult↗