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Biomedical subjects

G Germann

Publications and source records attributed to G Germann.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Accidental thermal injury to the hand].

Hands are most frequently involved in severe burns. The treatment of the burned hand is one of the most challenging problems in plastic surgery. The success of therapy is determined by the severity of the initial injury, the first aid provided, and the correct balance between mobilization, splinting and plastic surgery. In this respect, it is vital to have a highly qualified interdisciplinary team approach consisting of plastic surgeons, well-trained physical therapists, psychologists and a highly motivated patient.

Accidents↗
PubMed2005

Principles of microvascular reconstruction in burn and electrical burn injuries.

Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly developed during recent years, so have the indications for this procedure expanded. This study reports retrospectively the results of 75 free flaps in 60 severely burned patients using 20 different free flaps. This experience enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. In high voltage injuries (n = 26) early free flap coverage (<21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominantly the upper extremity and forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3-6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous flaps was the preferred method. In contrast to high voltage injuries, the trunk and the face were also recipient sites. In the upper extremity, the elbow and dorsum of the hand were the most frequent sites of reconstruction. Overall, the flap failure rate was 13% (n = 10). We were able to show a relationship between flap failure rate and timing of the procedure. Eight out of 10 flap failures occurred within 5-21 days after trauma, all 10-flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. For the reconstruction of complex or large defects (n = 14), we recommended combined 'chimeric' flaps, pre-expansion of free flaps, or the combination of a free and local flap. Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom tailored reconstructive solution.

Abdominal Injuries↗
PubMed2005

Disabilities of the arm, shoulder and hand (DASH) questionnaire: Determining functional activity profiles in patients with upper extremity disorders.

The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.

Adult↗
PubMed2005

[Does the disability of shoulder, arm and hand questionnaire (DASH) replace grip strength and range of motion in outcome-evaluation?].

Scoring systems currently used to evaluate functional disabilities in upper extremity conditions frequently combine so-called "objective" parameters such as grip strength and range of motion with "subjective" parameters such as pain. Since its introduction, the Disabilities of Arm, Shoulder and Hand Questionnaire has proven useful in the pre- and postoperative evaluation of functional limitations of the upper extremity. This study examines the relationship between DASH scores, the so-called "objective" parameters of grip strength and range of motion and those of "mixed scores" such as Krimmer and Cooney Scores. Based on the data of six diagnostic groups, Spearman's correlation coefficients were calculated. There was no correlation between DASH scores and range of motion, however, some of the diagnostic groups showed a moderate correlation between DASH scores and grip strength. Both the Krimmer and Cooney scores showed a significant correlation with the DASH scores, indicating that these "mixed-scores" can be replaced by the DASH. Since it has been shown that grip strength and range of motion do not capture patients' functional limitations adequately, their continued use in the evaluation of upper extremity conditions should be the topic of further discussion.

Arm Injuries↗
PubMed2005

[Functional outcome after midcarpal arthrodesis in the treatment of advanced carpal collapse (SNAC-/SLAC-wrist)].

PURPOSE: The purpose of this retrospective study was the evaluation of the functional outcome of midcarpal arthrodesis, its results in the treatment of SNAC/SLAC stage II and III and patients' satisfaction. METHODS: 49 patients that were treated with a midcarpal arthrodesis were re-examined at a mean follow-up time of 47 months. Range of motion was verified and grip strength was measured with a Jamar-Dynamometer II and a pinch-grip. Pain was evaluated by a visual analogue scale (VAS 0 to 100) for stress and under resting conditions. Patients' daily activities and general quality of life were estimated with the DASH questionnaire. Radiographic evaluation was done by conventional X-ray. RESULTS: Active range of motion was 56 % and grip strength was 76 % of the non-operated wrist. The DASH score was 29 points. Pain relief was 34 % during resting conditions and 31 % after stress respectively. 45 patients demonstrated bony consolidation in X-ray control. Six patients needed further treatment with a total arthrodesis because of pain or absence of bony consolidation. 77 % of the patients returned to their original occupation and 80 % were satisfied with the final result. CONCLUSION: Our data demonstrate that midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed.

Activities of Daily Living↗
PubMed2005

[Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II].

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

Activities of Daily Living↗
PubMed2005

[Defect coverage of the hand with the free serratus fascial flap].

PURPOSE: Coverage of exposed functional structures such as tendons, bones, vessels or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. Free fascial flaps are possible alternatives to cutaneous, fasciocutaneous and muscle flaps. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free serratus fascial flaps in our department. METHOD AND CLINICAL MATERIAL: From 1994 to 2002, ten patients underwent free fascial flap coverage of the hand with eleven serratus fascial flaps. Six patients could be re-examined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was after 34 months. RESULTS: Average active range of motion of the hand, functional improvement and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. CONCLUSION: We recommend the use of free serratus fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps since the functional results are excellent; no additional procedures were necessary and the aesthetical results are appealing.

Adult↗
PubMed2005

[Microsurgical reconstruction of the burned upper extremity].

BACKGROUND: Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded. MATERIAL AND METHODS: We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. RESULTS: In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction. CONCLUSION: Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

Adolescent↗
PubMed2004

[The role of plastic and reconstructive surgery within an interdisciplinary treatment concept for diabetic ulcers of the foot].

BACKGROUND AND OBJECTIVE: Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept. PATIENTS AND METHODS: In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results. RESULTS: Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients. CONCLUSIONS: Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.

Aged↗
PubMed2004

[Burn shock fluid resuscitation and hemodynamic monitoring].

Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24 h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5 ml/kg per h and 1 ml/kg per h and mean arterial pressures of >70 mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.

Burn Units↗
PubMed2004

[New developments in skin replacement materials].

Current treatment strategies in intensive care medicine permit survival of patients with burns of more than 80% of the total body surface area (TBSA). Major burns result in extensive skin defects. Thus, burn victims often suffer from scar contractures, altered thermoregulation, and unsatisfactory cosmetic results. In addition to the well-established cultivated epithelial autografts, a number of new composite grafts have been developed in the field of tissue engineering. The combination of synthetic and allogenic matrix structures together with an allogenic or autologous epithelium allows the possibility of mimicking skin structure. The aim is to achieve improved wound healing by regeneration of dermal tissue instead of scarring. This article provides an overview of the currently available products which have already been introduced into clinical routine as well as describing advantages and disadvantages of the individual products and their indications.

Biological Dressings↗
PubMed2004

[Reconstruction of burned extremities by free flap transplantation].

Free tissue transplantation in burn reconstruction presents a major challenge to reconstructive surgeons. The results of a retrospective analysis of 68 free flaps in 55 patients are reported. This experience facilitated the establishment of reconstructive principles and a decision-making algorithm for primary and secondary reconstruction of burned extremities. Fourty-two free flaps were used for primary reconstruction. The indications were predominantly extremity salvage.The safety of the microsurgical procedures is correlated with the timing of the reconstruction. The failure rate of the free flaps was 24% in primary reconstruction. Due to an increased post-traumatic thrombogenicity, the period between 5 and 21 days had the highest risk of flap failure (40%).Twenty-six flaps were used for secondary reconstruction, with a success rate of 100%. Due to their elasticity, adipo- and fasciocutaneous flaps provide a useful option for the release of contractures. The large variability demonstrated by the use of 19 different types of free flaps showed that the reconstruction of burned extremities requires a reconstructive concept individualized to each patient as well as sophisticated microsurgical techniques. This clearly demonstrates the importance of a close link between primary burn treatment and reconstructive plastic surgery.

Adolescent↗
PubMed2004

[Secondary plastic surgical reconstruction in severely burned patients].

Secondary reconstruction following severe burn trauma has improved markedly over the last few decades using all aspects of modern plastic surgery. In surgical reconstruction of burns, it is essential to design comprehensive, clear-cut, and long-term treatment plans. Good patient compliance and thorough follow-ups are imperative regarding the extent of scar and contracture formation, regularly requiring multiple-step surgery. Each treatment site will have to be evaluated separately, taking into account adequate surgical and conservative measures (the "reconstructive ladder"). Aiming at realistic and satisfactory results, surgery does not suffice alone in treating severely burned patients but also requires a well coordinated and seasoned team of occupational and physical therapists, psychologists, and plastic surgeons.

Burns↗
PubMed2004

[Primary treatment of burn patients].

Burn injuries can be caused by thermal, electrical, chemical, or mechanical trauma or radiation and are relatively rare, as they represent only about 1% of all emergencies. They are caused by accidents at home, during recreational activities, or in the occupational environment. Minor burn traumas are much more common than severe burn injuries with their systemic and potentially life-threatening effects. Altogether, these circumstances may result in a lack of routine for treating such injuries properly by physicians and their colleagues in the emergency room or intensive care unit. A clearly outlined concept for preclinical and clinical treatment can be the keystone of successful further clinical progress. The following article summarizes the current guidelines for first medical aid at the injury scene, burn stabilization and assessment in the emergency room, and the interdisciplinary approach for further clinical care. The treatment of dermatologic emergencies (acute epidermolytic syndromes) or caustic injuries by chemical agents is similar to the treatment of burn victims in many aspects but must be adapted in selected cases.

Burns↗
PubMed2004

[Defect coverage and reconstruction of thumb sensibility with the first dorsal metacarpal artery flap].

INTRODUCTION: The "Foucher" flap is a pedicled neurovascular island flap of the first dorsal metacarpal artery. METHODS: From 1992 to 2000, thirty-three neurocutaneous island flaps from the dorsal aspect of the index finger (FDMCA flap) were performed for defect coverage and reconstruction of sensibility in the thumb. RESULTS: Static 2-PD over the flap area averaged 10.8 mm (range 4-15), compared to 8.2 mm (4-15) over the dorsal aspect of the contralateral index finger. Response to the SW monofilaments showed no difference to normal skin or only diminished light touch in 76% (19/25) patients. Seventy-six percent (19/25) were able to return to their previous jobs or resume previous activities. CONCLUSION: Based on negligible donor site morbidity of the flap and the good sensate quality and aesthetic appearance, the Foucher flap has become our first choice in defect coverage and restoration of sensibility of the thumb.

Adolescent↗
PubMed2004

[The reconstruction of scaphoid pseudoarthroses with the operation of Matti-Russe. A retrospective follow-up analysis of 84 patients].

BACKGROUND: In a retrospective study 84 patients were examined who were treated with a Matti-Russe procedure between 1985 and 1997 due to scaphoid non-union. The purpose of this study was to evaluate the long term results after scaphoid reconstruction and to get impressions about subjective feeling of the patients. PATIENTS AND METHODS: 79 patients were male, 5 were female. The average follow-up period was 88 months. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale (VAS) from 0 to 100. The functional and subjective outcome was evaluated with the DASH-questionnaire. RESULTS: A bony consolidation could be verified in 82% of the patients. The mean postoperative pain score was 3 (non-stress) and 33 (stress) in patients with scaphoid union. The DASH-score reached 15. Active range of motion and grip strength were 82% and 92% compared to the contralateral side. 81% of the patients have been working in strenuous jobs. CONCLUSION: The results show the reliability of the Matti-Russe procedure in non-union of fractures of the scaphoid. Alternative treatment options have no advantages in bony union.

Adult↗
PubMed2004

Establishing a baseline for organisation and outcome in burn care-basic data compiled by German burn centres, 1991-2000.

From the years 1991 to 2000, basic data from patients admitted to the intensive care unit of burn centres in Germany, Austria and Switzerland, participating in the German Speaking Association for Burn Treatment, were collected prospectively. Starting in 1991 with 7 hospitals and 618 patients included in the study; in the year 2000, 19 hospitals representing nearly 1500 patients submitted their data. Over a period of 10 years, a total number of 10,259 patients could be included in the study. The majority of patients were adult, the male/female ratio was 70/30. Most of the patients suffered from household accidents, only 25% were occupational accidents. Medium total burn surface area (TBSA) and Abbreviated Burn Severity Index (ABSI) score were quite similar in the participating hospitals, while the medium length of stay in the ICU ranged from 6 to 24 days. The overall mortality was 17.5% and showed no decrease over the period of time.

Adolescent↗