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G Germann

Publications and source records attributed to G Germann.

At least 91 records · Page 5Linked 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

[Reconstruction of defects of the anterior abdominal wall].

Reconstruction of the abdominal wall is of importance in many clinical situations, but may require the entire spectrum of plastic and reconstructive surgery. Indications for particular procedures depend on the clinical situation and the patient's individual profile. One has to differentiate between life-saving primary measures and secondary corrections to improve form or function. The article outlines current actual concepts of plastic surgical defect reconstruction with which the general/visceral surgeon should be acquainted, in order to integrate these concepts into a multi-disciplinary approach in pertinent clinical situations.

Abdominal Muscles↗
PubMed2000

[Plastic surgery coverage of osteocutaneous defects of the sternum area with the vertical and transversal rectus abdominis muscle (VRAM/TRAM) flap].

Longitudinal osteocutaneous defects of the sternal region including the caudal third were reconstructed in 15 patients during a 3-year period by using the "vertical (VRAM)- and transverse rectus abdominis muscle" (TRAM) flap. The majority of the defects resulted from chronic osteomyelitis after previous cardiothoracic surgery or were due to former therapy of breast cancer. Three VRAM/TRAM flaps were primarily transferred as free flaps with microvascular anastomosis in the axilla region. Nine out of 12 pedicled VRAM or TRAM flaps required an additional microvascular anastomosis because of imminent venous or arterial insufficiency ("supercharging"). Therefore, operative technique and operating time of the pedicled and free flap for reconstruction of longitudinal sternal defects are comparable. Adequate reconstruction and rehabilitation was achieved in 11 cases. In 2 patients revision and partial secondary defect coverage was required. Two male patients died postoperatively due to their preexisting condition.

Adult↗
PubMed2000

[Covering soft tissue defects and unstable scars over the Achilles tendon by free microsurgical flap-plasty].

INTRODUCTION: Coverage of the exposed Achilles tendon requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result for the distal lower extremity. Various local flaps and free flaps have been described for reconstruction of small and large defects. Small defects can be closed with local tissue, whereas free flap coverage may be necessary for coverage of large defects. METHODS: From July 1993 to September 1998 14 patients between the age of 15 and 74 years (mean 47 years; 3 female, 11 male) underwent free flap coverage for the exposed Achilles tendon due to primary trauma, chronic wounds or tumors. The mean duration of follow-up was 33.3 months. The defect size ranged from 8 x 8 to 25 x 28 cm. RESULTS: Six parascapular flaps (three with a vascularized scapular fascial extension), four radial forearm flaps and four latissimus dorsi flaps (one combined with free serratus fascia) were used for soft tissue coverage over the Achilles tendon. Thirteen flaps survived. In one case a parascapular flap had to be removed due to venous thrombosis and a free latissimus dorsi flap was used as secondary salvage procedure. The donor site morbidity was acceptable for most patients after flap harvesting in the subscapular region and also satisfactory in the forearm region. Average active range of motion in the upper ankle joint was 15-0-40 degrees for extension/flexion. All patients were satisfied with the functional and aesthetic result. CONCLUSION: Soft tissue coverage over the exposed Achilles tendon requires an optimal solution for each patient to achieve an aesthetically pleasing result and acceptable function. Microvascular free flaps can be used to reconstruct medium and large defects and to provide gliding tissue for the Achilles tendon. The complication rate of microvascular flaps is comparable with that of local flaps.

Achilles Tendon↗
PubMed2000

[Effect of recombinant growth hormone on wound healing in severely burned adults. A placebo controlled, randomized double-blind phase II study].

INTRODUCTION: Recombinant growth hormone (rGH) has been used successfully in burned children with a shortened donor-site healing time and length of hospital stay as well as a protein-sparing effect. In adult burn patients, no comparable study exists to date. MATERIAL AND METHODS: The study was performed on 49 adults, aged 18-60, with an Abbreviated Burn Severity Index (ABSI) score of 7-I1 as a randomized, placebo-controlled, double-blind study. The treatment period was 28 days and follow-up period 1 year. rGH was administered subcutaneously at a dose of 0.5 lU/kg per day in 26 patients, 23 patients were in the placebo group. Wound-closure assessment was performed on the day of admission and on each day of dressing change. A wound-closure index (WCI) was calculated. RESULTS: Thirty-seven patients, 19 in the rGH group and 18 in the placebo group, survived and were available for primary efficacy analysis. The mean total body surface area (TBSA) burned was 41.5% (rGH) versus 36.7% (placebo); the average ABSI score was 8.27 (rGH) versus 7.9 (placebo). The wound-closure index was not significantly different in patients treated with rGH (1.92) compared with patients treated with placebo (1.72). WCI for partial thickness-loss burn wounds did not significantly differ from rGH (0.9) to placebo (0.69). The donor site healing time in rGH-treated patients (12 days) was not significantly different compared to placebo patients (10.4 days). CONCLUSION: In severely burned adult patients rGH has no positive effect on burn wound or donor-site healing.

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

Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienböck's disease.

Sixty patients underwent total wrist arthrodesis for post-traumatic arthrosis, or Kienböck's disease. All of them could be included in the study with complete data. The average follow-up time was 37 months. Forty-nine patients were males, 11 were females; the average age was 48 years. Outcomes were assessed by several methods. Grip strength was measured using the DEXTER-Computer-System and was reduced by 50% compared to the contralateral side. Pain was evaluated pre- and postoperatively with a visual analogue scale from 0 to 100 and was reduced to 55% of the preoperative values. Patient's activities of daily living (ADLs) and general postoperative quality of life were estimated with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. For functional evaluation additionally the Mayo and Krimmer wrist scores were used. The overall DASH score was 51.4, the wrist scores reached 46.4 and 50.5, respectively. Both scores correlated significantly with the DASH. It can be concluded from our data that pain relief was sufficient in the most patients, although complete pain relief was rare. Although 80% of the patients complained about reduction of postoperative quality of life with impaired personal hygiene and functional deficits, the majority (80%) would undergo the procedure again. Seventy percent of the patients returned to their original occupation. Compared to other measures commonly used to assess outcomes after wrist arthrodesis, the DASH questionnaire proved to be a very useful tool for the evaluation of subjective outcomes in upper extremity disorders as well.

Activities of Daily Living↗
PubMed2000

The fate of the dorsal metacarpal arterial system following thermal injury to the dorsal hand: A Doppler sonographic study.

Hands are involved in over 70% of all serious burns. This study comprised 80 hands in 41 patients with burns of the dorsum of the hand. Eighty percent of the hands in our study had deep partial-thickness and full-thickness burns that had to be grafted. This study was performed to evaluate the patency of the dorsal metacarpal artery (DMCA) system in burn-injured hands. Sixteen hands healed spontaneously; 62 had to be excised and grafted. Doppler mapping of the dorsum of the hand was completed using an 8-MHz probe. Patent vessels were found in a pattern similar to that of a normal population in spontaneously healed and grafted partial-thickness burns. The incidence of dorsal arteries decreased from 100% for the first DMCA to 80% for the DMCA in the fourth web space. In full-thickness burns the correlation of burned hands to normal volunteers was only 80%. It can be concluded from the data that the DMCA system is not damaged by deep partial-thickness burns that are excised and grafted. The DMCA system is still intact in 80% of patients with full-thickness burns. The potential for elevating a DMCA flap is therefore preserved after burn excision and grafting. Preoperative Doppler examinations are recommended before planning the flaps.

Adolescent↗
PubMed2000

Scapholunate ligament repair using the Mitek bone anchor.

A retrospective study was done to assess the outcome after repair of completely ruptured scapholunate interosseous ligaments using the Mitek Mini G2 bone anchor. From 1994 to 1996. 12 patients underwent scapholunate ligament repair using the bone anchor. A follow-up assessment was done at a mean of 19 months postoperatively and revealed excellent or good results in eight patients, satisfactory in two, and poor in two patients, one of whom had developed lunate necrosis. One patient with an excellent functional result demonstrated recurrent dissociation of the scapholunate gap radiographically. The technique described proved to be simpler than conventional procedures in our hands, and yields similar functional results.

Adult↗
PubMed2000

Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment.

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

Arthralgia↗
PubMed2000

[STT arthrodesis for treatment of stage III semilunar bone necrosis: functional outcome].

Scapho-trapezio-trapezoid arthrodesis for the treatment of Kienböck's disease is recommended as a salvage procedure for Stage III A and B in the Lichtman classification. This study reviews the results of 26 patients with stage III of Kienböck's disease treated by STT-arthrodesis. 26 patients (16 male, 10 female) were treated by STT-arthrodesis between 1993 and 1998. Fusion was established after seven weeks average. All patients were examined, the mean follow-up time was 35 (10 to 72) months. Active range of motion showed 63% of extension/flexion and 51% of radial/ulnar deviation on average, compared to the uninjured hand. Mean preoperative and postoperative pain scores were 58.4 (non-stress) vs. 82.5 (stress) and 16.4 (non-stress) vs. 33.7 (stress), eight patients claimed complete pain relief. Grip strength improved to 71% of the opposite side. Total DASH score reached 24.8. 20 of the 26 patients were satisfied with the final result and would undergo the operation again. We found a significant reduction of pain, a slightly reduced grip strength and a satisfying functional wrist mobility after STT-arthrodesis. Carpal height was unchanged and the carpal collapse did not progress. The mid-term data support that STT-arthrodesis will stand the test of time.

Adult↗
PubMed2000

[Use of a cannulated 3.0 mm AO screw with an intraosseous support washer in osteosynthesis of the scaphoid: results and analysis of problems in 28 cases].

The cannulated 3.0 mm AO/ASIF screw with threaded washer is a new implant for scaphoid osteosynthesis. After insertion into the distal scaphoid pole, the washer serves as an intraosseous support for the head of the cannulated lag screw. From June 1997 to March 1998 the new implant was used in 28 male patients between 14 and 50 years of age. In fourteen patients, acute scaphoid fractures were operated on, including five transscaphoid perilunate fracture dislocations (Herbert type B2 and B4, respectively). Fourteen patients had scaphoid pseudarthroses, among those two re-pseudarthroses after prior surgery elsewhere. Using a palmar approach, the scaphoid was reduced. In pseudarthroses an iliac cortico-cancellous bone block was inserted, and the implants were inserted in a distal-to-proximal manner. In the fourteen acute fractures, follow-up assessment at a mean of 11 months revealed one pseudarthrosis (7%) and four screw removals (29%) for screw back-out after bony consolidation. In the fourteen pseudarthroses, follow-up assessment at a mean of ten months revealed one re-pseudarthrosis (7%) after a technical fault. It was treated by re-operation using the same implant, and healing was now uneventful. One screw removal became necessary after bony consolidation in another patient (7%). In conclusion, our preliminary results suggest that the new implant is suitable for stabilization of scaphoid pseudarthroses after insertion of an iliac crest bone graft. The complication rate in the treatment of acute fractures was inacceptably high.

Adolescent↗
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↗
PubMed2000

The free musculocutaneous tensor fascia lata flap as a backup procedure in tumor surgery.

The musculocutaneous tensor fascia lata (TFL) flap provides a small muscle belly and a strong fascial layer in combination with abundant skin coverage (15 x 40 cm), which makes the flap an attractive unit for composite free tissue transfer. The free TFL flap was used in nine cases of recurrent cancer of the chest wall (N = 7) and the abdominal wall (N = 2). The mean size of the full-thickness defects after tumor excision measured 12 x 25 cm. The operating time ranged from 4 to 8 hours (mean operating time, 5.5 hours). The operation was performed with two teams, and no repositioning of the patient was necessary during the operation. By raising the TFL flap, no additional area of the trunk was involved. The authors did not experience a prolonged ventilation time in their group of multimorbid patients. The donor site was closed directly (4 of 9 patients) or split skin grafted (5 of 9 patients). There was no functional deficit. In one patient the venous anastomosis had to be revised. There were no further complications, and no flaps were lost. The hospital stay was short (21 days on average), the outcome successful, and primary healing was obtained. The free TFL flap proved to be a reliable flap that is easy technically to harvest. Thus the free TFL flap is a valuable backup procedure in tumor surgery.

Abdominal Muscles↗
PubMed1999

[Not Available].

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Journal Article↗