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Biomedical subjects

G Germann

Publications and source records attributed to G Germann.

At least 145 records · Page 8Linked to original sources
PubMed1996

[Functional results following surgical management of palmar fibrocartilagenous injuries].

Lesions of the palmar plate of PIP-joints were treated surgically during the past ten years in cases of dislocation of the PIP-joint, lesions to the collateral ligaments, or lesions to the extensor apparatus (according to types 3, 4 and 5 of Hintringer's classification). A followup of 97 patients showed nearly 90% good results in cases of ligamentous injuries, comparable to results after conservative treatment in other centres. In cases of fracture dislocation and open injuries, results were only fair. Conservative treatment is now preferred in most cases.

Adult↗
PubMed1996

Factors influencing the early prediction of outcome from burns.

OBJECTIVE: 1. To reexamine the predictive value of the variables usually used in admission scores in burned patients (age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT) and sex). 2. To evaluate whether risk factors (alcohol abuse (AA), nicotine abuse (NA)) or preexisting diseases influence outcome significantly. DESIGN: Retrospective study of prospectively collected data. PATIENTS: 498 burned patients admitted to the burn ICU within a 5 years period. The mean TBSAB was 29% and the mean age 38 years. 42% of the patients suffered burns greater than 30% and the incidence of IHT amounted to 43%. METHODS: Univariate analyses were used to determine the independent relation of the variables to mortality. The relative weight of the variables was estimated using the step-wise logistic regression model. An additional analysis of subgroups was performed using classification and regression trees (CART). RESULTS: The univariate analyses identified the following variables to have significant influence on mortality: age, TBSAB, FTB, IHT, sex, AA, NA, the combination of AA and NA, preexisting neurological diseases and cardiovascular diseases. The step-wise logistic regression analysis identified age and TBSAB to have the most important influence on the outcome. Of minor weight was IHT followed by FTB and sex. The weight of IHT was found to be 1.7 fold higher than the impact of FTB and sex. A significant influence of IHT was found in all patients, but especially in patients with a medium risk of death (20%-45%) regarding age and TBSAB. In this group AA and NA additionally caused a significant impact on mortality. In patients with a higher or lower probability of survival AA and NA did not influence the outcome. The CART analysis identified TBSAB to be the most discriminative variable followed by age. In the group up to 20% TBSAB age was the only additionally significant variable regarding the outcome. In the group with a TBSAB between 20% and 60% age, sex and AA became important variables. In patients up to 72 years with a medium risk of mortality (20%-70%) IHT, AA, combined AA and NA, sex, preexisting neurological diseases and cardiovascular diseases significantly influenced outcome. In older patients IHT was the only additional variable of importance. CONCLUSIONS: The study demonstrates that besides the "classical" variables of bum scores as age, TBSAB and IHT other variables such as sex, AA, NA and preexisting diseases have significant influence on the outcome. These variables especially gain important predictive value in patients with a medium risk of mortality.

Adult↗
PubMed1996

Experience with the modified Meek technique.

In 1958 Meek described the so called Meek-Wall dermatome to cut postage stamp skin grafts. This method was eclipsed by the introduction of mesh skin grafts. In 1993 Kreis and colleagues reintroduced a modified Meek technique using a dermatome running on compressed air. This technique has been used in our burn unit since August 1994. The aim of this paper is to compare the modified Meek technique with the mesh graft technique. Within a period of 20 months 41 patients were grafted using the modified Meek technique. The mean TBSAB was 54.4% with 50.0% full thickness burns. All patients were excised early. The expansion ratio was 1:4 and 1:6. In 20 patients the Meek technique was used exclusively for grafting of the trunk and the extremities with the exception of face, neck and hands. In 3 patients with a mean TBSAB of 68.3% a combination of postage stamp autologous skin grafts and cultured epithelial autografts (CEA) was applied. Compared with the mesh graft technique the Meek technique showed the following advantages: 1. The Meek method provides the true expansion ratio. 2. Small graft remnants can be utilized. 3. Grafting of full thickness burns up to 70 to 75% TBSAB becomes possible with one harvest of the donor sites. 4. The reliability of graft take is equal or better. 5. Epithelialization is achieved within 3 to 4 weeks depending on the expansion ratio. 6. The combination of widely expanded postage stamp split thickness grafts and CEA provides an excellent take rate and durable wound closure within a short time and avoids the problems associated with the engraftment of CEA on fascia. The method is simple but more demanding than the mesh technique. Compared with the mesh graft technique the preparation of Meek grafts is more time consuming and requires more staff than the Mesh technique. The cost of materials is higher. In our experience complete coverage of the Meek grafts with an overlay of meshed allografts after removal of the gauze as recommended by Kreis is not necessary using the 1:4 expansion ratio. Greater expansion ratios necessitate an overlay with meshed allografts. Regarding the scar formation no significant differences were observed compared with the mesh graft technique. In conclusion the modified Meek technique is reliable and simple to perform. This technique provides a sufficient expansion ratio enabling to graft patients with burns up to 75% TBSA with only one harvest of donor sides and without the necessity of CEA. In our opinion the Meek technique is reliable and simple to perform. This technique provides a sufficient expansion ratio enabling to graft patients with burns up to 75% TBSA with only one harvest of donor sides and without the necessity of CEA. In our opinion the Meek technique is advantageous in patients with burns greater than 45% TBSAB. In smaller burns mesh grafts should be used because of lower material cost and staff requirements. Especially in extensively burned patients the Meek technique may be cost effective avoiding the need of CEA.

Adolescent↗
PubMed1995

Extensive thrombosis of the caval venous system after central venous catheters in severely burned patients.

Central venous thrombosis is a rare but extremely dangerous complication following central venous catheter placement. Two cases of massive central venous thrombosis in severely burned patients are reported. The clinical course, diagnostic problems and treatment options are described and discussed. From these cases we conclude that central venous catheter thrombosis should be included early in the differential diagnosis of trunk and extremity oedema in patients with indwelling central venous catheters and that thrombolytic therapy is safe and effective even in the severely burned patient.

Adolescent↗
PubMed1995

Two new applications for the first dorsal metacarpal artery pedicle in the treatment of severe hand injuries.

Two new indications for the use of the first dorsal metacarpal artery (1st DMA) in reconstruction following severe hand injury are reported. In the first case, a primary pollicization of the index finger was based solely on the dorsal arterial network. The second case involves a microvascular arterial revascularisation of a 1st dorsal metacarpal artery island flap. Neither procedure has previously been described.

Arteries↗
PubMed1995

Functional soft-tissue coverage in skeletonizing injuries of the upper extremity using the ipsilateral latissimus dorsi myocutaneous flap.

The concept of early "functional" soft-tissue coverage is demonstrated in three cases of severe skeletonizing avulsion/contusion injuries of the upper extremity, including the replantation of a "frozen" arm. According to the MESS score, all extremities would have been allocated to the amputation group. Therapeutic strategy consisted of primary repair of all neurovascular structures, serial debridements, and early definitive coverage with simultaneous restoration of the elbow flexor or extensor muscles. Flap survival was 100 percent in all patients, and the muscle strength achieved after vigorous physical therapy was rated M3 to M5. One patient was even able to return to competitive tennis.

Adolescent↗
PubMed1995

[Homograft transplantation in severely burned patients. Principles, indications and possibilities].

Homologous skin transplantation has recently gained increased importance in treatment concepts of severely burned patients. It is used as optimal biologic dressing and serves as dermal matrix in autologous-homologous intermingled transplantations or in cultured epithelial cells (keratinocytes). The present clinical indications for homologous skin and the theoretical basics are demonstrated.

Burns↗
PubMed1995

[The value of wrist joint arthroscopy in injuries].

UNLABELLED: Wrist arthroscopy clearly shows lesions of carpal bone cartilages, the triangular fibrocartilage (TFC), and of carpal ligaments. Between October, 1993, and August, 1994, 37 out of 47 wrist arthroscopies were performed in the consequence of trauma. The indication was on one hand a joint check for planning further surgery, on the other hand a profound suspicion of a severe intraarticular damage, which was raised in a standardized clinical examination with localizing any points of tenderness, testing for carpal instability, and provoking carpal subluxations and pathological clicks. The standard arthroscopy ports were that between the third and fourth extensor compartment and the radial midcarpal port. RESULTS: 12 of 37 wrist arthroscopies were done within 3 months after trauma. Two patients had fresh cartilaginous lesions, three had severe ligament damages otherwise not diagnosed, and four patients had TFC tears. In all of these nine patients arthroscopy guided the following therapy. 25 arthroscopies were done more than 3 months after trauma. 9 cartilage lesions, 3 ligament tears and 6 TFC defects were demonstrated. In 16 out of these 18 patients the arthroscopic finding was of major influence on further therapy. We conclude that wrist arthroscopy is a powerful tool in diagnosing intraarticular lesions and in planning posttraumatic wrist joint surgery. We suggest that a profound suspicion of intraarticular damage, as gained in a standardized clinical examination, should lead to wrist arthroscopy within one or two weeks after trauma.

Adolescent↗
PubMed1994

[The so-called "minor hand injury" and its socioeconomic sequelae].

A study was carried out involving 167 patients who had received primary treatment in alio loco for injuries diagnosed as 'minor cuts, twists and sprain', and who were then seen in the out-patient department at a later date. The patient group was analyzed with regard to the following: a more precise identification of the initial injury, the initiated treatment regimen and more particularly, the socio-economic consequences of the injury. Duration of treatment programmes, loss of working days and compensatory payments were cost-analyzed. The results showed that a delayed primary surgical intervention was possible in only 17% of cases, it was necessary to alter the treatment regimen in 29% and in 28% it was no longer realistic even to initiate treatment. Comparisons between this population and a group of a patients who had received adequate primary care showed that in the study group length of treatment and days lost at work was prolonged by the factor 1.3; furthermore the number of cases in which the reduction of working ability was 20% and more was increased by 2.7. Increased costs incurred by financial compensations were approx. DM 27,000/patient.

Absenteeism↗
PubMed1993

[Reconstructive surgery of knee para-articular amputation stumps].

Reconstructive plastic procedures in primary care and in postprimary/secondary treatment following below knee and above knee amputation are discussed. Short amputation stumps and stumps suffering from insufficient soft tissue coverage should be primarily avoided employing salvage replantation techniques. Secondarily conventional flaps and grafts, tissue expansion and/or microsurgical free tissue transfer all serve for achieving stable skin conditions and preserve adequate stump lengths. Interdisciplinary treatment racionale will lead to improvement of functional and social rehabilitation.

Adolescent↗
PubMed1993

[Indications for vein interposition in microsurgical reconstruction of complex defects of the lower extremity after tumor and trauma].

Reconstructive microsurgery has become a routine procedure in plastic surgery. Success rates in major centers range between 95 and 98%. In selected "high risk" cases, vein grafts are required to facilitate microsurgical anastomoses, as in complex defects of the lower leg, post ischemic syndrome (PIS) or following major tumor resections. The indications and results of vein grafts or A-V loops are demonstrated in these three groups. 25 patients with defects of the lower leg were operated using vein interposition grafts. Ten A-V loops were created prior to flap transfer. Three flaps had to be revised, only one flap was lost due to recurrent arterial thromboembolism from an injured proximal segment. Data show that vein grafts are clinically reliable and may be used without hesitation in appropriate clinical situations.

Anastomosis, Surgical↗
PubMed1993

[Current aspects of burn treatment].

Burn treatment is a complex therapeutic regimen, enclosing immediate resuscitation, burn would care and the complete spectrum of surgical intensive care as well as plastic surgical reconstruction. The pathophysiology of a severe burn injury resembles a maximal trauma response by activating a wide variety of mediators, resulting in a generalized tissue edema (capillary leak). Most important are sufficient fluid resuscitation and primary care, correct referral to a burn center, early enteral feeding and a consequent operative tactic with early removal of necrotic tissue and stable wound coverage. Sepsis is still the major mortality factor (75%). Besides established methods like skin culturing, future efforts are directed towards the generation of composite skin grafts and an immunological approach to influence or prevent the course of a burn sepsis.

Burn Units↗
PubMed1993

[Clinical aspects, morphology and therapy of an unusual case of bilateral macrodactyly].

Macrodactyly, originally described by von Klein in 1824, is one of the rarest congenital anomalies of the hand. It displays a wide variety of manifestations, and its association with other congenital defects and syndromes has been discussed by many authors. A rare case involving an adult with bilateral, hyperostotic macrodactyly of the hands is presented. The hands were not treated in childhood. Clinical findings, pathology, and treatment are discussed.

Adult↗
PubMed1993

[Post-primary functional soft tissue coverage after extensive muscle-/soft tissue loss of the upper extremity].

Two cases of severe contusion/avulsion injuries of the upper extremity with involvement of the neuro-vascular structures and extensive muscle necrosis after post-ischemic syndrome (PIS) are demonstrated. The concept of early post-primary soft tissue coverage and the opportunity of a simultaneous "functional" soft-tissue replacement with pedicled neuro-vascular myocutaneous island flaps is elucidated.

Adult↗
PubMed1992

[The epaulette flap: replantation of osteomyocutaneous forearm segments in interscapulo-thoracic amputation].

Despite sophisticated artificial limb devices available today, forequarter amputation following trauma or tumor resection will lead to severe impairment of function. To close the posttraumatic or oncologically required extended defects and to improve prosthetic supplementation coverage of the thoracic wall should be performed by sparing the whole forearm as an osteomyocutaneous flap. In cases of concomitant serial rib resection radius and ulna will serve as stabilizators of the thoracic wall, thus avoiding a flail chest. Indications, technical details and clinical outcome of three salvage replantations after interscapulo-thoracic ablation will be discussed.

Amputation, Surgical↗
PubMed1992

[Differential, oncologically adequate therapy of basalioma].

Surgical treatment of basal cell carcinoma demands straightforward tumor management. This study investigated the radicality of surgical excision, procedures performed for defect coverage, the recurrency rate depending on the histological tumor type, among other parameters. Despite a low general incidence of 14%, sclerodermiformal BCC (morphea-like lesions) is found in 88% of all recurrencies. Based upon the results of this study, the following therapeutic guidelines are recommended: Resection with tumor-free margins must be insisted on, particularly in any exposed surfaces of the body. Histological subtyping by the pathologist is required. After initially incomplete resection in certain histological subtypes, subsequent radical resection is not mandatory. Complete resection of sclerodermiformal BCC is mandatory, and continuous follow-up of these cases is recommended.

Adult↗