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H Anderl

Publications and source records attributed to H Anderl.

At least 19 recordsLinked to original sources
PubMed1999

[Complex hand injuries. Importance of primary repair with free flaps].

BACKGROUND: The treatment of large and complex hand injuries is particularly challenching concerning the functional and cosmetic outcome. In this kind of injuries the primary defect cover is of paramount importance and so the initial situation for secondary reconstructive options may be evidently improved. MATERIAL & METHODS: Between October 1986 and Mai 1996 43 patients with large complex and combined hand injuries were primarily treated with 49 free flaps. The mean follow-up was 39 (6 to 92) months, the mean hospital stay was 19 (8 to 40) days. Depending on the time of the reconstruction and based on a classification established in our clinic, the patients were distributed among three groups: primarily (within 24 hours), delayed (between 2 and 7 days), and late (after 7 days till 3 weeks posttraumatically) reconstruction. RESULTS: Within the group of primary reconstruction the best results could be achieved, since radical debridement and primary defect cover by healthy tissue (free flap) led to physiological wound healing. That caused reduced hospital stay thus decreased costs, since flap failure, infection and multiple secondary surgical interventions could be diminished. Also earlier rehabilitation and reintegration into social life and profession was achievable. CONCLUSION: Due to the obtained results a primary treatment of large and complex hand injuries through radical debridement and reconstruction with free flaps seems to be effective and should already be considered in the emergency room.

Adolescent↗
PubMed1999

Transpositional replantation of digits. Case reports.

Heterotopic or transpositional replantation of digits is technically feasible with results similar to those of conventional replantation procedures. Occasionally in multiple digital amputations not all the digits may be replanted in their correct place as a result of complex injuries proximal to the amputation zone or severe damage to important fingers. In these circumstances the amputated digits that are in the best condition as regards undamaged tissue are used for replantation. The primary priority is an optimal functional outcome and the secondary priority the cosmetic outcome. Amputated long digits will always be used to substitute for a non-replantable thumb rather than to replace a long finger. We present 13 cases of successful transpositional digit or joint replantations in traumatic amputations of more than one digit.

Adult↗
PubMed1999

One-stage reconstruction of defects in the hypopharyngeal region with free flaps.

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula formations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive oncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lining, a satisfactory covering of cervical soft-tissue, and adequate functional rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flaps in the reconstruction of combined hypopharyngeal, cervico-oesophageal, and cervical skin defects.

Adult↗
PubMed1999

A new classification for the standardization of nomenclature in free flap wound closure.

A profusion of terms are currently used to describe free flap wound closure. It is important to broadly standardize nomenclature when embarking on a comparison of functional outcomes between institutions. Therefore, a series of 68 "emergency" (within 24 hours) free flaps performed by a single surgeon were reviewed with respect to a total experience of 188 free tissue transfers to formulate a consistent nomenclature applicable to free flap wound closure in general. The nomenclature presented divides free flap closure into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days). This system is analogous to the standard terms "primary," "delayed primary," and "secondary wound closure." It is consistent with known biologic and microbiologic principles of wound closure in general and should provide a simple basis for classifying free flap wound closure. Illustrative examples are presented to highlight the classification scheme.

Adolescent↗
PubMed1999

Reconstruction of large soft tissue defects in the inguinal and suprapubic region using a variety of flaps.

OBJECTIVES: To review a variety of optional reconstructive procedures for the surgical management of extensive soft tissue defects after radically curative or palliative resection of tumors, scars or damaged tissue in the inguinal and suprapubic region. METHODS: Clinical experience with 24 pedicled or free flaps applied in 20 patients to cover extensive defects with exposed underlying structures are presented. The proper selection of flap was based on the individual requirements of each patient taking into consideration age, cause, size, shape and deepness of the defect, donor site morbidity, the patient's general condition and the situation of vascular supply of the adjacent regions. RESULTS: A high success rate with a moderate rate of only minor complications leads to a reasonably short hospital stay with a definitive defect cover. In the cases of palliation a distinct improvement in quality of survival could be achieved. CONCLUSIONS: After extensive or radical resection almost every defect may be sufficiently covered in a single stage. The inferior epigastric flap serves as the most versatile flap, but nevertheless appropriate selection of the reconstructive technique must be adapted considering the complexity of the illness and defect in each individual case.

Abdomen↗
PubMed1998

Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle.

BACKGROUND: On the basis of studies with animals and experience with functioning muscle transfer in plastic surgery, we have developed a surgical technique to restore detrusor function for patients with bladder acontractility in whom there is no treatment alternative. METHODS: Three patients (aged 26 years, 28 years, and 68 years) with bladder acontractility as a result of spinal-cord injury (two patients) and chronic overdistension (one patient), who required catheterisation for bladder emptying for 5 years, 2 years, and 2 years, respectively, took part in our study. The patients were treated with microneurovascular free transfer of autologous latissimus dorsi muscle to the bladder to restore detrusor function. Follow-up included clinical and urodynamic evaluation, colour doppler sonography, intravenous urography, and flow-mode computerised tomography. FINDINGS: The three patients voluntarily emptied their bladders at 16 weeks, 16 weeks, and 30 weeks after surgery, respectively. There was no need for further catheterisation throughout the follow-up period. On urodynamic assessment at 12 months after the operation bladder capacity was found to be 600 mL, 600 mL, and 650 mL, residual urinary volume 0 mL, 50 mL, 90 mL, and maximum flow rate 26 mL/s, 25 mL/s, and 18 mL/s, respectively. Activity at the transplanted latissimus dorsi was confirmed by ultrasonography and flow-mode computerised tomography. INTERPRETATION: Microneurovascular free transfer of latissimus dorsi muscle to functionally restore a deficient detrusor muscle has proved to be successful for the three patients in our study. This technique may also be an option to restore the function of other smooth-muscle organs.

Adult↗
PubMed1998

Flap salvage in a "flow-through" flap by manual thrombectomy plus thrombolytic therapy.

A delay in identifying incipient flap failure may inevitably lead to complete pedicle thrombosis and the no-reflow phenomenon. The authors report a clinical case of a lateral arm free flap that suffered complete pedicle thrombosis. They successfully salvaged this flap, a type C fasciocutaneous "flow-through" flap, by manually moving the thrombus from proximal to distal in the main flap artery. This freed the septofasciocutaneous upward-perforating branches, by smoothing and applying firm pressure to the vessel, combined with thrombolytic therapy. Their technique is offered as an alternative procedure for salvaging a failing flow-through flap.

Adult↗
PubMed1998

The lateral arm flap: review of 72 cases and technical refinements.

Between 1985 and 1995, 72 free lateral arm flaps (LAFs) were transferred in 68 patients. The main purpose of the reported study was to demonstrate a comprehensive follow-up and essential technical refinements: extension of the flap, shaping of a custom-designed flap, the "emergency" free flap, and sensible nerve coaptation. The effect of nerve coaptation vs. no nerve coaptation was investigated by measuring objective and subjective grades of sensibility at the recipient site. The outcomes of sensory flap reinnervation showed no significant advantages of one over the other technique. The second intention was to clarify discrepant anatomic descriptions concerning the nomenclature of the supplying blood vessels. Current anatomic investigations revealed that the main blood supply derives from the posterior radial collateral artery (anastomosing with the interosseous recurrent artery); blood supply via the anterior radial recurrent artery (anastomosing with the radial recurrent artery) has a secondary importance.

Adolescent↗
PubMed1998

An unusual case of deep penetrating dermatofibroma of the lower leg. Case report.

Histological examination of a punch biopsy specimen of a slowly growing, irregular dermal tumour from the right lower leg of a 32-year-old woman, which had been diagnosed clinically as a dermatofibrosarcoma protuberans, showed it to be a deep penetrating dermatofibroma. The diagnosis was established by characteristic histological and immunohistochemical criteria. This allowed sequential excision in two sessions with primary closure and an optimal cosmetic result.

Adult↗
PubMed1998

Closure of complex defects in the chest wall with muscle flaps.

Aggressive treatment of thoracic malignancy may be complicated by complex defects in the chest wall. These may be associated with serious complications such as chronic infection, respiratory or cardiac failure, or major haemorrhage. Closure of the defect and restoration of the integrity of the chest wall is important for both functional and cosmetic reasons. Local flaps are often used, but may be inadequate or unavailable. Reconstruction with free flaps is better in these cases, as this provides as much abundant well-vascularised tissue as is required. We present 12 patients treated successfully for complex chest wall defects using various forms of local and free flap reconstruction. There were five complications, three healed spontaneously and two required secondary procedures before they healed.

Adult↗
PubMed1998

Lipofibromatous hamartoma (neural fibrolipoma) of a flexor nerve of the index finger.

A 24 year old woman presented with a painless fusiform mass in her right index finger. Exploration showed an enlargement of the nerve by fibrofatty tissue and microsurgical intraneural dissection was done. Histological examination identified the lesion as a lipofibromatous hamartoma of the nerve, which is both rare and benign. There are different options for treatment of this lesion.

Adult↗
PubMed1998

Combined fasciocutaneous abductor hallucis-medialis pedis transposition flap for defect coverage of the medial ankle.

A new method to cover a deep defect of the medial ankle with exposed bone, tendon, or metal implant is presented. In two cases a combined medialis pedis and abductor hallucis muscle flap, each based on separate vessels but linked by the musculocutaneous perforators, was used successfully as an island transposition flap. Among other available options, this flap is, in our opinion, an ideal solution that has superior advantages.

Aged↗
PubMed1998

Reconstruction of a complex hypopharyngeal cervical defect with a single latissimus dorsi free flap.

Large, complex hypopharyngeal defects that include mucosa and cervical skin, and that result from debridement of orocutaneous fistulas secondary to failed repairs of laryngectomy defects, are difficult to treat, especially when previous irradiation has damaged adjacent tissues. We have found that such defects can be repaired sufficiently in one stage using a latissimus dorsi musculocutaneous free flap. The wound is debrided until only healthy tissue remains. The skin paddle of the free flap is then used to reconstruct the hypopharyngeal mucosal defect, whereas the muscular portion serves to cover any cervical tissue that remains exposed. A split-thickness skin graft is then placed over the muscle to complete the repair. The resulting reconstruction is free of excess bulk, has no radiation damage, is well vascularized, and has an acceptable appearance.

Adult↗
PubMed1998

Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects.

Full-thickness abdominal wall defects continue to be a challenge for the reconstructive surgeon. The most frequently used reconstructive techniques are transfer of a pedicled, local abdominal flap or a distant flap from the thigh region. The purpose of this paper is to present a new approach to full-thickness abdominal wall reconstruction using an innervated free latissimus dorsi musculocutaneous flap. Four patients with large full-thickness abdominal wall defects underwent reconstruction with a free innervated latissimus dorsi muscle flap. In two patients, staged abdominal wall reconstruction was performed. Primary closure was first obtained with a skin graft. During the subsequent definitive reconstruction (with an innervated free latissimus dorsi muscle flap), this skin graft was not excised. Instead, deep dermabrasion of the skin graft was performed, leaving a residual dermal layer. This layer was then covered with a free innervated latissimus dorsi muscle flap. In these two cases, there was no need for the use of a prosthetic mesh. A single stage reconstruction was performed in the other two cases. After abdominal wall sarcoma resection, Prolene mesh was placed and subsequently covered with a free innervated latissimus dorsi muscle flap. There were no free flap failures. The average time of surgery was 4 hours, 50 minutes. The average hospital stay was 14 days. No significant complications occurred except for one donor site seroma. No hernias have occurred postoperatively. The mean follow-up was 21 months. Postoperatively, electromyographic testing was performed regularly in all patients to document reinnervation of the latissimus dorsi muscle flap. With reinnervation and intensive muscle training, the transplanted latissimus dorsi muscle offers enough contractile capacity and strength to adequately replace the function of the missing abdominal wall muscles. In complicated staged reconstructions, dermabrasion of the temporary skin graft allows for the use of a residual dermal layer as a fascia-like substitute to aid in the restoration of structural integrity. The combination of the dermal layer with an innervated free latissimus dorsi muscle provides a strong, vascularized fascial repair as well as an overlying vascularized soft-tissue coverage. In conclusion, adequate functional dynamic reconstruction of full-thickness abdominal wall defects is possible using an innervated free latissimus dorsi muscle flap. The reinnervated latissimus dorsi muscle is suitable for reconstitution of the missing functional and anatomic components of complex abdominal wall defects.

Abdominal Muscles↗
PubMed1998

Facial reconstruction using a retroauricular-temporal free flap.

Large and deep soft-tissue defects of the face usually require resurfacing by free-tissue transfer. An appropriate free flap for facial reconstruction may be harvested from the retroauricular and temporal region utilizing two arterial pedicles (superficial temporal artery and posterior auricular artery). This flap provides normal color, texture, and thickness and thus is an optimal anatomic and aesthetic reconstruction with minimal donor-site morbidity.

Adult↗
PubMed1998

Clinical experience and indications of the free serratus fascia flap: a report of 21 cases.

The free "serratus fascia" flap as a free flap was first described by Wintsch and named a free fascia flap of gliding tissue; however, it has not yet been given a distinct name. The particular advantages of this flap consist of an easy access and a low donor-site morbidity without functional deficit. Additionally, it may be designed very variably and molded even three-dimensionally as a tendon wraparound flap or folded to fill up cavities. In our clinic, we used this flap in 21 patients for distinct indications and in 7 patients as a vascular graft in fingers or great toe with a minimal adjacent layer of gliding tissue around the vessels for the treatment of cold intolerance after finger replantation or severe finger or toe trauma. In the other cases, this versatile flap served for the coverage of traumatically exposed tendons or bones at the extremities, covered with a skin graft. Eighteen flaps survived completely, whereas 3 flaps developed partial or superficial necrosis. Only once did a major complication by unintentional sacrification of the long thoracic nerve during flap harvesting occur, resulting in a wing scapula. We recommend this flap for defect cover at sites where a thin vascularized gliding layer for defect cover is needed, especially in distal extremities with exposed tendons or nerves, and present the current indications in discussing our experiences.

Adolescent↗
PubMed1998

[Use of the internal mammary artery in reconstructive microsurgery in the thoracic region: anatomical-radiologic study].

In this study, the topographic anatomy and the diameter of the internal mammary (thoracic) vessels was investigated in regard to their potential as a recipient vessel in reconstructive microsurgery in the ventral thoracic region. Particularly for reconstruction of large thoracic wall defects as well as for female breast reconstruction with free tissue transplantation, these vessels seem to be suitable due to their location. We performed an anatomical study on 86 cadavers and a radiological investigation on 50 female patients and volunteers. We found a mean diameter on 50 female patients and volunteers. We found a mean diameter of 1.8 mm of the artery and 2.1 mm of the commitant vein at the level of the fourth rib, one to two centimeters parasternally. We conclude that the internal mammary vessels can serve as recipient vessels in reconstructive microsurgery in the ventral thoracic region at the level of the fourth rib or cranially. Hypothetically, free muscle flaps for the treatment of sternal osteitis, free fasciocutaneous flaps to replace presternal burn scars or appropriate flaps to fill up a funnel chest cavity subcutaneously may be anastomosed to the internal mammary vessels.

Adult↗