Biomedical subjects

H Anderl

Publications and source records attributed to H Anderl.

At least 37 records · Page 2Linked to original sources

PubMed1998

Internal mammary vessels as a recipient site.

In breast reconstruction with a free flap, the selection of suitable recipient vessels remains one of the most critical decisions for the surgeon. Most surgeons use one of the branches of the axillary vascular system, the thoracodorsal vessels. Because of a number of difficulties using this recipient site, the authors investigated the anatomy and availability of the internal mammary vessels for free flap breast reconstruction. This article describes the anatomic considerations, surgical technique, clinical experience, advantages, and limitations of using these vessels. In recent years, free autogenous tissue transfer for breast reconstruction has become increasingly common. The free transverse rectus abdominis myocutaneous (TRAM) flap and the more recently described deep inferior epigastric artery (DIEA) perforator flap are currently the methods of choice for postmastectomy breast reconstruction. For patients who cannot have a TRAM flap, free flaps from other donor sites (superior gluteal flap, inferior gluteal flap, Rubens flap, lateral transverse thigh flap) also have become important options.

Female↗

PubMed1997

[Dynamic and functional abdominal wall stabilization, reconstruction of extensive abdominal wall defects].

The aim of any abdominal wall reconstruction is maximal functional stability and adequate soft tissue coverage. The anatomy, elevation and clinical application of the myofascial tensor fasciae latae transposition flap and of the microvascular musculocutaneous latissimus dorsi free flap are presented. Repairing extensive fascial defects and recurrent hernias with the tensor fasciae latae transposition flap provides strong, dynamic, and functional reconstruction of fascial continuity to prevent a further recurrence. Adequate functional and aesthetic repair of a full-thickness abdominal wall defect can be optimally managed by the innervated microsurgical latissimus dorsi free flap.

Abdominal Muscles↗

PubMed1997

[Infection prophylaxis in complex limb trauma through immediate definitive reconstruction via a free tissue transfer].

The concept of emergency free tissue transfer for severe extremity injuries represents a cutting-edge technology. We discuss our very positive results with this technique. The conceptual reasons for these favorable results, compared with conventional approaches, are also discussed. An initial, radical debridement is the most important part of the operation. This is then followed by osteosynthesis. The correct type of free tissue transfer is chosen according to the requirements of the soft tissue defect. Qualitatively better results with earlier definitive rehabilitation were achieved with free tissue transfer performed during the acute stage of limb wound treatment. The follow-up period ranged from 3 months to 8 years. We experienced neither flap loss, osteomyelitis, nor severe wound infection. Using the modern concept of emergency free tissue transfer, we reduced the rate of flap loss and associated morbidity while achieving a functionally improved reconstruction.

Adolescent↗

PubMed1997

[Replantation in childhood and adolescence. Long-term outcome].

In 31 (out of 48) patients with 43 (out of 63) replanted or revascularized digits or parts of the extremities a study of long-term results was performed. Their ages were below 16 years at the time of injury. The results concerning function, sensitivity, cold intolerance, growth disturbance, patient acceptance and occupational changes were evaluated. Early complications consisted of venous stasis in 10.6% (n = 4), skin necrosis of the wound margin in 5.3% (n = 2) and in finger-tip necrosis in 5.3% (n = 2). One lower arm and one finger replanted (5.3%, n = 2) were lost after several revisions due to venous problems. In no case did arterial problems occur. Tendon adhesions were the most common complication in 28.9% (n = 11), followed by deviation of the axis in a frontal plane of more than 20 degrees in 13.3% (n = 5) and by joint instability in 5.3% (n = 2). Only twice (5.3%) did ankylosis or in another case osteomyelitis of the proximal phalanx result. At amputation level II (between the DIP joint and the nail root), 37.5% (n = 3) developed a reduction of range of active movement (RAM) with a mean of 31.7 degrees, and once an arthrodesis was necessary, whereas 50% (n = 4) of the patients have full range of active motion. At amputation level III (between the MP and DIP joint) 52.7% (n = 10) developed a reduction of RAM at the PIP joint with a mean of 29.5 degrees, and twice an arthrodesis was necessary, whereas 26.4% (n = 5) of the patients have full range of active motion. Of the patients 78.9% (n = 15) developed a reduction of RAM at the DIP joint with a mean of 35.7 degrees, and twice an arthrodesis was necessary. Only twice was ankylosis present, but 10.5% (n = 2) of the patients have full range of active motion. Excellent sensory recovery was observed with a mean dynamic two-point discrimination of 4.8 mm. In addition, only 29% (n = 9) of the patients report a surprisingly low incidence of cold intolerance, which is in contrast to adults with up to 100% cold intolerance in replanted digits. In 67.7% a radiologically measured difference of length with a mean of 3.8 mm and clinically measured a difference in the length of the digits with a mean of 4.9 mm was observed without complaints by the patients, instead, there was moderate discontent with the aesthetically disturbing fingertip atrophy, which was up to 30% in 48.4% of the patients. Of the patients who are now adult, 16.7% (n = 4) changed their choice of profession due to the trauma or because of the dissatisfactory result. These results and the success rate of 94.7% suggest the conclusion that one should not hesitate to perform a replantation or revascularization in children with even multiple amputations as the results are excellent.

Adolescent↗

PubMed1997

Reconstruction of large palmar defects of the hand using free flaps.

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.

Adult↗

PubMed1997

Free-flap monitoring with tissue-oxygen measurement.

Flap monitoring by oxygen measurement with a microcatheter pO2 probe was carried out in 17 free flaps. The probe represents a new development among monitoring methods, allowing the measurement of oxygen pressure in all types of flaps including buried free flaps and vascularized bone grafts. Fourteen flaps survived with no problem. Three flaps with different degrees of problem are reported, and the advantage, and sources of error using this monitoring method are discussed.

Adult↗

PubMed1997

Primary flap closure in complex limb injuries.

Free-tissue transfers enable surgeons to reconstruct or salvage limbs injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerves. Primary free-tissue transfer is performed following debridement, bone fixation, and repair of injured structures within 24 hr after injury. Between 1987 and 1996, 57 patients who had complex extremity traumas were treated with primary free-tissue transfer, or free flaps. Long-term follow-up ranged from 4 months to 9 years (median: 4.5 years). No flap failure or serious wound-healing complication occurred using the protocol. Radical debridement and primary free-flap coverage in extensive extremity injuries can salvage limbs, provide improved functional and aesthetic results, and psychologically benefit patients through lowered morbidity. Other benefits include reduced incidence of free-flap failure, postoperative infection, secondary operative procedures, and invalidity, as well as shorter hospital stays, and lowered medical expenses.

Adult↗

PubMed1997

Internal mammary veins: classification and surgical use in free-tissue transfer.

The internal mammary artery has been well-investigated due to its frequent use in cardiac surgery. However, in reconstructive microsurgery in the thoracic region, the internal mammary vessels have been used rarely as recipient vessels, due to difficulties and lack of knowledge about the internal mammary veins. This study was designed to investigate the anatomy and topography of the veins. Its goal was to gain sufficient information about their availability in free-tissue transfer. Dissection of the vessels was performed in 86 cadavers bilaterally to the sternum. At the level of the fourth rib, which is the most desired access for microvascular anastomosis in reconstructive breast surgery with free flaps, the veins were found to be adequately large (range 0.64 to 4.45 mm). Results were in close agreement with 100 bilateral measurements obtained by color Doppler sonography in 16 patients preoperatively, and additionally in 34 healthy volunteers. Preoperative detection of vessels with the aid of sonography facilitated planning of surgical procedures. According to these findings, the internal mammary veins may be used as suitable recipient veins for free microvascular tissue transfer, especially for established autologous breast reconstruction with the free transverse rectus abdominis myocutaneous flap, or for reconstruction of complex thoracic-wall defects.

Adolescent↗

PubMed1997

Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention.

This prospective study reveals that the incidence of seroma formation after harvesting the latissimus dorsi muscle by scalpel is reasonably moderate. This incidence is lower when the resulting skin flaps are tacked to the underlying structures with resorbable sutures. In contrast, electrocautery dissection shows a significantly much higher rate of seroma formation, probably because of thermal injury of the wide fascial wound layers or the subcutaneous fat tissue. Fifty-eight patients were distributed among three groups. Within each group a specific way of latissimus dorsi muscle harvesting and donor site treatment was accomplished. The group of scalpel dissection and skin flap fixation to the underlying layers with additional tacking sutures shows the lowest rate of seroma formation (9.1%, N = 2) due to the avoidance of shearing effects. A clearly higher incidence is present in the group of scalpel dissection without tacking sutures (38.1%, N = 8), whereas seromas most frequently result after electrocautery dissection without skin flap fixation (80.0%, N = 12).

Cysts↗

PubMed1997

Free flap closure of recurrent palatal fistula in the cleft lip and palate patient.

Recurrent palatal fistulas present a particularly vexing problem for the cleft surgeon. In this setting, the cycle of repair followed by breakdown results in increasing scar formation with associated soft tissue contracture and a resultant increase in fistula size. This pernicious cycle of events renders random local tissue transfers obsolete. As such, the cleft surgeon must look to tongue flaps or local axial pattern flaps as a means of bringing well-vascularized, pliable tissue into the defect. Although this approach has been the standard of care for the last few decades, we believe that the modern-day success rates of free tissue transfers (95%) make them a viable, one-stage means of closing these defects. In this report we present our clinical experience with recurrent palatal fistulas and highlight the effective use of the dorsalis pedis-first dorsal metatarsal artery free flap as a means of repair.

Child↗

PubMed1997

Functional urinary bladder wall substitute using a free innervated latissimus dorsi muscle flap.

This study was designed to investigate the ability of the latissimus dorsi muscle in situ to evacuate a bladder reservoir and to study the functional, anatomic, and histopathologic results of partial or subtotal bladder reconstruction with an innervated free latissimus dorsi muscle in mongrel dogs. In group I (four dogs), the latissimus dorsi muscle was dissected and tailored in situ. Then the so-formed pedicled latissimus dorsi muscle flap was wrapped around tissue expanders of varying sizes (volumes of 50, 100, and 150 cc, respectively) to form a bladder-like reservoir. Electromyography and intraluminal pressure measurements were done at the time of surgery and 6 months thereafter using a standard electromyograph and a Dantec urodynamic unit. In group II (four dogs), the dome of the bladder wall was removed, with up to 50 percent of the mucosal layer being left intact. The resulting muscular defect was repaired with a free innervated latissimus dorsi muscle flap. The transferred latissimus dorsi muscle was shaped and wrapped around the bladder in a spiral form, with particular attention to the resting tension. The thoracodorsal vessels were anastomosed to the pelvic branches of the hypogastric vessels, and the thoracodorsal nerve was coapted to a pelvic motor nerve that was selected by use of a nerve stimulator. Cystography and urodynamic studies were performed after 3, 6, and 9 months. Electromyography was done after 9 months, before sacrifice of the animals, which was followed by regular histologic and electron microscopic examinations. Stimulation of the thoracodorsal nerve of the reconfigured latissimus dorsi muscle reservoirs in situ after 6 months yielded average intraluminal pressures of 190 cmH2O at maximum capacity and 35 cmH2O at a minimum capacity of 10 to 15 cc. Stimulation of the latissimus dorsi muscle transferred to the bladder resulted in a visible and measurable contraction of the transplanted muscle after 9 months. Urodynamic values preoperatively and postoperatively were basically unchanged. During cystography, the bladder outline was smooth during both filling and voiding. Light and electron microscopic examinations confirmed viable, reinnervated muscle. The reconfigured pedicled latissimus dorsi muscle has the ability to evacuate a bladder-like reservoir after nerve stimulation. A detrusor function of the bladder can be induced through the contractility of a reinnervated free latissimus dorsi muscle that was wrapped around the bladder. An innervated free latissimus dorsi muscle flap does not undergo severe muscle fibrosis, contracture, and atrophy such as occur after transfer of completely or partially denervated, pedicled muscle. This means that a functional bladder reconstruction/augmentation can be achieved by microneurovascular transfer of a latissimus dorsi muscle flap.

Animals↗

PubMed1996

[Plastic surgery treatment of extensive decubitus ulcers of the pelvic area].

Between 1980 and 1995, 207 patients with 219 extensive pelvic pressure sores underwent reconstructive surgery at our department. Eighty patients operated upon between 1992 and 1995 were followed up. The postoperative complication rate was 22% and the relapse rate 27%. Pre- and postoperative management has been standardized for the purposes of quality control. The value of preoperative management, choice of flap, operative procedure and postoperative care are discussed in this paper.

Adolescent↗

PubMed1996

The instep free flap to resurface palmar defects of the hand.

Large and deep soft-tissue defects of the hand require adequate resurfacing by free or distant pedicle flaps. A free flap of suitable size corresponding to the extended palm defect may be harvested from the instep region without encroaching on the weight-bearing area. Following Gillies's concept that "losses must be replaced in kind," and taking into consideration all possibilities of a free-flap reconstruction of the hand, we can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, and color and thus an optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity.

Adult↗

PubMed1996

Retrobulbar fibroblasts from patients with Graves' ophthalmopathy induce downregulation of APO-1 in T lymphocytes and protect T cells from apoptosis during coculture.

Retrobulbar fibroblasts are a main target of the immune process in Graves' ophthalmopathy (GO) and have been shown to have unique metabolic qualities. The aim of our study was to analyze the immunoregulatory properties of retrobulbar fibroblasts and particularly whether fibroblasts were able to protect T cells from apoptosis. Retrobulbar fibroblasts from patients with GO spontaneously expressed higher concentrations of HLA class I and HLA class II (p<0.05) than control cells, whereas basal CD54 expression was unimpaired. Stimulation with IFN gamma led to a more pronounced increase in HLA class I, class II and CD54 in autoimmune fibroblasts than in control cells (p<0.05). Fibroblasts from both groups had the capacity to prevent apoptosis in preactivated peripheral T cells during coculture. T cell survival was, however, more pronounced after coculture with retrobulbar fibroblasts than with control cells (p<0.05). Prevention of T cell death was associated with a decreased expression of APO-1 on the T cell surface, whereas the bcl-2 expression of the T cells remained unchanged. Our results suggest that the increased expression of immunoregulatory molecules combined with a pronounced capacity of autoimmune fibroblasts to protect infiltrating T cells from apoptosis might at least partly explain the site selectivity as well as the perpetuation of the extrathyroidal manifestation of Graves' disease.

Apoptosis↗

PubMed1996

The bipedicled flap on the lower leg, a valuable old method? Its indications and limitations in 12 cases.

Covering defects of the lower leg is still an exceptional problem when tendons or bone are exposed within small defects, particularly in the malleolar region. We present 12 cases of successful wound closure on the lower leg with the versatile bipedicled flap. We had a low incidence of minor complications, whether it was used as a cutaneous, fasciocutaneous, or myo-fasciocutaneous flap, in some cases also based on underlying perforators to guarantee perfusion of the flap. If it is limited to selected indications and patients, the bipedicled flap may be a reliable alternative to other, more sophisticated methods of tissue transfer.

Adult↗

PubMed1996

Emergency free flap cover in complex injuries of the lower extremities.

Nineteen patients with complex injuries of the lower extremities were treated with emergency free flap reconstruction after radical débridement, bone stabilisation, and primary repair of injured structures (nerves, tendons, vessels, and muscles). Two patients sustained complete below knee amputation associated with avulsion of soft tissue and had salvage free flap transfer to preserve length of stump and function of knee joint. Long-term follow up ranged from four months to eight years (median 3.5 years) No flaps failed and there were no serious complications of wound healing. Procedures were associated with minimal morbidity, a reduced number of secondary operations, shorter hospital stay, and good functional results.

Adolescent↗

PubMed1996

[Indications and concepts for plastic surgery therapy in chronic varicose ulcer].

In the treatment of extensive leg ulcers, surgical therapy is superior to conservative methods in many respects. Radical resection of sclerotic tissue around the ulcer and its causing veins is essential, followed by defect cover with mesh-skin grafts. Surgery leads to prompt healing with a shortened hospitalization and therefore decreases costs; it leads to a prompt relief of pain and a low rate of recurrence. Especially in the aged patient the indication for operation must be well-considered and discussed interdisciplinarily. Even though operative technique seems to be simple, it should be reserved for the plastic surgeon experienced in the treatment of these lesions.

Adult↗

PubMed1995

Internal mammary vessels: anatomical and clinical considerations.

This study was designed to investigate the anatomy of the internal mammary (thoracic) artery (IMA) and comitant vein(s) (IMV) relevant to their use in microsurgery. We dissected the internal mammary (thoracic) vessels bilaterally in 86 cadavers from the clavicle down to the 6th rib. At the level of the 4th rib, the distance between the sternum and the IMA was large enough [range 10.0-23.6 mm] and the diameter of the IMA [range 0.99-2.55 mm] and comitant vein(s) [range 0.64-4.45 mm] wide enough for both end-to-end and/or end-to-side anastomosis. These results were in close agreement with supplementary measurements obtained by Doppler ultrasound in 34 healthy female volunteers. Based on all these findings we suggest that the internal mammary vessels are suitable recipient vessels for free tissue transfers in the thoracic region, especially for breast reconstruction with the free transverse rectus abdominis myocutaneous (TRAM) flap.

Adult↗