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Biomedical subjects

H E Kleinert

Publications and source records attributed to H E Kleinert.

At least 37 records · Page 2Linked to original sources
PubMed1984

Primary microsurgical repair of ring avulsion amputation injuries.

Patients with ring avulsion injuries of the fourth and fifth digits often demand attempts at reconstruction rather than completion of the amputation. In the past, this has led to reconstruction involving a staged series of operations with results that were often less than desirable. Seven patients with ring avulsion amputation injuries that were reconstructed by use of microsurgical reanastomoses are reported. All were classified as either Carroll type IV or Urbaniak type III. Six patients (85%) had a successful replantation leading to a useful finger. The operating time averaged 5.5 hours. On average, 1.9 arteries (range 1 to 2) and 3.3 veins (range 2 to 5) were repaired for each digit. Average hospital stay was 6.7 days (range 4 to 15). Average range of motion was 0(2)/84(2) for metacarpophalangeal joint and 15(2)/90(2) for proximal interphalangeal joint (PIP) with distal interphalangeal joint ankylosis at between 0(2) and 15(2) of flexion. Sensibility was protective in all cases and good in three. If the PIP joint was damaged, completion of amputation was the treatment of choice. If the amputation is distal to the PIP with a functional superficialis tendon, primary microsurgical repair is the treatment of choice in complex ring avulsion injuries.

Adult↗
PubMed1984

Current state of flexor tendon surgery.

Successful restoration of function after flexor tendon injuries continues to present a challenge to the treating surgeon. Primary repair of tendon and associated injuries is the treatment of choice in clean wounds in all zones of the hand. In cases of untidy wounds or when associated injuries preclude primary repair, delayed primary or secondary repair may be performed. Tendon grafting in one or two stages is reserved for late secondary cases in which scarring of the bed, loss of pulleys, permanent retraction of the tendon ends, or joint contractures prevent direct repair. Meticulous attention to detail such as adequate exposure, careful opening and closing of the sheath, gentle handling of the tendons, a secure, smooth tendon juncture and proper postoperative splinting is essential for a successful outcome of direct repair. Tendon grafts done as a secondary procedure require the same attention to minutiae for an adequate functional outcome.

Biomechanical Phenomena↗
PubMed1983

Neurovascular cutaneous flaps for the management of radiation-induced fingertip dermal necrosis.

Acute local radiation burns to the fingertips of two patients were treated by late excision of the ulcerations and resurfacing with both free and axial island neurovascular cutaneous flaps. This technique has the advantage over local flaps and skin grafts of not only restoring fingertip function and relieving pain but also bringing in new blood supply to an area previously rendered ischemic.

Adult↗
PubMed1982

Vascularized autogenous whole joint transfer in the hand--a clinical study.

Nine vascularized autogenous whole joint transfers were employed in the reconstruction of traumatized joints of six male patients ages 6 to 38 years. The proximal interphalangeal joint was involved in four patients, the thumb metacarpophalangeal (MP) joint in two, and the small finger MP joint in one. In five patients, the donor joint came from the foot, and in one patient an MP joint was transferred from a digit that had sustained a more distal amputation. The mean follow-up was 24 months (range 13 to 38). Bony union as well as full radiographic preservation of the articular space has occurred in each case. Four joints were transferred with an open epiphysis and three demonstrated longitudinal growth and an intact epiphyseal plate. The mean range of active motion was 22 degrees/55 degrees. We believe the early results demonstrate the feasibility of this method of joint reconstruction in the young patient.

Adolescent↗
PubMed1982

Salvage replantation of lower limb amputations.

Three cases are reported in which the microsurgical salvage of parts of traumatic lower extremity amputations associated with degloved proximal skin loss provided sturdy, sensate skin and soft-tissue coverage and thereby preserved functional below-knee amputation levels. In two instances, a free innervated filletted flap was constructed from the foot of the amputated limb, and in the third case, the amputated lower leg was shortened, successfully replanted, and followed later by elective amputation of a foot at the Syme level. At a mean follow-up of 2 years, all three patients are ambulating well in below-knee prostheses.

Adult↗
PubMed1981

Three complications of untreated partial laceration of flexor tendon--entrapment, rupture, and triggering.

Three patients developed complications as a result of unrepaired and untreated partial laceration of flexor tendons. In one, narrowly based flaps of the tendons became entrapped in a rent in the flexor tendon sheath. In a second, delayed rupture of the flexor pollicis longus occurred when force was applied to the tendon 2 weeks after the injury. In the third, triggering of the thumb occurred 2 months after a laceration which passed through the annular pulley into the tendon.

Adult↗
PubMed1981

Reduction flexor tenoplasty. Treatment of stenosing flexor tenosynovitis distal to the first pulley.

Trigger finger due to stenosing flexor tenosynovitis distal to the first annular pulley is not a common finding; however, when present, it introduces a diagnostic and therapeutic challenge. Resection of the second annular pulley for release of triggering at this level may leave the patient with impaired function. The pulley can be preserved by removing an elliptical portion of the center of the tendon through a lateral incision.

Adult↗
PubMed1981

Present indications and contraindications for replantation as reflected by long-term functional results.

It is evident that the independent experiences of these hand surgery units in three completely different parts of the world are remarkable similar. For the most part, one can readily account for the differences reported on the basis of interpretations of such vague terms of evaluation as "good" or "poor" and on case selection, which is often dictated by local cultural considerations. For example, a hand with some useful prehension placed on an extremely shortened arm may be most welcome to a Chinese patient, whereas a hand attached to the humerus may be looked upon as grotesque in the Western cultures an so be psychologically devastating. Yet, such differences are minor compared with the common pattern of experience that clearly exists and upon which conclusions can be based for formulating some general guidelines. Indications for upper limb reattachments at this time are neither absolute nor static. They are relative, dynamic, and surely will change as experience increases and techniques become even more refined. Success must not be equated with tissue survival but measured only in terms of what the effort has done for the patient in a global sense. As yet, completely satisfactory system for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not change.

Arm↗
PubMed1980

Methods and results of replantation following traumatic amputation of the thumb in sixty-four patients.

Immediate survival and functional results were studied in 64 thumb replantations performed during a 3 year period. The failure rate, 27% overall, was higher in patients over 50 years of age (50%) and following avulsions with or without crushing injuries (58%). Long vein grafts from the radial artery proximally to the thumb arteries distally were employed in 15 patients to bypass the traumatized area in the first web space. A higher survival rate (90%) was associated with the use of vein grafts to restore venous return. Half of the patients followed 6 months or longer had good discriminatory sensibility (less than 10 mm). Sensory return and cold intolerance were worse in older patients and were not related to level of injury, mechanism of amputation, total ischemia time, or number of arteries or veins repaired. Loss of motion of the replanted thumb was a frequent cause for inadequate return of function. All thumbs should be considered for replantation, but the results will be poorer in older patients. If possible, motion of the interphalangeal and metacarpophalangeal joints should be preserved.

Adolescent↗
PubMed1980

Treatment considerations in carpal tunnel syndrome with coexistent Dupuytren's disease.

Twenty-nine patients with involvement of 31 hands presented with coexisting carpal tunnel syndrome and ipsilateral Dupuytren's disease. Analysis of the patient population showed a high proportion of women, dominant hand involvement, and repetitive manual trauma. Various treatment combinations were used and the results evaluated. Simultaneous surgical excision of Dupuytren's contracture and carpal tunnel release gave compromised long-term results, particularly among the women. To minimize complications, it is advised that carpal tunnel release not be performed at the same time as excision of Dupuytren's contracture.

Adult↗
PubMed1980

Giant cell tumor compression of the deep branch of the ulnar nerve.

A case of giant cell tumor compression of the ulnar nerve at the loge de Guyon is noted. Due to great variation of the anatomy of the deep branch, plus the varying locations of lesion appearance, numerous presentations of the ulnar tunnel syndrome are manifested. When recognized, early surgery and complete decompression are in order.

Adult↗