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Biomedical subjects

J Holle

Publications and source records attributed to J Holle.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Late results following surgical correction of syndactyly and symbrachydactyly].

Growth and the type of surgical treatment of the hand play an important role in the results of surgery in children. 29 patients have been operated on because of syndactyly and symbrachydactyly and were controlled. The following parameters were assessed: kind of incision and skin graft, functional results, x-ray to examine the skeleton and the depth of the commissure, colour of the skin graft and use of the hand. After operation of syndactyly all patients were able to use their hands normally, although full extend of flexion and extension was achieved only in 20 of 22 hands. In 5 divided pairs of fingers there was recurrence of syndactyly. In all cases except one, a split thickness skin graft has been used. After operative treatment of symbrachydactyly and complex syndactyly, full extent of flexion was achieved in 13 of 19 hands, in 6 hands the range of flexion was incomplete because of skeleton abnormalities. Recurrence occurred in 9 divided pairs of fingers; in 7 cases, a split thickness skin graft had been used. Despite this, all patients were able to use their hands normally. The use of split thickness skin grafts resulted in a 60% recurrence rate, whereas the use of full thickness skin graft led merely to 7.5% recurrence rate. Our results show the advantage of the full thickness skin graft. As a consequence, full thickness skin graft should be used in all cases. Furthermore, the operation should be performed at an early age, if fingers of unequal length have to be separated. Zig-zag incision should be used in all cases.

Child↗
PubMed1987

[Comparative study of primary and secondary management of flexor tendon injuries].

In 1974 a replantation service started at the authors' department. Before that time the treatment of flexor tendon injuries was mainly performed secondarily. Therefore, the authors had the opportunity to compare patients after primary and secondary surgery. In 52 primarily and 22 secondarily treated patients the technique of Kleinert was used. Following issues were investigated: functional results, decrease of grip strength, influence of early mobilization on sensibility restoration in cases of nerve injury, relation between sensitivity to cold and vessel and nerve injuries, duration of physiotherapy and disability. The damage of only one finger might lead to decrease of grip strength. Primary surgery was superior to secondary surgery. Early mobilization in cases of additional nerve injuries did not affect sensibility restoration. Poor sensibility increased the chance of cold sensitivity. The duration of physiotherapy and of disability depended on the need for second procedures such as tenolysis which was more common in the group of secondarily treated patients.

Adolescent↗
PubMed1986

Influence of long-term low direct current on rat ischiadic nerves.

The effects of a low direct current on peripheral nerves and electrodes on the ischiadic nerve were investigated, and a constant direct current was applied for various time periods. Afterwards clinicophysiological tests and histological evaluations were performed. The muscles of 55 rats could be stimulated by external stimulation during the follow-up examinations, but 90% of all animals showed microscopically visible nerve tissue alterations which might have been caused by mechanical rather than electrolytic factors.

Animals↗
PubMed1985

[Free muscle transplantation].

To survey the current use of free muscle transplantation in the German speaking part of Europe, a questionnaire was sent to all Replantation Centres in 1982/1983. The answers revealed that micro-neurovascular muscle transplantation for functional use is still an uncommon procedure. Its use in facial palsy, in the sphincter region and in reconstructive procedures in extremities is emphasized and postoperative healing and functional improvement is shown in a diagram. The follow-up period is too short to discuss functional improvement in detail. Regarding our own cases, we are quite impressed by the result of free microneurovascular muscle transplantation in unilateral irreversible facial palsy patients, but are unable to prove the final result in extremities because of short observation time.

Adult↗
PubMed1984

[The problem of scars in heart surgery with special reference to the use of static magnetic fields].

An attempt is made to survey the pathophysiology of wound healing, as well as the aetiological factors involved and the possibilities of therapeutic intervention to prevent the formation of hypertrophic scars and keloid after cardiac operations. Several prophylactic measures are discussed, with special reference to the use of static magnetic fields. Their application to scars after cardiac operations was carried out by energy pak foils. Patients treated with these foils showed slightly improved results as compared with a control group. The results, however, were not statistically significant.

Adult↗
PubMed1984

Breast reconstruction with an external oblique abdominis muscle turnover flap and a bipedicled abdominal skin flap.

A new technique of breast reconstruction is demonstrated using a turnover flap of the external oblique abdominis muscle together with a sheath of the rectus muscle to enlarge the submuscular pectoralis major pocket for the implant. To overcome a tight skin, a bipedicled abdominal skin flap is transposed for breast reconstruction. In so doing, a natural-looking breast is formed by a simple operative technique with rare complications. The technique has been applied in 11 patients with good results.

Abdomen↗
PubMed1984

[Operative technic in muscle transplantation with microneurovascular anastomoses based on animal experiment studies].

The influence of the transient ischemia during free muscle transplantation with microneurovascular repair was studied in the rectus femoris muscle of the rabbit, as well as the effect of denervation and reinnervation by nerve suture. Both factors, ischemia and nerve suture, were taken together in a separate series. The functional results of the different kinds of reinnervation by nerve suture, by nerve implantation and by muscular neurotisation were compared. The possibility to use a motor nerve elongated to the contralateral side by nerve grafting was tested. In a further series the effect of changes of the initial tension of the muscle during the transplantation was clarified. These isolated factors were compared with the real transplantation from the left to the right side. As the most representative parameter for function the maximal tetanic tension was chosen for evaluation. Our results show that the following considerations in the operative technique are significant. To shorten the time of ischemia the donor and recipient area should be prepared for transplantation at the same time, the recipient vessels should be elongated before the muscle transplant is taken off, and the arterial anastomoses should be performed before the venous. For reinnervation of the muscle transplant nerve suture is more successful than nerve implantation. Both methods can be combined to make good use of all the potential of reinnervation. The muscular neurotisation should be used only in the face and for sphincter reconstruction. A contralateral source of reinnervation is useful in the face, but it is not in the extremities. The restitution of the original initial tension of the muscle after transplantation is of great importance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

[Reconstruction of grip function in cases of a fingerless or missing hand].

In two cases a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient all fingers of the left hand were amputated at the metacarpo-phalangeal joint level. The second and the third finger were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. The distal and middle phalanx of the transplanted third toe had to be re-amputated because of mummification two weeks after the transplantation and was covered with a groin flap. Good function of the newly formed grip could be demonstrated. The second patient was a 21-year old man with amputation of both hands. Grip reconstruction in the right lower arm was performed by transplantation of the second toe of each foot together with a metatarsal bone and a dorsalis pedis flap. One year after the operation the follow-up study demonstrated good function of the newly formed hand. The patient is able to use his two new fingers during daily life mainly to hold small objects. The sensation and the range of movement of the newly formed right hand are demonstrated and discussed.

Adult↗
PubMed1984

Improvement of continence by myoplasty of the pelvic floor.

The authors report their experiences with sphincter reconstructions by free muscle transplant using a denervated muscle with its blood supply intact. The transplanted muscle is fixed to the remaining functioning sphincter musculature. New muscle fibres grow from this muscle into the transplanted muscle, allowing the reconstructed sphincter to contract voluntarily as well as reflexively. The operative technique depends on the existing sphincter defect. Free muscle transplantation is preferred if the external sphincter is still partially existing. Eight patients were examined 2 years after the reconstruction operation and the result was very satisfactory. Solid and semi-solid stool could be controlled by all patients. Large muscle transplantations carried out after the method reported by Thompson (1971) are followed by an increased intramuscular scar formation, as was shown by our experiments. A denervated muscle transposition with its own blood supply is therefore preferable. The change of innervation allows the transplanted muscle to perform its new function. In the treatment of congenital sphincter malformations, a larger muscle, i.e. transposition of the denervated gracilis muscle, should be used. This operation was performed in 7 cases of incontinence following operations for rectal atresia and in 1 case of extensive posttraumatic destruction of the sphincter apparatus. In only 1 case was continence for solid stool achieved. In 6 patients there was a temporary control of fluid stools, but under stress all patients with complex sphincter malformations soiled.

Adolescent↗
PubMed1983

[Percutaneous measurement of oxygen partial pressure as an evaluation method of free flaps].

Transcutaneous, polarographic pO2-measurement can be used to estimate and monitor the circulation in free tissue transfers. Our experience in this field using a modified Clark's electrode is reported by presenting some examples. Its value in intraoperative and postoperative monitoring and for the early diagnosis of a critical reduction of blood flow in free flaps with microvascular anastomoses is assessed in the light of our early experience with this technique.

Blood Gas Analysis↗
PubMed1982

An experimental comparison of the different kinds of muscle reinnervation: nerve suture, nerve implantation, and muscular neurotization.

In this experimental study, the changes in histologic pattern and functional recovery of the rectus femoris muscle of the rabbit were investigated 6 months after denervation and immediate microsurgical repair of the nerve supply of the muscle. Three different ways of reinnervation were used: nerve suture, nerve implantation directly into the muscle, and muscular neurotization by the underlying muscle. For evaluation, histochemical methods and tension measurements were used. In the results, nerve suture and nerve implantation were superior to muscular neurotization. Nevertheless, muscular neurotization was successful in all cases and led to positive EMG recordings. The functional recovery in the nerve suture and in the nerve implantation groups was astonishingly high and reached 70 to 80 percent of the tension of the control muscles. The results of this experimental study and their clinical relevance are discussed.

Animals↗
PubMed1982

Grip reconstruction by double-toe transplantation in cases of a fingerless hand and a handless arm.

In two cases, a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient, all fingers of the left hand were amputated at the metacarpophalangeal joint level. The second and third fingers were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. Although the distal and the middle phalanx of the transplanted third toe had to be amputated because of mummification 2 weeks after the transplantation and was covered with a groin flap, good function of the newly formed grip can be demonstrated. The second patient is a 21-year-old man with amputation of both hands at the wrist. A grip formation on the right lower arm was performed by transplantation of the second toe of each foot together with the metatarsal bone and a dorsalis pedis flap. Both metatarsal bones were fixed to the ulna and radius with metal plates, and tendons and nerves, together with a vascular supply, were reconstructed. One year after the operation, a follow-up study demonstrates good function of the newly formed "hand." The patient is able to use his two new "fingers" during daily life, mainly to hold small objects. A myoelectric prosthesis has been placed on the patient's left arm, and the patient uses this to hold bigger objects. Restoration of sensation and the range of movement of the newly formed right "hand" are demonstrated and discussed.

Adult↗
PubMed1982

[Bridging a lymphatic vessel defect using vein interposition (an experimental study)].

By means of improved microvascular surgery 10-15 mm long vein grafts were interposed into the lymphatic vessels in the groin area of 12 dogs. 6-12 weeks later a histological, clinical and radiological reexamination was performed. In 8 cases out of the 12 the interposed veins were patent, in 4 cases the lumina were occluded by fibrotic tissue. The clinical application of lymphatic vessel-defects in cases of lymphedemas is discussed.

Animals↗
PubMed1981

[Plastic surgery after extensive tumor surgery of the scalp].

Extensive resections of tumors of the scalp penetrating into the bone and the brain often require the use of free flaps for coverage as the only possibility. Four cases are reported and the specific problems of these microsurgical operations in this region are discussed.

Adult↗
PubMed1981

[Surgical specialties in replantation surgery].

Special operative techniques developed by the advances in the replantation surgery are the subject of a review. The replantation of an amputated finger in a more important position is demonstrated by a clinical case. Defects can be replaced by parts of non-replanted fingers or with the aid of transplanted structures, such as skin, vessels, bone and local flaps. Clinical examples are given of the primary transplantation of bone from the iliac crest and of enhancement of circulation from the healthy, neighbouring finger.

Amputation, Traumatic↗