Biomedical subjects
Publications and source records attributed to K Wilhelm.
Experimental studies on the long extensor tendon of the thumb have shown that experimental rupture of the tendon occurs in the same region as in clinical cases. The application of a new plastic imprint method has demonstrated an area of smallest diameter in the tendon. This part is nearly identical with the usual site of the rupture, which can, therefore, be simulated in experiments.
The analysis of a total of 500 patients with Dupuytren's contracture is reported. In agreement with the literature it was found that 90% of the patients are men. 29.9% are in the 5th decade of life at the time of the operation. The disease usually begins on one side. But after up to 3 years the second hand is also affected in 51%. The preferred location, both in its entirety and also in relation to the initial manifestation, is the ulnar portion of the hand. Because of the progressive nature of the complaint, relapses are to be expected even after a successful operation. At the time of the follow-up, 26.2% of the patients had recurrences. A correlation between the clinical picture and the histological phase classifications is not possible with certainty.
Subcutaneous ruptures of the extensor pollicis longus tendon are mostly due to an earlier wrist trauma and rarely caused by a degenerative systemic disease. The tendon usually ruptures close to the distal edge of the retinaculum extensorum where it is vulnerable in various respects and in addition exposed to increased mechanical strain. Functional loss of the extensor pollicis longus greatly impairs the function of the entire hand and requires surgical therapy. Transfer of the extensor indicis tendon has proven successful in 95% and thus appears to be the most appropriate therapeutic procedure.
Compared to the proximal rupture of the Biceps tendon the distal rupture is extremely rare. The numerous published methods of repair show that a reliable method has not yet been found. Considering functional principles we developed a method which combines a safe fixation of the tendon and a good function. An autologous tendon is brought through a burrhole placed obliquely through the mid position of the tuberosity. The Biceps tendon is now placed between the ends of the autologous tendon and fixed with resorbable u-sutures (Sandwich-technic). Thereby the tension on the tendon is adapted as necessary. The achieved results is demonstrated on two cases.
We examined 38 patients out of 41 with indicis tendon transfer, performed at the Department for Hand Surgery of the University of Munich during the past eight years; the patients had suffered a subcutaneous rupture or an open traumatic separaton of the extensor pollicis longus tendon. In five cases the function fo the operated had was found deteriorated by other causes. Of the remaining 33 patients 26 showed an excellent function and five patients a good function of the operated thumb. Deficient functional results were discovered with two patients. Almost in all cases extension of the index finger was found reduced in force; none of the patients, however become aware of it. In performing the tendon anastomosis care must be taken to apply proper tensions to the tendons joined.
The antithrombotic effect of dextran 60 (Macrodex) was studied in a prospective, randomized trial on patients undergoing general surgery. 42 patients (group A) received 500 ml of dextran 60 intraoperatively, 49 patients (group B) received an additional dose of 100 ml dextran 60 on days 1 to 5 after operation. As tested by the 125-iodine-radiofibrinogen test 16 patients (38%) from group A, but only 2 patients (4%) from group B developed deep venous thrombosis. The difference between both groups is statistically highly significant (P less than 0,0005). The use of dextran for thromboprophylaxis was associated neither with hemorrhagic complications nor with anaphylactoid reactions. The fractionated application of a total of 1000 ml of dextran 60 resulted in a very efficient prophylaxis against deep venous thrombosis.
Classification (119 patients) of age, sex and side distributions and the frequency of additional fibromatoses or other diseases in palmar fibromatosis (Morbus Dupuytren) showed extensive agreement with other investigations. Contractures were also found in mutiple foci with high cell density and without intensive collagen fiber formation corresponding to the proliferative or involution phase. Cells with contractile elements ("myofibroblasts") could also be demonstrated with both electron and immunofluorescence microscopes. These elements may be of importance for the formation of the contracture in palmar fibromatosis and may disappear again as the collagen becomes more mature.
One case of an aneurysmal bone cyst in the distal end of the radius of a 10 year old boy is described. These bone cysts probably develop from local hemodynamic disturbance and should be treated by evacuation and cancellous bone packing. Their propensity for recurrence is confirmed in the literature.
It is shown in 246 flexor tendon grafts in the so-called no man's land that autologous grafting in a single surgical procedure preserving the tendon sheath yields the best results, whereas good results can only be achieved by two operations after more extensive injuries of the sheath with or without accompanying injuries. For estimation of the results we developed our own scheme, because it seemed difficult to make reliable judgments when the rather divergent published criteria were applied.
Tear fractures of the os calcis are rare. If they do occur, the cause may be osteoporosis. This could be proved in an experimental study rupturing the achilles tendon. Usually, the tendon is the weakest link in the muscle-tendon-bone-chain. In case of osteoporosis, the insertion of the tendon is more vulnerable.
An account is given about the results of transplantation of homolouges lyophilisated nerves. 48 patients (56 nerves) could be reexamined. The critical clinical and neurological examination shows no positive results. Regarding the taken late results and the experimental findings the use of homolouges lyophilisated nerves for bridging larger defects in human must be rejected, at least at the present.
Avulsion of the extensor tendon of the terminal phalanx of the finger is the most frequent form of all subcutaneous tendon ruptures. The rupture may occur in the tendinous part or cause a fracture of the bone in the region of the insertion. Healing requires at least 5-6 weeks conservative therapy with a Stack's splint being attempted first. Surgical fixation of the terminal joint with Kirschner wire should only be carried out in exceptional cases because of the risk of infection and damage to the joint. Operative union of the ends of the tendon is only immediately indicated with open tendon severance and in old injuries in which complete severing of the tendon can be recognized. If tendon regeneration is unsatisfactory, the Georg method of purse-string suture with temporary arthrodesis is recommended later.
By means of one case problems of diagnosis and therapy of fatigue fractures of the fermoral neck are demonstrated and discussed by comparison to recent reports in literature. In case of uncertain diagnosis we recommend surgical revision of the fractured zone with take off of bone tissue for histological examination, especially in order to exclude a malignant bone process.
Beta-escin is highly effective in reducing postoperative edemas and swellings. It was tried to demonstrate the effect of beta-escin using the thermometry. The temperature of soft tissues and bones can be measured with the help of the thermometry, in this way the circulation of the skin can be determined. In 65 test persons so-called normal thermograms were established, using the infraredthermometer KT 41, which makes registrations without touching the skin. In 53 patients the temperature of the skin was checked after surgery of the hand. 27 patients received beta-escin (Reparil); 26 patients without medication served as controls. In every case the temperature of the operated hand was compared to the other hand. Among the patients, who received escin, the temperature of the operated hand rose for two days following surgery; afterwards it fell quickly. Among the controls the skin-temperature rose up to the 4. day after surgery and decreased slowly. These results demonstrate clearly that after using beta-escin there is a quick reduction of postoperative inflammation and edema.
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The proper treatment of squamous cell carcinoma of the hand is surgical only. Radical cure and preservation of function need not exclude one another if the following points are considered: praeoperative biopsy and intraoperative pathological examination, consideration of the degree of malignancy and the possibilities of surgical reconstruction.
From a group of more than 200 patients with median and ulnar nerve compression syndrome three cases of interest are demonstrated in detail. In these cases vascular complications led to acurate events accompanied by grave symptoms. In order to prevent irreversible damage surgical treatment of such cases is indicated as soon as possible.
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