Biomedical subjects

M Sauerbier

Publications and source records attributed to M Sauerbier.

At least 19 recordsLinked to original sources

PubMed2007

[Functional and aesthetic refinements of free flap coverage at the dorsum of the hand and distal forearm].

INTRODUCTION: Free coverage of exposed functional structures of the hand and distal forearm can be achieved using a variety of free flaps. However, there is a lack of data in the literature which tissue components are best used for defect coverage of this specific area regarding aspects such as tendon gliding and tissue elasticity. The purpose of this retrospective study was to compare and to evaluate the functional and aesthetical results using free cutaneous, fascial and muscle flaps. PATIENTS AND METHODS: Between 1994 and 2002, a total of 56 patients underwent free flap coverage at the dorsal side of the hand and forearm at our institution. Of these patients, 20 with 21 free flaps met the study criteria and were available for follow-up examination. Depending on the tissue component used patients were allocated into three different groups. In group 1 eight patients received a fascial flap, in group 2 eight a cutaneous flap and in group 3 five a muscle flap. The mean follow-up was 50 months (range: 4-103 months). At follow-up examination the patients answered the Client Satisfaction Questionnaire (CSQ 8) and the DASH questionnaire. RESULTS: Regarding range of motion of the wrist and fingers, fascial flaps clearly showed the best results. Concerning grip strength and pinch grip, fascial and cutaneous flaps demonstrated the same results. Patients with cutaneous flaps showed the best DASH score. Regarding the overall aesthetical outcome, fascial and cutaneous flaps were far better than muscle flaps. Donor site morbidity was lowest for fascial flaps followed by muscle flaps and was highest for cutaneous flaps. CONCLUSION: Cutaneous and fascial flaps had the best functional and aesthetical results. Fascial flaps achieved the best aesthetical outcome of the donor site. We recommend free fascial flaps and cutaneous flaps as the first choice due to their advantages in the specific area of the dorsal site of the hand and distal forearm which requires pliable and thin tissue coverage.

Adult↗

PubMed2006

[Burned palm reconstruction. Current concepts regarding grafting techniques, sensibility and hand function].

BACKGROUND: The purpose of this study was to evaluate the results of conservative and operative treatment for burn injuries in the palmar region of the hand. METHODS AND CLINICAL MATERIAL: One hundred ten patients from the severe burn center in Ludwigshafen, Germany were evaluated a mean of 28 months postoperatively. Sixty-one had been treated with split-thickness skin grafts (43 sheet and 18 mesh grafts). In addition to subjective evaluation (including pain assessment and aesthetic outcome rating by visual analog scale), objective outcome analysis included clinical tests, measurement of active range of motion and grip strength, and sensibility testing with the two-point discrimination and Semmes-Weinstein monofilament tests. RESULTS: Of the patients, 90% were satisfied with the results, showing excellent pain relief with an average score under 13 on the visual analog scale. Aesthetic outcome was rated good with sheet grafts; in appearance, mesh grafts tended to be rated average or insufficient. Functional outcome tests demonstrated a significant correlation between depth of injury and range of motion. Grip strength analysis revealed superior results with sheet grafts. Sensibility in the injured areas was lower than on the contralateral hands. The Semmes-Weinstein test average was 3.4 degrees at the burned area vs 3.0 degrees in healthy hands, underscoring lower sensibility after burns. CONCLUSION: Surgical treatment of burned palms leads to good subjective and objective results, if specialized burn units are involved. Overall sheet transplantation seems to be the better choice for surgical reconstruction of the palmar burned hand.

Adolescent↗

PubMed2006

[Abdominal hernias resulting from abdominal flap harvest].

The anatomic characteristics of the anterior abdominal wall allow the harvesting of various types of flaps, some of them with considerable volume. These flaps are used mainly for reconstruction of the female breast, thoracic wall, and perineal or ilioinguinal region. Even though general donor site morbidity is low, hernias and "bulging" can occur due to the harvest of muscle and fascia, which leads to a weakening of the abdominal wall. Hernias and bulging appear mostly after harvest of classic flap types, which include removal of the rectus abdominis muscle. Further refinements of these flaps, i.e. microvascular flaps, in particular perforator flaps, lead to a marked reduction in donor site morbidity. In the following overview, the problem of abdominal wall weakening as a result of flap harvest is discussed and possible therapeutic options are elucidated.

Hernia, Abdominal↗

PubMed2006

[Surgically treated intraarticular fractures of the trapeziometacarpal joint -- a clinical and radiological outcome study].

BACKGROUND: Fractures of the thumb metacarpal occur quite frequently at the base. Intra-articular metacarpal base fractures (such as Bennett or Rolando fractures) present treatment challenges and surgical therapy remains controversial. Malunion of these fractures may lead to the development of painful osteoarthrosis at the trapeziometacarpal joint which can seriously impair overall hand function. PATIENTS AND METHODS: In a retrospective analysis, 30 intra-articular fractures (24 Bennett's, three Rolando's and three comminuted fractures) treated between 1994 and 1999 in the Department of Hand, Plastic and Reconstructive Surgery in Ludwigshafen have been reviewed. A total of 25 patients (83%) could be examined clinically and radiologically at an average follow-up of 39 months. The subjective outcome was measured using the DASH-questionnaire. Clinical examination included grip strength and range of motion measurements. RESULTS: Four cases were treated with percutaneous pinning, in 26 cases open reduction with internal fixation was performed. Radiological analysis demonstrated good reduction in 90% of all cases (metacarpal base gap/step-off in articular surface: <1 mm in 63%, between 1-2 mm in 27%, >2 mm in 10%). Twelve patients (48%) were free of symptoms at follow-up. Slight restricted flexion was noted in 11 (44%) patients (75-90% of healthy collateral values), including one patient with moderate opposition deficit (<75% of uninjured value). Three patients (12%) demonstrated weakness in tip pinch and one patient had decreased key pinch compared to the uninjured hand. Overall, good functional results for radial abduction, flexion and opposition as well as good grip strength compared to their uninjured side were found. At follow-up a total of 64% radiological features of trapeziometacarpal arthrosis have been documented. Very low impairment rates in the DASH-scores of all three parts (below 9 points) were measured. There was no correlation between the quality of thumb base restoration and radiological or subjective outcome. CONCLUSION: Exact anatomical restoration of the articular surface may not be essential for obtaining satisfactory functional results.

Adolescent↗

PubMed2006

[Functional outcome after corrective osteotomy of the distal radius].

BACKGROUND: Malunited fractures of the distal radius frequently show disabling and painful reductions in active range of motion (AROM) of the wrist and forearm with reduced grip strength. Shortening and three-dimensional torsion of the distal radius occur with relative ulnar lengthening. Corrective osteotomy of the distal radius is indicated in these conditions. METHODS: We examined 24 of 30 patients after corrective osteotomy with respect to AROM, grip strength, DASH, and pain perception (visual analogue scale). The mean age of the population was 49 years (18-69 years), and the mean follow-up period was 22 months (6-63 months). RESULTS: Preoperative extension/flexion was 65 degrees , postoperative 92 degrees (p<0.05). Forearm rotation improved from 129 degrees preoperative to 160 degrees postoperative (p<0.01). The DASH score could be reduced from 40 (n=9) to 18 (n=24). Grip strength increased from 17 kg to 27 kg postoperative (p<0.01). Radioulnar inclination increased from 15 degrees preoperative to 24 degrees postoperative (p<0.05). Relative ulnar lengthening could be minimized from 4.3 mm to 0.7 mm (p<0.05). CONCLUSION: Data show that reconstruction of the distal radius improves grip strength and range of motion significantly with simultaneous reduction of pain perception and DASH scores.

Adolescent↗

PubMed2006

[Postoperative CT-controlled results of renewed osteosynthesis using screw fixation for acute scaphoid fractures].

BACKGROUND: Currently screw fixation of the scaphoid is a well-established method to treat unstable scaphoid fractures. PATIENTS AND METHODS: Between June 1995 and December 2000, 68 patients with an unstable acute scaphoid fracture were treated with screw fixation; 46 patients were reexamined on an average 35 months postoperatively. Range of motion and grip strength (Jamar dynamometer) were measured. The total data rating resulted from the Krimmer wrist score. RESULTS: The subjective results were evaluated with the DASH questionnaire. The average postoperative pain score was documented with a visual analogous pain scale from zero to 100 (VAS 0-100). X-rays as well as computed tomography were performed postoperatively. The average range of motion was 124 degrees for extension/flexion (92% of the opposite site), 57 degrees for radial/ulnarduction (=90%), and 177 degrees for pronation/supination (=98%). Postoperative strength was 47 kg (=90% of the opposite site). The postoperative pain score was 13 (0-100) after stress and 2 during resting conditions. Bony consolidation was reached in 44 cases. The Krimmer wrist score demonstrated a very good result in 39 cases, a good result in 5 cases, and a satisfactory result in 3 cases. The average DASH score was 8.3 points. CONCLUSIONS: The results demonstrate the reliability of internal screw fixation as treatment for acute scaphoid fractures. Functional results as well as subjective satisfaction of the patients are very good. Postoperative CT scans help to evaluate exact bony consolidation, position of the screw, and postoperative morphology of the scaphoid.

Adolescent↗

PubMed2006

[Improved outcome of nerve injuries in the upper extremity].

Nerve injuries in the upper extremity can result in severe disability. In the past three decades, progress in microsurgical techniques and instruments have resulted in improved outcomes for nerve injuries. If the prognosis is reasonably good, nerve repair is usually preferred over tendon or flap transfer procedures. However, lesions of peripheral stem nerves such as high radial nerve palsy may still yield unsatisfactory results, despite technically well-executed nerve repair. Prognosis further depends on the age of the patient; the regenerative process is delayed in older patients. Further criteria for the indication for tendon transfers are the personal and professional profiles of individual patients. Tendon or flap transfers to restore sensation can be performed at any time post trauma when it becomes clear that long-term rehabilitation is required. These procedures abbreviate the interval during which hand function is severely impaired, so that patients have alternatives to persistent nerve palsy with the need of permanent external splints, and long and costly rehabilitation can be shortened. Sophisticated techniques allow minimal donor site morbidity and leave options open in case function of the reconstructed nerve returns. The present article gives an overview of the most common procedures to restore hand function and sensation in the most important digits and provides help for decision making.

Neurosurgical Procedures↗

PubMed2006

[Experiences with the distally based dorsal metacarpal artery (DMCA) flap and its variants in 41 cases].

Distally based DMCA flaps are an established procedure for soft tissue reconstruction in the hand. Since the introduction of the DMCA flaps, several variants have been developed to match specific defect requirements. The aim of this retrospective study is to give an overview of the experience with the DMCA flaps based on a single center's experience. 41 distally based DMCA flaps have been performed from 2000 to 2004. Twenty-nine times a distally based DMCA flap has been performed, nine times the extended distally based DMCA flap and three times a distally based DMCA fascial flap. In summary, 34 flaps showed no complications, five had a partial necrosis, but were successfully treated with split-thickness skin graft, and two flaps were lost due to infections. The distally based DMCA flaps II to IV have proven to be reliable flaps, but nevertheless require sufficient surgical experience. They are suitable for any kind of defects, including burn reconstruction. Defects of the entire finger can be covered by the various variants of the DMCA flaps.

Adolescent↗

PubMed2005

Coverage of soft-tissue defects of the hand with free fascial flaps.

Coverage of exposed functional structures such as tendons, bones, vessels, or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free fascial flaps. From 1994-2002, 14 patients underwent free fascial flap coverage of the hand with 4 tempo-parietal fascia flaps and 11 serratus fascia flaps. Eight patients could be reexamined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was 41.7 months. Average active range of motion of the hand, functional improvement, and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. We recommend the use of free fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps, since the functional results are excellent, no additional procedures were necessary, and the aesthetic results are appealing.

Adult↗

PubMed2005

[Accidental thermal injury to the hand].

Hands are most frequently involved in severe burns. The treatment of the burned hand is one of the most challenging problems in plastic surgery. The success of therapy is determined by the severity of the initial injury, the first aid provided, and the correct balance between mobilization, splinting and plastic surgery. In this respect, it is vital to have a highly qualified interdisciplinary team approach consisting of plastic surgeons, well-trained physical therapists, psychologists and a highly motivated patient.

Accidents↗

PubMed2005

Principles of microvascular reconstruction in burn and electrical burn injuries.

Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly developed during recent years, so have the indications for this procedure expanded. This study reports retrospectively the results of 75 free flaps in 60 severely burned patients using 20 different free flaps. This experience enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. In high voltage injuries (n = 26) early free flap coverage (<21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominantly the upper extremity and forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3-6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous flaps was the preferred method. In contrast to high voltage injuries, the trunk and the face were also recipient sites. In the upper extremity, the elbow and dorsum of the hand were the most frequent sites of reconstruction. Overall, the flap failure rate was 13% (n = 10). We were able to show a relationship between flap failure rate and timing of the procedure. Eight out of 10 flap failures occurred within 5-21 days after trauma, all 10-flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. For the reconstruction of complex or large defects (n = 14), we recommended combined 'chimeric' flaps, pre-expansion of free flaps, or the combination of a free and local flap. Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom tailored reconstructive solution.

Abdominal Injuries↗

PubMed2005

Disabilities of the arm, shoulder and hand (DASH) questionnaire: Determining functional activity profiles in patients with upper extremity disorders.

The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.

Adult↗

PubMed2005

[Does the disability of shoulder, arm and hand questionnaire (DASH) replace grip strength and range of motion in outcome-evaluation?].

Scoring systems currently used to evaluate functional disabilities in upper extremity conditions frequently combine so-called "objective" parameters such as grip strength and range of motion with "subjective" parameters such as pain. Since its introduction, the Disabilities of Arm, Shoulder and Hand Questionnaire has proven useful in the pre- and postoperative evaluation of functional limitations of the upper extremity. This study examines the relationship between DASH scores, the so-called "objective" parameters of grip strength and range of motion and those of "mixed scores" such as Krimmer and Cooney Scores. Based on the data of six diagnostic groups, Spearman's correlation coefficients were calculated. There was no correlation between DASH scores and range of motion, however, some of the diagnostic groups showed a moderate correlation between DASH scores and grip strength. Both the Krimmer and Cooney scores showed a significant correlation with the DASH scores, indicating that these "mixed-scores" can be replaced by the DASH. Since it has been shown that grip strength and range of motion do not capture patients' functional limitations adequately, their continued use in the evaluation of upper extremity conditions should be the topic of further discussion.

Arm Injuries↗

PubMed2005

[Functional outcome after midcarpal arthrodesis in the treatment of advanced carpal collapse (SNAC-/SLAC-wrist)].

PURPOSE: The purpose of this retrospective study was the evaluation of the functional outcome of midcarpal arthrodesis, its results in the treatment of SNAC/SLAC stage II and III and patients' satisfaction. METHODS: 49 patients that were treated with a midcarpal arthrodesis were re-examined at a mean follow-up time of 47 months. Range of motion was verified and grip strength was measured with a Jamar-Dynamometer II and a pinch-grip. Pain was evaluated by a visual analogue scale (VAS 0 to 100) for stress and under resting conditions. Patients' daily activities and general quality of life were estimated with the DASH questionnaire. Radiographic evaluation was done by conventional X-ray. RESULTS: Active range of motion was 56 % and grip strength was 76 % of the non-operated wrist. The DASH score was 29 points. Pain relief was 34 % during resting conditions and 31 % after stress respectively. 45 patients demonstrated bony consolidation in X-ray control. Six patients needed further treatment with a total arthrodesis because of pain or absence of bony consolidation. 77 % of the patients returned to their original occupation and 80 % were satisfied with the final result. CONCLUSION: Our data demonstrate that midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed.

Activities of Daily Living↗

PubMed2005

[Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II].

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

Activities of Daily Living↗

PubMed2005

[Defect coverage of the hand with the free serratus fascial flap].

PURPOSE: Coverage of exposed functional structures such as tendons, bones, vessels or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. Free fascial flaps are possible alternatives to cutaneous, fasciocutaneous and muscle flaps. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free serratus fascial flaps in our department. METHOD AND CLINICAL MATERIAL: From 1994 to 2002, ten patients underwent free fascial flap coverage of the hand with eleven serratus fascial flaps. Six patients could be re-examined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was after 34 months. RESULTS: Average active range of motion of the hand, functional improvement and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. CONCLUSION: We recommend the use of free serratus fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps since the functional results are excellent; no additional procedures were necessary and the aesthetical results are appealing.

Adult↗

PubMed2005

[Microsurgical reconstruction of the burned upper extremity].

BACKGROUND: Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded. MATERIAL AND METHODS: We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. RESULTS: In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction. CONCLUSION: Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

Adolescent↗

PubMed2004

[Reconstruction of burned extremities by free flap transplantation].

Free tissue transplantation in burn reconstruction presents a major challenge to reconstructive surgeons. The results of a retrospective analysis of 68 free flaps in 55 patients are reported. This experience facilitated the establishment of reconstructive principles and a decision-making algorithm for primary and secondary reconstruction of burned extremities. Fourty-two free flaps were used for primary reconstruction. The indications were predominantly extremity salvage.The safety of the microsurgical procedures is correlated with the timing of the reconstruction. The failure rate of the free flaps was 24% in primary reconstruction. Due to an increased post-traumatic thrombogenicity, the period between 5 and 21 days had the highest risk of flap failure (40%).Twenty-six flaps were used for secondary reconstruction, with a success rate of 100%. Due to their elasticity, adipo- and fasciocutaneous flaps provide a useful option for the release of contractures. The large variability demonstrated by the use of 19 different types of free flaps showed that the reconstruction of burned extremities requires a reconstructive concept individualized to each patient as well as sophisticated microsurgical techniques. This clearly demonstrates the importance of a close link between primary burn treatment and reconstructive plastic surgery.

Adolescent↗