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M Sauerbier

Publications and source records attributed to M Sauerbier.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Primary treatment of burn patients].

Burn injuries can be caused by thermal, electrical, chemical, or mechanical trauma or radiation and are relatively rare, as they represent only about 1% of all emergencies. They are caused by accidents at home, during recreational activities, or in the occupational environment. Minor burn traumas are much more common than severe burn injuries with their systemic and potentially life-threatening effects. Altogether, these circumstances may result in a lack of routine for treating such injuries properly by physicians and their colleagues in the emergency room or intensive care unit. A clearly outlined concept for preclinical and clinical treatment can be the keystone of successful further clinical progress. The following article summarizes the current guidelines for first medical aid at the injury scene, burn stabilization and assessment in the emergency room, and the interdisciplinary approach for further clinical care. The treatment of dermatologic emergencies (acute epidermolytic syndromes) or caustic injuries by chemical agents is similar to the treatment of burn victims in many aspects but must be adapted in selected cases.

Burns↗
PubMed2004

[Defect coverage and reconstruction of thumb sensibility with the first dorsal metacarpal artery flap].

INTRODUCTION: The "Foucher" flap is a pedicled neurovascular island flap of the first dorsal metacarpal artery. METHODS: From 1992 to 2000, thirty-three neurocutaneous island flaps from the dorsal aspect of the index finger (FDMCA flap) were performed for defect coverage and reconstruction of sensibility in the thumb. RESULTS: Static 2-PD over the flap area averaged 10.8 mm (range 4-15), compared to 8.2 mm (4-15) over the dorsal aspect of the contralateral index finger. Response to the SW monofilaments showed no difference to normal skin or only diminished light touch in 76% (19/25) patients. Seventy-six percent (19/25) were able to return to their previous jobs or resume previous activities. CONCLUSION: Based on negligible donor site morbidity of the flap and the good sensate quality and aesthetic appearance, the Foucher flap has become our first choice in defect coverage and restoration of sensibility of the thumb.

Adolescent↗
PubMed2004

[The reconstruction of scaphoid pseudoarthroses with the operation of Matti-Russe. A retrospective follow-up analysis of 84 patients].

BACKGROUND: In a retrospective study 84 patients were examined who were treated with a Matti-Russe procedure between 1985 and 1997 due to scaphoid non-union. The purpose of this study was to evaluate the long term results after scaphoid reconstruction and to get impressions about subjective feeling of the patients. PATIENTS AND METHODS: 79 patients were male, 5 were female. The average follow-up period was 88 months. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale (VAS) from 0 to 100. The functional and subjective outcome was evaluated with the DASH-questionnaire. RESULTS: A bony consolidation could be verified in 82% of the patients. The mean postoperative pain score was 3 (non-stress) and 33 (stress) in patients with scaphoid union. The DASH-score reached 15. Active range of motion and grip strength were 82% and 92% compared to the contralateral side. 81% of the patients have been working in strenuous jobs. CONCLUSION: The results show the reliability of the Matti-Russe procedure in non-union of fractures of the scaphoid. Alternative treatment options have no advantages in bony union.

Adult↗
PubMed2004

[Free microvascular fibula graft for skeletal reconstruction after tumor resections in the forearm -- experience with five cases].

Plastic-reconstructive surgery for upper extremity tumors not only follows the fundamental principles of oncologic surgery, but also requires attention to functional and aesthetic aspects. For soft tissue reconstruction, a variety of surgical options are available, whereas for the reconstruction of extensive bony defects only the free microvascular fibular transplant appears to be a reasonable method. Its advantages are its slim shape and variable length, the possibility of achieving a stable osteosynthesis suitable for early physiotherapy, and low donor site morbidity, even if the fibula is harvested as an osteoseptocutaneous flap. Between 1994 and 2000, five patients underwent a free fibula transplantation for radius reconstruction. In all cases, a two-stage reconstructive approach with initial tumor biopsy was chosen. The resected tumors were two osteosarcomas, one extraosseous Ewing sarcoma, one aneurysmatic bone cyst and one desmoplastic fibroma. Surgical and pathohistological tumor-free margins were achieved in all cases (R(0)). Two patients received an osteocutaneous graft. All grafts were revascularized to the radial artery and subcutaneous veins. The transplanted fibula grafts were between 10 cm and 17 cm in length. All proximal osteosyntheses were performed fibuloradially, the distal stabilizations were fibulo-scapho-lunate (2 x) and fibulo-radial (3 x), depending on the extent of resection. All microvascular transplants survived completely and showed a stable osseous integration, both clinically and radiologically. Depending on the postoperative course, an adapted intensive physiotherapy regimen yielded good or satisfactory function. In the follow-up of up to seven years in one case a tumor recurrence (osteosarcoma, 35 months post-operatively) required forearm amputation. The reconstruction of tumor-associated wide bony defects in the upper extremity with a free microvascular fibula graft allows for a successful therapy with respect to oncologic, functional and aesthetic considerations.

Adolescent↗
PubMed2003

[Proximal row carpectomy: a motion-preserving procedure in the treatment of advanced carpal collapse].

Proximal row carpectomy (PRC) is a motion-sparing procedure for the treatment of advanced carpal collapse. The goal of the operation is the creation of a new joint between the capitate and the radius. The purpose of this retrospective study was the evaluation of the functional outcome after PRC. The evaluation included range of motion, grip strength, and pain reduction. The DASH questionnaire was used to estimate restrictions of the activities of daily living (ADL). Results were ranked with the Mayo and Krimmer wrist scores. Thirty-three patients with a mean age of 41.2 years were evaluated after 36 months. Flexion/extension was 70 degrees and radial and ulnar deviation was 33 degrees. The grip strength was 54% of the unaffected side. The results of Mayo and Krimmer wrist scores were 66 and 69 points. The mean DASH score was 27.8. Eighty-seven percent of the patients reported that pain was better than preoperatively. Resection of the proximal carpal row is technically an easy surgical procedure. It preserves good functional range of motion and provides good pain relief, but low grip strength.

Activities of Daily Living↗
PubMed2003

[History of arthroplasty for finger joints].

The history of joint prostheses does not begin before the end of the 19th century. Prior to that, resection arthroplasty of functionally impaired joints was attempted with results sometimes allowing flexion or straightening of a previously immobile joint. These operative methods developed into interposition arthroplasty, which in its turn represents the predecessor of joint implantation. Lower extremity joint implantation is nowadays a well established and rewarding strong hold of orthopaedic and trauma surgeons. Due to certain obstacles specific to the hand, a similar success story for prostheses of the finger joints is still awaited. Although there have been many different designs of finger joint prostheses over the last 50 years, there is still no implant which offers satisfactory and reliable long-term results such as those that we have become accustomed to expect from lower extremity joint allo-arthroplasty. Only recently are we able to speak of an acknowledged standard of PIP-joint allo-arthroplasty. Using the library of the German historical museum of orthopaedic surgery as well as the relevant sources of international medical literature, a survey of the development of finger joint implantation is made.

Arthroplasty↗
PubMed2003

[Radioulnar impingement after distal ulnar resection and ulnar head hemiresection interposition arthroplasty (Bowers procedure). An experimental biomechanical study].

Resection of the distal ulna (Darrach operation) and the ulnar head hemiresection interposition arthroplasty (Bowers procedure) are common methods of treating the arthrotic distal radioulnar joint (DRUJ). The purpose of this study was to evaluate the dynamic effects of both the Bowers operation and the resection of the distal ulna on radioulnar impingement and dorsal-palmar displacement and to compare their biomechanical performances. With a dynamic forearm simulator forearm rotation was performed with simultaneous loading of relevant muscles. Torque along the forearm axis was generated by simulated muscle action with loading of the relevant tendons while the wrist was constrained to prescribed ranges of motion. The instability of the radius relative to the ulna was evaluated using displacement data of digitized landmarks in an ulnar coordinate system. Seven fresh-frozen cadaver upper extremities were used. Resection of the distal ulna created a significant instability of the forearm with movement of the radius ulnarly. Anteroposterior translations in each loading condition could be detected as well but the magnitude of displacement was little and less predictable. The results of the Bowers operation demonstrated significantly less instability compared with the Darrach results. Our data demonstrates that the dynamic behavior of the Bowers procedure is superior to the mechanical performance of complete resection of the distal ulna.

Arthroplasty↗
PubMed2002

[The use of fillet flaps in upper extremity and shoulder reconstruction].

Extensive soft tissue defects of the upper extremities were reconstructed with major fillet flaps in nine patients over a 5-year period at two institutions. Etiologies included trauma and tumor resection. Defect locations were the shoulder ( n=3), combined defects of the shoulder plus neck, arm or chest wall ( n=4) as well as one upper arm and one forearm defect. Seven of nine flaps required microsurgical free tissue transfer. Fillet flaps harvested from amputated parts represent the "spare part" concept, providing coverage of defects without additional donor site morbidity. Unlike the classic "spare part" fillet flap concept, the partial or complete conversion of an anatomically intact arm was performed for the coverage of large defects, especially for tumor reconstruction, in this series. Fillets flaps facilitate reconstruction in difficult and complex cases. Major fillet flaps represent a valuable option for reconstruction in the upper extremities with either pedicled or free tissue transfers involving extensive tissue defects.

Adult↗
PubMed2002

[Dynamic radioulnar convergence after Darrach operation, soft tissue stabilizing operations of the distal ulna and ulnar head prosthesis implantation--an experimental biomechanical study].

The most common method of treating the arthrotic distal radioulnar joint (DRUJ) is resection of the entire ulnar head (Darrach procedure). Complications related to instability of the distal forearm resulting from loss of the ulnar head are usually manifested by pain and weak grip strength and have remained the drawbacks of this procedure. In an attempt to mechanically stabilize the distal forearm, an endoprosthesis was developed to replace the ulnar head after Darrach resection. The purpose of this study was to: 1) evaluate the dynamic effects of the Darrach procedure on radioulnar convergence; and 2) evaluate the mechanical efficacy of two soft tissue stabilizing techniques (Pronator quadratus advancement flap and ECU/FCU tenodesis) for the unstable distal ulnar stump and 3) the stability after the implantation of an ulnar head endoprosthesis following a Darrach resection on radioulnar convergence. With a dynamic PC-controled forearm simulator the rotation of 7 fresh-frozen cadaver upper extremities was actively and passively performed while loading relevant muscles. Resultant total forearm torque and the 3-dimensional kinematics of the ulna, radius and third metacarpal were recorded simultaneously. The implantation of the ulnar head endoprosthesis effectively restored the stability of the DRUJ. There were significantly better results after the implantation of the prosthesis compared with the Darrach and the soft tissue stabilization procedures. This study provides laboratory validity to the option of implanting an ulnar head endoprosthesis as an attempt to stabilize the distal forearm after Darrach resection in lieu of performing soft tissue stabilization techniques.

Biomechanical Phenomena↗
PubMed2002

[The hypothenar hammer syndrome].

The hypothenar hammer syndrome (HHS) is a rare form of secondary Raynaud's phenomenon in workers who frequently use the ulnar side of the palm as a hammer. Clinically the patient with HHS shows neurologic symptoms such as paresthesia, numbness and pain and signs of vascular insufficiency such as coldness, pallor, discoloration and blanching of the affected ulnar sided fingers. The diagnosis is verified by angiography, showing thrombosis or aneurysm of the distal ulnar artery. We report on the treatment and outcome of 5 patients with HHS. All patients were painfree after treatment. But with the ongoing working habit of using the hand as a hammer there is always the risk of a recurrence. Therefore the job environment has to be changed considerably and the most effort should go into prevention and prophylaxis. If the change of the working habit is not possible, the job is clearly at stake.

Accidents, Occupational↗
PubMed2002

The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study.

Resection of the entire ulnar head (Darrach operation) and the hemiresection interposition arthroplasty are common methods of treating the arthritic distal radioulnar joint (DRUJ). Biomechnical investigation about both of these procedures is lacking. The purpose of this study was to evaluate the dynamic effects of both the hemiresection interposition arthroplasty and the Darrach procedure on radioulnar convergence and dorsal-palmar displacement and to compare their biomechanical behaviours. With a dynamic computer-controlled testing device, cadaveric forearm rotation was performed with simultaneous loading of relevant muscles. Torque along the forearm axis was generated by simulated muscle action through pneumoactuators attached to relevant tendons while the wrist was constrained to prescribed ranges of motion. The instability of the radius relative to the ulna was evaluated using displacement data of digitized landmarks in an ulnar coordinate system. Seven fresh-frozen cadaver upper extremities were used. The Darrach resection created an extreme instability of the forearm with movement of the radius ulnarly. Anteroposterior translations in each loading condition could also be detected, but the magnitude of displacement was small and less predictable. The results of the hemiresection interposition arthroplasty demonstrated significantly less instability compared with the Darrach results.

Aged↗
PubMed2002

[The Epping resection-suspension arthroplasty procedure. A standard procedure in the operative treatment of trapeziometacarpal osteoarthrosis?].

The surgical treatment of painful osteoarthrosis of the trapeziometacarpal joint with the Epping technique consists of excision of the trapezium and reconstruction of the first intermetacarpal ligament by using the distally based half of the flexor carpi radialis tendon. This ligament reconstruction procedure aims to prevent proximal migration of the first metacarpal, restore function and stability of the neoarthros. This retrospective study presents operative outcome results after using the Epping arthroplasty technique. The Epping technique has been performed in seventy cases and could be evaluated after a mean follow-up of 34.6 months in 92.4 % of all operated patients. Subjective results were evaluated using patient-based questionnaires such as the Buck-Gramcko-Score and the German Version of the DASH V2.0 questionnaire. Objective and functional outcome analysis including range of motion, strength measurements with the computer-based JAMAR dynamometer and various X-ray views, have been used as further methods of evaluation. Excellent pain relief and very good subjective results with 86 % patient satisfaction have been reported by our patients. The objective outcome analysis demonstrated good functional results with respect to radial abduction (51 degrees) and palmar flexion (45 degrees), and improvement in grip strength, key pinch and pulp pinch. Some patients reported remaining problems with pain during performance of activities of daily life and professional activities. A significant proximal metacarpal migration without correlation to the objective or subjective outcome was found in follow-up X-ray controls. The Epping ligament reconstruction procedure has proven to be a valuable standard procedure after a mid-term follow-up period. Good functional outcome and high patient satisfaction could be achieved, but some patients still remain with problems in different activities. Long-term results still need to be evaluated.

Adult↗
PubMed2001

[Therapeutic strategies for covering traumatic defects of the heel area].

Tissue defects of the heel region are a challenging problem. Various reconstructive techniques were performed in 44 patients with 59 defects around the heel region, who were treated between 1994 and 1999 following a traffic accident in 27%, a burn injury in 25%, and other traumatic causes in 48%. Free flap coverage was performed in 20 defects (36%), local flaps were used in 15 patients (27%) and autologous skin transplantation in 21 patients (36%). The overall complication rate was 18% with the highest rate after local flap procedures. A therapeutic strategy was developed, which is based mostly on the localization and extension of the defect area.

Adolescent↗
PubMed2001

[Management of proximal scaphoid bone pseudarthroses and fractures with the mini-Herbert screw via a dorsal approach].

32 patients, aged 16 to 49 years, were treated by osteosynthesis using the Herbert mini screw. The indications were five fractures (type B3, Herbert classification), two delayed unions (type C) and 25 nonunions (type D1 to D3, Filan and Herbert classification). Six patients received no bone grafts, 19 received cancellous bone graft from the radius. An interpositional iliac crest bone graft was used in four, and a vascularized bone graft from the distal radius in three cases respectively. The average postoperative immobilisation in a forearm splint was nine weeks. 26 patients could be recruited for clinical follow-up at an average of 14.5 months. The radiological results were assessed in 30 cases (94%). Bony consolidation was achieved in 26 cases (100% of the fractures, 84% of the nonunions). In three cases a loosening of the screw, and in three further cases a dislocation into the radiocarpal joint were observed. A humpback deformity was present in four cases. Three patients showed a persisting nonunion, one patient a fibrous union. Early degenerative changes of the radiocarpal joint were observed in six cases. The clinical follow up examination showed an average grip strength of 91% (JAMAR II), 94% for the three finger, and 95% for the pinch grip compared to the contralateral side. The mean postoperative pain score on the visual analog scale was one for resting conditions, eleven for motion and 33 under stress. The range of motion was 79% of the opposite side for extension/flexion and 83% for radial/ulnar deviation. The average DASH-score reached 15 points. The Herbert mini screw has proven to be a reliable implant for reconstruction of proximal pole fractures and nonunions of the scaphoid.

Adolescent↗
PubMed2001

Reverse segmental pedicled ulna transfer as a salvage procedure in wrist fusion.

A new technique for wrist fusion using vascularized bone graft is described. A distally based, pedicled segment of the distal ulna, nourished by the ulnar artery or the distally based palmar-ulnar branch of the anterior interosseus artery was used in three patients to restore carpal height after infection (n=2) or tumour resection (n=1). The forearm is converted to a situation similar to a wide ulnar resection. All three wrist fusions healed uneventfully. This new technique is suitable in cases where a vascularized bone graft is required, but microsurgical techniques are not appropriate or are rejected by the patient.

Adult↗
PubMed2001

[Defect coverage of the hand and forearm with a free scapula-parascapula flap].

BACKGROUND: Complex defects of the forearm and hand are associated with the loss of important structures. Single-stage reconstruction of these defects requires composite tissue transplantations. The subscapular region offers various components for the coverage of complex defects. The scapular and the parascapular flaps can be used each as cutaneous, fasciocutaneous and osteocutaneous or as a combined flap as well. The purpose of this study was to present our experience with the combined scapular-parascapular free flap for defect coverage of the forearm and hand in 13 patients. PATIENTS AND METHOD: Evaluation of 12 patients who underwent coverage of forearm and hand defects with the combined scapular-parascapular free flap during a five-year period. Other treatment options are discussed. RESULTS: Average age of the patients was 39 years, there were ten male and two female patients. Average follow-up was 20 months. Eleven patients suffered from massive trauma, one patient from severe infection of the forearm and hand. The defect size varied from 12 x 8 cm to 45 x 20 cm. In nine cases, a cutaneous and/or fasciocutaneous scapular-parascapular flap was used, two patients underwent defect coverage with an osteocutaneous scapular-parascapular flap, and in one patient, a "four-flap-mega-flap" was transplanted. One flap developed a partial necrosis. Eight patients developed a good or very good functional outcome with their hand and forearm, two patients have a moderate degree of disability. Two patients can use their hand as a supporting hand. CONCLUSION: This study demonstrates that the combined scapular-parascapular free flap is a reliable treatment choice for early coverage of defects of the forearm and hand. The advantages are the long, large and consistent vascular pedicle, the possibility of combination with other flaps and "custom-tailoring", including whatever component is necessary to close the particular defect.

Adult↗
PubMed2001

[Possible applications of pedicled vascularized bone transplants of the distal radius].

Reverse-flow pedicle vascularized bone grafts (VBGs) from the distal radius may be used for the surgical treatment of carpal fracture nonunions and avascular necrosis. Such grafts remain viable with quantifiable blood flow as demonstrated in a recent canine experiment. In this paper, the vascular anatomy of the distal radius is demonstrated and the surgical technique of VBG harvest is described. Our indications and results for treatment of scaphoid nonunion and Kienböck's disease are discussed and compared with the current literature. Fifteen patients with scaphoid nonunion and nine patients with Kienböck's disease stage IIIa were treated by reverse-flow pedicled VBG. Range of motion and grip strength were measured postoperatively and compared to the contralateral hand in all patients. An outcome questionnaire was used to measure patient's satisfaction and ADL's in the patients with Kienböck's disease. The radiologic diagnostic was performed with conventional X-rays, trispiral tomograms and MRI. In the scaphoid nonunion group, all patients were male, with an average age of 27.6 years. Five patients had prior attempts of autogenous bone grafting which failed. Six patients had a radiographic suggestion of proximal fragment avascular necrosis. All scaphoids healed. Time to union was 11.1 weeks on average. Average follow-up was 36.2 months. Pain relief, range of motion and grip strength were very promising. The treatment of Kienböck's disease was also promising in nine patients. Mean patient age was 31 years, and follow-up averaged 32 months. Six patients had complete pain relief, and three had occasional pain. Grip strength reached 86% of the contralateral side (a 25% improvement from preoperative values). Postoperative MRI demonstrated progressive revascularization with time. The results of treating scaphoid nonunions are promising. The use of vascularized bone graft facilitates rapid, reliable union of established scaphoid nonunion, even with proximal location and/or avascular changes. Clinical results in Kienböck's disease have been gratifying as well, with MRI evidence of gradual revascularization on follow-up studies.

Adolescent↗