Search PubMed⌕ Search

Biomedical subjects

R E Horch

Publications and source records attributed to R E Horch.

At least 37 records · Page 2Linked to original sources
PubMed2005

Treatment of therapy-refractive ulcera cruris of various origins with autologous keratinocytes in fibrin sealant.

BACKGROUND: Evaluation of the effects of cultivated, subconfluent, autologous keratinocytes in fibrin sealant (BioSeed-S) on the healing of therapy-refractive chronic wounds. PATIENTS AND METHODS: Open observational study in 60 patients with chronic leg ulcers and impaired wound healing of various origins. After whole-skin excision and cultivation of the autologous keratinocytes, the suspended cells were applied to the preconditioned wound in fibrin sealant. Wound epithelization and wound size were recorded at defined times. RESULTS: Fifty-two of the 60 participating patients could be evaluated. After 6 weeks, 29 ulcers (55.8%) were healed. The mean epithelization increased between the 8th and 42nd postoperative day from 23% to 62.5%. In 50.0% of the patients, global assessment of the wound showed a high degree of epithelization or healing after 42 days. In 32.6% of treated patients, improvement was observed, while no healing tendency was to be found in 17.4%. CONCLUSION: The present observational study indicates that the transplantation of autologous keratinocytes suspended in fibrin sealant could be of advantage in the treatment of refractive leg ulcers.

Aged↗
PubMed2005

The effect of carpal tunnel release on median nerve flattening and nerve conduction.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and extensive surveys have been given on the time course of electrophysiological findings pre- and postoperatively. In patients with clinical and electrophysiological confirmed diagnosis of CTS surgical decompression of the carpal tunnel is a first line treatment and has proven to be successfull in 70 to 90% of all cases. The objective of this work was to study the morphological changes of the median nerve after endoscopic release of the carpal tunnel. We used high resolution ultrasound to quantify flattening of the median nerve and to calculate a flattening ratio before endoscopic release as well as 2 weeks and 3 months postoperatively. Ten patients with clinical and electrophysiological confirmed CTS were included in the study. There was significant normalization of the calculated flattening ratio of the median nerve already 2 weeks after surgical release, whereas nerve conduction studies needed a longer period of time to normalize and thus were still abnormal 3 months postoperatively. We conclude that ultrasound is a simple and excellent objective method for visualizing the morphological recovery of the median nerve very early after decompression surgery. In complex cases with unsatisfactory outcome ultrasonography may prove useful in confirming successfull or failed decompression of the median nerve.

Carpal Tunnel Syndrome↗
PubMed2004

[The role of plastic surgery in remodeling the body image].

On the basis of comprehensive information on the realistic possibilities and outcomes of esthetic corrective surgery, such operations can contribute to an effective and lasting improvement in the patient's quality of life and self-esteem. However, the esthetic surgeon's scalpel must never be considered an alternative to necessary psychotherapy. Exaggerated expectations, obsessions, and an absent sense of reality coupled with the projection of psychological and social problems on a certain part of the body must be interpreted as dysmorphophobia with a disordered personality structure. For a reputable plastic surgeon they must be considered a contraindication to esthetic surgery. Against a background of constantly changing social conditions and attitudes, too, surgical body sculpting should no longer be uncritically accepted as a legitimate field for esthetic surgery. Currently, the question as to where the lines are to be drawn for the performance of body-modeling surgical interventions remains unanswered.

Body Image↗
PubMed2004

[Breast-reduction surgery--a long-term survey of indications and outcomes].

Between 1986 and 2003, breast-reduction surgery was performed in a total of 814 women. The indication was established on the basis of physical complaints, chronic back pain, stiff neck or recurrent intertrigo in the foldbeneath the breasts. A proportion of the patients were interviewed postoperatively using a questionnaire, to determine the impact of the operation on their quality of life. 91% of those surveyed reported a postoperative improvement in the perception of their own body, and 80% were satisfied with the reduced size of their breasts. In conclusion, in the hands of an experienced breast surgeon, breast-reduction surgery for the proper indication results in a reliable and safe diminishment in breast size and tightening of slack tissue, leading to a significant enhancement in the patient's quality of life.

Adolescent↗
PubMed2004

[Possiblities for breast reconstruction following cancer surgery].

Cancer of the breast is the most common malignant disease of women, and currently affects approximately 10% of all women. In the large majority of cases, mammary carcinoma can be treated without having to sacrifice the breast. In some 30% of the cases, however, amputation continues to be needed, in particular when a relatively large tumor presents, or when its removal with an adequate safety margin in a relatively small breast would result in appreciable deformation. Reconstruction of the breast is often an important psychological factor, since, as a visible organ, the breast is a determining feature of a woman's physical appearance and her effect on the opposite sex. The availability of various procedures and modern techniques of breast reconstruction make it possible to comply with the individual wishes of the woman concerned.

Breast Implantation↗
PubMed2004

Composition and characteristics of an autologous thrombocyte gel.

BACKGROUND: The purpose of the current study was to characterize and compare an autologous thrombocyte gel containing several blood components with a commercially available glue. MATERIALS AND METHODS: Twenty-five volunteers had blood drawn, and lab values, characteristics of the platelet-enriched plasma (PRP), thrombocyte aggregation, electron microscopic examinations, and the breaking strength were determined and compared to a commercial glue. RESULTS: Overall 65% of the total thrombocytes could be isolated from the volunteers and an enrichment of 300% with an autotransfusion device could be achieved. Thrombocyte aggregation as a marker for thrombocyte function decreased from 92% in patients to 71% in the PRP. The autologous glue demonstrated a significant reduced breaking strength (0,76 N/cm(3)) compared to the commercial glue (7.42 N/cm(2)), P < 0.05. The decrease in breaking strength could be correlated with the thrombocyte concentration, P < 0.05. CONCLUSIONS: In the present study we have shown that an autologous platelet-enriched plasma cannot be used as a glue in the common sense to seal stitches or prosthesis. Platelet gels, however, have a high concentration of platelets that release the bioactive proteins and growth factors are necessary to initiate and accelerate tissue repair and enhance dermal and epidermal regeneration. To evaluate the possible clinical implication prospective, randomized studies should be performed to examine the effect of autologous plasma platelet-enriched plasma on wound healing.

Blood Platelets↗
PubMed2004

[Use of vacuum therapy during defect coverage of the upper extremity with microsurgically grafted arterialized venous flaps].

Arterialized venous soft tissue flaps are defined as tissue portions usually harvested from the anterior and distal third of the forearm over a venous pathway to be transplanted to another recipient area. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. At the recipient site flaps are perfused by a nourishing artery while the other veins are connected to one or more regional veins. The retrograde blood perfusion often results in edema, temporary epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. To circumvent these drawbacks grafting of arterialized flaps was combined with local application of vacuum to overcome the venous initial stasis, resulting in improved healing and survival of these flaps.

Adult↗
PubMed2004

[Salvage of exposed alloplastic materials in irradiated wounds - a case report].

BACKGROUND: Modern multimodal concepts of complex reconstructions and advanced wound management enlarge strategies for surgical oncological therapies. One of the mainstays of classical surgical therapy in case of exposed alloplastic materials in irradiated wounds was to remove the foreign body due to the risk of infection. This loss of integrity and function of the contaminated host bed was to allow wound healing and closure. METHOD: We report the management of a 56-year-old female patient who developed a lyomyosarcoma at her left shoulder girdle 8 years after radiation of the left thorax because of breast cancer. After radical tumor resection and exarticulation of her left arm in the shoulder joint a necrosis of the soft tissue envelope developed, leading to an exposed alloplastic mesh. Staged debridement and continuous application of negative pressure was performed three times. Ultimate plastic coverage was performed by means of a pectoralis myocutaneous island flap from the other breast. RESULTS: After staged debridement and repeated vacuum application excellent wound cleaning, neovascularisation, wound contraction and formation of granulation tissue within the previously irradiated tissue zone was observed. Until fourteen months postoperative wound coverage remained stable and no signs of infection were observed. DISCUSSION: By means of negative pressure therapy even in radiated wounds excellent wound cleaning and sufficient formation of granulation tissue can be achieved. In some cases negative pressure therapy together with staged debridement allows reintegration of exposed and therefore potentially contaminated alloplastic meshes into new formed granulation tissue in radiated wounds respectively radiation ulcers. Thus leading to the possibility of ultimate plastic coverage.

Breast Neoplasms↗
PubMed2004

[Basics foundation and results of the vacuum therapy in the reconstructive surgery].

Vacuum therapy (vacuum assisted wound closure (V.A.C.(R)) is a non invasive method to promote wound healing. It is based on defined, controlled negative pressure application via medical-grade reticulated polyurethane ether or polyvinyl foam dressing to wound surfaces. The technique is characterized by continuous removal of wound exudates and hence reduction of extravascular, interstitial fluid, subsequently leading to enhanced microcirculation. Experimental studies revealed a positive influence both on local microcirculation and on granulation tissue formation. Local mechanical physical factors, yet not completely understood, similar to tissue expansion, apply to the wound surface and seem to promote cell growth. In our own patients the vacuum technique has been used to pretreat chronic wounds in 139 patients, to fix split thickness skin grafts in 148 patients and to prefabricate or delay free or pedicled flaps in 11 patients so far. Thorough surgical debridement remains the mainstay of wound care. Vacuum therapy however, as an adjunctive procedure, offers significant advantages compared to conventional wound care methods, which call for further clinical and experimental studies to elucidate the basic mechanisms.

Debridement↗
PubMed2004

[Indication and clinical results of buried skin grafting to treat problematic wounds].

In 1920 Braun described a technique of skin grafting particularly designed for areas where shearing forces, high pressure and extensive secretion cause repetitive loss of conventionally transplanted skin. During the last 10 years we successfully used this technique when impaired wound healing was encountered due to various reasons. Clinical examples of application and results are presented. By combining this technique with vacuum therapy, formation of granulation tissue can be accelerated, thereby resulting in successful transplantation of problematic and therapy resistant wounds.

Adult↗
PubMed2003

[Treatment of decubitus ulcers in the geriatric patient].

Pressure sores (decubitus ulcers) and their treatment are a typical problem of old people in need of nursing care, after traumatization or in diseases of the peripheral nervous system. Patient instruction and appropriate schooling of nursing staff with regard to risk factors, and the use of standardized risk assessment aids, such as the Norton scale, can improve risk identification and prophylaxis, and minimize recurrent ulcers. Patients put at particular risk by paralysis, cachexia, shock, disturbed arterial perfusion, anemia, dehydration or major surgery should be bedded appropriately. In addition to the development of numerous modern wound dressings, the introduction of continuous vacuum therapy (V.A.C.) is of proven value, both as sole treatment resulting in healing and for accelerated preparation for plastic surgery. In stage 3 and 4 ulcers, plastic surgery involving displacement of tissue are usually required for permanent treatment.

Age Factors↗
PubMed2003

Ancient traditional Chinese medicine in burn treatment: a historical review.

Burn treatment in traditional Chinese medicine (TCM) has a long and remarkable history. This article provides a review of it's philosophy and knowledge, basic principles and treatment strategies as well as their modifications during 1300 years of medical development. The specific features presented are still influencing modern traditional Chinese medicine practitioners as well as modern Chinese burn treatment with considerable benefit for the treatment of burn victims.

Burns↗
PubMed2003

[The preconditioning and prelamination of pedicled and free microvascular anastomised flaps with the technique of vacuum assisted closure].

BACKGROUND: Since the technique of vacuum assisted closure has been clinically introduced, the possibilities in reconstructive head and neck surgery have greatly increased. Preconditioning and prelaminating allows a pedicled or free flap plasty to be epithelialized on both sides before the flap gets transferred to its future location. METHODS: We describe the technique of preconditioning and prelaminating of pedicled and free microvascular anastomised flap plasties and we report our experience with 5 cases. Our results are compared with data from the literature. RESULTS: The procedures concerned take only little time and the flap gets optimally prepared for its task in view of the postoperatively modified hemodynamics. By preconditioning, the flap to be lifted is prepared for the future centralised blood supply exclusively via the pedicle vessel without leaving the donor side. Thereby the skin island of such flaps can be increased in size over the natural angiosomes without an increased risk of necrotisation. CONCLUSIONS: By the technique of prelamination, skin or mucosa tissue may be applied onto both sides of the flap so that it can resist the biochemical and mechanical tasks which will be required after transposition. Especially for the reconstruction of defects in the upper aerodigestive tract this is a great advantage, since the inner side of the flap has to resist saliva which represents one of the most aggressive secretions in the human body.

Adult↗
PubMed2002

New and rapid fully automated method for determination of tazobactam and piperacillin in fatty tissue and serum by column-switching liquid chromatography.

A sensitive and rapid HPLC assay for determining tazobactam and piperacillin in fatty tissue and serum is described. While the common methods need liquid-liquid extraction before the injection in a automated column switching HPLC, the new method works by direct injection of the filtered tissue extract or diluted serum in a automated column switching HPLC without any other pre-treatment. This was performed by the use of a NH2-precolumn and enrichment/transfer at different pH-level. During the analyses, the NH2-precolumn was automatically regenerated with acetonitrile-water. The chromatogram peaks for piperacillin and tazobactam were identified by the retention time and quantified by peak area. The calibration curve was linear between 1 and 16 microg/ml. The quantification limit of tazobactam was about 1 microg/ml in fatty tissue extracts and in diluted serum (calculated for pure serum 2 microg/ml), respectively. For piperacillin it was less. The described procedure allows sample clean-up and determination of the antibiotic within 35 min. The chromatograms with this easy sample treatment had the same quantity of matrix peaks and in contrast to liquid-liquid extraction no loss of piperacillin. Because of the automatically rinsing of the NH2-precolumn during the chromatographic separation, more than 50 different biological samples could be measured with one NH2-precolumn without loss of performance.

Adipose Tissue↗
PubMed2002

Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography.

Our objective was to describe the imaging features of hypothenar hammer syndrome using minimally invasive contrast-enhanced MR angiography in comparison with oscillography study. In five patients with hypothenar hammer syndrome Gd-BOPTA-enhanced elliptically reordered 3D pulse sequence MR was compared with oscillography findings and clinical symptoms focusing on angiographic appearance of vessel injury, distribution pattern of hand vasculature and joining branches between the radial and ulnar artery supply. All patients showed segmental occlusion at the site of trauma impact with varying involvement of the superficial palmar arch, common volar digital arteries. Embolic disease was present in 50% of patients and could be clearly identified with MRA. Good correspondence was found between angiographic appearance including the presence of collaterals, clinical symptoms and oscillography. Bilateral comparison was helpful in distinguishing between vessel variants and pathology. Bilateral Gd-BOPTA-enhanced MR angiography is a minimally invasive method to depict clearly the localization and extent of vessel injury in hypothenar hammer syndrome providing valuable information about distribution pattern of hand vasculature and presence of collaterals; however, no flow data can be obtained.

Adult↗
PubMed2001

[With scalpel and suction against fatty tissue. Indications and methods of fatty tissue surgery].

Currently the most common indications for surgical removal of excess fat concern the abdomen, hips, thighs and arms. The main surgical procedures are liposuction and dermolipectomy. Liposuction is associated with minimal complication rates, but can be applied only when the overlying skin is capable of retracting and adapting to the new situation. If there is considerable excess of skin and tissue, dermolipectomy is performed to remove excess tissue by surgical resection via appropriately large incisions. Optimally, incisions should be places such that the resulting scar is invisible.

Adipose Tissue↗
PubMed2001

Management of hypovascularized wounds not responding to conventional therapy by means of free muscle transplantation.

BACKGROUND: Chronic ulceration as a complication of arteriosclerotic disease, venous congestion or diabetes mellitus is still a serious clinical problem, resulting in immobilization, extended hospitalization and cost-intensive treatment. Other than standard conservative treatment protocols or early amputation, microsurgical free transfer of well vascularized muscle tissue onto chronic wounds can induce angiogenesis and improve wound healing even in the hypovascularized wound. PATIENTS: From 1993-1999 we treated 12 patients (mean age: 46 years) with vascular ulcers of the lower extremity with free muscle or fasciocutaneous tissue transfer. RESULTS: The average hospitalization was 51.4 days. The perioperative mortality was zero. In one patient with factor V deficiency a partial flap necrosis occurred. Two revisions of the micro anastomoses had to be performed. Two seromas occurred at the donor site. No secondary flap loss was observed. Extremity or stump length preservation was achieved in all cases. CONCLUSIONS: Optimal postoperative treatment with physiotherapy and orthopaedic shoe support is important. If all these factors are present and if the patient is highly motivated a reintegration into normal life can be achieved.

Adult↗