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Biomedical subjects

W Fleischmann

Publications and source records attributed to W Fleischmann.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Vacuum sealing as carrier system for controlled local drug administration in wound infection].

Between 1.4.96 and 1.3.97 27 patients with acute infections of bone and soft tissues (n = 13), chronic osteomyelitis (n = 8), and chronic wounds (n = 6) were treated by using Instillation-Vacuum-Sealing. Polyvinylalcohol sponges with drainage tubes were used to cover the internal or external wound surfaces which resulted from surgical debridement. Having hermetically covered the wound with a transparent film dressing a vacuum source generated a partial vacuum in the sponge which was modified according to the type of wound between 20 and 80 kPa. Several times daily, the vacuum line was blocked and, in an alternating fashion, antiseptic or antibiotic solution instilled for 30 minutes. Then, the vacuum was reestablished and the fluids drained from the wound. Seven days later, intermittent drug instillation was stopped and there was either immediate or delayed wound closure by secondary suturing (n = 22), skin grafting (n = 3) or spontaneous epithelialization (n = 2). During a follow-up from the beginning of the instillation treatment of 4.2 (3-14) months there was one recurrency of infection in a patient with chronic osteomyelitis.

Adolescent↗
PubMed1998

[Instillation vacuum sealing--report of initial experiences].

Patients with acute (n = 13) or chronic (n = 14) infections were treated by the novel technique of instillation vacuum-sealing, which uses the PVA sponge as a drug-release system for antibiotic and antiseptic solutions. During a follow-up of 4.2 (3-14) months there was one recurrence of infection in a patient with chronic osteomyelitis.

Adolescent↗
PubMed1997

[Treatment of infection by vacuum sealing].

Between 1 January 1992 and 31 July 1995, 313 patients with acute and chronic infections were treated by vacuum sealing (VS). The average duration of VS treatment was 16.7 days, and there was an average of 3.1 changes in the VS system. In acute infections (n = 203) the wounds were closed by secondary suturing (65.5%), spontaneous epithelialization (17.2%), skin grafting (12.3%) and flap transfer (2%). Six patients died (3%). Infection recurred in 3.9% and was cured by another VS treatment. Unstable scar formations (1%) were treated by free flap transfers. When compared with standard open-wound treatment, the low-cost VS technique offers great advantages with regard to hospital hygiene, patient comfort and therapeutic results.

Abscess↗
PubMed1996

[Closure of defect wounds by combined vacuum sealing with instrumental skin expansion].

Between 1.6.1995 and 31.12.1995, 17 trauma defect wounds were closed by suturing in 12 patients with a median of age of 35 (11-65) years, a new type of instrument for skin stretching being used in combination with a vacuum sealing procedure. According to clinical experience, closure of the skin defect would have required skin grafting in all patients. After secondary suturing 15 wounds healed without problems, while in the case of 1 wound there was a small skin defect, which healed spontaneously. In another sutured wound a partial dehiscence occurred over the medial malleolus on the 10th postoperative day; this also healed spontaneously without further surgical measures. There were no wound infections or necroses of the wound edges. This procedure is recommended for the closure of defect wounds, as it reduces the risk of wound infections, shortens the period of treatment and avoids cosmetically and functionally inadequate skin grafts.

Adolescent↗
PubMed1996

Bacterial recolonization of the skin under a polyurethane drape in hip surgery.

This study investigated the proliferation of skin flora under polyurethane (PU) wound dressings following surgical interventions. In vitro the film proved to be impermeable to staphylococci. However, bacteria migrated under the film, showing a preference for the adhesive rather than the adhesive-free areas. The skin of 43 patients with incisions of the proximal thigh was covered postoperatively with a transparent PU-dressing. This was examined bacteriologically preoperatively and at the third and seventh postoperative days. The use of an antiseptic (povidone iodine) reduced the number of colony forming units in the postoperative skin but at the same time there was a significant reduction of bacteria under the film in comparison with the uncovered skin. The numbers and species of bacteria in different areas under the film did not suggest a spread of organisms from the uncovered skin to the skin under the film, but rather that there was a multifocal microbial regeneration.

Adult↗
PubMed1996

[Vacuum assisted wound closure after dermatofasciotomy of the lower extremity].

Between 1 January 1992 and 15 March 1994 25 patients with compartment syndromes of the lower limb were treated by the vacuum-sealing technique (VS). Ten out of 25 patients had multiple injuries. Eight compartment syndromes were located in the thigh, 14 in the lower leg and 3 in the foot. The average time of VS was 12.7 (4-31) days with 2.1 (1-8) changes per patient. The wounds were either closed by secondary suturing (n = 20) or by skin grafts after partial closure of the wounds by suturing (n = 5). One patient developed a superficial wound necrosis, which healed spontaneously without invasive surgical treatment. In 52 intraoperative swabs of the wound surface there was bacterial growth in five bacteriologic specimens, but there were no clinical signs of infection.

Compartment Syndromes↗
PubMed1995

Increase of stability in external fracture fixation by hydroxyapatite-coated bone screws.

A major problem in fracture treatment by external fixation is screw loosening, which often results in reduced stability and can lead to prolonged treatment. A load-carrying experiment was conducted to determine whether coating implants with bioactive hydroxyapatite (HA) increases screw stability. Twelve HA-coated ASIF screws with 3 different macroporosities were inserted in 12 sheep that had already been fitted with a 6-pin external fixator for the treatment of a tibial osteotomy. The same number of uncoated polished steel screws served as controls. Although initial stability was not different for HA-coated screws, average removal torque after a 9-week implantation period increased with increasing macroporosity of the HA coating (p < .002). Instability of some screws was accompanied by histologic findings of cartilagenous tissue and proliferation of periosteal callus. Near the threads in the tibial cortex and in the shaft area of the screw were seen large numbers of HA particles that had been sheared off during implantation as well as during screw removal because of high contact forces between the HA coating and bone. Particulate debris of HA particles as well as the release of small bone fragments during explanation is likely to be unavoidable since HA adherence to bone is greater than adherence to steel after several weeks of implantation.

Animals↗
PubMed1995

Displaced scapular fractures: indication and long-term results of open reduction and internal fixation.

Displaced scapular fractures are often found in polytraumatized patients. In emergency treatment they assume a minor role. Advances in dealing with severely injured patients in most instances allow us to perform an operation on the fractured scapula within the first 2 weeks after injury. A differentiated approach is necessary as exclusively conservative treatment does not always bring about good results. From 1981-1991 we performed open reduction and internal fixation (ORIF) in 25 patients with displaced fractures of the scapula. The long-term results could be assessed in 20 patients after an average of 6.1 years. The different types of fractures were classified according to Habermeyer/Ideberg, and the Constant score was used in the evaluation of results. Some 64% of patients were involved in road accidents, and 64% suffered concomitant injuries. Articular fractures (n = 6) were the most common ones, followed by fractures of the coracoid process (n = 5) and the neck of the scapula (n = 2). There was no early postoperative complication, and follow-up showed a breakage of K-wires in one patient (fracture of the acromion). Thirteen patients obtained a very good, two patients a good, four a fair and one a poor result (according to the Constant score). Fractures of the scapular neck had the best results in terms of pain, daily activity, range of motion, and strength) as compared with fractures of the glenoid and apophyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Open segmental bone transport. A therapeutic alternative in post-traumatic and osteitis soft tissue and bone defects].

Between 1990 und 1992, 22 patients with bone and soft tissue defects were treated by open segmental bone transport according to Ilizarov, and 20 of these were followed up over a period of 18 months after removal of the external fixator. In 19 cases the bone defect could be filled by callus distraction only, while 1 patient needed additional spongeous bone transplantation because of delayed ossification. In 1 case amputation was necessary because of extensive fistula carcinoma of the resected bone and soft tissue. Closure of soft tissue defect was achieved in 14 patients simultaneously with docking of the bone segments. In 5 patients additional skin transplantation was needed, and in 1 case a latissimus dorsi flap had to be transferred because of unstable scar formation. Transporting vital bone simultaneously with the overlying tissue into a defect allows for limb salvage even in poor biological conditions and in patients with vascular problems. Open bone transfer has extended the range of methods available for the treatment of bone and soft tissue defects.

Adolescent↗
PubMed1995

Diagnosis of pyogenic abscesses by ultrasound.

Pyogenic infections are common in tropical countries and draining pus is one of the most frequent surgical operations all over the developing world. While superficial abscesses are easily detectable by clinical means the diagnosis of deeper abscesses in muscles, joints, parenchymatous organs and body cavities is frequently difficult or even impossible. In those situations B-mode ultrasound represents a valuable diagnostic tool. Furthermore, diagnosis may be confirmed or defined by ultrasound guided needle aspiration and ultrasound-guided drainage. Those measures may save surgical interventions and cost. Based on our experience with more than 3820 ultrasound examinations in 2746 patients of Northern Zaire sonographic characteristics of pyogenic abscesses are defined. Clinical examples of pyogenic affections with the corresponding ultrasound morphology are presented.

Abdomen, Acute↗
PubMed1994

[Treatment of problem fractures with the Ilisarow procedure. Minimally invasive fixation technique and callus distraction].

Between march 1990 and december 1992, 19 patients with compound fractures were treated with Ilisarow's external fixator at the Department of Traumatology of the University of Ulm. The device was applied as a primary implant in 7 patients, most of whom showed fractures of infectious cavities or refractures in a latent state of infection. 12 patients were stabilized with a change to the ringfixator in secondary fracture treatment during 4 weeks after trauma. 5 of these patients suffered of acute osteomyelitis after internal fracture fixation, 3 patients had metaphyseal fractures and in four cases extensive bone defects were filled by callotasis. Treatment could be completed with the ring device in 16 patients whereas in 3 patients a change to internal fixation had to be performed due to delayed union or atrophic pseudarthrosis. The main disadvantages of this system consisted in the comparatively time consuming operative procedure and limited comfort for the patient. Nevertheless, Ilisarow's device has proved to be an useful tool in the treatment of compound fractures or fracture treatment under poor biological conditions due to its minimal invasive fixation technique.

Accidents, Traffic↗
PubMed1993

Thromboxane--co-factor of pulmonary disturbances in intramedullary nailing.

UNLABELLED: Pulmonary complications during and after intramedullary nailing particularly in trauma patients have directed clinical interest to thromboembolic events and metabolic alterations, as found in different methods of fracture stabilisation. In 30 patients (mean age 34 years) isolated, closed or 1 degree open fractures of the tibia were operated on in three groups with reamed nailing (RN; n = 11), unreamed nailing (UN; n = 11) and external fixation (EF; n = 8) respectively. In blood samples of the femoral vein of the fractured limb, a 5-7 fold increase of the thromboxane (TXB2) concentration was found in all patients. However, differences of TXB2 concentrations in the arterial blood after passage of the lungs were conspicuous. The highest arterial TXB2 concentrations were found in connection with RN, followed by UN and finally EF. The transpulmonary TXB2-clearance displayed the following relationship: EF > UN > RN (5.7:4,4:2.2). A similar correlation was found for PGF2 alpha while other arachidonic acid metabolites showed no significant behaviour. TXB2 and PGF2 alpha cause bronchoconstriction, pulmonary vasoconstriction and aggregation of thrombocytes. These pulmonary disturbances may results in ARDS, a feared complication after intramedullary nailing. CONCLUSION: Early fracture stabilisation particularly in severely injured patients is an established procedure. To prevent pulmonary disturbances the external fixator is preferrable to the UN and finally the RN. Our data suggest that for the prevention of pulmonary disturbances EF is superior to UN and RN.

Adolescent↗
PubMed1993

Indications for operative fracture treatment in tropical countries.

In the period 1 January 1987 to 30 June 1989, 3003 operations were performed at the regional hospital of Gbadolite, northern Zaire. In 123 patients fractures were reduced operatively, in 86 patients by internal fixation and in 37 patients by external fixation. There was no additional bone infection after external fixation but six of 28 patients (21%) with internal fixation by plate and screws developed postoperative osteitis. Non-union was observed in 12% after intramedullary nailing, in 4% after screw fixation alone, and 14% after internal fixation by Kirschner wires. Based on these data, indications and contraindications for operative fracture treatment in tropical countries are defined.

Adolescent↗
PubMed1993

Philosophy of osteosynthesis in shoulder fractures.

A wide range of workable instrumentation is available for the treatment of proximal humeral fractures, whereas osteosynthesis of scapular fractures is commonly achieved by plate/screw fixation. Older persons are confronted with a steadily rising incidence of osteoporotic fractures. Especially for this group of patients, minimally invasive and minimally instrumented surgical procedures, such as K-wiring and bone sutures, seem to have superseded plate fixation. For the treatment of scapular fractures, an important question remains: Which fracture types provide better functional results with open reduction and internal fixation, and which with conservative treatment? Our indications for an operative procedure are limited to the floating shoulder, dislocated scapular neck fracture, and dislocated glenoid fracture.

Fracture Fixation, Internal↗
PubMed1993

[Vacuum sealing as treatment of soft tissue damage in open fractures].

In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing. Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect. Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria. The connection of the drainage tubes to a suction device, such as vacuum bottles, produces negative pressure in the polyvinyl foam, which means a high-contact zone of the foam-wound interface. This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue. Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique. When the correct technique was applied the infection cleared up.

Adolescent↗
PubMed1992

[Surgical treatment of fractures in tropical countries].

In tropical countries, the indication for operative treatment of fractures treatment must be restrictive. Based on our own experience and the treatment results, the prerequisites for operative treatment are given and proposals concerning indication, preoperative preparation and operative tactics. The osteosyntheses recommended are the different forms of external fixation, in particular the external fixator (AO) and the transfixational plaster cast technique. The external fixator is the basic tool in tropical traumatology.

Adolescent↗
PubMed1992

Treatment of bone and soft tissue defects in infected nonunion.

In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of pseudarthrotic and infected bone tissue, and of diseased surrounding soft tissue. External fixation devices are the preferred method of stabilization of the bone. Based on the data of a retrospective study of 31 Papineau procedures, 65 local flap transfers, and 46 free flap transfers we found that the Papineau procedure works in minor bone and soft tissue defects. Unstable scar formation is a major disadvantage of this method. Local muscular flaps are indicated in the treatment of soft tissue defects in the proximal and medial portions of the lower leg. A prerequisite for free flap transfers is the availability of trained personnel and suitable technical equipment. The option is limited by the patient's vascular situation. This kind of tissue transfer seems to be superior to other methods. For the substitution of bone defects corticocancellous bone transplantation may be used. A promising alternative method to deal with extensive bone defects is osteogenesis produced by callus distraction.

Bone Transplantation↗