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Biomedical subjects

A H Schwabegger

Publications and source records attributed to A H Schwabegger.

At least 19 recordsLinked to original sources
PubMed2007

[Combined latissimus dorsi-thoracodorsal artery perforator-transpositional free flap].

BACKGROUND: Reconstruction or complete cover of extended but polygonal defects is limited by the size of transplantable tissue. One of the largest composite tissue components to be transplanted is the myocutaneous latissimus dorsi flap. Under certain circumstances even this large-scale flap is not sufficient for complete defect cover. Based on experiences with the thoracodorsal artery perforator (TAP) flap, the skin island adjacent to the latissimus muscle may be raised, pedicled on the perforator vessels penetrating the underlying muscle. Thus this island may easily be transposed or rotated to enable additional defect cover. METHODS: This method was applied in eight patients for defect cover at the extremities, thorax or for hypopharynx reconstruction. The exact location of perforator vessels may be determined pre- or intraoperatively with a hand Doppler so that skin flap transposition can already be planned before surgery. RESULTS: All of the skin flaps transposed or rotated healed without complications. It may even be assumed that utilizing this method helped to avoid further complications like scar contractures, because tension-free wound closure was feasible. CONCLUSIONS: The combined latissimus dorsi- thoracodorsal artery perforator-transpositional free flap is capable of covering very extensive polygonal as well as defects over joints in order to prevent scar contractions.

Adolescent↗
PubMed2004

[Emergency free microvascular flap transfer for repair of a pharyngeal defect manifesting as carotid artery erosion hemorrhage].

We report on a case of an emergency free flap cover of a pharyngeal defect which was made necessary by aggressive digestive salivatory and radiation effects 3 weeks after neck-dissection and laser ablation of an epidermoid left tonsil carcinoma. Life threatening intraoral bleeding resulted from the erosion of branches of the external carotid artery. After management of the bleeding, massive blood transfusions and restoration of the patient's general condition, a sandwich patch cover of the transmural pharyngeal defect was achieved using a microvascular lateral arm flap. This aimed at preventing further digestive effects and bacterial colonisation of the neurovascular structures at the carotid triangle. Unfortunately, due to external mechanical forces, the flap became avascular and thus necrotic at the eighth postoperative day; however, until the successful replacement by a myocutaneous latissimus dorsi flap it remained water-tight and fulfilled its sealing task.

Anastomosis, Surgical↗
PubMed2002

[Technical refinements in planning and surgical therapy of pectus carinatum].

From 1998 to 2002 ten patients underwent surgical correction of pectus carinatum using a new diagnostic preoperative three-dimensional volume rendering mode computed tomography. Particularly the deformed rib cartilages can now also be visualized, which allows exact preoperative planning of the extent of cartilage resection and localization of required sternum osteotomies. This additional information results in a focused surgical approach and hence minimizes scars. As an additional innovation, resorbable plates and screws were used for refixation of the osteotomized parts of the sternum. For postoperative thorax immobilization and hypertrophic scar circumvention, a special keel chest brace was applied in all patients for 6-8 weeks. No complications occurred in any case, and all patients were very content with the aesthetic results achieved.

Absorbable Implants↗
PubMed2002

Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature.

We report our experience with the thoracodorsal artery perforator flap. Its use and pitfalls are critically highlighted, especially in terms of its application as an island flap. Publications on this recently described flap are scarce, possibly because it is rarely used as a result of the high level of skill needed in its preparation. In our hospital, we have used this flap twice as an island flap, both of which failed, and ten times as a free flap, one of which failed. Transfer as a free flap is a delicate procedure involving transmuscular vessel preparation; transposition as an island flap is limited by range. Based on our limited experience, we recommend this flap only in very selected cases. This procedure has to be performed by experienced microsurgeons, after training on cadavers, and after preoperative colour Doppler imaging to determine the precise location of the main perforators. Use of this perforator flap is indicated in cases where a long vascular pedicle for an appropriate free tissue transfer is necessary, and where aesthetic appearance and minimising donor-site morbidity are more important than a potentially high risk of failure.

Adolescent↗
PubMed2002

[The thoracodorsal artery perforator flap].

This report presents our experience with the thoracodorsal artery perforator flap. Its use and pitfalls are critically highlighted, especially the application of this flap as an island flap. Only few publications on this recently described flap are available, possibly because of the high level of skill needed in its preparation. In our hospital, this flap was twice used as an island flap, both of which failed, and ten times as a free flap one of which was a failure. Harvesting of this flap is a delicate procedure involving transmuscular vessel preparation, additionally transposition as an island flap is limited in range. Based on our limited experience, we can recommend use of this flap only in carefully selected cases. This procedure has to be performed by experienced microsurgeons, after training on cadavers, and after preoperative color Doppler imaging for determining the precise location of the main perforators. Only in cases, where a long vascular pedicle for an appropriate free tissue transfer is necessary, and where aesthetic appearance as well as minimizing donor-site morbidity are more important than a potentially higher failure rate, utilizing this perforator flap is justified.

Amputation Stumps↗
PubMed2001

[A new classification for standardizing nomenclature in wound closure by microvascular flap-plasty].

The profusion of terms currently used to describe microvascular flap wound closure according to the time of reconstruction makes reliable comparisons of outcomes between institutions difficult if not impossible. To address the issue, a consistent terminology applicable to microvascular flap wound closure in general was formulated with respect to our experience with a total of 197 microvascular tissue transplantations. The nomenclature presented divides microvascular flap closure into three categories: "primary microvascular flap closure" (within 24 hours). "delayed primary microvascular flap closure" (two to seven days), and "secondary microvascular flap closure" (after seven days). This is consistent with known biological, microbiological, and surgical principles of wound closure in general and should provide a simple basis for classifying microvascular flap wound closure. Sample cases are selected to illustrate the categories within this new classification scheme.

Adolescent↗
PubMed2001

Fetal spinal-cord allograft as a substitute for peripheral-nerve reconstruction: a preliminary experimental and histologic study.

The aim of this preliminary experimental study consisted of an exploration of the suitability of fetal spinal-cord allograft as an alternative guiding conduit for bridging peripheral-nerve defects, since fetal tissue is considered to be less immunogenic than tissue from adults or maturely born individuals. The experiment was carried out with 10 Long Evans inbred rats. Within the control group, autologous sural-nerve grafts served to bridge an artificially created defect of 1.5 cm along the course of the sciatic nerve in the thigh of adult male rats. On the contralateral thigh, a defect of the same size was bridged by spinal cord, taken from 17- to 20-day old fetuses. Ten weeks thereafter, the reconstructed nerves were examined histologically. Compared to the autologous nerve grafts with optimal regeneration, the spinal-cord grafts showed less ingrowth of axons. But, surprisingly, an exceptionally long survival time of astrocytes and other nerve cells resulted while, at the graft margin, bundles of astrocytes apparently served as a conduit for ingrowing axons. Using fetal spinal-cord allograft to reconstruct peripheral-nerve defects may present a future alternative for coexisting methods, but further studies with longer follow-ups, a greater number of larger animals, and with the additional evaluation of immunologic interactions, should be attempted, to draw clear conclusions.

Animals↗
PubMed2001

[Viability monitor of free flaps in hypopharynx reconstruction].

Single-stage microvascular reconstruction of neck defects with jejunum or other free flaps are well established methods. However, these flaps usually are buried subcutaneously and viability surveillance is difficult. Alternatively to technical monitoring devices, we present a simple method using a "sentinel" part of the free jejunum flap transposed outside to the skin surface or sutured into the skin when using fasciocutaneous or myocutaneous flaps. Although this method is not new, it is rarely used. Compared to pure technical monitoring devices, it is easily performed and monitoring of buried free flaps especially in the neck region is reliable.

Esophageal Neoplasms↗
PubMed2001

The lateral arm flap.

The authors contend that the conventional flap (LAF) and the ELAF should be considered among the best choices of all possible fasciocutaneous flaps for head and neck reconstruction. Easy and quick dissection under tourniquet, design variability, and potential sensory innervation make these flaps superior to other fasciocutaneous flaps. The ELAF provides the same pliable, thin fasciocutaneous tissue and a longer pedicle than the RFF. In contrast to the RFF, the donor site can be closed primarily and heals with an acceptable scar without any functional deficit. The authors therefore strongly recommend clinical application of these flaps in head and neck reconstruction.

Aged↗
PubMed2000

The lateral thoracic fasciocutaneous island flap for treatment of recurrent hidradenitis axillaris suppurativa and other axillary skin defects.

A series of eight axillary skin defect reconstructions in seven patients using the lateral thoracic island fasciocutaneous flap is presented. The defects originated from wide excision of recurrent hidradenitis axillaris suppurativa and in one case from radical melanoma resection with axillary lymph node clearance. The technique used to cover the resulting large defects is advancement or transposition of an island flap from the lateral thoracic wall, pedicled on two or three nourishing vessels arising from the lateral thoracic or thoracodorsal vessels. No flap complications occurred and the results with respect to donor site morbidity, functional and aesthetic outcome were very satisfactory.

Axilla↗
PubMed2000

Limb salvage after fulminant septicemia using a free latissimus dorsi cross-leg flap.

A 15-year-old boy survived fulminant meningococcal septicemia, with extensive tissue necrosis involving the face and the right arm, complicated by peripheral gangrene of the fingers on both hands and the distal parts of the feet. Although still often fatal, the mortality of fulminant septicemia has dropped substantially in the past decades, leading to more survivors, and requiring concurrent reconstruction of all extremities. This report discusses the advantages of using a single, free, latissimus dorsi (LD) myocutaneous cross-leg flap to salvage both feet, and the use of pedicled groin flaps bilaterally for coverage of fingers and hands, as illustrated by this case.

Adolescent↗
PubMed2000

Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.

The authors' experience with simultaneous reconstruction of the quadriceps femoris or patellar tendon or both and soft tissue defect using a musculotendinous unit of the gastrocnemius muscle is presented. Five patients with a partial or complete defect of the quadriceps or patellar tendon or both and additional large soft tissue defects underwent reconstruction applying this technique as a one-stage surgical procedure in different variations. In cases with a partial defect of the tendon or loss of tendon thickness, the thick aponeurosis from the deeper aspect of the gastrocnemius was dissected and transferred as a pedicled tendon flap to reconstruct the tendon defect. In cases with a complete defect of the tendon, the superficial layer of the Achilles tendon together with the deep aponeurotic layer of the gastrocnemius muscle served to reconstruct the tendon. In both procedures the gastrocnemius muscle belly provided soft tissue coverage and was covered with a split thickness skin graft. One patient had a marginal deep necrosis develop that had to be covered with the other gastrocnemius muscle in a second operation. One patient with chronic polyarthritis and infection of his knee prosthesis declined additional reconstruction surgery and had the leg amputated. The average followup was 3.5 years. All patients achieved good results in active extension of the knee with an extension deficit of only 5 degrees to 15 degrees. The range of flexion was at least 90 degrees. The surgical technique described in this report provides functional tendon reconstruction and adequate soft tissue repair simultaneously.

Adolescent↗
PubMed1999

[Complex hand injuries. Importance of primary repair with free flaps].

BACKGROUND: The treatment of large and complex hand injuries is particularly challenching concerning the functional and cosmetic outcome. In this kind of injuries the primary defect cover is of paramount importance and so the initial situation for secondary reconstructive options may be evidently improved. MATERIAL & METHODS: Between October 1986 and Mai 1996 43 patients with large complex and combined hand injuries were primarily treated with 49 free flaps. The mean follow-up was 39 (6 to 92) months, the mean hospital stay was 19 (8 to 40) days. Depending on the time of the reconstruction and based on a classification established in our clinic, the patients were distributed among three groups: primarily (within 24 hours), delayed (between 2 and 7 days), and late (after 7 days till 3 weeks posttraumatically) reconstruction. RESULTS: Within the group of primary reconstruction the best results could be achieved, since radical debridement and primary defect cover by healthy tissue (free flap) led to physiological wound healing. That caused reduced hospital stay thus decreased costs, since flap failure, infection and multiple secondary surgical interventions could be diminished. Also earlier rehabilitation and reintegration into social life and profession was achievable. CONCLUSION: Due to the obtained results a primary treatment of large and complex hand injuries through radical debridement and reconstruction with free flaps seems to be effective and should already be considered in the emergency room.

Adolescent↗
PubMed1999

Transpositional replantation of digits. Case reports.

Heterotopic or transpositional replantation of digits is technically feasible with results similar to those of conventional replantation procedures. Occasionally in multiple digital amputations not all the digits may be replanted in their correct place as a result of complex injuries proximal to the amputation zone or severe damage to important fingers. In these circumstances the amputated digits that are in the best condition as regards undamaged tissue are used for replantation. The primary priority is an optimal functional outcome and the secondary priority the cosmetic outcome. Amputated long digits will always be used to substitute for a non-replantable thumb rather than to replace a long finger. We present 13 cases of successful transpositional digit or joint replantations in traumatic amputations of more than one digit.

Adult↗