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Biomedical subjects

D Hebebrand

Publications and source records attributed to D Hebebrand.

At least 19 recordsLinked to original sources

[Surgical management of soft tissue sarcomas: principles of resection and reconstructive plastic procedures].

1. Adequate complete surgical resection with a oncologic radical or wide margin of normal tissue represents the most important measure to prevent a local recurrence. Limited excision with "shelling-out" of the tumor, through its "pseudocapsule" almost invariably means positive microscopic margins. The pathohistologically or macroscopically marginal or intralesional positive resection margins make a salvage surgery necessary. 2. A close safety margin of < 1 cm due to neighboured anatomic structures indicates a high risk of local recurrence and makes an adjuvant radiotherapy mandatory. Plastic-reconstructive surgery should prepare the radiotherapy fields, to avoid cavities or ulcerations. 3. Facts should be stated in the clinical record and the operation report, e.g. the safety margin should be defined by the surgeon and the pathologist; the histopathologic stage and grade are absolutely basic requirements. If necessary, a second histopathologic review should be asked for. 4. Tumor resection and reconstructive oncoplastic measures should correspond individually to the oncologic parameters, to the functional demands and to the age of the patient. 5. Multidisciplinary cooperation in a tumorboard is a precondition for an adequate treatment.

Humans↗

Limb xenotransplantation using FK506 and RS61443 immunosuppression.

A new model of limb xenotransplantation has been developed to determine whether the newer immunosuppressive agents, FK-506 and RS-61443, either alone or in combination, can delay the rejection of a composite limb xenograft from donor Golden Syrian hamsters to recipient Lewis rats. Using a short-term course of immunosuppression for 14 days post-transplant, both FK-506 2 mg/kg/day and RS-61443 30 mg/kg/day were able to delay rejection. FK-506-treated animals had a mean rejection time of 10.2 days and RS-61443-treated animals had a mean rejection time of 10 days, compared with a mean rejection time of 6.4 days in non-immunosuppressed controls. Combination and sequential immunosuppression with both FK-506 and RS-61443 did not produce any improvement, compared with single-agent immunosuppression, and were quite toxic. Histologically, FK-506 seemed to prevent signs of rejection in the skin and muscle components of the limb xenograft better than RS-61443.

Animals↗

[Genetic methods in experimental xenogenic nerve transplantation].

The ready availability of xenografts and the promising results of genetic engineering both may offer new methods in peripheral xenotransplantation. FK506 and RS61443 are able to prolong survival of nerve xenografts. The incorporation of adenoviral sequences in xenogeneic tissues is possibly a new option for decreasing the toxicity of immunosuppressive drugs and immunogenicity of grafts.

Animals↗

[Reconstructive plastic surgery of thoracic wall defects].

Full-thickness defects of the thoracic wall following tumor resection, irradiation damage or secondary wound healing in thoracic surgery require early interdisciplinary cooperation to achieve patient-specific treatment modalities. Plastic surgical differential therapy allowing for sufficient soft tissue coverage, stabilisation of the thoracic wall and space filling in intrathoracic cavities, is presented and critically discussed.

Adult↗

Nerve xenograft transplantation. Immunosuppression with FK-506 and RS-61443.

An experimental model has been developed to study the potential transplantation of nerve xenografts using the newer immunosuppressive agents RS-61443 and FK-506. Sciatic nerve grafts of 2 cm were transplanted from donor Golden Syrian hamsters into a 0.5 cm gap in the sciatic nerve of recipient Lewis rats. Walking track analysis, somatosensory evoked potentials and histology demonstrated improved regeneration across the nerve xenografts that had been immunosuppressed with RS-61443 and FK-506 compared with non-immunosuppressed controls, but the function never approached that seen in control isografts. Regeneration across nerve xenografts immunosuppressed with FK-506 was better than xenografts immunosuppressed with RS-61443.

Animals↗

Gene transfer into nerve and muscle by isolated limb perfusion or during replantation.

In this study, the authors tested the feasibility of adenovirus vectors transferring functional genetic material into relevent soft-tissue structures during replantation of mouse hindlimbs. An adenovirus vector was constructed encoding the marker gene LacZ and CMV promoter and titered by plaque forming assay to 5 x 10(9) particles/ml. C3H mouse hindlimbs were divided into three groups. In Group 1 (n = 9), the femoral neurovascular bundle was divided and re-anastomosed . Group 2 (n = 9) hindlimbs were transected at mid-femur, perfused with adenovirus, and replanted. Group 3 limbs (n = 4) were perfused with saline only, followed by replantation. After 48 hr, morbidity and mortality were assessed, and the replanted limbs were assayed for gene transfer by histochemistry and polymerase chain reaction. 12/18 limbs were viable after 48 hr. Histochemical staining for adenovirus-mediated LacZ expression was positive within skeletal muscle, femoral nerve, and capillaries adjacent to the anastomoses. Distal muscle was also gene transfer positive. PCR analysis confirmed adenovirus-mediated gene transfer within the femoral nerve and skeletal muscle. This study confirms that viral-mediated gene transfer can be accomplished into the soft tissues of a replanted extremity.

Adenoviridae↗

[Changes in therapeutic principles in fractures of the extremities with severe soft tissue injuries exemplified by tibial fracture].

Functional results after open fractures have been improved during the last decades. Especially the rates of amputation and chronic osteitis after open tibial fractures have been reduced from 30% to less than 5%. The initial management of this type of fracture includes reconstruction of the perfusion of the involved vessels, subsequent debridement with resection of avascular tissues, decompression of compartments by fasciotomy and initial shortening of the tibia by osteotomy and followed by callus distraction in order to achieve the physiological length of the leg. Cortical bone with periostal stripping has to be covered by local muscle transfer or by free vascularized tissue transfer within 3-7 days. Bone defects are either reconstructed by cancellous bone graft or, if the defect is longer than 2 cm, by continuous segmental transfer, according to the technique described by Ilizarov.

Amputation, Surgical↗

[Plastic soft tissue coverage in defect fractures of the tibia].

Sequential radical debridement and early soft-tissue reconstruction have considerably decreased the amputation rate, length of hospital stay, chronic osteitis, the rehabilitation period and secondary reconstructive procedures in lower leg injuries. The introduction of distraction osteotomy and "biologic osteosynthesis procedures" have led to shorter and safer osteoplastic methods. The indication, tactics and technical pitfalls of current interdisciplinary treatment options requiring modifications in soft-tissue coverage are presented.

Bone Lengthening↗

[Lymphocyte subpopulations in spleen and blood after early wound debridement and acute/chronic treatment with hyperbaric oxygen].

Thermal burns as well as hyperbaric oxygen (HBO) may cause immuno-suppression. This is one of the reasons why there is some controversy in the literature regarding adjuvant HBO treatment for thermal burn patient, despite the fact that HBO is known to decrease edema formation and possibly inhibits the progression from second to third degree burns. In this study, lymphocyte subpopulations were labelled with monoclonal antibodies W3/25 for helper cells, and OX-8 for cytotoxic/suppressor cells, to determine changes following early burn wound excision and acute or chronic HBO treatment in a 10% full-thickness burn model in rats. Lymphocyte subpopulations were extracted from blood and spleen on day 1, 8, and 15 following burn and/or treatment. W3/25 cells did not show any significant changes in blood or spleen over time. Significantly lower OX-8 cell counts were found in the group with burn + excision + chronic HBO treatment on day 8 and 15. Acute or chronic HBO treatment alone did not produce evidence of immuno-suppression.

Animals↗

[Biological and molecular biology aspects of burn therapy].

Early wound closure, permanent skin replacement and management of postburn deformities are still unsolved problems in the treatment of burns. However, recent developments in biology and molecular biology provide new possibilities for improved therapy. This includes the enhancement of burn wound healing by growth factors and growth hormone, modulation of immunogenicity of skin allografts by gene transfer, cytokine treatment of burn sepsis and the use of cell membrane stabilizers in electrical injuries.

Animals↗

[Preoperative patient education in plastic surgery].

Federal guidelines requires written informed consent for each operation. The patient has to be informed about important facts concerning the treatment. The specific risks always have to be mentioned in detail. If the patient is not able to agree expressly because of his serious injury, he can be treated without express consent. The extent of the preoperative information depends on the indication: the more urgent the treatment, the less detailed the amount of information and vice versa.

Germany↗

[Abductor digiti minimi-plasty: a local muscle flap for treatment of calcaneus fractures with limited soft tissue injuries].

Wound healing complications and osteitis following calcaneus fractures are common problems due to compromised local soft-tissue perfusion. Transposition of the M. abductor digiti minimi was successfully performed in 12 cases. The problem of soft tissue coverage could be solved by this procedure. Up to now, no negative influence on the myo-osseous architecture of the feet could be observed.

Adult↗

Use of glycerolized human allografts as temporary (and permanent) cover in adults and children.

Multiple efforts to achieve immediate and complete burn wound closure following early debridement have been attempted to prevent septic complications, and to decrease the morbidity and mortality associated with major burns. The BG University Hospital Bergmannsheil Bochum (BGUBB) Burn Centre admitted 157 patients with deep partial thickness and full thickness skin burns during 1991 and 1992. Twenty-eight of these patients (18 per cent) were treated with glycerolized human allografts. A total of 57 allograft transplantations were performed on these 28 patients. Our indications for the use of glycerolized human allografts, as well as our results, are presented and discussed.

Adolescent↗

[Laparoscopic or classical appendectomy? A prospective randomized study].

Though laparoscopic appendectomy started endoscopic surgery in general surgery, it has yet not reached the acceptance as is the case with cholecystectomy. The application of this technique in possibly bland appendices and reports that the technique was accompanied by severe complications, increases the scepticism about it. This made us decide to start a randomized controlled trial: laparoscopic vs. conventional appendectomy. More than 1000 endoscopic interventions mainly performed at the gallbladder and the stomach and 165 prospectively documented and partly treated patients with acute appendicitis were the basis to start this trial. "Acute Appendicitis" was diagnosed on the basis of clinical symptoms by means of the computer-aided questionnaire of the EC-study "Acute Abdominal Pain", a self-developed validated diagnostic score, the macroscopic findings and the careful assessment of the histology of the resected appendix. Beside the technical feasibility, principle end-points were mainly intensity and course of postoperative pain measured by means of the Visual Analogue Scale (VAS) in lying, standing and moving position and the postoperative consumption of analgesics. We assessed a difference of 15 points on the VAS as clinically relevant. Of 57 patients with acute appendicitis we performed open appendectomy in 23 and laparoscopy in 34 patients according to randomization. In 9 patients of the laparoscopy group it was necessary to change over to open appendectomy for different reasons resulting in a direct comparison of 25 laparoscopies versus 23 open appendectomies. There were no differences between sociodemographic and preclinical data in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

[Reconstructive surgery of knee para-articular amputation stumps].

Reconstructive plastic procedures in primary care and in postprimary/secondary treatment following below knee and above knee amputation are discussed. Short amputation stumps and stumps suffering from insufficient soft tissue coverage should be primarily avoided employing salvage replantation techniques. Secondarily conventional flaps and grafts, tissue expansion and/or microsurgical free tissue transfer all serve for achieving stable skin conditions and preserve adequate stump lengths. Interdisciplinary treatment racionale will lead to improvement of functional and social rehabilitation.

Adolescent↗