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Biomedical subjects

F Hölzle

Publications and source records attributed to F Hölzle.

14 recordsLinked to original sources
PubMed2006

Double-skin paddle perforator flap from the lateral lower leg for reconstruction of through-and-through cheek defect - a report of two cases.

Extensive defects after ablative surgery of oral cancer, involving exterior skin of the cheek, demand for complex reconstruction. It often requires two free flaps, or double-skin paddle scapular-, radial forearm- or fibular-flap to reconstruct through-and-through cheek defects. The outcome is mostly described as successful and functional. Nevertheless donor site morbidity and functional impairment should not be neglected. This report describes the use of double-skin paddle perforator flaps from the lateral lower leg for combined intra and extraoral reconstruction after tumour resection. This kind of flap first avoids the need of an additional free flap, secondly it produces minimal donor site morbidity because of consequent preservation of the peroneal artery and primary wound closure. Thirdly it enables a good aesthetic outcome possible because of the primarily thin, pliable and variable skin paddles.

Adenoma, Pleomorphic↗
PubMed2006

The early use of a perforator flap of the lateral lower limb in maxillofacial reconstructive surgery.

The development of perforator-based flaps led to new donor sites and enlarged the spectrum of recipient vessels using arteries and veins of very small calibres. Although these flaps, which are directly anastomosed at their terminal cutaneous branches, are becoming more and more important for reconstructions in other regions of the body, perforator-based flaps have not played an important role in maxillofacial surgery until now. This study reports the experience with 24 consecutive perforator flaps from the lateral lower limb for intra- and extraoral defect coverage. Septo- or myoseptocutaneous perforators from the peroneal artery served as the flap pedicle having a length of 4-7 cm and diameters of 1-2 mm. Indications were reconstructions of the floor of the mouth (10), soft palate (3), tongue (6), closure of perforating cheek defects (2) and reconstruction of the facial skin (3). Anastomoses were performed to the lingual, facial, temporal or thyroid superior artery. Except for 2 cases, all perforator-based flaps were healed well and the morbidity of the donor site was nearly negligible. According to the early experience in this study, perforator-based flaps from the lateral lower limb may have an indication if recipient vessels available are close to the defect and if very low donor site morbidity is important to the patient.

Aged↗
PubMed2005

Reversible ischaemia after raising a radial forearm flap with ulceration of three fingers in a cigarette smoker.

The radial forearm flap is a standard method for the reconstruction of intraoral defects of soft tissues. We report the case of a middle-aged man who developed ischaemia in three fingers after a fasciocutaneous radial flap had been raised. The preoperative Allen test to diagnose occlusion of radial or ulnar artery was satisfactory. Soon after the operation the patient resumed smoking and four weeks later he developed ulcers on the thumb, index, and middle fingers. Only after he had stopped smoking and been given acetylsalicylic acid and heparin did blood flow and capillary hemoglobin oxygenation increase. As a result, his radial fingers recovered completely.

Anticoagulants↗
PubMed2005

[Limitations of blood supply to the skin flap in face lift surgery].

BACKGROUND: Besides nerve injuries or hematomas, one of the main risks of face lift surgery is the development of skin necrosis. We therefore investigated which arteries contribute to the blood supply of the face lift skin flap and how extensively mobilization can be performed before arterial cutaneous circulation is endangered. MATERIAL AND METHOD: In six cadavers, selective dye injections into the branches of the carotid external artery were performed to determine the location of their vascular territories in relation to the face lift region. In another 12 cadavers, face lift flaps were raised with different extension of the undermined skin area before dye injections were performed. RESULTS: It was shown that the facial artery provides blood supply to the area of the face lift flap by perforating vessels in the paranasal, perioral and submental regions and the transverse facial artery by a perforating vessel below the malar bone prominence. Although the perforating vessel of the transverse facial artery was transected by standard mobilization, the face lift flaps were sufficiently perfused via the paranasal and perioral perforating vessels of the facial artery alone. CONCLUSION: We conclude that undermining of the face lift flap should not exceed the nasolabial fold to preserve the perforating vessels of the facial artery in the centrofacial region.

Arteries↗
PubMed2005

[Castleman's disease].

CASE REPORT: A 25-year-old patient with fever, dysphagia, and reduced general condition was referred to our department by his dentist after 1 week of antibiotic therapy. He presented with a painful palpable mass in the right lower jaw that had developed 2 weeks before. The orthopantomogram showed a caries and periapical lesion at the right lower wisdom tooth. During extraction of the tooth and putative intra- and extraoral abscess incision, no pus could be drained and the mass persisted. CT scans then revealed lobulated soft tissue masses on both sides of the neck with the main focus on the right side. In an additional operation with excision of the mass, Castleman's disease of the hyaline vascular type was diagnosed. HISTOPATHOLOGIC FINDINGS: Staging could not detect further pathological findings and the patient's postoperative general condition improved continuously. The histological features of the hayline vascular type of Castleman's disease were characterized by multiple germinal centers surrounded by circumferentially arranged layers of small lymphocytes interconnected by a prominent vascular stroma with occasional plasma cells ("onion skin"). CONCLUSION: Castleman's disease is a rare and yet poorly understood disease, characterized by inhomogeneous growth of lymphoid tissue. Mostly benign it remains a diagnostic challenge before histological investigation. In unclear submandibular swellings and neck lumps assumed to be an abscess, this rare differential diagnosis must be considered. Facing recurrence and potential for malignancy, follow-up of the patients over several years is necessary.

Adult↗
PubMed2005

[Simultaneous noninvasive monitoring for radial forearm and fibula flaps using laser Doppler flowmetry and tissue spectrophotometry].

AIM: In the literature currently available monitoring devices are usually divided into two major groups: those for monitoring perfusion and those for measuring tissue oxygenation. The O(2)C (oxygen to see) system combines these two ways of monitoring free flap viability. The aim of this prospective study was to determine the necessity of flap revision and when unnecessary revision can be avoided. Another point of interest was the question of whether critical values for the successful course of free flaps could be defined and in addition whether such values would differ for different flap types. PATIENTS AND METHODS: In a prospective study 82 free flaps (61 radial forearm flaps and 21 fibula flaps) were monitored with the O(2)C monitoring unit. Measurements were carried out intraoperatively and postoperatively up to 14 days. RESULTS: Perfusion compromise occurred in 12 (14.6%) of 82 monitored free flaps. Operative exploration was performed in seven cases, in five of them successfully. Five flaps (three radial forearm and two fibula flaps) were lost due to vascular compromise, which led to an overall success rate of 93.4%. Venous congestion was identified by a rapid increase in hemoglobin concentration of more than 30%. An abrupt decline of blood flow and hemoglobin oxygenation indicated arterial occlusion. Vascular complications were detected in all cases prior to clinical assessment with no false positive or negative results. For radial forearm flaps a hemoglobin oxygenation of 15%, a superficial flow of 10 AU, and a deep flow of 20 AU were identified as minimum values for flap viability. For fibula flaps a hemoglobin oxygenation of 10%, a superficial flow of 5 AU, and a deep flow of 15 AU were determined as minimum values. CONCLUSION: O(2)C combines laser Doppler flowmetry and tissue spectrophotometry and for the first time allows simultaneous measurement of the microcirculatory parameters including blood flow, flow velocity, hemoglobin concentration, and hemoglobin oxygenation. We found this new noninvasive technique to be a reliable and accurate method for evaluating flap viability and improving the success rate in free flap transfer.

Adolescent↗
PubMed2004

[Botulinum toxin for treatment of gustatory sweating. A prospective randomized study].

BACKGROUND: Botulinum toxin A has meanwhile become a proven method for treatment of gustatory sweating (focal hyperhidrosis, Frey's syndrome). Clear-cut recommendations regarding dosage of botulinum toxin A in Frey's syndrome are currently not available. The aim of this prospective randomized study therefore was to investigate botulinum toxin A with respect to its efficacy in Frey's syndrome, the ideal dose yielding maximal duration of the effect, and patient contentedness as well as unwanted side effects in patients of the Clinic of OMF Surgery at the Ruhr-University of Bochum. PATIENTS AND METHOD: Twenty patients suffering from severe Frey's syndrome as a result of operations of the parotid gland were examined with the starch iodine test according to Minor. The gustatory skin areas were re-examined after intracutaneous injection of botulinum toxin A for up to 1 year. The patients ( n=20) were randomly assigned to two different treatment groups (group I: 2 MU/cm(2), n=10; group II: 3 MU/cm(2), n=10). RESULTS: Mean sweating skin areas in the two treatment groups ranged between 39+/-9 and 32+/-12 cm(2), respectively. A single injection of 3 MU botulinum toxin A resulted in a nearly complete blockade of gustatory sweating for the observation period of 1 year. In the group treated with 2 MU botulinum toxin A, 44% of the total gustatory skin areas were still sweating, thus necessitating a second injection of botulinum toxin A in these patients. CONCLUSION: Intracutaneous injection of botulinum toxin A represents a highly effective and minimally invasive procedure for the treatment of Frey's syndrome. This study shows for the first time that a dosage of 3 MU/cm(2) of botulinum toxin A achieves a complete and reliable blockade of gustatory sweating lasting for at least 12 months. This dose may therefore be recommended for treatment of this syndrome.

Adult↗
PubMed2004

[Management of zygomatic fractures via a transconjunctival approach with lateral canthotomy while preserving the lateral ligament].

INTRODUCTION: This study reports on a modified approach to treat zygomatic fracture. For the surgical approach, a transconjunctival incision and, instead of a lateral canthotomy, a superficial incision of the skin and subcutaneous tissue was used, preserving the lateral ligament. The results are compared with those of previous techniques, especially the subciliary incision. PATIENTS: In a prospective study, 30 patients (9 females and 21 males, mean age 32.1 years) with zygomatic fractures were operated using this approach. Mean follow-up time was 6 months after removal of the plates. Fractures were caused by trauma due to fighting, bicycle falls, or sport accidents. Follow-up radiographs were used to evaluate the position of the zygoma after reduction and rigid fixation. RESULTS: Reduction and rigid fixation of the fractures were possible to perform in all cases. The access to the orbital floor and the exposure of the inferior and lateral rim were satisfactory and an additional latero-orbital cut was not necessary. The disadvantage of the complete incision of the lateral ligament with the necessity of intraoperative refixation and possible ectropium of the eyelid could be avoided. Injuries or infections of the cornea or the bulbus did not occur. Postoperative complications such as scar formation resulting in entropium or ectropium were not seen. CONCLUSION: These results show that the transconjunctival approach with lateral superficial incision preserving the lateral ligament for treatment of zygomatic fractures is satisfactory in all cases of rigid fixation of both inferior and lateral rims. Because of its esthetic and functional advantages this approach has become standard in our department.

Adult↗
PubMed2003

[Evaluation of the lower leg vessels before microsurgical fibula transfer. Magnetic resonance angiography versus digital subtraction angiography].

BACKGROUND: Since the introduction of the fibula flap by Taylor in 1975, and its first application in the lower jaw by Hidalgo in 1989, it has become an option of first choice in mandibular reconstruction of large oromandibular defects. Perfusion of the osteomyocutaneous fibula transplant is based on the peroneal artery. To avoid postoperative ischaemia of the lower leg after sacrificing this artery, especially in smokers, adequate perfusion must be guaranteed preoperatively by radiological evaluation. Progress in the field of magnetic resonance angiography (MRA) enables an increasing number of primary non-invasive evaluations of vessels. The aim of this prospective study was to answer the question of whether MRA enables a accurate representation of anatomical variation and pathological stenoses of the lower leg vessels and can therefore replace conventional digital subtraction angiography (DSA). MATERIALS AND METHODS: We carried out conventional DSA of the lower leg before raising a fibula transplant and postoperative MRA with contrast medium in a prospective study with 15 patients. Vessels were assessed for atherosclerotic, occlusive or hypoplastic changes and anatomical variations by three radiologists. RESULTS: High resolution of MRA enables a reliable judgement of the lower leg vessels. Hypoplastic vessels, stenoses, occlusion or atherosclerotic changes of the vessels could definitely be detected by MRA just as by DSA. Thus, all patients without these diagnosed contraindications could be operated successfully. CONCLUSION: MRA of the lower leg enables a definitive determination of the vessel quality and the site of preference for harvesting the flap. Because MRA is a low risk procedure, can be carried out on an outpatient basis and causes no radiation load, it should be preferred to conventional DSA.

Adult↗
PubMed2003

The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction.

According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.

Bone Transplantation↗
PubMed2002

[Oxygen-carrying solutions improve tissue oxygenation in striated skin muscle subjected to critical ischemia].

AIM: The aim of the present study was to investigate the effects of the oxygen-carrying hemoglobin solution DCLHb (diaspirin-crosslinked hemoglobin) on microvascular perfusion and tissue oxygenation in striated skin muscle after the induction of critical ischemia followed by reperfusion. MATERIAL AND METHODS: Using intravital fluorescence microscopy the functional capillary density was analyzed in the striated skin muscle of Syrian golden hamsters before the induction of a 4-h period of ischemia and again after 0.5 h, 2 h and 24 h of reperfusion ( n=8 in each group). In other animals ( n=8 in each group), the identical protocol was applied to determine tissue oxygenation by means of the multi-wire surface electrode (MDO, Eschweiler, Kiel, Germany). Animals in the treatment group ( n=8) received a bolus infusion of 5 ml of DCLHb per kg of body wt. (10 g/dl; Baxter, Ill., USA) 15 min before reperfusion. Control animals ( n=8) received equivalent volumes of isotonic saline (Braun, Melsungen, Germany). RESULTS. Functional capillary density was dramatically reduced in control animals, while in DCLHb-treated animals significantly higher values were observed. Efficient restoration of tissue PO(2) was also seen in DCLHb-treated animals and not in control animals. CONCLUSIONS: These results show that the oxygen-carrying solution DCLHb is significantly more efficient than the commonly used crystalloid solutions in restoration of tissue PO(2) after ischemia-reperfusion. The use of this solution therefore appears promising as a means of protecting the tissue put at risk by ischemia from reperfusion damage.

Animals↗
PubMed2002

[Indications for primary surgical therapy of vascular abnormalities in infancy].

LASER THERAPY: Since the introduction of laser therapy for treatment of hemangiomas and vascular malformations, primary surgical therapy has gradually lost importance. Particularly hemangiomas, but also venous malformations and lymphangiomas, are nowadays primarily treated by different types of lasers. Especially the Nd:YAG laser with a percutaneous or transcutaneous application technique often leads to satisfying results. SURGICAL THERAPY: Surgical therapy is mostly used secondarily in late childhood or in adults after several laser applications for excision of residual scars or other corrective procedures. Despite these improvements in laser therapy, there is still an indication for primary surgical treatment in subcutaneous vascular malformations and in rapidly growing hemangiomas after unsuccessful laser therapy. Even in large vascular anomalies, safe excision with only a little blood loss is possible if the tumors are encapsulated. CASE REPORTS: In this paper we want to point out the necessity of primary surgery in three children in whom complications such as loss of sight, facial nerve palsy, and a lethal outcome due to massive hemorrhage in a cystic lymphangioma could be avoided.

Arteriovenous Malformations↗