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G A Giessler

Publications and source records attributed to G A Giessler.

8 recordsLinked to original sources
PubMed2006

[Blast injuries of the hands. Patterns of trauma and plastic surgical treatment].

BACKGROUND: Blast injuries of the hand represent a demanding surgical emergency for the reconstructive hand surgeon. Commercially available fireworks are often regarded as less dangerous compared to combat ammunition, but the following examples demonstrate their real potential for devastating hand injuries. Some of the closed injuries can represent a pitfall for correct assessment of trauma severity. PATIENTS AND METHODS: Fifty patients who were seen after fireworks explosions from December 1995 until April 2005 were analyzed in respect to their patterns of injury and their subsequent surgical treatment. The severity was graded using the Hand Injury Severity Score (HISS). The majority of patients were injured during the New Year's day celebrations and presented with complex blast injuries due to commercially available, CE-certified fireworks. RESULTS: Depending on the size of the explosives comparable patterns of injury were seen. Larger shells led to traumatic subtotal amputations of the exposed fifth finger ray and thenar ray. Complex destructions with multiple fractures and avulsions of the midhand were also present. Smaller explosives caused multiple lacerations in the palm of the hand, subcutaneous flexor tendon ruptures, and closed fingertip fractures. DISCUSSION: Acute neurapraxias and neural compartment syndromes were clinically present. All patients (50) had to be operated primarily, and subsequent operations were necessary in 19 cases (number of operations 1-4, med. 1). In the HISS grading, 18 "minor" (HISS <20), 16 "moderate" (HISS 21-50), 7 "severe" (HISS 51-100), and 9 "major" (HISS >100) explosion injuries were present (range: 2-155, med. 47). CONCLUSION: Blast injuries of the hand need a fast, strategically planned surgical approach. This is also true for presumably harmless, CE-certified fireworks. In a multiple patient scenario, triage based on surgical urgency may be necessary. A detailed clinical examination and surgical exploration is mandatory to avoid possible pitfalls like in closed injuries. Profound skills in reconstructive and microvascular hand surgery are essential to achieve an optimal clinical outcome.

Adolescent↗
PubMed2005

[Accidental thermal injury to the hand].

Hands are most frequently involved in severe burns. The treatment of the burned hand is one of the most challenging problems in plastic surgery. The success of therapy is determined by the severity of the initial injury, the first aid provided, and the correct balance between mobilization, splinting and plastic surgery. In this respect, it is vital to have a highly qualified interdisciplinary team approach consisting of plastic surgeons, well-trained physical therapists, psychologists and a highly motivated patient.

Accidents↗
PubMed2004

[Free fibula transfer. Analysis of 76 consecutive microsurgical procedures and review of the literature].

Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.

Adolescent↗
PubMed2004

[Secondary plastic surgical reconstruction in severely burned patients].

Secondary reconstruction following severe burn trauma has improved markedly over the last few decades using all aspects of modern plastic surgery. In surgical reconstruction of burns, it is essential to design comprehensive, clear-cut, and long-term treatment plans. Good patient compliance and thorough follow-ups are imperative regarding the extent of scar and contracture formation, regularly requiring multiple-step surgery. Each treatment site will have to be evaluated separately, taking into account adequate surgical and conservative measures (the "reconstructive ladder"). Aiming at realistic and satisfactory results, surgery does not suffice alone in treating severely burned patients but also requires a well coordinated and seasoned team of occupational and physical therapists, psychologists, and plastic surgeons.

Burns↗
PubMed2004

[Primary treatment of burn patients].

Burn injuries can be caused by thermal, electrical, chemical, or mechanical trauma or radiation and are relatively rare, as they represent only about 1% of all emergencies. They are caused by accidents at home, during recreational activities, or in the occupational environment. Minor burn traumas are much more common than severe burn injuries with their systemic and potentially life-threatening effects. Altogether, these circumstances may result in a lack of routine for treating such injuries properly by physicians and their colleagues in the emergency room or intensive care unit. A clearly outlined concept for preclinical and clinical treatment can be the keystone of successful further clinical progress. The following article summarizes the current guidelines for first medical aid at the injury scene, burn stabilization and assessment in the emergency room, and the interdisciplinary approach for further clinical care. The treatment of dermatologic emergencies (acute epidermolytic syndromes) or caustic injuries by chemical agents is similar to the treatment of burn victims in many aspects but must be adapted in selected cases.

Burns↗
PubMed2004

[Free microvascular fibula graft for skeletal reconstruction after tumor resections in the forearm -- experience with five cases].

Plastic-reconstructive surgery for upper extremity tumors not only follows the fundamental principles of oncologic surgery, but also requires attention to functional and aesthetic aspects. For soft tissue reconstruction, a variety of surgical options are available, whereas for the reconstruction of extensive bony defects only the free microvascular fibular transplant appears to be a reasonable method. Its advantages are its slim shape and variable length, the possibility of achieving a stable osteosynthesis suitable for early physiotherapy, and low donor site morbidity, even if the fibula is harvested as an osteoseptocutaneous flap. Between 1994 and 2000, five patients underwent a free fibula transplantation for radius reconstruction. In all cases, a two-stage reconstructive approach with initial tumor biopsy was chosen. The resected tumors were two osteosarcomas, one extraosseous Ewing sarcoma, one aneurysmatic bone cyst and one desmoplastic fibroma. Surgical and pathohistological tumor-free margins were achieved in all cases (R(0)). Two patients received an osteocutaneous graft. All grafts were revascularized to the radial artery and subcutaneous veins. The transplanted fibula grafts were between 10 cm and 17 cm in length. All proximal osteosyntheses were performed fibuloradially, the distal stabilizations were fibulo-scapho-lunate (2 x) and fibulo-radial (3 x), depending on the extent of resection. All microvascular transplants survived completely and showed a stable osseous integration, both clinically and radiologically. Depending on the postoperative course, an adapted intensive physiotherapy regimen yielded good or satisfactory function. In the follow-up of up to seven years in one case a tumor recurrence (osteosarcoma, 35 months post-operatively) required forearm amputation. The reconstruction of tumor-associated wide bony defects in the upper extremity with a free microvascular fibula graft allows for a successful therapy with respect to oncologic, functional and aesthetic considerations.

Adolescent↗
PubMedDate not supplied

Nonfunctional parathyroid carcinoma.

Parathyroid carcinoma is a rare entity accounting for 0.5% to 5% of parathyroid neoplasia. Most of these malignancies present as functional hormone-producing masses with elevated serum levels of parathormone and calcium. These tumors may also be nonfunctional. Clinical detection of nonfunctioning parathyroid malignancies preoperatively is primarily based on symptoms of an expanding neck mass. This ominous complaint is typically accompanied with an advanced stage of the disease at initial diagnosis. Because there is a paucity of data in the literature regarding nonfunctioning parathyroid carcinoma, prognosis can not be readily assessed. In both functional and nonfunctional parathyroid carcinoma, early surgery has proven to be the only curative treatment approach whereas both chemotherapy and radiation therapy fail to produce systemic or regional benefit when used alone. Hence, parathyroid cancer should be considered in every patient evaluated for a neck mass regardless of the blood calcium and blood parathormone level.

Carcinoma↗