Biomedical subjects
Publications and source records attributed to G Freilinger.
Extensive resections of tumors of the scalp penetrating into the bone and the brain often require the use of free flaps for coverage as the only possibility. Four cases are reported and the specific problems of these microsurgical operations in this region are discussed.
Special operative techniques developed by the advances in the replantation surgery are the subject of a review. The replantation of an amputated finger in a more important position is demonstrated by a clinical case. Defects can be replaced by parts of non-replanted fingers or with the aid of transplanted structures, such as skin, vessels, bone and local flaps. Clinical examples are given of the primary transplantation of bone from the iliac crest and of enhancement of circulation from the healthy, neighbouring finger.
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Anal sphincter reconstruction with muscle transplantation according to Thompson and transposition of the denervated gracilis muscle onto the surface of the pelvic floor muscles are described. The transplanted and transposed muscles are reinnervated by a collateral nerve from the adjacent functioning muscles. The follow-up examination of 16 cases of anal incontinence two years after anal sphincter reconstruction demonstrates in all but one case ontinence for firm feces and in most of them, continence for fluid feces. Reflectoric contractions of the new reconstructed sphincter can be demonstrated by myographic and manometric investigations. The advantages of dynamic sphincter reconstruction with muscular neurotization compared to other more static techniques are discussed.
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Besides the special microsurgical operative technique, dynamic splinting is one of the basic fundamentals of KLEINERT's technique for primary repair of flexor tendons. The principle of this splinting is explained. Further applications are reported: 1. after secondary repair of flexor tendons (by tendon transfer or tendon transplantation), and 2. after tenolysis. According to our good results the application of dynamic splinting in the above mentioned cases seems to be advisable.
A rare syndrome, first described in 1938 by FREEMAN and SHELDON, two English doctors, is discussed. The condition affects the face and both hands to a degree that no useful function is possible. The characteristic malformations are described in detail. They are caused by a soft tissue disorder and no bony involvement has been found so far. Therefore, the term "Cranio-carpo-tarsal dystrophy" is misleading. Conservative treatment by dynamic splints has brought very little improvement.
Good regeneration of tissue, easy adaptation and rapid nerve regeneration are all favourable factors of hand surgery in infants and children. On the other hand, unfavourable factors include diagnostic difficulties, especially following early trauma and the absence of co-operation, as well as late damage due to growth retardation. Indications for surgery include malformation, accident, burns, infections, and rarely tumours, and treatment should as far as possible, be delayed until preschool age. Accurate operative technique and careful planning of surgery are essential. Post-operative fixation and bandaging is equally important but even in the paediatric surgery group good results can be achieved.
Modern methods of mammary investigation currently enable the detection of tiny-tumours which are not clinically palpable and referral of these patients to surgery at an early stage. This poses a challenge to the surgeon, who cannot rely on palpation as a guide to accurate extirpation of the tumour, but has to rely wholly on the radiological report. A method was, thus, worked out in this department to provide accurate evaluation of the position of the suspect area of the breast to facilitate operative measures and, furthermore, act as safety measure between the time of tumor biopsy and receipt of the histological report. Preparation radiography proves that the suspect area on mammography is identical with removed specimen. The advantages of this procedure are obvious. The surgeon can rely fully on the radiodiagnostic findings and enlist the radiologist as essential member of the therapeutic team. As a result the operative procedure can be finely gauged by the surgeon and the tumour removed with maximum sparing of healthy breast tissue. This procedure has produced excellent results in 35 patients and can be recommended for application to patients with tiny tumours.
The tendency towards less radical, stage-dependent procedures in the surgical management of breast cancer has opened the way to improvement in the reconstructive measures available. Reconstruction of the female breast can be undertaken with greater or lesser success and facility according to whether the initial procedure was subcutaneous mastectomy, modified radical mastectomy or the Rotter--Halstedt radical operation. The different plastic reconstructive methods developed over the past years are discussed and illustrated by cases treated under our care.
Successful replantation of total amputated parts of the hand having been performed during a period of five years were investigated as a homogenous group. Long-term function of replanted parts was evaluated by objective criteria, as signs of use, trophique, vascularisation, mobility, sensibility and the integration of replants into general function of the hand, and on the other side by subjective criteria as usefulness in professional and private life, retrospective personal attitude to replantation and subjective complaints.
If the distribution of the types of nerve fibers in the various intercostal nerves is taken into consideration, an intercostal nerve segment can be an acceptable donor nerve graft for sensory and/or motor nerve replacements. We describe the distribution of motor and sensory axons in various segments of the upper and lower intercostal nerves.
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A Replantation Team was instituted in Vienna 3 years ago. This team is the oldest in Europe. One hundred and eighty-one complete and incomplete amputated parts of 118 patients were replanted during this period. A survival rate of 86% and a useful functional result ("integrated parts") in 78% of the cases was obtained. Appropriate preparation of the amputated parts, the right timing, a 24 hour service and a clear indication with intensive postoperative physicotherapeutical treatment are the fundamental points for this result.
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The extensor digitorum longus muscle of the rat was denervated and transplanted onto the vastus lateralis muscle of the same limb 1 or 2 weeks after denervation. The morphological changes appearing after transplantation were examined by light and electron microscopy. Only three to four superficial layers of muscle fibers remained unchanged after transplantation. The other parts of the transplanted muscle degenerated nearly entirely during the first 10 days. The myofibrils were removed by macrophages, thus within the tubes of basal lamina no contractile material could be observed. In a second period, regeneration of myofilaments took place. 6 weeks after transplantation, newly formed muscle could be observed, capable of normal function. The diameter of the fibres, however, was smaller and the connective tissue between the fibres markedly increased as compared to the normal muscle of the other side. The importance of the findings for muscle transplantation, especially the relationship between satellite cells and myoblasts, is discussed.
Intraoperative and postoperative complications in the field of microvascular surgery are summarised. Some of them are discussed in detail (confusion of vessels, anastomosis under tension etc.), and precautions are outlined to avoid these complications. Failures can result from wrong indications, from incorrect technique of operation or from incorrect postoperative care.
The paper reports on 11 patients with very advanced melanoma, who were treated with a modified version of multiple-stage cancer therapy. No improvement in the course of the illness resulted, but survival may have been slightly prolonged.