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Biomedical subjects

G Ingianni

Publications and source records attributed to G Ingianni.

At least 19 recordsLinked to original sources
PubMed2006

Compression therapy after complex soft tissue trauma, and flap coverage: optimization of scar development, swelling, function, and aesthetic result.

Problems after severe soft tissue injuries, skin grafting, and flap procedures are uncontrolled hypertrophic scarring, unstable scars, functional deficits, and aesthetic disfigurements. Ongoing swelling and lymphatic stasis are also a common problem, and do contribute to functional problems. After deep skin / soft tissue injuries, an unstructured replacement tissue is formed (scar), and does not have all functions of healthy skin. After an initial increase of vascularisation in the scar region, the formation of unstructured collagen fibers takes place, spontaneously subsiding later with a shrinkage of the tissue. Compression therapy in these patients strongly enhances the reconstitution of form, and function. The consequence is a significant step forward in the rehabilitation of these patients, and earlier social as well as professional reintegration.

Adult↗
PubMed2003

[Intraoperative histological sections in obstetric brachial plexus lesions--comparison of macroscopic appearance, HE staining and toluidine blue staining].

In brachial plexus lesions and their revision, evaluation of nerve stumps is very important for the reconstructive strategy. We intraoperatively perform cryostat sections, Haematoxilin-Eosin (HE) stained, and compare the clinical appearance of the nerves to the microscopic results. Toluidine blue staining is later used to validate the structural details. Intraneural fibrosis can be traced safely with both staining methods, in root avulsions a histology is helpful, too. For more proximal, intraforaminal lesions semithin section stained with toluidine-blue are less informative than are HE-stained cryostat sections. In these lesions the clinical control by electrical stimulation and evoked potentials is superior.

Adult↗
PubMed2003

[Microsurgical lympho-venous anastomosis in the treatment of secondary lymphoedema of the upper extremity].

At the end of the 1960's, lymphonodo-venous anastomosis has been performed by Olszewski and Nielubowicz experimentally as well as in clinical cases. Later on, various authors performed in clinical cases microsurgical anastomoses between lymphcollectors and veins. The rationality of this procedure is based on the knowledge that lymph always find the way back to the venous system, that the pressure of the lymph vessels is higher than in venous system of the extremities and that competent valves guarantee a centripetal flow. Beginning in the middle of the 1980's, we performed microsurgical end-to-end lympho-venous anastomoses in invagination technique for the treatment of secondary arm lymphoedema. The operation can be performed in local anesthesia, the anastomoses are performed on the proximal lower arm and on the medial portion of the upper arm. In each localisation three to four lympho-venous anastomoses are performed. Not only subjectively there is a decrease of the complaints but also variable reduction of the volume of the edematous arms can be achieved. In average the volume-reduction reaches 30 %. Data of a follow-up of 53 patients up to ten years show stable results. This is a long-standing benefit and supports further conservative therapy as manual lymphdrainage. Nevertheless lymphoedema is a chronical and irreversible disease which cannot be definitively cured with operative or with conservative procedures.

Anastomosis, Surgical↗
PubMed2002

The two-stage concept with temporary subcutaneous implantation of a vacuum sealing system: an alternative surgical approach in infected partial abdominal defects after lapratomy or abdominoplasty.

BACKGROUND: Infected abdominal defects after laparatomy or abdominoplasty may present serious complications. The management of a progressive infection in the abdominal region with partial necrosis -without peritoneal irritation - is treated variously. Multiple revisions due to re-infection or seroma are often necessary. The different surgical treatment options almost always necessitate an extended immobilisation and hospitalisation of the patient. PATIENTS AND METHODS: In five patients with infected partial abdominal defects after abdominoplasty (n = 3) or laparatomy (n = 2) successful management of infection was achieved in a two stages with temporary subcutaneous implantation of a polyurethane foam, combined with a vacuum assisted wound closure device, followed by secondary wound closure. In the first step a debridement, subcutaneous implantation of the foam, combined with intermittent subathmospheric pressure through a V.A.C. device was performed. In the second step an explantation of the foam, re-debridement and secondary wound closure was possible over 2 - 4 drains. RESULTS: In all patients - after a temporary immobilisation of 5 days, and systemic antibiotic administration - wound healing was achieved. In one diabetic patient another single revision was necessary, because of the necrosis of a distal wound edge. The mean hospitalisation after application of these procedures was 15 days (12 - 19). CONCLUSIONS: The surgical treatment of infected partial abdominal defects after laparatomy or abdominoplasty - performed in a two-stage procedure with temporary subcutaneous implantation of a V.A.C.-system, and secondary wound closure, offers a high level of safety, and presents an useful alternative tool in the difficult management of these patients.

Abdominal Muscles↗
PubMed2002

The cervical rib. A predisposing factor for obstetric brachial plexus lesions.

Controversy surrounds the aetiology of obstetric brachial plexus lesions. Most authors consider that it is caused by traction or compression of the brachial plexus during delivery. Some patients, however, present without a history of major traction during delivery, and some delivered by Caesarean section also suffer the injury. In our series of 42 infants, 28 had an Erb's palsy, and the remaining 14 presented with a more extensive lesion, involving the lower roots. In five of these, a complete ossified cervical rib was found. We believe that anatomical variations, such as cervical ribs or fibrous bands, can cause narrowing of the supracostoclavicular space, and render the adjacent nerves more susceptible to external trauma.

Brachial Plexus Neuropathies↗
PubMed2000

Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap.

The anatomical basis of the blood supply to the deep inferior epigastric perforator (DIEP) flap and the circulation of the cutaneous territory zone IV have been studied in 40 anatomical dissections on fresh cadavers. The pedicle length, diameter and the number and distribution of the major perforator vessels were recorded. The cutaneous territories supplied by the perforator vessels were studied by injecting blue dye in the pedicle of ten specimens. In addition, intravital blue dye studies were performed by injecting the largest perforating vessel of five patients at abdominoplasty. The resulting cutaneous staining was recorded. The deep inferior epigastric artery was present in all cadaver dissections with an average length of 10.3 cm (range 9.0-13 cm) and an average diameter of 3.6 mm (range 2.8-5.0 mm). There were consistently one or two major perforator vessels for each pedicle, located within a radius of 8 cm below the umbilicus. The results of the injection study revealed cutaneous staining of zones I-III. Zone IV was stained weakly or not at all. The same findings were obtained in the clinical cases of abdominoplasty. Zone IV must be critically assessed in clinical cases of the DIEP flap.

Abdomen↗
PubMed2000

[Integrated rehabilitation of patients with hand injuries--a model of cooperation between acute and rehabilitation clinics].

Close cooperation between acute and rehabilitation clinics are an exception even today. Although operative reconstruction may have been successful, hand injuries will have poor functional results if rehabilitation is insufficient. With the establishment of multi-disciplinary intensive rehabilitation of patients with complex hand injuries under inpatient conditions, a close cooperation of the Clinic of Plastic and Hand Surgery, Klinikum Wuppertal, and the Orthopaedic Clinic, Rhein-Sieg-Klinik Nümbrecht, was created. A good functional outcome of the injured hands with a low percentage of remaining invalidity and an early return to work of the affected patients are the dominant aims of this rehabilitation model. When the initial and reconstructive treatment is finished in the Clinic of Plastic and Hand Surgery, inpatient rehabilitation by an experienced rehabilitation team starts immediately. Clinical control of all patients with complex hand injuries is performed in a weekly consultation hour by the hand surgeons and the rehabilitation team. Weekly reports guarantee close and timely documentation of the clinical course. After the end of inpatient rehabilitation, patients return to work, take part in vocational rehabilitation or, if necessary, continue with ambulant treatment organized and controlled by the acute clinic.

Employment↗
PubMed2000

Stewart-Treves syndrome: lymphangiosarcoma following mastectomy.

Lymphangiosarcoma (LAS) is an aggressive, malignant vascular tumor following long-lasting chronic lymphedema. Patients with LAS demonstrate a history of breast cancer treated by radical mastectomy in the majority of patients. In the 1960s the incidence of LAS in patients with a 5-year survival after radical mastectomy varied from 0.07 to 0.45%. Today, due to changes in the operative techniques of breast cancer, less chronic lymphedema is seen with only a scant number of LAS patients. The etiology of this enigmatic tumor is not yet completely understood. Histologically, LAS arises from vascular endotheliocytes, and all vascular sarcomas originating in the setting of a chronic lymphedema are categorized as LAS. There is no standard treatment of LAS. The treatment options include radical ablative surgery, radiation therapy, and chemotherapy. The prognosis of LAS is poor; long-term survival is the exception. Only early recognition and radical surgery offer a chance of cure.

Aged↗
PubMed1998

Thoracic Outlet Syndrome: Follow-up on 33 Cases with Regard to Vascular Compression

This follow-up study on 33 operations performed for thoracic outlet syndrome (TOS) proves high efficiency in relieving neurological and arterial symptoms, whereas benefit to venous compression is somewhat less. Twenty-six patients (average age was 36 years) were operated on for TOS, seven of them on both sides. There was a higher incidence in females. All patients showed neurological symptoms. In 15, operations on various entrapment syndromes of the upper extremity were performed previously. Six patients presented with an incomplete resection of the first rib. Arterial compression symptoms were evident in 15 cases, symptoms of venous compression in 14 limbs. All patients underwent a resection of the first rib, bilateral in seven cases, using the axillary and supraclavicular approach. In seven patients, a cervical rib and scalenus muscles were resected additionally, in three patients bilaterally. In two cases a neurolysis of the brachial plexus was performed. Using the supraclavicular approach, no complications occurred. In one early patient using the transaxillary approach to a postoperative hemothorax required a revision. Neurological results after surgery showed a total release in 26 limbs (n = 33). In 14 limbs (n = 15) with arterial compression symptoms and in 6 (n = 14) with symptoms of venous compression the operation showed a curative effect.

Journal Article↗
PubMed1998

Surgical management after doxorubicin and epirubicin extravasation.

Doxorubicin and epirubicin are strong antineoplastic agents widely used in chemotherapy. One major complication of their use is skin sloughing after subcutaneous extravasation, the degree of which is often underestimated. Both drugs have a tendency to produce liquefying necrosis in soft tissue and chronic ulcers if extravasation occurs. Three cases of extravasation, their surgical treatment and final results are presented. In cases of doxorubicin and epirubicin extravasation it is very important to perform an early extensive surgical débridement with delayed closure to avoid long hospitalization and disabling results.

Aged↗
PubMed1998

[Birth-related brachial plexus paralysis].

According to the literature, in Europe 0.4-1.2 cases of obstetrical plexus brachial paresis occur per 1000 births. A 4-6 times higher energy in axial delivery of the newborn leads to a neurotmesis of the plexus. If the energy used is more than 10 times higher, root avulsion occur. Early operative therapy for obstetrical plexus paresis is mandatory. The best period for an operation is between the 3rd and 6th months of age. CT and MRI imaging as well as electrophysiological investigations are of the utmost importance. Birch, Gilbert and Gu think there is an indication for operation if no active elbow flexion can be performed at the age of 6 months. Primary coaptation is easier in babies than in adults. However, large defects have to be a bridged by autologous nerve grafts. For root avulsions, neurotization with the accessory and phrenic nerves (Gu) is being used more and more. In 362 children with 52 operated cases, after a follow-up from 2 to 10 years, we found 37 functional, useful recoveries. Nine operations were unsatisfactory and two had poor results. In four cases the operation was unnecessary.

Birth Injuries↗
PubMed1997

[A rare insertion variant of the extensor pollicis brevis tendon. A case report].

Two brothers are presented with uni- and bilateral congenital palmar subluxation of the metacarpophalangeal joints of the thumbs as well as extensor lag. A hypoplastic extensor pollicis brevis tendon inserting atypically to the tendon of the extensor pollicis longus at the metacarpophalangeal joint level was found. In each case, arthrodesis of the metacarpophalangeal joint of the thumb was performed. This very rare variation of the insertion of the extensor pollicis brevis tendon is presented, surgical therapy and the pertinent literature reviewed.

Adolescent↗
PubMed1993

[A three-year aid program for plastic surgery in Peshawar (Pakistan). Ongoing management of severely injured patients of the Afghanistan war: 1,528 large operations, 5,171 smaller interventions, 15,932 patients examined].

Since 1980 Interplast Germany has sent many plastic surgeons to developing countries. In 1989 a new Interplast Germany program for helping Afghan refugees in Pakistan's Peshawar was started. The Federal Republic of Germany financed the first two years; thereafter, the European Community and Help supported the project. Twenty-four teams with 123 nurses, surgeons and anesthesiologists operated on 1,528 patients in two hospitals. In the same period 5,171 smaller operations have been performed and 15,932 patients have been examined. Low expense for the teams, good support by officials, and professional administration have made this project highly effective for 3 years.

Adult↗
PubMed1992

[Myocutaneous flaps for reconstruction of large tissue defects of the trunk].

Large defects in the thorax and abdominal wall require a stable reconstruction. The use of muscle flaps offers many advantages: 1. Anatomically constant vascular patterns with a good blood circulation of the overlying fascia and skin. 2. Stable reconstruction of the whole wall as well as effective substitution of infected or irradiated tissue. Clinical cases and technical details are presented.

Abdominal Neoplasms↗
PubMed1987

[Functional results following complicated injuries of the extremities--how can they be improved?].

This study evaluates the critical points in the management of 48 patients with injured arteries of the lower limb between 1980 and 1986. 77% of the traumas were resultant from blunt vehicular traffic mishaps. 13 patients were treated within 6 h, 8 patients later than 6 h, 21 patients later than 24 h post injury. Delays in diagnosis occurred due to lack of or no indication for vascular trauma. Careful physical examination and aggressive use of angiography is essential in improving limb salvage rates, while doppler investigation may lead to improper diagnosis. Overall limb salvage was 69%, however, no reconstruction was possible in 6 cases (13%). 38 of the 42 arterial reconstructions required interposition of venous bypass grafts, four end to end anastomoses. Eleven patients had associated venous injuries, which in nine cases were repaired. Venous ligation in three cases was attributed with increased complication. In three cases ischemia time was shortened by the use of temporary javid shunts for rapid restoration of arterial flow. 50% of the patients were found to require fasciotomy, either pre- or postvascular repair. Early fasciotomy, however was found to be most beneficial. Fractures were treated in 15 cases with the external fixator, in 21 cases with internal fixation. Delayed revascularization after 24 h combined with aggressive debriding of muscle necrosis and the employment of vascularized muscular and skin flaps resulted in a decline in amputation rates and improved functional results.

Adult↗
PubMed1986

[Exulcerating breast cancer].

24,000 women a year are submitted in the Federal Republic of Germany to surgery because of breast cancer. This disease causes about 10,000 deaths a year. Early diagnosis by preventative check-up and wide-spread awareness of the disease in the population gives the best chance for reducing mortality. However, in our study we found that only 38% of the patients were presented at a favourable stage. Every tenth patient already had involvement of the thoracic wall or of the skin. Every sixteenth patient had an ulcerated carcinoma of the breast.

Adult↗