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Biomedical subjects

G Pierer

Publications and source records attributed to G Pierer.

At least 19 recordsLinked to original sources
PubMed2002

[Malignant transformation of perianal Buschke-Löwenstein tumor. Extensive abdominoperineal rectum excision and reconstruction with transpelvic myocutaneous rectus abdominis muscle flap].

INTRODUCTION: The Buschke Löwenstein tumor (giant condyloma) in its perianal variant is an extremely rare disease caused by human papilloma virus. Although of histologically benign appearance, it infiltrates and destroys the surrounding tissue. There is a high risk of local recurrence and malignant transformation. The treatment of choice is wide surgical resection. CASE: A 56-year-old woman presented with perianal giant condyloma infiltrating the rectum and vagina. The extensive soft tissue defect resulting from wide resection was filled with a transpelvic myocutaneous rectus abdominis flap. Histology showed a squamous cell carcinoma arising in the Buschke Löwenstein tumor with clear resection margins. Therefore, the patient was irradiated locally after uneventful primary wound healing. CONCLUSION: A simultaneous reconstruction of a large pelvinoperineal soft tissue defect with the transpelvic myocutaneous rectus abdominis flap allows primary healing, accelerated rehabilitation, and safe adjuvant radiotherapy without risk of serious radiation damage to the small bowel by preventing it from protruding into the pelvic defect.

Anal Canal↗
PubMed2002

Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy.

OBJECTIVE: Besides other factors, the choice of reconstructive method for full thickness thoracic wall defects depends on the morbidity of preceding surgical procedures. The pedicled latissimus dorsi flap is a reliable and safe option for reconstruction of the thorax. A posterolateral thoracotomy, however, results in division of the muscle. Both parts of the muscle can be employed to close full thickness defects of the chest wall. The proximal part can be pedicled on the thoracodorsal vessels or the serratus branch; the distal part can be pedicled on paravertebral or intercostal perforators. This retrospective study was undertaken to evaluate the reconstructive potential of both parts of the latissimus dorsi in thoracic wall reconstruction after posterolateral thoracotomy. METHODS: Between 1987 and 1999, 36 consecutive patients underwent reconstruction of full-thickness thoracic wall defects with latissimus dorsi-flaps after posterolateral thoracotomies. The defects resulted from infection and open window thoracostomy (n=31), trauma (n=3) and resection of tumours (n=2). The patients' average age was 57 years (range 22-76 years). Twenty-five patients were male, 11 were female. In 31 cases the split latissimus dorsi alone was employed; in five cases additional flaps had to be used due to the size of the defects, additional intrathoracic problems or neighbouring defects. RESULTS: In 34 cases defect closure could be achieved without major complications. Empyema recurred in the pleural cavity in one case and one patient died of septicaemia. The 15 patients who had required a respirator in the preoperative phase could be extubated 4.8 days (average) after thoracic wall reconstruction. Postoperative hospital stay averaged 16 days. CONCLUSIONS: Different methods are available for reconstruction of full thickness defects of the thoracic wall. After posterolateral thoracotomy in the surgical treatment of empyema, oncologic surgery and traumatology, the latissimus dorsi muscle still retains some reconstructive potential. Advantages are low additional donor site morbidity and anatomical reliability. As it is located near the site of the defect, there is no need for additional surgical sites or intraoperative repositioning. In our service, the split latissimus dorsi muscle flap has proven to be a valuable and reliable option in thoracic wall reconstruction.

Adult↗
PubMed2001

[Water jet dissection in fatty tissue].

BACKGROUND: The first report about the use of water-jet dissection in surgery dates 1982. The advantage compared to conventional cutting is the preservation of vessels and nerves, thus facilitating the precise coagulation thereafter. Devices of the new generation with coherent jet are used in liver surgery in order to reduce blood loss. The use of water-jet dissectors in other fields of surgery is currently under investigation. The preparation of vessels in fatty tissue is of special interest for plastic surgeons. The technical parameters of the hydro- or water-jet device have to be optimised. METHOD: Abdominal fat tissue of fresh cadavers was cut under standardised conditions with different parameters of the dissector. The depth of the cuts and the morphology of the blood vessels were analysed. RESULTS: Between 20 and 60 Bar cutting pressure of the water-jet and one single pass the cuts are 8 mm deep. Deeper cuts can be achieved by repeated application on the same cut. When using 40 Bar and 5 passes the cutting depth is 1.7 cm. Higher pressure as 50 or 60 Bar do not lead to deeper cuts. The water-jet dissection leads to a water uptake of the cut tissue. Morphologically all the vessels, lying in the cut are undamaged if the pressure doesn't exceed 40 Bar pressure range. CONCLUSION: The optimal pressure for water-jet dissection of fatty tissue lies between 30 and 40 Bar. Higher pressure does not lead to deeper cuts, but increases the risk of vessel damage. The vessels in the remain morphologically intact if he cutting pressure lies below 50 Bar. The effect of the mechanical irritation of the vessels has to be investigated in vivo, before using the water-jet dissector for preparation of blood vessels in humans e.g. for flap dissection.

Adipose Tissue↗
PubMed2000

Surgical treatment of CHILD nevus.

We report a young girl with an unusual manifestation of CHILD syndrome in whom skin lesions showed involvement of the right side of her neck as well as symmetrically distributed ptychotropic involvement of the large body folds. Excision resulted in improvement and finally healing of skin lesions within the submammary folds, where breast reduction was also performed, whereas excision of axillary lesions and subsequent grafting with split skin turned out to be unsuccessful.

Adolescent↗
PubMed1999

Fabricating auricular prostheses using three-dimensional soft tissue models.

This article describes a method for fabricating an auricular prosthesis. This procedure uses the contours of the soft tissue surface from computerized tomography scans to fabricate a computer-generated, side-inverted 3-dimensional soft tissue model from a solid block of polyurethane using an Endoplan milling machine. The resultant 3-dimensional soft tissue model can then be used as the basis for a wax sculpture. This procedure facilitates the planning of the prosthesis; symmetrical modeling, especially for large, hemifacial defects; and the impression, which can be made on the model itself.

Acrylic Resins↗
PubMed1999

Case report. Atypical cutaneous pseudallescheriosis refractory to antifungal agents.

We report on a 65-year-old male heart transplant recipient who was otherwise in good condition. The patient was immunocompromised secondarily due to cyclosporin, prednisolone and azathioprine when widespread pustular skin lesions with erythematous margins subsequently developed on his left forearm. There was no history of trauma or septic temperature. Bacterial cultures were sterile and the results of native and cultural investigation studies were negative. A biopsy specimen of the lesion demonstrated hyalohyphomycosis with numerous septate hyphae within granulomas throughout the dermis. Subcutaneous tissues were not involved. Culture plates inoculated with pus and skin from the punch biopsy showed growth of a mould yielding Pseudallescheria boydii. Sensitivity testing was performed with miconazole, ketoconazole and itraconazole showing the best in vitro activity against P. boydii. In spite of treatment with itraconazole, the erythema and pustules continued to spread and therapy was changed to intravenous miconazole. Due to ongoing progression after 3 months of antifungal therapy surgical debridement was required. After 2 years of follow up, he had no recurrence.

Aged↗
PubMed1999

[The lower trapezius muscle island flap. Anatomic principles and clinical relevance].

Up to now, there is no uniform anatomic description neither of the branches of the subclavian artery nor of the pedicle of the lower myocutaneous trapezius flap. A dissection study was carried out on 140 necks in 70 cadavers. Variations of the subclavian artery and its branches, vessel diameter at different levels, the course of the pedicle under the levator scapulae muscle, the arc of rotation of the island flap, and the variations of the segmental intercostal branches to the lower part of the trapezius muscle were examined. Results of this study enable us to suggest a new nomenclature for the branches of the subclavian artery, a proper pedicle definition, and a technique for safe flap elevation. The lower trapezius island flap is a thin and pliable myocutaneous flap with a constant pedicle which ensures safe flap elevation. This flap has the potential for a wider acceptance due to minor donor site morbidity, large arc of rotation, and an ample range of clinical applications in the head and neck area as an island flap as well as a free flap.

Angiography↗
PubMed1998

Transsection of the peroneal nerve complicating knee arthroscopy: case report and cadaver study.

We report the case of a 36-year-old male patient who sustained a hyperextension trauma of the left knee. After performing diagnostic arthroscopy (partial tear of the anterior cruciate ligament) and partial resection of the anterior cruciate ligament, the patient experienced a complete paralysis of the peroneal nerve. One year after the first surgical procedure, a reconstructive repair of the peroneal nerve and a transfer of the anterior tibial muscle was performed. This complication is reported for the first time in literature.

Adult↗
PubMed1998

Venous thrombosis in a replanted finger with underlying factor V Leiden mutation.

Resistance to activated protein C (APC resistance) was described recently as a cause for thrombophilia. APC inactivates coagulation co-factors Va and VIIIa. A single base-pair mutation changing Arg506 to Gln at the APC cleavage site of the factor V gene leads to a factor V Leiden variant, which is the most frequent cause of APC resistance. Recently, its role in peripheral venous thrombosis during pregnancy was described. We here report a case with thrombosis of the venous anastomoses after finger replantation with resistance to activated protein C associated with factor V Leiden mutation.

Adult↗
PubMed1998

[The posterior interosseous flap--review and personal experience].

The posterior interosseous flap was first introduced by Zancolli and Angrigiani (1985) and short time later by Penteado and Masquelet (1986). The flap is used for soft tissue reconstruction in the hand but has not gained wide acceptance due to tedious pedicle dissection and venous problems. In 1993, Angrigiani et al. published a simplified modification in the elevation of the flap. They included a constant fasciocutaneous perforating vessel in the flap to enhance the viability. We applied the modified elevation technique in twelve patients. Our experience, indications, and complications will be discussed. In contrast to Angrigiani's statement, our flaps still show a temporary mild to moderate venous congestion similar to the flaps raised in the original technique.

Aged↗
PubMed1997

Systematized inflammatory epidermal nevus with symmetrical involvement: an unusual case of CHILD syndrome?

The CHILD syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects) is usually characterized by lateralization of all associated anomalies. It has been assumed that the event of X-inactivation coincides and interferes with a clone of organizer cells controlling a large developmental field. A 16-year-old girl with bilateral manifestations of CHILD syndrome is described. The inflammatory skin lesions affected the body folds (ptychotropism) in a symmetrical distribution, although only the right side of the neck was involved. In addition, absence of several facial muscles, vertebral defects, and shortening of the leg on the right side were noted, and a ventricular septum defect was present. This unusual case may be explained by the assumption that X-inactivation did not coincide with the origin of inducer cell clones controlling large morphogenetic fields on either side of the body.

Abnormalities, Multiple↗
PubMed1997

Life-saving muscle flaps in tracheobronchial dehiscence following resection or trauma.

OBJECTIVE: In the presence of acute inflammation and necrosis of the wall, tracheo-bronchial defects are difficult to manage. The absence of adequate vascularization and the contaminated area prevent successful direct re-suturing. METHODS: In order to restore a sufficient blood supply we used a pedicled latissimus dorsi or a pectoralis major flap that was entered into the thorax after a 10-cm resection of the second rib. A portion of the muscle was fitted into the tracheo/bronchial defect by reinforced sutures. The remaining muscle was sutured to the tissue surrounding the defect. This method was applied in various septic conditions: Bronchial defects; complete dehiscence of the right (n = 6) or left (n = 1) main bronchus at the carinal level following resection for lung cancer (n = 4) or for tuberculous (n = 2) on nontuberculous pleuropneumonia (n = 1). Tracheal defects; (1) destruction of one third of the tracheal circumference involving the cricoid down to the fourth ring following tracheotomy in presence of a septic sternum after intrathoracic goiter and Bechterew's disease; (2) 30% dehiscence of the anastomosis and septic sternum following tracheal resection; (3) Mediastinitis involving tracheal and esophageal wall following a 7 cm long iatrogenous laceration of the intrathoracic trachea. RESULTS: In one case the latissimus dorsi developed venous stasis on day 2 and was replaced by the pectoralis major muscle which showed uneventful healing. In all other patients the muscle flap resulted in an uneventful closure of the defect and recovery. CONCLUSIONS: Large, well vascularized, pedicled muscle flaps ensure a safe closure of tracheo-bronchial defects or dehiscences even in presence of gross necrosis and sepsis.

Aged↗
PubMed1997

Can ASA grade or Goldman's cardiac risk index predict peri-operative mortality? A study of 16,227 patients.

This trial was designed to study the correlation between peri-operative mortality in patients undergoing elective surgery and the physical status classification of the American Society of Anesthesiologists, the Goldman multifactorial cardiac risk index or the two indices combined. All patients scheduled for elective surgery over a 5-year period were evaluated pre-operatively and were scored according to both indices. Of 16,227 patients studied, 215 died within 4 weeks of operation. Both indices correlated significantly with peri-operative mortality, the ASA grade showing a closer correlation. A regression tree analysis divided the combination groups into five subgroups where the mortality was lowest (0.4%) in ASA grade < or = 2 and cardiac risk index group I (score 0-5 points) and increased up to 7.3% in ASA grade = 4 and cardiac risk index group > or = 3 (score > 13 points). We conclude that for this large number of patients peri-operative mortality can be predicted with the ASA grade and, to a lesser degree, with the cardiac risk index. Applied in the correct way, the combination of the two scores can increase the accuracy of prediction of peri-operative mortality.

Adult↗
PubMed1996

Anatomic basis of the lower trapezius musculocutaneous flap.

Differences in the description of the blood supply of the lower trapezius m. and the fact that all former findings are based on very few cases caused us to reinvestigate the arterial supply of the lower trapezius m. Based on the anatomic investigation of 70 human cadavers, the trapezial branch of the dorsal scapular a. was found to be the constant vessel to the lower trapezius m. The origin of the dorsal scapular a., however, was found to be very variable. In 45% it was a direct branch of either the subclavian a. or the costocervical trunk. In the remaining 55% the dorsal scapular a. formed different trunks with the superficial cervical a. and/or suprascapular a. branching off either the subclavian a., the thyrocervical trunk, or the internal thoracic a. Additional segmental musculocutaneous perforators also supply the lower part of the trapezius m. and the overlying skin. Consequently, the lower or ascending part of the trapezius m. has a vascular pattern type V. Thus, the lower trapezius musculocutaneous flap merits consideration in head and neck reconstruction.

Back↗
PubMed1995

[Cutaneous calciphylaxis in chronic renal failure].

A case of a 53-year-old chronically uraemic female patient who suddenly developed widespread cutaneous necrosis on both thighs is presented. On the basis of the typical histopathological features a diagnosis of calciphylaxis was made and supported by elevated serum parathyroid hormone levels. Calciphylaxis is a rare and serious disease, mostly seen in uraemic patients subjected to chronic haemodialysis. Typical features are calcifying panniculitis and thrombosis of small to medium-sized blood vessels followed by necrosis of the skin. The poor prognosis is due to systemic calcifications of visceral organs. When acute cutaneous necrosis of the skin is encountered in patients with chronic uraemia calciphylaxis should always be considered as a possible cause in the differential diagnosis. Determination of the serum parathyroid hormone level is recommended.

Biopsy↗
PubMed1995

[Results of various reconstructive methods after subcutaneous mastectomy and objective evaluation of tissue fibrosis with a new measurement procedure].

Of 35 patients undergoing subcutaneous mastectomy performed within the last 15 years, 25 were evaluated for follow-up studies. Reconstruction had been achieved either using silicone implants or autologous tissue formed from the resulting dermal-fat pedicles. The patients were interviewed for subjective results. In addition, firmness of the breast according to the classification of Baker was investigated. The compressibility of the breast was electronically measured, employing a new compression device. In 13 patients, the breast was distorted after reconstruction with implants. The deformity did not correlate with submuscular or subcutaneous placement of the implants. The aesthetic results after dermal-fat pedicle techniques were superior to reconstruction with silicone implants. Compressibility to 32% of breast diameter was defined to be a border value between a soft and firmer breast, correlating with clinical conditions between Baker 2 and Baker 3.

Adult↗