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Biomedical subjects

G Wechselberger

Publications and source records attributed to G Wechselberger.

At least 73 records · Page 4Linked to original sources
PubMed1997

Reconstruction of large palmar defects of the hand using free flaps.

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.

Adult↗
PubMed1997

Free-flap monitoring with tissue-oxygen measurement.

Flap monitoring by oxygen measurement with a microcatheter pO2 probe was carried out in 17 free flaps. The probe represents a new development among monitoring methods, allowing the measurement of oxygen pressure in all types of flaps including buried free flaps and vascularized bone grafts. Fourteen flaps survived with no problem. Three flaps with different degrees of problem are reported, and the advantage, and sources of error using this monitoring method are discussed.

Adult↗
PubMed1997

Primary flap closure in complex limb injuries.

Free-tissue transfers enable surgeons to reconstruct or salvage limbs injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerves. Primary free-tissue transfer is performed following debridement, bone fixation, and repair of injured structures within 24 hr after injury. Between 1987 and 1996, 57 patients who had complex extremity traumas were treated with primary free-tissue transfer, or free flaps. Long-term follow-up ranged from 4 months to 9 years (median: 4.5 years). No flap failure or serious wound-healing complication occurred using the protocol. Radical debridement and primary free-flap coverage in extensive extremity injuries can salvage limbs, provide improved functional and aesthetic results, and psychologically benefit patients through lowered morbidity. Other benefits include reduced incidence of free-flap failure, postoperative infection, secondary operative procedures, and invalidity, as well as shorter hospital stays, and lowered medical expenses.

Adult↗
PubMed1997

Internal mammary veins: classification and surgical use in free-tissue transfer.

The internal mammary artery has been well-investigated due to its frequent use in cardiac surgery. However, in reconstructive microsurgery in the thoracic region, the internal mammary vessels have been used rarely as recipient vessels, due to difficulties and lack of knowledge about the internal mammary veins. This study was designed to investigate the anatomy and topography of the veins. Its goal was to gain sufficient information about their availability in free-tissue transfer. Dissection of the vessels was performed in 86 cadavers bilaterally to the sternum. At the level of the fourth rib, which is the most desired access for microvascular anastomosis in reconstructive breast surgery with free flaps, the veins were found to be adequately large (range 0.64 to 4.45 mm). Results were in close agreement with 100 bilateral measurements obtained by color Doppler sonography in 16 patients preoperatively, and additionally in 34 healthy volunteers. Preoperative detection of vessels with the aid of sonography facilitated planning of surgical procedures. According to these findings, the internal mammary veins may be used as suitable recipient veins for free microvascular tissue transfer, especially for established autologous breast reconstruction with the free transverse rectus abdominis myocutaneous flap, or for reconstruction of complex thoracic-wall defects.

Adolescent↗
PubMed1996

[Plastic surgery treatment of extensive decubitus ulcers of the pelvic area].

Between 1980 and 1995, 207 patients with 219 extensive pelvic pressure sores underwent reconstructive surgery at our department. Eighty patients operated upon between 1992 and 1995 were followed up. The postoperative complication rate was 22% and the relapse rate 27%. Pre- and postoperative management has been standardized for the purposes of quality control. The value of preoperative management, choice of flap, operative procedure and postoperative care are discussed in this paper.

Adolescent↗
PubMed1996

A simple method of free-flap monitoring using a superficial vein.

A new, simple method for flap monitoring is presented. Dissecting a superficial flap vein, which is closed by an Acland clamp, and opening the clamp shortly thereafter, allows objective, postoperative flap monitoring. The surgical technique, advantages, and possible difficulties of the procedure are discussed.

Humans↗
PubMed1996

The instep free flap to resurface palmar defects of the hand.

Large and deep soft-tissue defects of the hand require adequate resurfacing by free or distant pedicle flaps. A free flap of suitable size corresponding to the extended palm defect may be harvested from the instep region without encroaching on the weight-bearing area. Following Gillies's concept that "losses must be replaced in kind," and taking into consideration all possibilities of a free-flap reconstruction of the hand, we can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, and color and thus an optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity.

Adult↗
PubMed1996

The bipedicled flap on the lower leg, a valuable old method? Its indications and limitations in 12 cases.

Covering defects of the lower leg is still an exceptional problem when tendons or bone are exposed within small defects, particularly in the malleolar region. We present 12 cases of successful wound closure on the lower leg with the versatile bipedicled flap. We had a low incidence of minor complications, whether it was used as a cutaneous, fasciocutaneous, or myo-fasciocutaneous flap, in some cases also based on underlying perforators to guarantee perfusion of the flap. If it is limited to selected indications and patients, the bipedicled flap may be a reliable alternative to other, more sophisticated methods of tissue transfer.

Adult↗
PubMed1996

[Indications and concepts for plastic surgery therapy in chronic varicose ulcer].

In the treatment of extensive leg ulcers, surgical therapy is superior to conservative methods in many respects. Radical resection of sclerotic tissue around the ulcer and its causing veins is essential, followed by defect cover with mesh-skin grafts. Surgery leads to prompt healing with a shortened hospitalization and therefore decreases costs; it leads to a prompt relief of pain and a low rate of recurrence. Especially in the aged patient the indication for operation must be well-considered and discussed interdisciplinarily. Even though operative technique seems to be simple, it should be reserved for the plastic surgeon experienced in the treatment of these lesions.

Adult↗
PubMed1995

Internal mammary vessels: anatomical and clinical considerations.

This study was designed to investigate the anatomy of the internal mammary (thoracic) artery (IMA) and comitant vein(s) (IMV) relevant to their use in microsurgery. We dissected the internal mammary (thoracic) vessels bilaterally in 86 cadavers from the clavicle down to the 6th rib. At the level of the 4th rib, the distance between the sternum and the IMA was large enough [range 10.0-23.6 mm] and the diameter of the IMA [range 0.99-2.55 mm] and comitant vein(s) [range 0.64-4.45 mm] wide enough for both end-to-end and/or end-to-side anastomosis. These results were in close agreement with supplementary measurements obtained by Doppler ultrasound in 34 healthy female volunteers. Based on all these findings we suggest that the internal mammary vessels are suitable recipient vessels for free tissue transfers in the thoracic region, especially for breast reconstruction with the free transverse rectus abdominis myocutaneous (TRAM) flap.

Adult↗