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Biomedical subjects

Gottfried Wechselberger

Publications and source records attributed to Gottfried Wechselberger.

At least 19 recordsLinked to original sources
PubMed2006

Nipple reconstruction using a modified arrow flap technique.

Nipple reconstruction is the perfection of breast reconstruction. Although many reconstruction techniques are available, all come with the risk of projection loss. Most of the commonly used local flap techniques give reliable immediate results, but are associated with a loss in projection of 50 to almost 70% over the first three postoperative years. We herein present a modification of the nipple reconstruction technique as presented by Thomas et al. in 1996. By forming a deepithelialized area when closing the skin donor site, a firm foundation plate for the new nipple is created. The authors observed that this solid foundation plate, as well as the separation of the nipple cavity of the subcutaneous fat, results in less nipple projection loss.

Adult↗
PubMed2006

Nerve injury caused by removal of an implantable hormonal contraceptive.

Implanon insertion and removal are relatively uncomplicated procedures in the hands of medical professionals familiar with the technique. However, injury to branches of the medial antebrachial cutaneous nerve during Implanon insertion and removal can result in impaired sensibility, severe localized pain, or the formation of painful neuroma that can be quite devastating to the patient. The best way to avoid injury to the medial antebrachial cutaneous nerve is to better understand its position relative to the standard area of Implanon insertion. In the event that an injury to the nerve is recognized, immediate plastic surgical measures should be undertaken to avoid displeasing sequels of nerve injuries. Therefore, the benefit of this generally well-tolerated, highly effective, and relatively cost-efficient contraception is guaranteed only in the hands of medical professionals familiar with the technique.

Adult↗
PubMed2006

Reduction mammaplasty and axillary-subclavian venous thrombosis.

We present a woman with distinct mammahypertrophy and simultaneous catheter-associated axillary-subclavian venous thrombosis characterized only by chronically dilated collateral vein over the chest. Despite this massively dilated subcutaneous vein covering the chest on the affected side, bilateral reduction mammaplasty of modified Pitanguy method was successfully performed among protection of this collateral vein.

Axillary Vein↗
PubMed2006

Respecting the aesthetic unit in autologous breast reconstruction improves the outcome.

BACKGROUND: In postmastectomy breast reconstruction, a patchwork-like appearance and a double-bubble phenomenon may result from scar contracture and the possible destruction of the normal inframammary fold during mastectomy. Restoring an age-related breast ptosis can be difficult, and often contralateral breast surgery has to be performed to achieve symmetry. The purpose of this article is to present a technique that respects the aesthetic unit in autologous reconstruction, improves the outcome, and minimizes secondary surgery. METHODS: The area between the resected mastectomy scar and the marked inframammary fold is deepithelialized. The inferior skin margin of the flap is sutured to the lower line of the deepithelialized area, which corresponds to the inframammary fold of the contralateral side. The degree of ptosis can be adjusted by insetting greater or lesser amounts of skin. From December of 2000 to June of 2004, 12 patients underwent secondary breast reconstruction using this technique. The patients' ages ranged from 39 to 63 years (median, 51 years). Three patients had reduction mammaplasty of the contralateral breast. RESULTS: Mean patient follow-up was 14.7 months (range, 4 to 45 months). There were no free flap failures. Cosmetic evaluation of the reconstructed breasts by two independent plastic surgeons showed good results with regard to symmetry in 10 patients and fair results in two patients. Concerning visibility of the inferior scar, 11 patients had a good result and one patient had a fair result. All patients had a good result in terms of age-appropriate ptosis. CONCLUSIONS: The authors' technique facilitates the formation of an age-appropriate ptosis. Altogether, the aesthetic unit of the breast is restored.

Adult↗
PubMed2006

The superficial inferior epigastric artery (SIEA) flap: indications for breast reconstruction.

The lower abdominal skin and fat have become a standard for breast reconstruction because the abdominal tissue can mimic the breast to a high degree. With today's increasing focus on safety and routine of microsurgical interventions, more attention must be paid to donor-site morbidity. The superficial inferior epigastric artery (SIEA) free flap is the least invasive microsurgical procedure for breast reconstruction because this operative technique does not require harvesting of the rectus muscle or the abdominal fascia. A total of 11 breast reconstructions were performed with this technique and had an average follow-up of 23 months. The anatomy, operative technique, and various indications for the SIEA flaps are demonstrated.

Adult↗
PubMed2005

Peroneal nerve lesion after sural nerve graft harvest: an unusual complication--case report.

After harvesting of the sural nerve, the patient developed a partial palsy of the common peroneal nerve due to a lesion of the peroneal nerve and a neuroma of the sural nerve stump. Motor function recovered after performing neurolysis of the common peroneal nerve and mobilization of the neuroma. The sural nerve, in this case originating from the common peroneal nerve, was harvested using a nerve stripper and four small skin incisions. Direct lesion by the forced use of the nerve-stripping instrument followed by the formation of a neuroma close to the peroneal nerve are the suspected reasons for motor dysfunction. Although many authors report using a nerve stripper as a safe, less invasive method to gain nerve material for transplantation, we recommend lengthening the skin incision so as to be aware of anatomical variations and to refrain from pulling the nerve distally to avoid the described complications.

Adult↗
PubMed2005

Gracilis muscle flap for aesthetic reconstruction in the head and neck region.

Microsurgical tissue transfer has constantly improved the therapeutic options for reconstruction in the head and neck region, but the ideal flap has yet to be found. The purpose of this study is to discuss the aesthetic potential of the free gracilis muscle flap in difficult head and neck reconstruction. We report our experience with the free gracilis muscle flap in seven patients who underwent reconstruction in the head and neck region for a variety of indications. In all seven patients, the transplanted muscle flaps healed well, with no flap loss. Postoperative complications consisted of skin-graft loss in one patient requiring a second split-thickness skin graft. Donor-site morbidity was minimal in all patients. For difficult reconstruction in the head and neck region, the free gracilis muscle flap offers a number of advantages, including reliable vascular anatomy, relatively great plasticity, and a concealed donor area. Thus this type of flap offers a valuable option whenever an aesthetically pleasing result is sought.

Adult↗
PubMed2004

Free anteromedial thigh flap: clinical application and review of literature.

The anteromedial thigh (AMT) flap is reviewed in terms of its vascular anatomy and previous clinical reports in the literature. Our own series of 5 patients treated with this flap for defects in the head and neck region and lower extremity is presented. Although several authors controversially discussed vasculature, we constantly found the pedicle as an emerging septocutaneous perforator at a point where the medial border of the rectus femoris muscle is crossed by the sartorius muscle. In all 5 patients, the AMT flap provided stable coverage with no flap loss. Based on our findings, we conclude that the anteromedial thigh flap offers all the advantages of fasciocutaneous flaps. Therefore, we recommend this flap as an alternative for defects requiring coverages of thin to moderate skin thickness. However, it should be remembered that variations in vascular anatomy are possible.

Aged↗
PubMed2004

Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome.

In severely injured lower extremities with loss of the anterior compartment, the free functional rectus femoris musculocutaneous flap was used to restore extension of the foot and in soft-tissue reconstruction. From June 2000-July 2002, 3 patients were treated with this technique. Mean follow-up of the 3 patients was 27 months. Electromyography and the Stanmore system (recording pain, need for orthosis, ability to wear normal shoes, activity level, muscle power, active extension of the foot, and foot posture) were used to assess results of functional rectus femoris transfer. One patient had an excellent result, one patient had a good result, and one patient had a poor result, as assessed by the Stanmore system. Free functional rectus femoris transfer can obtain excellent results in treating foot-drop and soft-tissue defects due to lower leg compartment syndrome and loss of all muscles of the anterior compartment. (c)

Adolescent↗
PubMed2004

Pregnancy as a tissue expander in the correction of a scar deformity.

Tissue expansion is an established method for the correction of scars and tissue defects. During pregnancy the abdominal skin becomes gradually stretched over the growing uterus, providing a "natural" tissue expander. We present a case of a woman with posttraumatic scarring of the lower abdomen and thigh where tissue expansion during pregnancy was successfully used for scar correction.

Abdominal Injuries↗
PubMed2004

Management of subcostal scars during DIEP-flap raising.

The lower abdomen continues to be the favourite donor site for free tissue transplantation in autologous breast reconstruction. The deep inferior epigastric artery (DIEP)-flap has revolutionised microsurgical reconstruction of the breast after mastectomy. However, previous abdominal operations with resulting subcostal scars limit the use of this flap due to possible severe complications such as fat necrosis or wound break down at the donor site. We present a method to avoid such problems that could equally be applied in simple abdominoplasties under similar conditions. After harvest of the DIEP-flap the cephalad wound edge has to be undermined for direct wound closure. Instead of ligating encountered perforating vessels, one of these perforators is prepared and left intact to provide perfusion for the distal part of the cranial abdominal flap below the scar. With this technique, the DIEP-flap can be harvested safely even in the presence of abdominal scars and, thus, is not contraindicated under these circumstances any longer.

Abdomen↗