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Biomedical subjects

H Fansa

Publications and source records attributed to H Fansa.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical treatment of groin soft tissue defects].

BACKGROUND: Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. MATERIAL AND METHODS: From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. RESULTS: All flaps healed primarily. There were no secondary infections or lymphorrhea. CONCLUSION: The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

Carcinoma, Squamous Cell↗
PubMed2006

[Distally pedicled peroneus brevis muscle flap for defect coverage on the lower leg].

BACKGROUND: Defects of the lower leg with exposed tendons or bone require either a local or free flap coverage. The distally pedicled peroneus brevis muscle flap has been proven to be a sufficient local flap alternative. MATERIAL AND METHOD: Using this technique the muscle is perfused by the non dominant distal perforators. This allows the muscle to be transposed to more distal lesions. The muscle is then covered with meshed split skin graft. Between 2000 and 2004 12 patients with defects of the lower leg in the distal lower third have been treated by using this muscle flap. The defects were located over the tibial bone, the extensor tendons, the achilles tendon and the lateral malleolar region. RESULTS: All muscles healed primarily, 4 patients had minor wound healing complications of the skin graft, which in all cases healed conservatively. The muscle and skin graft remained stable. Donor site morbidity is restricted to the scar in the lateral lower leg. Pronation of the foot is not impaired. CONCLUSION: These cases show that the distally based peroneus brevis muscle has a wide range of coverage and even allows a closure down to the calcaneal tuberosity. Additionally, a local flap management with a safe muscle transposition is an economic procedure with short operation time and decreased hospital stay. If the muscle does not cover the wound sufficiently, free flap surgery can still be performed.

Adult↗
PubMed2006

[Transfer of trapezius muscle for reconstruction of abduction of the shoulder].

INTRODUCTION: After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used. PATIENTS AND METHODS: We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80 degrees abduction for 6 weeks followed by 10 degrees adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score. RESULTS: In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15 degrees (0-30 degrees) to 54 degrees (35-80 degrees) postoperatively. The external rotation was 9 degrees (-20-40 degrees) preoperatively and 19 degrees (0-70 degrees ) postoperatively. DISCUSSION: Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.

Adolescent↗
PubMed2006

[Value of V.A.C.-therapy in the treatment of sternal infections].

Osteomyelitis of the sternum is a dreaded complication after sternotomy and is related to high mortality. Control of infection by radical debridement is the key to successful treatment. Instability of the thoracic cage can lead to a high complication rate. 16 Patients with an infected and unstable sternum underwent radical debridement with resection of the sternum and adjacent ribs. 6 Patients (group A) received an immediate defect coverage with a pedicled muscle flap. 10 Patients (group B) were treated with a vacuum-assisted closure (V.A.C.)-therapy until stabilization of their general condition and underwent defect coverage in a second operation. Healing of the flaps was uneventful in all cases despite minor problems. 5 patients of group A had severe complications with pulmonary or cardiac failure and thoracic instability which lead to prolonged periods of mechanical ventilation. 2 patients of this group died due to multi organ failure. All patients of group B survived and there were no major complications. All of the patients were free of recurrence from their osteomyelitis during follow-up. V.A.C.-therapy after radical resection of sternum osteomyelitis proved to be an effective measure to bridge time while optimizing the status of the patient and it's wound. With this approach we believe to have lowered the rate of major complications in this multi-morbid patient group by reducing the burden of one large operation and by improving thoracic stability.

Aged↗
PubMed2006

[Malignant eccrine poroma].

INTRODUCTION: Malignant eccrine poroma is a very rare tumour of the sweat glands with high malignancy and presenting with a polymorph clinical and histological picture. CASE REPORT: We describe the case of a 99-year-old patient with a malignant poroma on the buttock. Despite the large size of the tumour, no metastasis was found with standard examination techniques. Radical excision and defect closure with a Limberg flap was performed. RESULT: The healing course was uneventful and without complications. CONCLUSION: The malignant poroma is a tumour of high malignancy which can easily be misdiagnosed because of its different forms of presentation. Radical surgical therapy is the only known effective treatment.

Acrospiroma↗
PubMed2006

[Patients' satisfaction and social reintegration after breast reconstruction with the DIEP/TRAM flap].

The aim of the study was to evaluate social reintegration and patients' perception after breast reconstruction with the free TRAM/DIEP flap. Between 2004 and 2006, 100 patients with an average age of 48 years with breast cancer, capsular contracture and lymphangioma underwent single or second stage autologous tissue transfer. In 7 patients reconstruction was performed on both sides (altogether 107 flaps). The patients were seen for postoperative evaluation and were asked for their personal acceptance after reconstruction. Postoperatively, no instability of the abdominal wall was seen. 3 patients had a total flap loss, in 2 patients a partial loss was evident, 1 had a hematoma, 2 showed successfully treated thrombosis of the flap vein, and 2 patients suffered from wound healing problems at the flap and 4 patients at the abdomen. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent and patients' satisfaction was high.

Adult↗
PubMed2005

[Intramuscular angioma in the hand. A case report].

Intramuscular angiomas are rare vascular tumors with locally aggressive growth between the fibers of muscle. A malignant aspect poses a danger for the function of the hand. We report the case of a 32-year-old woman with a painless tumor in the thenar. Physical examination showed a 2 x 3 x 5 cm fixed and engorged swelling. Perfusion and sensibility were intact. The flexion and opposition of the thumb were reduced. CAT showed a tumor of the thenar with a solid structure with signal enhancement after administration of contrast medium. Histologic examination after local resection showed an intramuscular angioma. Intramuscular angiomas have a malignant aspect because of the rapid and infiltrative growth followed by functional impairment, pain, and deformity. A high rate of recurrence is described. Thus, radical excision is indicated.

Adult↗
PubMed2005

The pedicled rectus femoris muscle flap for reconstruction of complicated abdominal wall defects.

AIM OF THE STUDY: Large or complicated abdominal wall defects caused by recurrent incisional hernias, infections or tumor resections often require the use of prosthetic mesh, local tissue transposition or even distant muscle flaps for proper reconstruction. Due to the sometimes discouraging results of meshes muscle flaps are an appreciated alternative. We followed up a series of cases to assess the value of the pedicled rectus femoris muscle flap. METHODS: Follow up time ranged from 6 months to 4 years. 12 cases of reconstruction of the abdominal wall using pedicled rectus femoris muscle flaps after tumor resections, recurrent incisional hernias, and infection are presented. Abdominal wall stability was examined clinically. The aesthetic and the functional results were assessed using a standardized questionnaire. The loss of torque in the quadriceps muscle was evaluated using a dynamometer. RESULTS: In all but one patients a stable abdominal wall could be reconstructed. We saw no major complications. The loss of true muscular capacity in the quadriceps muscle of the operated leg was 19% compared to the nonoperated leg, but was tolerated very well. CONCLUSION: The donor site morbidity is moderate. The flap provides an easy and save possibility to reconstruct the abdominal wall. The rectus femoris muscle flap should be considered as an alternative for abdominal wall reconstruction.

Abdominal Wall↗
PubMed2004

Axillary hidradenitis suppurativa: a further option for surgical treatment.

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice. METHODS: We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks. RESULTS: No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients. CONCLUSIONS: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.

Adult↗
PubMed2004

[Abdominal wall reconstruction with pedicled rectus femoris muscle flap].

INTRODUCTION: Large abdominal hernias or abdominal wall defects often require the use of prosthetic mesh, local tissue transposition or even distant muscle flaps for proper reconstruction of the abdominal wall. The disadvantages of meshes are well known. The use of muscle flaps is an appreciated alternative. PATIENTS AND METHODS: We present 12 cases with reconstruction of the abdominal wall using pedicled rectus femoris muscle flaps after tumor resections, incisional hernias, and infection. Follow up time ranged from 6 months to 4 years. Abdominal wall stability was examined clinically. The aesthetic and the functional result were assessed using a standardized questionnaire. To objectively evaluate the loss of force in the quadriceps muscle the maximal voluntary knee extension torque was measured. RESULTS: In all patients except one a stable abdominal wall was achieved. No major complications occurred. The loss of torque in the operated leg was tolerable. DISCUSSION: The donor site morbidity is relatively low and the flap provides an easy and save possibility to reconstruct the abdominal wall. The rectus femoris muscle flap should be considered as an alternative for abdominal wall reconstruction.

Abdominal Wall↗
PubMed2004

[Secondary nerve reconstruction in the upper extremity in children--results with respect to number of motor units].

After nerve injury, the therapy of choice is primary suture. If this, however, is not possible or inadequate, a secondary reconstruction must be carried out within a suitable period of time. This study shows results after nerve transplantation within a timeframe of six weeks. Seventeen children with peripheral nerve injuries of the upper extremity were treated. Secondary nerve reconstruction was accomplished by sural nerve transplantation. Eight children, aged from 5 to 13 years, were examined. The median nerve was affected in three and the ulnar nerve in five cases. The examination included clinical and electrophysiological assessments. The length of grafts was correlated with the clinical result. Besides the calculation of sensitive and motor nerve conduction velocity the number of motor units from the flexor pollicis brevis muscle or abductor digiti minimi muscle were determined by motor-unit-estimation (MUE) on both sides. The observation time period was on an average 2.9 years. Results were good to excellent. A persisting Hoffmann-Tinel's sign was found only once in median nerve lesion. Loss of sensitivity following harvesting of sural nerve was not noted as a problem by any of these children. Length of grafts did not affect the results. Standard values were reached in every case in the electrophysiological examination. The number of motor units of the abductor pollicis brevis muscle and abductor digiti minimi muscle decreased to approximately 50% compared to the healthy side. Sural nerve grafting resulted in good motor and sensory function. We recommend grafting within six weeks, as Wallerian degeneration is completed and regeneration from the proximal nerve stump is optimal. Although children have a very good regeneration potential, the examined cases did not achieve a complete restoration of all motor units of the muscles.

Action Potentials↗
PubMed2004

[Morbidity of the abdominal wall after breast reconstruction and elective abdominoplasty].

INTRODUCTION: The free TRAM flap is commonly used in breast reconstruction after mastectomy. Donor-site morbidity of the abdominal wall is usually determined by scars, loss of sensation and functional restrictions. Similar aesthetic and functional problems are described for patients after elective abdominoplasty. Is morbidity of the abdominal wall after breast reconstruction based on muscle lesions or on the trauma from operation? PATIENTS AND METHODS: 21 patients after breast reconstruction and 20 patients after elective abdominoplasty were evaluated concerning the aesthetic results, scars and herniasation. Satisfaction with the result was assessed. In addition, the function of the abdominal wall was noted according to Janda. RESULTS: The postoperative course was uneventful. Three cases after elective abdominoplasty developed a recurrence of rectus muscle diastasis. After breast reconstruction there was one hernia and one patient showed a rectus diastasis. Loss of sensation, functional and aesthetic problems were seen in both groups. DISCUSSION: There are no statistic significant differences between elective abdominoplasty and abdominoplasty after breast reconstruction. In both groups loss of sensation, functional and aesthetic problems were noted. Even in elective abdominoplasty there is a loss of function in the abdominal wall. Donor-site morbidity after breast reconstruction is not only caused by the muscle lesion, but the functional and aesthetic problems are due to the general trauma of the abdominal wall.

Abdominal Wall↗
PubMed2004

[Autologous tissue transplantation (TRAM/DIEP) as an option of therapy in capsular contracture].

Free microvascular abdominal tissue transfer (TRAM/DIEP) has become standard in breast reconstruction after mastectomy. A new indication for abdominal tissue transfer is severe capsular contracture after augmentation by implants. Capsular contracture following aesthetic or reconstructive augmentation mammaplasty occurs in only a small percentage of cases, but warrants adequate therapy. Between 1999 and 2003, six patients with an average age of 35 years with symptomatic capsular contracture after augmentation mammaplasty underwent autologous tissue transfer with the free TRAM/DIEP flap. The flap was harvested either with a perforator of the deep epigastric artery (DIEP) or as muscle sparing flap (TRAM) and was anastomosed to vessels of the subscapular system. Operation time was reduced by operating with two teams. Besides minor dog-ear deformities at the donor sites, no complications were noted. Postoperatively, neither, instability of the abdominal wall nor flap loss was seen. In some cases, a secondary mastopexy was necessary. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent. In our experience, the free microvascular transfer of abdominal tissue (TRAM/DIEP flap) offers a treatment option for patients seeking alternatives other than repeated capsulectomies and implant changes for severe capsular contracture.

Adult↗
PubMed2004

Comparison of different biogenic matrices seeded with cultured Schwann cells for bridging peripheral nerve defects.

Tissue-engineering as laboratory based alternative to human autografts and allografts provides "custom made organs" cultured from patient's material. To overcome the limited donor nerve availability different biologic nerve grafts were engineered in a rat sciatic nerve model: cultured isogenic Schwann cells were implanted into acellular autologous matrices: veins, muscles, nerves, and epineurium tubes. Autologous nerve grafts, and the respective biogenic material without Schwann cells served as control. After 6 weeks regeneration was assessed clinically, histologically and morphometrically. The PCR analysis showed that the implanted Schwann cells remain within all the grafts. A good regeneration was noted in the muscle-Schwann cell-group, while regeneration quality in the other groups (with or without Schwann cells) was impaired. The muscle-Schwann cell graft showed a systematic and organized regeneration including a proper orientation of regenerated fibers. All venous and epineurium grafts had a more disorganized regeneration. Seemingly, the lack of endoneural tube like structures in vein grafts lead to impaired regeneration. And, apparently, the beneficial effects of implanted Schwann cells into a large luminal structure can only be demonstrated to a limited extent if endoneural like structures are lacking. A tube offers less area for Schwann cell adhesion and it is more likely to collapse. This underlines the role of the basal lamina, or at least an inner structure acting as scaffold in axonal regeneration. Although the conventional nerve graft remains the gold standard, the implantation of Schwann cells into an acellular muscle provides a biogenic graft with basal lamina tubes as pathway for regenerating axons and the positive effects of Schwann cells producing neurotrophic and neurotropic factors, and thus, supporting axonal regeneration.

Animals↗
PubMed2003

Tissue engineering of peripheral nerves: Epineurial grafts with application of cultured Schwann cells.

After a simple nerve lesion, primary microsurgical suture is the treatment of choice. A nerve gap has to be bridged, with a nerve graft sacrificing a functioning nerve. Alternatively, tissue engineering of nerve grafts has become a subject of experimental research. It is evident that nerve regeneration requires not only an autologous, allogenous, or biodegradable scaffold, but additional interactions with regeneration-promoting Schwann cells. In this study, we compared epineurial and acellularized epineurial tubes with and without application of cultured Schwann cells as alternative grafts in a rat sciatic nerve model. Autologous nerve grafts served as controls. Evaluation was performed after 6 weeks; afterwards, sections of the graft and distal nerve were harvested for histological and morphometrical analysis. Compared to controls, all groups showed a significantly lower number of axons, less well-shaped remyelinizated axons, and a delay in clinical recovery (e.g., toe spread). The presented technique with application of Schwann cells into epineurial tubes did not offer any major advantages for nerve regeneration. Thus, in this applied model, neither the implantation of untreated nor the implantation of acellularized epineurial tubes with cultured Schwann cells to bridge nerve defects was capable of presenting a serious alternative to the present gold standard of conventional nerve grafts for bridging nerve defects in this model.

Animals↗
PubMed2003

[Replantation at lower leg level].

INTRODUCTION: Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. METHODS: We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. RESULTS: Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. CONCLUSIONS: We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Accidents, Occupational↗
PubMed2003

[Suprascapular nerve entrapment].

Isolated compression of the suprascapular nerve is a rare entity, that is seldom considered in differential diagnosis of shoulder pain. Usually atrophy of supraspinatus and infraspinatus muscles is present, resulting in weakened abduction and external rotation of the shoulder. Mostly the patients do not note the paresis, but complain about a dull and burning pain over the dorsal shoulder region. In a proximal lesion (at level of the superior transverse scapular ligament) electromyography reveals changes in both muscles, while in a distal lesion (spinoglenoidal notch) only the infraspinatus shows a pathology. From 1996 to 2001 we diagnosed an isolated suprascapular entrapment in nine patients. Seven patients were operated: The ligament was removed and the nerve was neurolysed. The average age was 36 years. All patients showed pathological findings in electrophysiological and clinical examination. Five patients had an atrophy of both scapula muscles, two showed only infraspinatus muscle atrophy (one with a ganglion in the distal course of the nerve). Six patients were followed up. All showed an improvement. Pain disappeared and all patients were able to return to work and sport activities. Electrophysiological examination one year after operation revealed normal nerve conduction velocity. The number of motor units, however, showed a reduction by half compared to the healthy side. Lesions without history of trauma are usually caused by repetitive motion or posture. Weight lifting, volley ball and tennis promote the entrapment. Rarely a lesion (either idiopathic or due to external compression) is described for patients who underwent surgery. Patients with a ganglion or a defined cause of compression should be operated, patients who present without a distinct reason for compression should firstly be treated conservatively. Physiotherapy, antiphlogistic medication and avoiding of the pain triggering motion can improve the symptoms. However, if muscle atrophy is evident, an operation is indicated from our experience.

Adult↗