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Biomedical subjects

H Mandl

Publications and source records attributed to H Mandl.

At least 19 recordsLinked to original sources
PubMed1989

[Reconstruction of deformities of the external ear].

Microtia is a rare malformation. Reconstruction of microtia is not a routine operation because of its rarity of occurrence and the complex deformity. In this paper the indication for surgical treatment, technique, results and complications are discussed. Two different operation methods were used in our patients. A multiple-stage and a single-stage reconstruction procedure. We used autogenous rib cartilage. Five of the seven treated patients came to the follow-up examination. Reconstruction was performed 2 years ago in two cases and between 4 and 12 years ago in three cases. Our patients were content with the result in so far as they would be prepared to undergo treatment again. Carefully built rib framework is an essential prerequisite for a successful postoperative result. Microtia represents a greater psychological problem than a cosmetically imperfect result after reconstruction.

Adolescent↗
PubMed1989

[Late results following surgical correction of syndactyly and symbrachydactyly].

Growth and the type of surgical treatment of the hand play an important role in the results of surgery in children. 29 patients have been operated on because of syndactyly and symbrachydactyly and were controlled. The following parameters were assessed: kind of incision and skin graft, functional results, x-ray to examine the skeleton and the depth of the commissure, colour of the skin graft and use of the hand. After operation of syndactyly all patients were able to use their hands normally, although full extend of flexion and extension was achieved only in 20 of 22 hands. In 5 divided pairs of fingers there was recurrence of syndactyly. In all cases except one, a split thickness skin graft has been used. After operative treatment of symbrachydactyly and complex syndactyly, full extent of flexion was achieved in 13 of 19 hands, in 6 hands the range of flexion was incomplete because of skeleton abnormalities. Recurrence occurred in 9 divided pairs of fingers; in 7 cases, a split thickness skin graft had been used. Despite this, all patients were able to use their hands normally. The use of split thickness skin grafts resulted in a 60% recurrence rate, whereas the use of full thickness skin graft led merely to 7.5% recurrence rate. Our results show the advantage of the full thickness skin graft. As a consequence, full thickness skin graft should be used in all cases. Furthermore, the operation should be performed at an early age, if fingers of unequal length have to be separated. Zig-zag incision should be used in all cases.

Child↗
PubMed1988

Inadequacy of conventional computerized tomography scans for treatment planning of tangential breast (chest wall) fields.

The use of transverse tomography treatment-planning scans, which have to be taken in the exact treatment position of the patients, is essential for precision radiotherapy of breast cancer. Transverse tomography scans give all necessary informations for an optimal isodose distribution within the target volume for the individual patient, and maximal sparing of normal tissues (e.g. lung) is achieved. The exact topography of internal mammary nodes may also be incorporated in the planning scan with the help of lymphoscintigraphy. Conventional computerized tomography (CT) scanners have too small gantry openings (50-70 cm) to allow for proper positioning of the patients under treatment conditions. Using such treatment-planning scans for patients in the actual treatment position would cause an underdosage in excess of 5% within the target volume, when 60Co fields are used. Also, a much larger volume of normal tissues (mainly lung) would unnecessarily be irradiated. Treatment-planning scans obtained by TAT (transverse analog tomography) do not have the crucial positioning problems of conventional CT scanners and enable the precise transformation of a valid isodose distribution to each patient. In addition, positioning wedges (with adjustable wedge angles) may be placed under the patient to achieve the optimal treatment position. A useful alternative of TAT scanning for precise treatment planning of patients with breast cancer would be a CT scanner with a wide enough gantry opening to allow for any patient positioning under actual treatment conditions.

Breast Neoplasms↗
PubMed1987

[Comparative study of primary and secondary management of flexor tendon injuries].

In 1974 a replantation service started at the authors' department. Before that time the treatment of flexor tendon injuries was mainly performed secondarily. Therefore, the authors had the opportunity to compare patients after primary and secondary surgery. In 52 primarily and 22 secondarily treated patients the technique of Kleinert was used. Following issues were investigated: functional results, decrease of grip strength, influence of early mobilization on sensibility restoration in cases of nerve injury, relation between sensitivity to cold and vessel and nerve injuries, duration of physiotherapy and disability. The damage of only one finger might lead to decrease of grip strength. Primary surgery was superior to secondary surgery. Early mobilization in cases of additional nerve injuries did not affect sensibility restoration. Poor sensibility increased the chance of cold sensitivity. The duration of physiotherapy and of disability depended on the need for second procedures such as tenolysis which was more common in the group of secondarily treated patients.

Adolescent↗
PubMed1984

[Reconstruction of grip function in cases of a fingerless or missing hand].

In two cases a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient all fingers of the left hand were amputated at the metacarpo-phalangeal joint level. The second and the third finger were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. The distal and middle phalanx of the transplanted third toe had to be re-amputated because of mummification two weeks after the transplantation and was covered with a groin flap. Good function of the newly formed grip could be demonstrated. The second patient was a 21-year old man with amputation of both hands. Grip reconstruction in the right lower arm was performed by transplantation of the second toe of each foot together with a metatarsal bone and a dorsalis pedis flap. One year after the operation the follow-up study demonstrated good function of the newly formed hand. The patient is able to use his two new fingers during daily life mainly to hold small objects. The sensation and the range of movement of the newly formed right hand are demonstrated and discussed.

Adult↗
PubMed1983

[Percutaneous measurement of oxygen partial pressure as an evaluation method of free flaps].

Transcutaneous, polarographic pO2-measurement can be used to estimate and monitor the circulation in free tissue transfers. Our experience in this field using a modified Clark's electrode is reported by presenting some examples. Its value in intraoperative and postoperative monitoring and for the early diagnosis of a critical reduction of blood flow in free flaps with microvascular anastomoses is assessed in the light of our early experience with this technique.

Blood Gas Analysis↗
PubMed1982

Grip reconstruction by double-toe transplantation in cases of a fingerless hand and a handless arm.

In two cases, a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient, all fingers of the left hand were amputated at the metacarpophalangeal joint level. The second and third fingers were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. Although the distal and the middle phalanx of the transplanted third toe had to be amputated because of mummification 2 weeks after the transplantation and was covered with a groin flap, good function of the newly formed grip can be demonstrated. The second patient is a 21-year-old man with amputation of both hands at the wrist. A grip formation on the right lower arm was performed by transplantation of the second toe of each foot together with the metatarsal bone and a dorsalis pedis flap. Both metatarsal bones were fixed to the ulna and radius with metal plates, and tendons and nerves, together with a vascular supply, were reconstructed. One year after the operation, a follow-up study demonstrates good function of the newly formed "hand." The patient is able to use his two new "fingers" during daily life, mainly to hold small objects. A myoelectric prosthesis has been placed on the patient's left arm, and the patient uses this to hold bigger objects. Restoration of sensation and the range of movement of the newly formed right "hand" are demonstrated and discussed.

Adult↗
PubMed1982

[Bridging a lymphatic vessel defect using vein interposition (an experimental study)].

By means of improved microvascular surgery 10-15 mm long vein grafts were interposed into the lymphatic vessels in the groin area of 12 dogs. 6-12 weeks later a histological, clinical and radiological reexamination was performed. In 8 cases out of the 12 the interposed veins were patent, in 4 cases the lumina were occluded by fibrotic tissue. The clinical application of lymphatic vessel-defects in cases of lymphedemas is discussed.

Animals↗
PubMed1981

[Plastic surgery after extensive tumor surgery of the scalp].

Extensive resections of tumors of the scalp penetrating into the bone and the brain often require the use of free flaps for coverage as the only possibility. Four cases are reported and the specific problems of these microsurgical operations in this region are discussed.

Adult↗
PubMed1981

[Microsurgical reconstruction of lymphatic system defects].

In a group of eighteen dogs (1977-79) artificially interrupted lymphatics have been bridged by suitable small vein grafts. Patency was controlled by different methods: by clinical microscopical control, by microlymphangiography and by histological examinations. The patency rate in this group was 61.1 per cent. So for the first time it could be shown experimentally that it is possible to restore interrupted lymphatics by grafting. This might be the basis for a causal therapy of secondary lymphedema by reconstruction of interrupted or occluded lymphatics. In a further group of fifteen dogs different autologous grafts have been compared. Each five lymphatic, venous and arterial grafts have been interposed in lymph collectors of 0.3 to 0.6 mm in diameter by the same surgeon applying the same microsurgical and atraumatic technique. The grafts varied from 8 to 25 mm in length. While all the lymphatic grafts remained patent, one of the five venous and all arterial grafts were occluded. There could not be found any correlation of patency rate to length of the grafts. Light microscopical and electron microscopical examinations of the harvested vessels showed heavy pathological findings of the arterial walls. In the venous grafts the intima was thickened to different extent. This could be explained by the lack of blood supply from the lumen. Very likely the occlusion of all arterial grafts seems to be explained by the disturbance of the vessel wall blood supply. The lymphatic grafts histologically showed nearly no pathological damage. There was complete reendothelialization at the suture line of all patent grafts. From these experimental results it is concluded that arteries are not suitable for interposition in order to restore lymph drainage. It could be shown that veins and lymphatics are equally usable for this purpose. Therefore these two structures have been used clinically in cases of therapy resisting lymphedemas for reconstruction of the destroyed lymph paths.

Animals↗
PubMed1981

[Surgical specialties in replantation surgery].

Special operative techniques developed by the advances in the replantation surgery are the subject of a review. The replantation of an amputated finger in a more important position is demonstrated by a clinical case. Defects can be replaced by parts of non-replanted fingers or with the aid of transplanted structures, such as skin, vessels, bone and local flaps. Clinical examples are given of the primary transplantation of bone from the iliac crest and of enhancement of circulation from the healthy, neighbouring finger.

Amputation, Traumatic↗
PubMed1981

[Microsurgical intervention in a case of Raynaud's gangrene].

In a case of typical Raynaud's gangrene a microsurgical therapeutic intervention has been tried. To interrupt the periarterial sympathetic nerve network, 1,5-2 cm of both collateral arteries of the affected right index finger were excised and replaced by two venous grafts. In addition both collateral nerves were dissected and reanastomosed for elimination of sensation and pain for some time. In the early postoperative time the patient was free of pain and started using the finger during daily life. 6 weeks after the operation a control-angiography was performed and since that moment the patient complained again of severe pain in the affected finger. The angiography had led to vascular spasm with consequent thrombosis of the patent ulnar venous graft. Because of the severe pain in the finger we were forced to amputate the finger.

Adult↗
PubMed1981

[Evaluation criteria for the functional determination after replantation in the hand region].

A method of recording the functional results of replantations in the hand is presented, supplying reproducible results of sufficient accuracy by simple means and within a reasonable time. The following criteria are evaluated: fitness for work, usefulness of the hand, mobility, sensibility, circulation and trophic changes, esthetics, perspiration and the retrospective attitude of the patient to replantation and pain. The several parameters are evaluated according to their relevancy and graded according to a scale of values. The total of these values gives the final result. The different results are classified as excellent, good, functionally sufficient and poor. This method of recording the results of digital replantation was evaluated in a series of 28 follow-up examinations with 33 replanted parts. The method of evaluation and the results are discussed in detail.

Amputation, Traumatic↗
PubMed1980

[Dynamic splinting in flexor tendon surgery].

Besides the special microsurgical operative technique, dynamic splinting is one of the basic fundamentals of KLEINERT's technique for primary repair of flexor tendons. The principle of this splinting is explained. Further applications are reported: 1. after secondary repair of flexor tendons (by tendon transfer or tendon transplantation), and 2. after tenolysis. According to our good results the application of dynamic splinting in the above mentioned cases seems to be advisable.

Fingers↗
PubMed1979

[Reconstruction of the breast after surgery for cancer (author's transl)].

The tendency towards less radical, stage-dependent procedures in the surgical management of breast cancer has opened the way to improvement in the reconstructive measures available. Reconstruction of the female breast can be undertaken with greater or lesser success and facility according to whether the initial procedure was subcutaneous mastectomy, modified radical mastectomy or the Rotter--Halstedt radical operation. The different plastic reconstructive methods developed over the past years are discussed and illustrated by cases treated under our care.

Breast↗