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H Piza-Katzer

Publications and source records attributed to H Piza-Katzer.

At least 19 recordsLinked to original sources
PubMed2007

[Possible nerve injuries in ankle dislocations. Trimalleolar fracture including the proximal fibula].

We present a patient with an exceptional fracture type--a Maisonneuve fracture associated with a lateral ankle fracture--and the therapy of this injury. The Maisonneuve fracture consists of a proximal fibular fracture which is associated with failure of the deltoid ligament or medial malleolus and diastasis of the distal tibiofibular syndesmosis. Diverse nerves of the lower leg can be affected by severe trauma as well as by fracture-associated complications or an operation. Fracture fragments, an excessive distension caused by the trauma, or a fracture-associated hematoma can cause injury to the deep peroneal nerve or the branches of the superficial peroneal nerve at the level of the ankle. We want to point out the possibility of nerve lesions of the lower leg associated with this complex fracture. Additionally the operative access to the ankle in this context is discussed.

Ankle Injuries↗
PubMed2006

[Plastic surgical considerations of conservative weight loss in the treatment of morbid obesity].

BACKGROUND: According to the literature, conservative weight loss seems to be ineffective for morbidly obese subjects. Nevertheless, the significance of nonsurgical strategies for the treatment of morbid obesity is still unclear. PATIENTS: From 1999 to 2003, 197 reconstructive operations were performed on 120 morbidly obese patients. Initial body mass index (BMI) was higher than 35-40, and weight loss exceeded 40% of the original body weight. RESULTS: Gastric banding was performed in 66% of the patients; 34% reduced their body weight by conservative means. Conservative weight loss could be achieved at each level of BMI. CONCLUSION: Conservative weight loss is a valuable option for the treatment of morbid obesity in a selected group of patients. Condiolates candidates for conservative weight loss should be selected carefully by a multidisciplinary team with psychiatric expertise.

Abdominal Wall↗
PubMed2006

[Effect of cigarette smoking on skin perfusion of the hand].

BACKGROUND: Cigarette consumption leads to postoperative wound healing disturbances by impairing skin circulation. MATERIALS AND METHODS: Fourteen nonsmokers and 44 smokers were investigated and classified according to age (<40 and >40 years) and duration of cigarette consumption. Circulation at the tip of the middle finger was measured in both groups under standard conditions with laser Doppler imaging. RESULTS: There was a reduction in skin blood circulation of 24% in smokers (young 39%, older 11%, P=0.001) and 30% in nonsmokers (young 35%, older 18%, P=0.019). With longer duration of cigarette consumption, the effect grew weaker (<10 years 25%, 11-30 years 18%, >30 years 15%). There was no correlation between the number of cigarettes consumed per day and impaired circulation. CONCLUSION: Younger subjects react to cigarette consumption with a stronger reduction in circulation. In elective surgery, especially in young smokers we recommend a 6- to 8-week nicotine abstinence prior to surgical intervention.

Adult↗
PubMed2006

[Heterotopic hand replantation following radical tumor resection in the elbow region. Functional results 15 months after surgery].

BACKGROUND: In a 28-year-old male who had suffered an olecranon fracture, delayed diagnosis was made of epithelioid sarcoma in the left upper extremity. Radical tumor resection was carried out which included removal of the entire elbow joint. MATERIAL AND METHODS: The amputated hand with the distal one-third of the forearm was replanted at the upper arm. It was important to ensure that all tendinous structures of the forearm were attached to the three muscles of the upper arm and the nerves of the distal forearm with the nerves of the upper arm, which are incongruent in diameter with the former. Details of the operation are given below. RESULTS: The anatomic peculiarities involved in this form of replantation, the early intensive therapy, reintegration of the replanted hand in the body scheme, and the usability of such a shortened extremity are described and the extremely good functional results documented in numbers and figures.

Adult↗
PubMed2006

[Chronic compartment syndrome of the flexor muscles in the forearm due to motocross].

A case of a mechanic and motorcyclist is reported who developed unilateral chronic exertional compartment syndrome of the flexor muscles in the forearm. After years of discomfort and medical check-ups, a subcutaneous fasciotomy of the superficial compartments of the flexor muscles in the forearm led to a complete relief of symptoms, which allowed the patient unrestricted activity.

Adult↗
PubMed2006

[Xanthoma disseminatum: a rare case involving the upper extremity].

We describe a dramatic case of class II non-Langerhans cell histiocytosis, xanthoma disseminatum, in a 30-year-old male patient with progressive involvement of the skin, vocal cords, eyes, bones and nerves in spite of chemotherapy with Vespesid and immunotherapy with interferon-gamma. At the age of 43 years, the patient required surgical clearance of airways, eyelids and peripheral nerves, but at present exhibits stable disease on a combination of lipid-lowering drugs including thiazolidinedione.

Adult↗
PubMed2006

[Surgical treatment of persisting and recurrent carpal tunnel syndrome from 1999 to 2003].

The operative treatment of carpal tunnel syndrome is relatively simple and is carried out by doctors from various surgical specialities. In cases of persisting pain or postoperative worsening of the condition, the indication for the procedure could have been wrong or an iatrogenic complication may have to be taken into consideration. We have analysed 42 patients (48 hands) who underwent surgical treatment for carpal tunnel release from 1999 to 2003. We treated eight men and 34 women with an average age of 56 years in this way. Ten patients were initially operated upon by endoscopic release. We found an incompletely transected or even untouched retinaculum flexorum in 16 patients. In eight patients we found an iatrogenic nerve lesion and 24 patients developed serious scarring. Revision surgery should be undertaken only by a surgeon who is a specialist in hand surgery and has extensive experience in this field. In the same context, postoperative hand therapy is essential for a good result, which is performed by occupational therapists in our clinic.

Adult↗
PubMed2006

Status 5 years after bilateral hand transplantation.

Graft survival and function early after hand transplantation is good. It remains unknown, however, whether long-term survival is limited by chronic rejection. We here describe the clinical course and the status 5 years after bilateral hand transplantation with emphasis on immunosuppression (IS), function, morphology and graft vascular changes. Clinical observation, evaluation of hand function, skin biopsies, X-ray, ultrasound, angiography, CT angiography, electrophysiologic studies including compound motor and sensory action potentials (CMAP, CSAP) and somatosensory evoked potentials were performed and results recorded at regular intervals. Following reduction of IS one mild (grade II) rejection episode occurred at 4 years. Subsequently, skin histology remained normal and without signs of chronic rejection. Hand function continuously improved during the first 3 years and remained stable with minor improvement thereafter. CMAP and CSAP progressively increased during the observation period. Latencies of the cortical responses were prolonged but amplitudes were within normal range. Investigation of hand vessels revealed no signs of occlusion but showed revascularization of a primarily occluded right radialis artery. Motor and sensory function improved profoundly between years 1 and 5 after hand transplantation. No signs whatsoever of chronic rejection have been observed.

Angiography↗
PubMed2005

Extracorporal shock wave may enhance skin flap survival in an animal model.

Several methods have been used in an attempt to increase blood supply and tissue perfusion in ischemic tissues. The authors investigated the effect of extracorporal shock wave (ESW) treatment on compromised skin flaps. For this purpose, the epigastric skin flap model in rats, based solely on the right inferior epigastric vessels was used. Twenty male Sprague-Dawley rats were divided into two groups (ESW-group, Control group) of 10 rats each. The ESW-group was administered 2500 impulses at 0.15 mJ/mm(2) immediately after surgery, whereas, the control group received no treatment. Flap viability was evaluated on day 7 after the operation. Standardised digital pictures of the flaps were taken and transferred to the computer, and necrotic zones relative to total flap surface area were measured and expressed as percentages. Overall, there was a significant reduction in the surface area of the necrotic zones of the flaps in the ESW group compared to the control group (ESW group: 2.2+/-1.9% versus control: 17.4+/-4.4% (p < 0.01). In this study, the authors demonstrated that treatment with ESW enhanced epigastric skin flap survival, as confirmed by the significant reduction of necrotic flap zones. ESW treatment seems to represent a feasible and cost effective method to improve blood supply in ischemic tissue.

Animals↗
PubMed2005

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

Adult↗
PubMed2005

[Dupuytren's contracture -- surgery of recurrencies].

BACKGROUND: The present study is a retrospective investigation of patients who underwent surgery for recurrence of Dupuytren's contracture. We discuss the indications for this intervention, operative methods, and postoperative therapy. Surgical treatment for recurrence of this condition is incomparably more difficult and risky than the primary operation. METHODS: At the Innsbruck University Clinic for Plastic and Reconstructive Surgery, 50 patients underwent 70 operations for treatment of recurrence of Dupuytren's contracture between March 1999 and September 2004. Thorough pre- and postoperative clinical investigations and assessment of hand status as well as analysis of the indication for the first operation and the surgical method used were carried out. All patients underwent intensive postoperative hand therapy from day 1 for restoration of function and flexibility. RESULTS: After completion of therapy, in 32 patients there was an improved ROM of between 40 and 270 degrees per finger, in five patients an unchanged ROM, and in three patients, reduction in ROM by 5 to 58 degrees; six patients failed to show up for their follow-up despite being asked to do so several times. No data are as yet available on four patients who had undergone primary operation elsewhere and were operated within the past six months for recurrence in our clinic. In nine patients, there was a decrease in sensation immediately after surgery; but improvement was achieved within six months in three of these patients after intensive hand therapy. CONCLUSION: Careful assessment of hand function, establishing the indications for surgery at the right time, choice of the appropriate surgical approach and initiation of intensive hand therapy immediately after surgery are decisive for effective treatment of recurrent Dupuytren's contracture. However, amputations and ray resections cannot be avoided in all cases, especially if nerve injuries incurred during previous operations, resulting in joint stiffness.

Adult↗
PubMed2004

Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg.

Compression syndromes of the common fibular nerve and its branches frequently occur primarily as well as secondarily to trauma and surgery. A keen knowledge of the course and the relationship of the deep fibular nerve to adjacent anatomical structures in the proximal leg is mandatory. Previous literature often lacks detailed information on the course of the deep fibular nerve and is based on a limited number of observations. The aim of this study was to investigate the common fibular nerve and its branching pattern with special regard to the relationship between the deep fibular nerve and the anterior intermuscular septum of the leg. Variations in the course of the fibular nerve were demonstrated. The fibular compartments of the leg (n = 111) were dissected in 57 embalmed cadavers and included: 1) investigation of the number of muscular branches; 2) entering passages to the respective compartments of the leg; and 3) the relationship between the fibularis longus muscle and the deep fibular nerve. The most proximal muscular branch of the deep fibular nerve directly "pierced" the anterior intermuscular septum of the leg. Narrow passages within the fibular compartment and, in consequence, areas of possible higher incidence of nerve compression were suggested at the level of the intermuscular septa of the leg, between the two distinct portions of the fibularis longus muscle and the crossing of the supplying vessels. There were hardly ever statistically significant differences between the two sides or male and female gender. According to our results, the anterior intermuscular septum of the leg may be regarded as an important landmark for the surgeon when dissecting the muscular branches of the deep fibular nerve. The variable branching pattern of the deep fibular nerve within the fibular compartment of the leg should be taken into account.

Aged↗
PubMed2004

[Eyebrow injuries. Classification and therapy concept].

The aim of primary treatment for eyebrow injuries should be preservation of the original eyebrow under any circumstances. Debridement should be kept to a minimum even when the wound is severe. The treatment of total or partial loss of an eyebrow concerning the exact reconstruction of details and aesthetic aspects is a challenge for the surgeon. The therapy option depends on the type of eyebrow selected for reconstruction. We present a classification for eyebrow injuries, which considers type and size of defects. Based on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are discussed and illustrated by several examples.

Eye Injuries↗
PubMed2004

[Primary multicentric cutaneous epithelioid angiosarcoma of the hand. Case report and review of the literature].

CASE: The case of a primary multicentric cutaneous epithelioid angiosarcoma is described. A 39-year-old female patient presented with a tumor on the left distal forearm and the fourth finger of the left hand. Partial amputation of the left hand and local excision of the tumor on the left forearm were performed. For the next three years the patient was free of local or systemic recurrence. After this time period, a left shoulder exarticulation had to be performed because of tumor recurrence in the left axilla. The patient died 64 months after diagnosis. CONCLUSION: Cutaneous epithelioid angiosarcoma is a highly malignant tumor which has only been described once on the hand. The treatment primarily is a surgical one. If possible, the function of the extremity should be preserved as long as possible.

Adult↗
PubMed2004

Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome.

Cubital tunnel syndrome represents the second most common compression neuropathy in the upper limb. There are three main surgical procedures to deal with this issue, namely simple decompression, medial epicondylectomy and anterior transposition. Nevertheless, optimal surgical treatment is still open to question. In the past three years we performed decompression of the nerve with or without external neurolysis and epineuriotomy on 52 patients (55 extremities). Preoperative diagnostic procedures included functional hand status, neurophysiological evaluation, X-ray of the elbow and neurosonography. Patients were then divided into three groups according to the staging criteria of Dellon. After an average follow-up of 13 months, the outcome was evaluated by complete examination of hand function, electrophysiological studies and interview with the patients. Postoperatively, two-point discrimination as well as strength improved significantly. Postoperative grip was 28.78 kg (79.8 % of the other hand), compared to 20.31 kg (58 % of the other hand) preoperatively (p = 0.000). Evaluation of each stage individually showed that the best functional outcome was achieved by the minimum-staged group with improvements in strength and sensory in all patients and total relief in two-thirds. In the severe-staged group, improvement could still be found in 75 % of the patients. Evaluation of conduction velocities showed highly significant improvements for both motor and sensory conduction velocities. In summary, simple decompression, if necessary modified with external neurolysis and epineuriotomy, showed high success rates in all stages. Decompression is a minimally invasive procedure, but very effective for mild as well as for severe cases and therefore the optimal treatment in cubital tunnel syndrome.

Adult↗
PubMed2004

[Epithelioid sarcoma of the hand, a seldomly recognized tumor].

BACKGROUND: The epithelioid sarcoma of the hand is often misdiagnosed. This tumor occurs most frequently in children and young adults, has an uncharacteristic course, and carries a high risk for local recurrence and metastases. The characteristic histopathology is helpful in establishing the correct diagnosis. Differential diagnosis includes synovialoma, fibromatosis and Dupuytren's contracture. Multinodular appearance is not uncommon. PATIENTS AND METHOD: Three young patients (one male and two female) were operated on the hand for treatment of Dupuytren's contracture, synovialoma and fibromas, respectively. The necessity for surgical revision in these patients led to a reevaluation of the primary histological data. The original diagnosis having been found to be incorrect, the correct diagnosis was established namely, epithelioid sarcoma. RESULTS: Surgical revision was performed, which involved partial amputation of the extremity. None of the patients underwent adjuvant radio- or chemotherapy. The patients were followed-up for ten, four and two and a half years, respectively. They are currently free of recurrences. CONCLUSION: Prognosis depends on the size and the location of the tumor. Adequate treatment requires early radical excision; amputation may be required if the primary tumor is located in the fingers or treatment of recurrent growth. The tumor tends to metastasize via the lymphatic system. Patients must be monitored with yearly lung X-rays since recurrence or metastasis may occur many years after the initial diagnosis and treatment.

Adult↗
PubMed2004

Quantitative assessment of periarticular osteopenia in patients with early rheumatoid arthritis: a preliminary report.

BACKGROUND: Involvement of the metacarpophalangeal (MP) joints is one of the major problems in patients with rheumatoid arthritis (RA). Although several data about the cumulative influence of steroid intake on bone are available, the course of demineralisation in RA has not been described by quantitative methods until now. PATIENTS AND METHODS: Computed tomography (CT) sections of 96 MP joints in 12 RA patients and of 32 MP joints in four age-matched healthy controls were investigated. Patients were classified according to Steinbrocker. Densitometric evaluation of subchondral bone density was performed by CT osteoabsorptiometry (CT-OAM). Quantitative CT-OAM was used to evaluate mineralisation of the articular surfaces in MP joints. RESULTS: In the distal articular surface of MP joints, the number of density maxima was reduced from 3 to 2.1+/-0.3, 1.9+/-0.5 and 1.3+/-0.3 in RA patients with early, mild to moderate, and severe disease, respectively. Means of calcium concentrations were 633.4+/-35. 3 mg Ca2+/mL, 518.9+/-56.2 mg Ca2+/mL, 497.7+/-23.8 mg Ca2+/mL and 455.1+/-28.6 mg Ca2+/mL for controls and RA patients with early, mild to moderate, and severe RA, respectively. Mineralisation of the distal articular surface was significantly reduced in all groups of RA patients [probability (p) = 0.005]. Regarding the number of density maxima, no differences were detected in the proximal articular surface of normal and RA fingers. However, mineralisation of the proximal articular surface was significantly reduced in all groups of RA patients (p = 0.004). Means of calcium concentrations of the proximal articular surface were 494.1+/-48.5 mg Ca2+/mL, 413.0+/-16.2 mg Ca2+/mL, 406.0+/-51.4 mg Ca2+/mL, 390,4+/-41.1 mg Ca2+/mL for controls and RA patients with early, mild to moderate, and severe RA, respectively. CONCLUSION: Patients with early and untreated RA show loss of mineralisation and altered morphology of the MP joints of the hand, even before corticosteroid therapy. CT-OAM provides evidence for an early alteration of functional anatomy in MP joints.

Adult↗