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H Piza-Katzer

Publications and source records attributed to H Piza-Katzer.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Coverage of pressure sores with free flaps].

INTRODUCTION: The coverage of recurrent pressure sores with unstable scar in the surrounding tissue is still an unsolved problem in the literature. Local and regional transfer of tissue often does not meet the requirements of the tissue deficit. Especially in recurrent pressure sores, the adjacent skin has already been consumed due to multiple surgeries. As a good alternative, the microsurgical transfer of flaps offers viable tissue to cover even large pressure sores. METHODS: We performed a total of six free flaps in five patients who suffered from intractable pressure sores in the hip region. The age of the patients was between 41 and 63 years. The defect size varied between 6 x 6 cm and 25 x 30 cm. Two combined myocutaneous scapula-latissimus dorsi, two myocutaneous latissimus dorsi, one anteromedial thigh, and one rectus femoris flap were used to cover the defects. RESULTS: The average follow-up time was 29 months. Flaps provided stable coverage in four of five patients at 12-month follow-up. There was one subtotal flap necrosis that was subsequently treated with split-thickness skin grafting. CONCLUSION: In this series of five patients with six free flaps, we were able to show that the microsurgical transfer of tissue is a valuable option in the treatment of difficult pressure sores. Even in older and debilitated patients, this method is a good alternative to conventional local flaps.

Adult↗
PubMed2003

Transverse resection: a new technique of reduction mammaplasty.

In patients who undergo breast reconstruction after unilateral mastectomy for breast cancer, the contralateral natural breast is often disproportionately large in comparison with the reconstructed breast. Such patients may express a desire to have reduction of the larger breast in order to achieve symmetry. A novel technique is described for breast reduction in such cases, which, despite the presence of visible scars, found acceptance among patients. The primary goal of reduction mammaplasty in these cases is symmetry, keeping in mind the shape, volume and degree of ptosis of the reconstructed breast, and not achieving youthful-looking breasts.

Adult↗
PubMed2003

[Free tissue transplantation for defect coverage of the dorsum of the hand: aesthetic and functional aspects].

BACKGROUND: Complex and large soft-tissue defects of the dorsum of the hand, which cannot be covered with skin grafts or local flaps have to be reconstructed by means of free tissue transplantation. The purpose of this study was to present our experience with free fasciocutaneous flaps and muscle flaps with split-thickness skin graft for defect coverage of the dorsum of the hand in eight patients. PATIENTS AND METHOD: Evaluation of eight patients who underwent coverage of the dorsum of the hand with free flaps during 1997 to 2001 is presented. Other treatment options are discussed. RESULTS: Average age of the patients was 57 years and average follow-up was 25 months. For defect coverage we used a later alarm flap in four cases, a gracilis muscle flap with split-thickness skin graft in three cases and a latissimus dorsi flap with split-thickness skin graft in one case. In five patients we performed an extensor tendon reconstruction. Three of those cases achieved a good, one a fair and one case had a bad functional result. In one patient we had a partial flap loss. Muscle flaps with skin graft revealed better esthetic results than fasciocutaneous flaps. CONCLUSION: Microvascular free-tissue transplantation has expanded our options, giving us the opportunity for more refinement in hand reconstruction and improving the standards for a successful outcome.

Adult↗
PubMed2003

[Endoscopically-assisted latissimus dorsi muscle harvest in a young child].

Free tissue transplantation is nowadays regarded as an established method in reconstructive surgery - even in infants. Adequate diameters of vessels for microsurgical anastomosis have been shown in numerous studies. Especially the latissimus dorsi muscle seems to be ideal as a standard flap in this age group. The main disadvantage of this muscle flap lies in its donor-site morbidity with the risk of scar contracture and limitation of shoulder movement. A possible solution to this problem is the endoscopically-assisted harvest of this muscle. A three-year old boy sustained a subtotal amputation of his right heel with consecutive necrosis of soft-tissue. After debridement, a latissimus dorsi-muscle flap was transplanted to cover the defect. The flap was harvested endoscopically-assisted through a single, 2 cm long incision in the left axilla. Healing of the flap was uneventful. At 30 months follow-up the patient showed stable conditions at the right heel without limitations of movement and a hardly visible scar in the left axilla without any noticable growing impairment. Free microvascular muscle-flaps are the treatment of choice in infants with extensive traumatic defects. With the use of minimally invasive operation techniques it is possible to significantly reduce donor-site morbidity and increase therapeutic success even in the youngest patients.

Age Factors↗
PubMed2002

[Plastic reconstructive operations after weight loss through gastric banding].

The number of patients who desire reconstructive surgery after a huge weight loss through gastric banding is increasing. From 1999 to 2001, 40 reconstructive operations were performed on 25 patients after an average decrease in weight of 58 kg. Six months later, a follow-up examination was done. A questionnaire was handed out and the aesthetic results were judged by five independent plastic surgeons. The department of psychology judged the patient's attitude towards their body, the presentation of their body for attractiveness, satisfaction with life, anxiety and depression, and changes in experience and behavior. The results showed a discrepancy between the subjective satisfaction of the patients and the judgment of the plastic surgeons; the preference for long scars instead of remaining surplus tissue, the necessity of a strict indication for transplantation of one's own tissue, the importance of detailed preoperative information using pictures, advantages and disadvantages of simultaneous operations in different anatomical regions, the need for exact planning and postoperative care as well as the importance of interdisciplinary teamwork. These results will influence the indication for a reconstructive operation in the future.

Abdominal Wall↗
PubMed2002

Functional impairment of the abdominal wall following laparoscopic and open cholecystectomy.

BACKGROUND: Subcostal incisions for open cholecystectomy (OC) denervate the right upper and middle abdomen. METHODS: Sensory and abdominal muscle function (Janda's muscle function test, Cybex 6000) was evaluated. Healthy volunteers (10 women, 12 men) were compared with 13 women and 12 men after OC and 11 women and 11 men after laparoscopic cholecystectomy (LC). For computed tomography (CT) studies, a spiral scanner was used. RESULTS: Of the OC patients, 21 (95.5%) complained of dys- and anesthesias below the incision. Of the LC patients, only nine (2.4%) reported anesthesias around the port sites. Normal subjects scored significantly higher in muscle strength (p <.01). LC patients scored higher than OC patients at 10 degrees and 20 degrees trunk flexion (p <.05). Depending on the flexion angles, the men in all groups developed 30-114% more muscle power than the women. Denervation of the abdominal muscles was confirmed by CT. CONCLUSION: OC reduced skin sensitivity and abdominal muscle function. Although the procedure is minimally invasive, LC also causes sensory and functional losses, albeit minor ones.

Abdominal Muscles↗
PubMed2002

Adventitial stripping of the radial and ulnar arteries in Raynaud's disease.

Adventitial stripping of the palmar arch, the palmar common digital arteries, or the proper digital arteries is a last resort in the treatment of refractory primary or secondary Raynaud's phenomenon. Seven patients who had adventitial stripping of the ulnar and radial arteries proximal to the wrist and resection of the nerve of Henle, if identifiable, are presented. All of them were evaluated by telethermography, acral rheography, and a questionnaire before and after surgery. All were asymptomatic after surgery with satisfactory healing of the ulcers at the fingertips. None of them relapsed during the follow-up time of 1.5 years.

Adult↗
PubMed2002

Dupuytren's disease in children-differential diagnosis.

BACKGROUND/PURPOSE: Dupuytren's disease in children is uncommon; only a few histologically confirmed diagnoses are found in literature. In its early, proliferative phase with many fibroblasts, it can resemble the early stadium of an epitheloid sarcoma, which also is a rare tumor. The purpose of this report is to show pediatric surgeons and pathologists the importance of differential diagnosis of nodules and fibrotic bands in children's hands, especially to exclude a malignancy. METHODS: Between 1998 and 2000, 3 children at ages of 2(1/2) years, 9 years, and 10 years, respectively, presented with the clinical signs of Dupuytren's disease of the hand. Each of them had fibrous bands with a flexion contracture of the fingers. All of them underwent fasciectomy. RESULTS: In patient 1, a 10 degrees extension lag of the index finger resulted after 3 operations. Histology findings showed the typical features of Dupuytren's disease. In patient 2, histology findings showed a recurring digital fibroma of childhood. After consultation with the pathologist and reevaluation of the slides, the histologic diagnosis was corrected to Dupuytren's disease. Full extension and thumb abduction has been achieved. In patient 3, histology of the first and second operation was misdiagnosed as Dupuytren's disease. In the third operation 2(1/2) years later, the histologic diagnosis of epitheloid sarcoma was made. Amputation of the forearm was necessary. CONCLUSIONS: Exact anamnesis, location of the lesion, and suspicious diagnosis must be mentioned to the pathologist in the case of biopsy or excision of Dupuytrenlike lesions in children's hands. Awareness of the possibility of the epitheloid sarcoma may help prevent misdiagnosis.

Age Factors↗
PubMed2002

Free allogeneic muscle transfer for cranial reconstruction.

An allogeneic muscle transfer was used to cover a large cranial defect in one of a pair of craniopagus twin separated a decade ago. Both separated twins died, 7 months apart, with the twin that had received the transfer dying first. The cause of death was generalised cytomegalovirus infection. An autopsy showed extensive brain necrosis caused by vascular insufficiency, a result of the abnormal vascular anatomy at birth. The muscle allograft showed no signs of rejection. Progress in immunosuppressive treatment over the last decade, which has enabled successful allogeneic nerve grafts and composite-tissue transplantations, might make muscle transplantation for the coverage of large defects, with and without functional demands, feasible in the future.

Child, Preschool↗
PubMed2002

Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature.

We report our experience with the thoracodorsal artery perforator flap. Its use and pitfalls are critically highlighted, especially in terms of its application as an island flap. Publications on this recently described flap are scarce, possibly because it is rarely used as a result of the high level of skill needed in its preparation. In our hospital, we have used this flap twice as an island flap, both of which failed, and ten times as a free flap, one of which failed. Transfer as a free flap is a delicate procedure involving transmuscular vessel preparation; transposition as an island flap is limited by range. Based on our limited experience, we recommend this flap only in very selected cases. This procedure has to be performed by experienced microsurgeons, after training on cadavers, and after preoperative colour Doppler imaging to determine the precise location of the main perforators. Use of this perforator flap is indicated in cases where a long vascular pedicle for an appropriate free tissue transfer is necessary, and where aesthetic appearance and minimising donor-site morbidity are more important than a potentially high risk of failure.

Adolescent↗
PubMed2002

Double hand transplantation: functional outcome after 18 months.

In March 2000, we performed a double hand transplantation on a patient who had suffered traumatic hand amputations 6 years previously. The transplantations were both successful and, 18 months later, the patient has regained some complex hand functions and remarkably good tactile gnosis.

Amputation, Traumatic↗
PubMed2002

Pitfalls in diagnosing carpal tunnel syndrome.

The aim of this paper is to point out the differential diagnosis be-tween a thumb hypoplasia type 1/11 and a carpal tunnel syndrome. Both syndromes have symptoms in common. Two children and an adult with hypoplastic thumbs were sent to our department with the diagnosis carpal tunnel syndrome. In both children, the diagnosis was changed after an exact history and examination, and in one child an opponensplasty was done. The adult patient had already been operated unsuccessfully for a carpal tunnel syndrome elsewhere and again at our department. The exact diagnosis was only made after the second operation,when an extended questioning was done. This shows how important a careful history taking, an exact clinical examination, X-ray examinations of both hands, knowledge of type 1/11 hypoplasia, and finally electroneurography and sonography are important for a correct diagnosis.

Adolescent↗
PubMed2002

[Bilateral hand transplantation].

In March 2000 we performed a bilateral hand transplantation on a 47-year-old policeman who had lost both hands in a bomb accident. Although he was fitted with myoelectric prostheses, he kept investigating the possibility of hand transplantation. The ethical, surgical, medical, legal and human aspects of this special kind of reconstruction was discussed in a symposium in Vienna, and it was decided to go ahead with it if a suitable candidate presented. The operation was successful, the immunosuppressive regimen well-planned and carried out, the post-operative course without any remarkable events. Under intensive physical therapy, the patient gradually but steadily regained sensory and motor functions in his hands. Now, two years after the operation, the patient is practically independent in the activities of daily living and is able to work at his job.

Activities of Daily Living↗
PubMed2002

[The thoracodorsal artery perforator flap].

This report presents our experience with the thoracodorsal artery perforator flap. Its use and pitfalls are critically highlighted, especially the application of this flap as an island flap. Only few publications on this recently described flap are available, possibly because of the high level of skill needed in its preparation. In our hospital, this flap was twice used as an island flap, both of which failed, and ten times as a free flap one of which was a failure. Harvesting of this flap is a delicate procedure involving transmuscular vessel preparation, additionally transposition as an island flap is limited in range. Based on our limited experience, we can recommend use of this flap only in carefully selected cases. This procedure has to be performed by experienced microsurgeons, after training on cadavers, and after preoperative color Doppler imaging for determining the precise location of the main perforators. Only in cases, where a long vascular pedicle for an appropriate free tissue transfer is necessary, and where aesthetic appearance as well as minimizing donor-site morbidity are more important than a potentially higher failure rate, utilizing this perforator flap is justified.

Amputation Stumps↗
PubMed2002

[Congenital arterio-venous malformations of the hand (type C)--the only therapeutic option].

We report on a 36-year-old male patient with a congenital arterio-venous malformation (type C) of the hand. Symptoms onset was three years ago with an ulcer on the tip of the left middle finger, with the fingers and the palm of the hand turning increasingly livid. The shunt-volume in the area of an arterio-venous fistula was 70 ml/min, there was also involvement of the third metacarpal bone. Increasing pain from the index to the ring fingers with no tendency of healing in the middle finger were indications for surgical intervention. In view of the diffuse expansion to all the tissue layers and the danger of peripheral circulatory disturbance and associated necrosis if embolisation was performed, the entire middle finger along with the third metacarpal bone was resected, and the index and the ring fingers were also amputated. Seven months postoperatively, the patient had no pain, had good grip function and was able to use his hand freely in his job as a labourer.

Adult↗
PubMed2002

[Periarterial sympathectomy of the radial and ulnar arteries in Raynaud's phenomenon--a preliminary study].

PURPOSE: Assessment of the post-operative results of peripheral sympathectomy in Raynaud's phenomenon. METHODS: Six patients with therapy refractory Raynaud's phenomenon underwent a 4 cm long adventitial stripping of the radial and ulnar arteries proximal to the wrist. The nerve of Henle was followed up to the surface of the palmar arch and resected. The pre- and postoperative examinations were performed using the help of a questionnaire, telethermography and infra-red laser reflexion rheography. RESULTS: All but two patients (two hands) were free of complaints (four patients, six hands), the three ulcers on the finger tips healed well. According to the questionnaire there was a dramatic improvement in the quality of life of the patients. CONCLUSION: In the follow-up period of two years, there was no recurrence. Adventitial stripping of the radial and ulnar arteries and resection of the nerve of Henle proximal to the wrist have demonstrated favourable results in the treatment of therapy-resistant complaints in Raynaud's phenomenon.

Adult↗
PubMed2002

[The sympathetic axons of the nerves of the hand].

PURPOSE: In the hand surgery literature, more and more studies seem to indicate that the number of sympathetic fibers in the median and the ulnar nerves varies. However, there are no studies that confirm this suspicion. METHOD AND MATERIAL: Six hours post mortem samples were taken from the median and ulnar nerves, the superficial branch of the radial nerve, and from all digital nerves (each five females and males, average age 78 years). 13 samples were taken from one hand. To make sympathetic fibers visible, the immunohistochemical staining technique with tyrosinhydroxylase (TH) antibodies was used. Quantitative assessment of the sympathetic axons was made in whole cross-sections of the nerve. Statistical evaluation was performed with Wilcoxon rank-sum tests. RESULTS: The TH-positive axons are arranged in groups and are located in the endoneurium. No isolated sympathetic fibers were found in the peri- and epineurium. TH-positive axons were present on the arterial walls including the smallest arterioles. Proximal to the wrist, the median nerve has more sympathetic fibers than the ulnar nerve. The number, however, of the fibers was the same in each fascicle. A comparison of the digital nerves shows significant differences only between the radial nerve of the thumb and the ulnar nerve of the ring finger and between the radial nerve of the index finger and the ulnar nerve of the little finger. CONCLUSION: Although the median nerve proximal to the wrist has on average 20 fascicles and the ulnar nerve only 14, the number of fibres in each fascicle is the same. Therefore, based on the present study we conclude that there is no significant difference in the sympathetic fiber distribution of the two nerves.

Adrenergic Fibers↗