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Biomedical subjects

H Piza-Katzer

Publications and source records attributed to H Piza-Katzer.

At least 55 records · Page 3Linked to original sources
PubMed2001

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that lasted longer than 4 years, 26 with an avascular pole fragment, and 13 with scaphoid nonunion after previous surgery) who were treated by a small free vascularized iliac crest bone graft. All 60 patients have routinely been followed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 percent, leading to progressive arthritis and carpal collapse. Complaints concerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony deformity. Bone deformations on the donor site were detected radiologically in 63.3 percent of the patients. In 31.7 percent, an impairment of the lateral femoral cutaneous nerve was noted. Reconstruction of the scaphoid by means of implantation of a vascularized iliac bone graft proved efficient to treat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avascular proximal pole fragments.

Adolescent↗
PubMed2001

[Pedicled flap plasty in closure of defects after recurrence of tumors of the back].

Resection of recurrent tumors of the back often results in large transmural defects. Sometimes, radiation therapy is applied after the first operation, leading to indurated, badly vascularized skin and surrounding tissue, often complicated by infection. For this reason, it is necessary to remove not only the tumor but also the surrounding tissue. To reconstruct such wide defects, we use large axial pattern flaps with extension through a fasciocutaneous flap. This leads to safe reconstruction of a complex defect with well-vascularized tissue. We report on two patients with recurrent tumors of the back, reconstructed with combined, extended axial pattern flaps.

Aged↗
PubMed2001

[External ear injuries--classification and therapeutic concept].

The treatment of traumatic defects of the auricle concerning the exact reconstruction of details and aesthetic aspects is exacting for the surgeon. To face the expectations towards best trauma care, the different locations and extent of auricular injuries should be included in the different therapeutic strategies. The insufficient treatment results in mostly difficult secondary conditions. We present a classification for ear traumas, which considers size and location of defects. Depending on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are pointed out and discussed with several examples and with the present literature.

Adolescent↗
PubMed2001

Gracilis muscle flap with a tissue-engineered lining for experimental bladder wall reconstruction.

OBJECTIVE: To assess a pedicled gracilis muscle flap pre-laminated with autologous, in vitro-expanded urothelial cells to reconstruct an entire supratrigonal bladder-wall defect in rats. MATERIALS AND METHODS: A gracilis muscle flap was harvested from 36 male Wistar rats, transposed into the abdomen and wrapped around a silicon-block space holder. Urothelial cells were harvested and expanded ex vivo. Cells were then suspended in fibrin glue and seeded into the gracilis muscle pocket. One week later this pre-laminated flap was transposed into a surgically created supratrigonal bladder-wall defect. All animals underwent such a pre-laminated gracilis flap bladder reconstruction and were categorized into three experimental groups. All surviving animals with urothelial-culture pre-laminated gracilis flap bladder reconstruction were killed 12 weeks (group 1) later. Control rats had gracilis flaps with no cell seeding and treated only with fibrin glue (group 2) or a standard culture medium (group 3) before reconstruction. RESULTS: Specimens stained with haematoxylin and eosin, and a specific immunohistochemical staining (AE1 and AE3-anti-cytokeratin monoclonal antibody stain) showed a continuous, multilayered functioning urothelial lining along the transposed pre-laminated gracilis flap in group 1. All animals in group 1 with an intact urothelial lining on the gracilis muscle survived, in contrast to most animals in groups 2 and 3, where eight and all 12 animals died, respectively. The surviving four animals in group 2 had no detectable urothelial lining. CONCLUSION Successful urinary reconstruction requires a contractile neo-reservoir resistant to resorption over time and a stable, protective urothelial lining. A gracilis muscle flap can be seeded with autologous cultured urothelial cells suspended in fibrin glue. This pre-laminated flap can be safely transposed on its pedicle and be successfully integrated into the remaining bladder wall, with a urothelial lining and the potential to contract. Further studies in larger animals, with a urodynamic assessment, are warranted to determine if this type of bladder-wall replacement technique is suitable for urinary reconstruction in humans.

Animals↗
PubMed2001

Muscle prelamination with urothelial cell cultures via fibrin glue in rats.

The purpose of the study was to transplant autologous cultured urothelial cells onto a muscle via fibrin glue as a delivery vehicle to create a vascularized, living matrix lined with urothelium that could subsequently be used for urinary reconstruction. Bladder tissue specimens from male Wistar rats (n = 32; 350--500 g) were harvested for urothelial tissue culture. After 8--10 days when the primary cultures became confluent, the cultured urothelial cells were injected underneath the rectus sheath onto the rectus muscle. As delivery vehicle we compared standard culture media and fibrin glue. At 1- and 4-week intervals following urothelial cell grafting, sections of the muscle were analyzed for urothelial graft take using Hematoxylin & Eosin and immunohistochemical staining. The histology demonstrated viable, multilayered clusters of urothelium cells on the muscle surface only in the group using the fibrin glue delivery vehicle. We conclude that a muscle can be successfully prelaminated with autologously cultured urothelial cells via fibrin glue and has therefore potential for urinary reconstructions.

Animals↗
PubMed2001

A new contralateral split-breast flap for breast reconstruction and its salvage after complication: an alternative for select patients.

Different approaches to breast reconstruction have been described and nowadays nearly optimized. One major aim in further developments is to reduce donor site morbidity as low as possible. Theoretically, the lowest donor site morbidity could be achieved by using tissue that would be normally discarded during an operation necessary for a different reason. The authors present a new method of breast reconstruction in a mastectomy patient who needed a reduction mammaplasty on the remaining side in addition to the reconstruction. A single-stage split-breast flap from the reduced contralateral side pedicled on its internal mammary perforators was used, thus lowering donor site morbidity by using otherwise discarded tissue. The technical details, patient selection, advantages, possible pitfalls, management of complications, and the risk factors for contralateral malignancy are discussed.

Breast↗
PubMed2001

Silicone implant correction of pectus excavatum.

Between May 1989 and December 2000 in 24 adult patients with pectus excavatum, a subcutaneous implantation of silicone prostheses was performed. Of the 24 patients, 20 were followed. During follow-up the authors encountered seroma complications in 13 patients and postoperative hematoma in 4 patients. The patients stayed in the hospital 5 days on average, and showed excellent aesthetic results in 80% (N = 16), good results in 10% (N = 2), and fair results in 10% (N = 2). Patient satisfaction was also taken into consideration. A follow-up survey questioned whether patients were satisfied with the cosmetic outcome. On a scale of 1 to 5 points, with 1 point being the highest level of satisfaction, 85% of patients used ratings of 1 and 2 to express satisfaction levels. Silicone implant correction of pectus excavatum in adult patients without any impairment of cardiopulmonary function has value. The major advantages are the minimally invasive operation, the short hospital stay, good aesthetic results, and high patient satisfaction

Adolescent↗
PubMed2001

Examination of postoperative peripheral nerve lesions with high-resolution sonography.

OBJECTIVE: Peripheral nerve lesions after surgery are common and are related either to direct compromise of the nerve by the surgical procedure (iatrogenic lesions) or to postoperative events such as scar formation. Despite a high sensitivity, electrodiagnosis may not reveal the exact location and cause of a nerve lesion. We hypothesized that high-resolution sonography could be helpful in diagnosing postoperative peripheral nerve lesions by direct visualization of the nerve and surrounding tissues. SUBJECTS AND METHODS: Eighteen patients with postoperative peripheral nerve lesions that were confirmed with clinical examination and electrodiagnosis were examined on sonography. Eight patients had lesions caused by direct nerve surgery, and 10 patients had undergone a previous orthopedic operation or open biopsy. Sonographic diagnoses were correlated with neurologic examinations and surgical findings. RESULTS: Reliable visualization of injured nerves on sonography was feasible in all patients. Axonal swelling of a nerve was diagnosed in three patients, direct compromise of a nerve by surrounding scar tissue or surgical implants was diagnosed in 10 patients, a neuroma was diagnosed in three, and insufficient surgical repair, in two. Sonographic findings were confirmed during surgery in all except one patient. CONCLUSION: In contrast to electrophysiologic tests, high-resolution sonography can show the exact location, extent, and type of a postoperative peripheral nerve lesion and the concurrent disease of surrounding tissues. Because the latter can often be the causative agent for the development of a lesion or the lack of improvement with conservative treatment, sonography yields important information that may not be obtained with other diagnostic modalities.

Adult↗
PubMed2000

[Streptococcal toxic shock-like syndrome with necrotizing myositis].

Streptococcal toxic shocklike syndrome is caused by group A streptococci and characterized by multiorgan failure and soft-tissue necrosis, often in young patients with a bland history and at most a minor trauma. Diagnosis is reached through the clinical presentation, imaging methods and positive bacterial verification. The course is fulminant and in the case of muscle involvement, mortality reaches 80-100%. Therapy consists of immediate fasciotomy and often of debridement of affected soft tissues with high-dose antibiotics in intensive care. Sometimes an unconfirmed diagnosis must be sufficient to operate. We report the case of a 29-year-old man without an exceptional history who was forced to undergo thigh amputation, multiple soft-tissue debridements, and after a total of 240 erythrocyte concentrates, finally hip joint enucleation.

Adult↗
PubMed2000

[Extra-abdominal fibromatosis--extra-abdominal desmoid. Review and personal experiences].

Extraabdominal desmoids represent one group of deep fibromatoses. These aggressive nonmetastasizing tumorlike lesions have a strong tendency to local infiltration, with a recurrence rate of about 40%. Trauma, hormones and heredity have been implicated as etiologic factors. Shoulder, chest wall, back and thigh are favored sites. By combination of different diagnostic procedures the number of differential diagnoses can be reduced to only a few. While in former times surgery was thought to be the only kind of therapy, nowadays adjuvant procedures like radiation, hormonal therapy and also chemotherapy are becoming more and more important. Amputation or other mutilating procedures should be done only if the tumor recurs repeatedly.

Adolescent↗
PubMed2000

[Chronic recurrent, locally destructive siliconomas after breast augmentation by liquid silicone oil].

At the beginning of the sixties the injection of liquid silicon oil was frequently used for breast augmentation. It was thought to be safe, simple and effective. But as complications such as local silconomas, inflammatory reactions, induration, foreign body extrusion and foreign body migration were published this procedure was not used anymore. We report about a 45-year-old female patient who suffered from late complications, chronic recurrent local destructive siliconomas, which have not been described in the literature yet. Because of the destruction forced by the primary silicone implant a bilateral subcutaneous mastectomy had to be performed and siliconomas were excised at regions different from the original injection site. Several breast reconstructions have been performed but this tissue has also been destroyed by the recurrent and aggressive siliconomas. As there can be a long period of latency before the aforementioned complications of liquid silicon injections can occur, we recommend careful follow-up for these patients.

Breast↗
PubMed2000

Intraneural nerve metastasis with multiple mononeuropathies.

Although cancer is a frequent condition, neoplastic involvement of the peripheral nervous system is rare. The mechanisms are heterogeneous and include lesions within the cerebrospinal fluid (CSF) space, local invasion (e.g. brachial plexus), compression, rarely direct infiltration, perineurial spread and even rarer intranerval metastasis. A 47-year-old woman had been treated for a carcinoid 10 years earlier and had received axillar irradiation. At presentation she suffered from weakness of the biceps brachii and was experiencing pain radiating from the axilla into the forearm and thumb. MR scans of the brachial plexus were negative and her symptoms were primarily considered to stem from a postradiation brachial plexopathy, Because of increasing pain, the brachial plexus was explored and a metastasis in the left musculocutaneous nerve was resected. Several months later, numbness and pain appeared in the ulnar nerve and another intrafascicular metastasis in the ulnar nerve was discovered. Resection with preservation of remaining fascicles was performed. This rare case report demonstrates that multiple mononeuropathies, resembling multiplex neuropathy, may be caused by intranerval metastasis.

Brachial Plexus Neuropathies↗
PubMed2000

[Preoperative intermittent pneumatic extension treatment stage III and IV Dupuytren contracture].

BACKGROUND: The purpose of this study was the development of a non-invasive preoperative soft-tissue extension device for the treatment of patients with Dupuytren's contracture grade III and IV according to the classification of Tubiana, based on the experience of continuous extension treatment using the external fixator of Messina. METHODS: Intermittent pneumatic distraction (IPD) of soft tissue using a pneumatic extension device was employed for three weeks preoperatively on ten patients. RESULTS: After three weeks the active and passive extension deficit was reduced by 30.02% and 44.64% respectively. Eight months postoperatively an increase of extension on average of 110 degrees was attained. In contrast, a second group of ten patients with Dupuytren's contracture grade III and IV (Tubiana) without preliminary treatment was listed. In these patients, three times a skin graft was needed; in addition, the stay in hospital and time of rehabilitation was longer. CONCLUSIONS: The preoperative reduction of contracture simplifies the surgical treatment and reduces the complication rate. We present a new non-invasive technique for preoperative continuous extension of Dupuytren's contracture yielding at least equal results to the method introduced by Messina. Comparing the two groups of patients, the patients with preliminary treatment had a shorter stay in the hospital and a shorter time of rehabilitation.

Aged↗
PubMed2000

Breast reconstruction facilitated by vertical banded gastroplasty.

BACKGROUND: Vertical banded gastroplasty (VBG) causes weight loss, which is often associated with redundant abdominal tissue. This redundant tissue can be used successfully for breast reconstruction or breast augmentation in case of mastectomy or ptotic hypotrophic breasts. METHOD: One patient with bilateral mastectomy is described in whom the weight fell from BMI 52 to BMI 26 after VBG, giving the patient an abdominal "apron", which facilitated bilateral breast reconstruction. RESULTS: Bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction after weight reduction following VBG resulted in an esthetic pleasing result with additional correction of the cutis laxa abdominis. CONCLUSION: Autologous breast reconstruction can be performed safely with the methods used today, after successful weight loss following obesity surgery.

Breast Neoplasms↗