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Biomedical subjects

H Piza-Katzer

Publications and source records attributed to H Piza-Katzer.

At least 91 records · Page 5Linked to original sources
PubMed1994

[A case of popliteal pterygium syndrome. Considerations of timing and method of therapy].

A case of popliteal pterygium syndrome is presented and the various possibilities of treatment so far reported in the literature are discussed. The medical history of the 22-year-old male patient shows that there is no uniform concept in its therapy and that even multiple operations, which dealt only with the skin contracture and the shortened achilles tendon, were not successful. An extensive neurolysis of the sciatic nerve, its transposition into deeper muscle layers and slow extension of the knee joint with a dynamic splint did improve the patient's condition and this seems to be the concept to follow even in patients with multiple previous operations. For children with popliteal pterygium syndrome, an evaluation of the severity of contracture in degrees would be useful and a conservative treatment with splints should be begun within the first months after birth. In case of no response to conservative therapy, an operation becomes necessary. Surgery consists of the transposition of the sciatic nerve into deeper layers with simultaneous excision of fibrotic tissue, flap transfer or Z-plasty and postoperative extension of soft tissue in the knee by splinting and physiotherapy.

Abnormalities, Multiple↗
PubMed1994

[Functional follow-up of combined musculocutaneous tensor fasciae latae and rectus femoris flap repair. Supplementary information on the Handchir. Mikrochir. Plast. Chir. 21 (1989) 315-317 contribution].

As a supplement to our publication in the Journal Handchirurgie, Mikrochirurgie, Plastische Chirurgie 21 (1989) 315-317, we would like to report a five-year follow up of a patient with recurrent sigmoid carcinoma, infiltrating all layers of the abdominal wall. Treatment was by radical tumor excision and reconstruction with a combined tensor fasciae latae and rectus femoris flap. Abdominal wall, hip, and knee functions were evaluated by gait-analysis (Motion Analysis Corporation AMTI) and dynamometry (Cybex 6000). The dynamometry of knee motion showed a slight deficit of the operated side regarding the parameters of strength-endurance as well as work-recovery. All other parameters (peak-torque) were equal for both sides corresponding to the activities of daily living of the patient. Gait-analysis showed a reduced rotation of the pelvis as well as a functional deficit of extension of the knee during stance and swing phase. We can document a good functional result in all motions without major impairment of every-day activities.

Abdominal Muscles↗
PubMed1994

[Complications of antecubital arteriovenous fistula].

A serious complication following the insertion of an a-v shunt for dialysis in a 41-year-old man is reported. Three weeks after the operation, arterial and venous circulatory disturbances occurred in the hand, accompanied by cyanosis distally of the shunt and a lymphatic fistula in the operated cubical area, and followed by the symptoms of a compartment syndrome in the forearm with impaired mobility of the hand. In order to restore normal hemodynamic conditions, the shunt was interrupted and the infected area covered by a local flap. Several weeks later a false aneurysm developed and the circulation had to be reconstructed by an extra-anatomic vein graft. At present the hand is functionally fully rehabilitated.

Adult↗
PubMed1994

[Intra- and postoperative nerve lesions and their treatment].

Injuries to the central or peripheral nerves caused by medical intervention are called iatrogenic nerve lesions. The caudal relationship between medical intervention and iatrogenic nerve injuries is frequently not very clear. Careful pre- and post-operative examination of the patient, however, will in most instances reveal a nerve lesion in a timely manner. Iatrogenic nerve lesions in the clinical cases available to us were predominantly due to indirect influences, such as pressure, insertion of a retractor or heat; we discovered that only in a few cases a nerve was partially or completely severed or damaged by the material used for osteosynthesis. The pre- and postoperative clinical neurological and electrophysiological examinations of our patients were performed by a neurologist. Nerve-repair was achieved by neurolysis in 19 cases; a primary or secondary suture was performed in three cases. A nerve graft was used in five cases to regain continuity. Those patients (nearly 75%) who underwent restitutive surgery within an six-month period after iatrogenic injury in the primary operation were treated successfully. These results suggest that timely treatment is decisive for good outcome.

Adolescent↗
PubMed1993

[Functional and cancerologic aspects in the use of jejunum in the ENT area].

In this article, we report about the experiences at our ENT-University Clinic in Vienna in 76 patients with free transplanted microvascularly anastomosed autologous jejunum used for reconstruction following extensive resection of mainly stage IV carcinomas in the head and neck. Jejunum was inserted as a siphon-like tube between the trachea and the hypopharynx in 43 patients primarily for restoration of speech (in 10 cases the pharynx was also reconstructed). In 33 patients, the upper digestive tract was reconstructed, as either patch or tube. They were then evaluated according to functional results of speech and swallowing, aesthetics as well as 5-year survival rates. We achieved good results in 35 speech patients (81.4%) and in 22 swallowing patients (66.6%). The aesthetic function was influenced favourably because the volume of the jejunal transplant fills up the defect in the neck after resection and creates a tolerable neck-shape. The 5-year survival of all available 54 patients was 26%, patients for speech restoration 31.7% and patients for swallowing restoration 17.5%. These results are to be considered under the aspect that patients with swallowing restoration primarily had more severe disease. Complications such as like perioperative mortality and total necrosis can be avoided by careful evaluation of the patients to be operated on. With the experiences gained from this study, we now have exact indications for the use of jejunum grafts and thus can expect very high rates of success.

Adenocarcinoma↗
PubMed1993

Sensory recovery in myocutaneous, noninnervated free flaps: a morphologic, immunohistochemical, and electron microscopic study.

The aim of this study was to clarify the following questions: (1) Do newly sprouting axons use the empty neurilemmal sheaths of a flap as conduits? (2) To what extent can sensibility recover? (3) Does sensory recovery occur at the margins of the flap or at its center? (4) Does chemotaxis influence the regeneration process? In 16 free myocutaneous flaps (12 latissimus dorsi, 4 rectus abdominis) we investigated pain (pinprick), constant touch, temperature, 30- and 256-Hz vibration, and static and moving two-point discrimination between 1 1/2 and 8 years after surgery. Four flaps were anesthetic, eight recovered partly, and four had six or more modalities present all over the flap; six of ten flaps with poor recovery showed better sensitivity close to the anastomosis. Nine patients agreed to have two punch biopsies (6 mm) taken from their flaps (seven from areas with different degrees of sensory recovery and two from the center and the periphery when recovery was homogeneous). Biopsies from the areas with better sensory recovery showed slightly more nerves than the other punches in five instances, showed no difference between the two biopsies in one instance, and seemed to have more nerves in the biopsy from the area with less recovery in the last instance. The two pairs of biopsies from the homogeneously recovered flaps showed similar amounts of nerves. S-100 protein-positive neural structures (Schwann cells) were found in 13 biopsies, and neuron-specific enolase-positive nerve fibers (nerve axons) were found in 10 biopsies. Electron microscopy showed mainly unmyelinated fibers, always adjacent to vessels and sometimes with regenerative phenomena. We believe that sprouting axons probably grow into a flap attracted by chemotaxis from hair follicles, the basement membrane, and the laminin contained in the sheath. We recommend maximum scar excision at the recipient site to enhance sensory recovery in flaps. We conclude that (1) the sprouting axons primarily use the empty neurilemal sheaths as conduits, (2) sensory recovery can reach two-point discrimination equal to the donor site of the flap, and (3) sensory recovery occurs mainly from the margin of the flap but also from the bed.

Adult↗
PubMed1993

[Pectoralis major muscle island flaps. Personal experiences].

Fifty-six pectoralis major island flap procedures were carried out in 52 patients for the immediate reconstruction of defects after resection of head, neck or thoracic tumors. In 28 we used only a part of the muscle covered with meshgraft, in another 28 as a myocutaneous island flap. The complication rate was low: One partial flap necrosis, two bleedings postoperatively on the donor site, four fistulas (one required a second operation). One necrosis of ribs required the resection and covering with a latissimus dorsi flap. One patient died with mediastinitis. The functional aspects of the muscle donor site is stressed out.

Adult↗
PubMed1992

[Distal external lymph fistula of the tibia as a complication of vena saphena magna harvesting].

In a 71-year-old woman with coronary disease the great saphenous vein was excised for use as an autologous graft vein. Two weeks later a crural ulcer developed at the distal excision site. Conservative treatment by ointment and compression was not successful and plastic surgery was considered. A clear, protein-rich liquid was discharged from the wound. The interdigital injection of methylene blue resulted in appearance of the dye in the ulcer after 45 seconds. Surgery revealed a severed lymph collector. After ligation of the lymph vessel the ulcer within a week.

Aged↗
PubMed1991

[Functional and electromyographic long-term results following primary microsurgical repair of the recurrent laryngeal nerve].

Six patients with unilateral recurrent nerve paralysis underwent phoniatric follow-up after neurolysis or primary microsurgical repair of the recurrent laryngeal nerve. Four patients were controlled by electromyography of the vocal muscle 14 to 80 months post-operatively. In six patients the paralyzed vocal cords were in median to paramedian position with sustained muscle tonus. Phoniatric parameters were found to be close to the average range in healthy persons. EMG findings indicated degenerative neurogenous paralyses in two patients, signs of reinnervation in another. In one case biphasic action potentials could be recorded.

Adult↗
PubMed1991

Is breast reduction plasty in an eleven-year old girl indicated? Case report.

The history and the problems of surgical therapy of an eleven-year old girl with infantile hypertrophy of both breasts is described. It is only by good cooperation between paediatricians and plastic surgeons that the indication for operation can be evaluated. Careful weighing of the "pros" and "cons" will help in making this decision.

Body Image↗
PubMed1991

[How long is a musculocutaneous microvascular transplant flap dependent on its vascular pedicle?].

Two cases of open fractures of the lower leg with microvascular flap reconstruction for soft-tissue coverage illustrate the time span necessary for neovascularisation of the flap. In the first case, the supplying artery of the flap had to be ligated due to a septic aneurysm 17 days after operation. Because of sufficient blood circulation between the flap margin and the surrounding tissue, there was no ischemic damage to the flap. A similar observation was made in a second case, where more than one year postoperatively, venous congestion was managed with leeches. Careful consideration must be given to incisions of these microvascular flaps prior to any further surgical procedure, particularly if the traumatised region is badly vascularised and the flap consists only of a split thickness skin grafted muscle.

Adult↗
PubMed1991

[One-stage nose reconstruction using a forehead island flap].

Only part of the nasal skeleton remains after resection of extensive tumours penetrating all layers of the nose. In most cases a multiple-stage procedure is necessary for reconstruction of subtotal and total nasal defects. However, a one-stage reconstruction is needed in old and physically disabled patients who cannot undergo multiple operations for medical or social reasons. Three cases of nasal reconstruction with an inverted forehead island flap are reported. The skin of the inferiorly transposed flap serves as an inner lining for the reconstructed nose; the outer layer of the flap, which forms the surface of the reconstructed nose, is covered by a split thickness skin graft. The advantages of the method are: (1) one-stage reconstruction of the nose after tumour resection without further operations; and (2) the relative stability of the reconstructed nose without cartilaginous or bony implants.

Aged↗
PubMed1990

[Evaluation of shoulder function after removal of the latissimus dorsi muscle for surgical flap].

The latissimus dorsi muscle is frequently used in reconstructive surgery. The present study was undertaken to determine the post-operative function of the shoulder girdle with respect to dominance in 26 patients following latissimus dorsi flap transplantation mainly for soft tissue coverage in the lower leg. The patients were interviewed and examined, with special attention being paid to shoulder mobility, dexterity and muscular strength. On interview, a considerable majority felt that very good results had been achieved. Raising the latissimus dorsi flap did however influence shoulder retroversion, particularly when surgery was performed on the non-dominant side. The influence of dominance was further noted as regards inward rotation of the shoulder and the ability to lead the hand backward over the shoulder. Dexterity was determined by a modified tapping test in the sagittal plane. Other than a minor correlation with age, post-operative function depended on whether the latissimus dorsi flap had been raised from the dominant or non-dominant shoulder. No effect of operation or dominance was observed in terms of isometric muscular strength, measured with an electronic device (Hottinger-Baldwin-Messtechnik). We believe that the function of the latissimus dorsi muscle can be compensated for by synergistic muscles. Yet, in rehabilitation, particular attention must be paid to the function of the non-dominant shoulder since it is used less in daily activity.

Adolescent↗
PubMed1990

[Isolated rupture of the vinculum longum superficiale (V1) following blunt trauma].

The anatomy and topography of the vincula are described. Their role in the blood supply to the flexor tendons is reviewed in the light of current reports. The authors present the case history of a 59-year old patient with blunt trauma to the middle finger of the right hand. This patient suffered from severe pain in the area of the proximal phalanx and the PIP joint of the third finger, as well as from reduced extension with a deficit of 20 degrees in the PIP joint. The differential diagnosis and clinical picture are discussed. The operative findings suggest a rare instance of detachment or rupture of the vinculum of the intact superficial flexor tendon.

Arteries↗
PubMed1989

Refixation of muscular insertions after endoprosthetic replacement of the proximal humerus.

We describe the refixation of muscle insertions after resection of the proximal humerus in tumor patients. The prosthesis specially designed for this purpose carries large drill holes in the places corresponding to the anatomical sites of the muscle insertions. The muscles are attached to the prosthesis by means of tendon strips from the fascia lata. This can be expected to produce better functional results and to prevent subluxation.

Biomechanical Phenomena↗
PubMed1989

Groin infections following vascular surgery: obturator bypass (BYP) versus "biologic coverage" (TRP)--a comparative analysis.

Deep infections in the groin complicating vascular surgical procedures pose a serious problem, in the treatment of which two alternative methods are available: (1) Removal of the graft and the construction of an extra anatomic bypass (obturator canal bypass, BYP), or (2) retaining the graft and achieving healing of the infected wound by various biological materials, such as omentum or an inferior rectus abdominis muscle flap (TRP). The probability of patient and limb survival was estimated by the Kaplan-Meier method and possible differences between both groups checked using Breslow's and Mantel's tests. No statistically significant differences were found and a variety of factors with potential influence on the outcome were considered equally balanced. However, as soon as the catastrophic event of infection plus haemorrhage enforced emergency surgery, the incidence of success differed markedly: in the BYP group 6 infections healed out of 8 and in the TRP group 1 out of 6.

Adult↗