Biomedical subjects
Publications and source records attributed to H Piza-Katzer.
In a 36-year old man a large recurrent sigmoid carcinoma, exophytically infiltrating the abdominal wall, was resected. The full-thickness defect in the middle and lower abdomen was reconstructed with a Vicryl-mesh and a combined tensor fasciae latae-rectus femoris flap.
In young patients with bilateral carpal tunnel syndrome and a negative history of synovialitis, trauma, and metabolic disease one has to consider rare muscle variations as a cause of the syndrome. Besides variations of the lumbrical muscles and the superficial flexor digitorum muscles, variations of the palmaris longus muscle can be the causative anomalous structure. A case of carpal tunnel syndrome caused by a palmaris profundus muscle in presence of a normal palmaris longus muscle is reported.
The case of a 52-year-old patient with uremia and infection in his av-shunt (homologous saphenous vein) is described. Due to the infection a rupture of the venous anastomosis in the cubital area with acute hemorrhage occurred and the av-fistula had to be removed and the artery repaired by an autologous vein patch. To cover the exposed cubital artery and the infected ventral elbow area a brachioradial muscle flap was inserted. By this procedure the amputation of the upper extremity could be avoided. Full range of extension and flexion was obtained within 4 weeks.
Two patients had an avulsing injury of the penis with considerable loss of skin. One was bitten by a dog and the other lost the skin when his clothes were caught by a rotating machine and thus the skin was stripped off by traction and crushed. The detached skin was resutured immediately after injury and in both cases the cosmetic and functional result was more than satisfactory. Though it is not easy to judge the extent of the crush injury in this type of an accident, we feel--even when going against common literature (skin grafting usually is suggested)--that resuturing of the skin is a highly successful method.
The authors report on a patient having a simultaneous true and false aneurysm along the superficial palmar arch. The clinical diagnosis was substantiated by ultrasound and angiography and the findings confirmed histologically. The classification of aneurysms according to their etiology and pathological anatomy is discussed. The clinical symptoms as well as alternative surgical procedures are illustrated with particular emphasis placed on the restoration of adequate peripheral blood circulation in the digits via microvascular anastomosis.
In the distally-pedicled radial island flap a reverse venous flow was observed. In 20 cadaver extremities the veins of the lower arms were perfused and dissected and the island flaps elevated. The 3 venous systems are described here according to the number, site and shape of the valves and the venous flow from the flap is also discussed.
An example of a full skin thickness burn injury on the medial aspect of the knee joint with exposed joint cavity is presented. Adequate coverage was possible using a cranially based medial gastrocnemius muscle flap. A specially manufactured plaster cylinder was applied to the joint to enable early mobilization of the 81-year-old patient. The treatment of deep burns in weightbearing joints is discussed.
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A 39-year-old patient with an epiglottic carcinoma stage T4N2M0 was treated initially by radiotherapy, but later underwent laryngectomy for irradiation necrosis. A pharyngeal fistula occurred in the irradiated area. After resection of the damaged skin reconstruction was performed by a double skin paddle myocutaneous pectoralis major flap. A recurrence of the fistula in the same area was closed by invagination of the flap. Three years later a massive scar stenosis developed in the reconstructed hypopharynx, so that the patient was unable to swallow. This required a total resection of the scar tissue which extended from the entrance of the hypopharynx to the upper oesophageal sphincter. The gap was bridged by a free microvascular jejunal graft. To date 6 months have elapsed since this operation and the patient is symptom free.
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A 68-year-old man with squamous cell carcinoma of the right thumb underwent a finger-saving operation. The lesion (2 X 2.3 cm) was located near the IP joint. There were no distant metastases. A wide local excision including the MP joint was performed, and the axillary lymph nodes were dissected. To avoid any loss of length the bone defect was treated with a 2.5-cm-long bone graft from the third rib. The skin defect was closed with a local flap. In the histological examination tumor cells reached the subcutaneous layer; the deeper layers and the bone were not involved. Two years after the operation neither local recurrence nor distant metastases were found and the function of the right hand was good. The good outcome of this case does not allow any general conclusion on the best treatment for such cases; but it does emphasize the difficulties of deciding on the treatment (amputation or excision) to be applied in this area.
A case of bursitis intermetacarpophalangea calcarea is presented which, after clinical and X-ray examination, raised problems regarding differential diagnosis. Because of the rarity of the findings, the anatomical localization as well as the surgical procedure is presented. Calcifications which may show in tendons and ligaments are discussed. In cases of acute calcareous infiltration in hands, surgery very rarely is indicated. By contrast, in cases of bursitis intermetacarpophalangea calcarea, surgery should be performed as soon as possible to preserve normal hand function.
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In the distally pedicled radial island flap a reverse venous flow was observed. In 20 cadaver extremities the veins of the forearms were perfused, dissected and also island flaps elevated. The three venous systems are described as to number, localization and shape of the flaps with an explanation of the venous flow.
Report on a woman patient, 69 years of age, suffering from a recurrent extensive basalioma of the external ear that was considered inoperable, as the tumour had invaded the petrous bone, the parotid gland, the mandibular joint, and the adjacent nerves. Because of unbearable pain it was decided to perform a radical operation with resection of the tumour, the petrous bone, the parotid gland, the ascending mandibular branch, the facial nerve, and part of the oral mucous membrane. The exposed large cervical vessels, dura mater, and the bony skull--of which the periosteum had to be removed--were primarily covered with a large pectoral muscle island flap and an occipital advanced flap. Twenty-four months after surgery the patient had no relapse and was free from pain.
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Cadaveric anatomical preparations of the deep inferior epigastric artery showed the origin, the course, and the size of the artery to be consistent with few variations. Flaps which have been dissected on this vascular system can be used as island flaps or free flaps. The indications, application, and technical details, especially with regards to closure of the abdominal wall, are discussed in nine cases. The good results achieved by the use of this flap, particularly in long and narrow defects, serve as a recommendation for this type of management.
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