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Biomedical subjects

J Holle

Publications and source records attributed to J Holle.

At least 19 recordsLinked to original sources
PubMed1995

Long term results of inflatable mammary implants.

In this retrospective study, the long term results of 167 inflatable mammary implants in 77 patients who underwent either breast reconstruction or augmentation between 1972 and 1990 were evaluated. All inflatable implants were manufactured by Heyer-Schulte/Mentor company, and were equipped with a posterior leaf valve (style 1800). The mean follow-up was 9 years (SD = 4.3). Complete deflation was found in 23.9% of the implants (22.2% deflation rate from 1972 to 1984 and 25.5% from 1985 to 1992). The incidence of this complication was significantly higher in patients who underwent previous open (p = 0.012) or closed (p = 0.038) capsulotomy. Severe contracture of the implant fibrous capsule (BAC 3 and 4) was found in 37.6% of the patients. Its incidence increased significantly when the postoperative blood loss (assessed by the volume of blood collected by suction drainage) exceeded 250 cc (p = 0.025). Neither the site of the implant (submuscular/subglandular) nor the indication for surgery (reconstruction/augmentation) influenced the rate of severe capsular contracture significantly in this retrospective study.

Adolescent↗
PubMed1995

The extended gracilis muscle flap for reconstruction of the lower leg.

The width of the gracilis muscle was measured before and after removal of the epimysium in 10 fresh cadavers. The average extent of muscle widening achieved by epimysium removal was over 100% (mean 112.6%; standard deviation 11.9%). This extended muscle flap enabled us to cover successfully even large soft tissue defects measuring up to 300 cm2. In 27 consecutive patients, soft tissue defects of the lower leg with exposed bone have been repaired by free tissue transfer of a gracilis muscle flap, covered with split skin grafts. The advantages of the gracilis muscle flap were the low donor site morbidity with almost no recognisable functional loss, the easy surgical access, the thin and flat shape of the muscle, and its adequate size after excision of the epimysium. Reconstruction with a gracilis muscle flap resulted in an inconspicuous, stable, and flat contour of the lower leg. The entire length of the vascular pedicle of the gracilis muscle was easily harvested in our patients by routinely dissecting the pedicle on both sides of the adductor longus muscle.

Adolescent↗
PubMed1995

Donor-site morbidity of the gracilis flap.

To determine whether there is a specific donor-site morbidity inherent in the elevation of the gracilis flap, we retrospectively examined 42 patients who underwent elevation of their gracilis muscles. We found, on dynamometric measurement, that the adduction strength of the hip joint was decreased by 11 percent when the gracilis muscle was elevated. This decrease in strength was not noticed by the patients. We also found an area of hypesthesia corresponding to the cutaneous territory of the obturator nerve in 40.5 percent of the patients. In addition, many patients were dissatisfied with the aesthetic appearance of the donor site, and a contour deformity of the thigh was present when a myocutaneous flap was elevated. Therefore, we conclude that the gracilis flap has a low but definite rate of donor-site morbidity. The advantages of the flap outweigh by far, however, the sequelae at the donor site.

Adult↗
PubMed1992

Long-term results of nervous tissue alterations caused by epineurial electrode application: an experimental study in rat sciatic nerve.

In order to evaluate the long-term effects of epineurial electrode application for functional electrical stimulation (FES) the left sciatic nerve of seven rats was exposed. Four ring-shaped stainless steel wire electrodes were sutured to the epineurium of each nerve in the same manner as performed clinically for carrousel stimulation in man. The nerves were reexposed 1 year after implantation and the stimulation threshold to obtain a tetanic contraction in the lower limb was determined for each electrode. Afterwards the animals were sacrificed. The electrodes were excised and cross sections of the sciatic nerve directly at site of the electrodes, 2-mm proximal and 2-mm distal to them were harvested for histologic and planimetric assessment of nerve lesions. The area of damaged neural tissue was expressed as a percentage of the total cross-sectional area within the perineural sheath. The sciatic nerves of the right side served as controls. The values for the stimulation thresholds ranged between 0.1 and 1.0 mA (mean 0.43 mA). By morphometric examination five of seven nerves were seen altered, the altered areas captured between 1% and 4.8% of the total cross-sectional area of the nerves within the perineural sheath. Besides two specimens, all altered nerve segments exhibited distinct signs of nerve fiber regeneration. The clinical implications of the results for long-term electrical stimulation, such as phrenic pacing, are discussed.

Animals↗
PubMed1991

Histological assessment of nerve lesions caused by epineurial electrode application in rat sciatic nerve.

The left sciatic nerve of 36 rats was exposed and four ring-shaped stainless steel wire electrodes were sutured to the epineurium of each nerve in the same manner as performed clinically for "carousel stimulation" in man. The rats were sacrificed 10 days (Group 1), 3 weeks (Group 2), or 3 months (Group 3) after implantation. The electrodes were excised, the nerves were embedded in Epon, and semithin sections were obtained for histological and planimetric assessment of lesions caused by the epineurially sutured electrodes. The right sciatic nerves served as controls. The total area of neural tissue within the perineurium was determined at three levels: at the site of the electrodes, 8 mm proximal, and 8 mm distal. The area of neural tissue damaged by the surgical procedure was expressed as a percentage of the total area. In Group 1, nine of 12 nerves showed lesions ranging from 0.39% to 25.39% of the total area of neural tissue, in Group 2 eight of 11 sciatic nerves showed lesions ranging from 0.24% to 13.03% of the total area, and in Group 3 five of 12 nerves showed lesions ranging from 0.21% to 4.96% of the total area. The pathologically altered areas in Groups 2 and 3 exhibited distinct signs of nerve fiber regeneration. The reasons for the decrease in damage from Group 1 to Group 3 and the clinical implications of the results for long-term electrical stimulation are discussed.

Animals↗
PubMed1989

[Reconstruction of deformities of the external ear].

Microtia is a rare malformation. Reconstruction of microtia is not a routine operation because of its rarity of occurrence and the complex deformity. In this paper the indication for surgical treatment, technique, results and complications are discussed. Two different operation methods were used in our patients. A multiple-stage and a single-stage reconstruction procedure. We used autogenous rib cartilage. Five of the seven treated patients came to the follow-up examination. Reconstruction was performed 2 years ago in two cases and between 4 and 12 years ago in three cases. Our patients were content with the result in so far as they would be prepared to undergo treatment again. Carefully built rib framework is an essential prerequisite for a successful postoperative result. Microtia represents a greater psychological problem than a cosmetically imperfect result after reconstruction.

Adolescent↗
PubMed1989

[Late results following surgical correction of syndactyly and symbrachydactyly].

Growth and the type of surgical treatment of the hand play an important role in the results of surgery in children. 29 patients have been operated on because of syndactyly and symbrachydactyly and were controlled. The following parameters were assessed: kind of incision and skin graft, functional results, x-ray to examine the skeleton and the depth of the commissure, colour of the skin graft and use of the hand. After operation of syndactyly all patients were able to use their hands normally, although full extend of flexion and extension was achieved only in 20 of 22 hands. In 5 divided pairs of fingers there was recurrence of syndactyly. In all cases except one, a split thickness skin graft has been used. After operative treatment of symbrachydactyly and complex syndactyly, full extent of flexion was achieved in 13 of 19 hands, in 6 hands the range of flexion was incomplete because of skeleton abnormalities. Recurrence occurred in 9 divided pairs of fingers; in 7 cases, a split thickness skin graft had been used. Despite this, all patients were able to use their hands normally. The use of split thickness skin grafts resulted in a 60% recurrence rate, whereas the use of full thickness skin graft led merely to 7.5% recurrence rate. Our results show the advantage of the full thickness skin graft. As a consequence, full thickness skin graft should be used in all cases. Furthermore, the operation should be performed at an early age, if fingers of unequal length have to be separated. Zig-zag incision should be used in all cases.

Child↗
PubMed1987

[Comparative study of primary and secondary management of flexor tendon injuries].

In 1974 a replantation service started at the authors' department. Before that time the treatment of flexor tendon injuries was mainly performed secondarily. Therefore, the authors had the opportunity to compare patients after primary and secondary surgery. In 52 primarily and 22 secondarily treated patients the technique of Kleinert was used. Following issues were investigated: functional results, decrease of grip strength, influence of early mobilization on sensibility restoration in cases of nerve injury, relation between sensitivity to cold and vessel and nerve injuries, duration of physiotherapy and disability. The damage of only one finger might lead to decrease of grip strength. Primary surgery was superior to secondary surgery. Early mobilization in cases of additional nerve injuries did not affect sensibility restoration. Poor sensibility increased the chance of cold sensitivity. The duration of physiotherapy and of disability depended on the need for second procedures such as tenolysis which was more common in the group of secondarily treated patients.

Adolescent↗
PubMed1986

Influence of long-term low direct current on rat ischiadic nerves.

The effects of a low direct current on peripheral nerves and electrodes on the ischiadic nerve were investigated, and a constant direct current was applied for various time periods. Afterwards clinicophysiological tests and histological evaluations were performed. The muscles of 55 rats could be stimulated by external stimulation during the follow-up examinations, but 90% of all animals showed microscopically visible nerve tissue alterations which might have been caused by mechanical rather than electrolytic factors.

Animals↗
PubMed1985

[Free muscle transplantation].

To survey the current use of free muscle transplantation in the German speaking part of Europe, a questionnaire was sent to all Replantation Centres in 1982/1983. The answers revealed that micro-neurovascular muscle transplantation for functional use is still an uncommon procedure. Its use in facial palsy, in the sphincter region and in reconstructive procedures in extremities is emphasized and postoperative healing and functional improvement is shown in a diagram. The follow-up period is too short to discuss functional improvement in detail. Regarding our own cases, we are quite impressed by the result of free microneurovascular muscle transplantation in unilateral irreversible facial palsy patients, but are unable to prove the final result in extremities because of short observation time.

Adult↗
PubMed1984

[The problem of scars in heart surgery with special reference to the use of static magnetic fields].

An attempt is made to survey the pathophysiology of wound healing, as well as the aetiological factors involved and the possibilities of therapeutic intervention to prevent the formation of hypertrophic scars and keloid after cardiac operations. Several prophylactic measures are discussed, with special reference to the use of static magnetic fields. Their application to scars after cardiac operations was carried out by energy pak foils. Patients treated with these foils showed slightly improved results as compared with a control group. The results, however, were not statistically significant.

Adult↗
PubMed1984

Breast reconstruction with an external oblique abdominis muscle turnover flap and a bipedicled abdominal skin flap.

A new technique of breast reconstruction is demonstrated using a turnover flap of the external oblique abdominis muscle together with a sheath of the rectus muscle to enlarge the submuscular pectoralis major pocket for the implant. To overcome a tight skin, a bipedicled abdominal skin flap is transposed for breast reconstruction. In so doing, a natural-looking breast is formed by a simple operative technique with rare complications. The technique has been applied in 11 patients with good results.

Abdomen↗
PubMed1984

[Operative technic in muscle transplantation with microneurovascular anastomoses based on animal experiment studies].

The influence of the transient ischemia during free muscle transplantation with microneurovascular repair was studied in the rectus femoris muscle of the rabbit, as well as the effect of denervation and reinnervation by nerve suture. Both factors, ischemia and nerve suture, were taken together in a separate series. The functional results of the different kinds of reinnervation by nerve suture, by nerve implantation and by muscular neurotisation were compared. The possibility to use a motor nerve elongated to the contralateral side by nerve grafting was tested. In a further series the effect of changes of the initial tension of the muscle during the transplantation was clarified. These isolated factors were compared with the real transplantation from the left to the right side. As the most representative parameter for function the maximal tetanic tension was chosen for evaluation. Our results show that the following considerations in the operative technique are significant. To shorten the time of ischemia the donor and recipient area should be prepared for transplantation at the same time, the recipient vessels should be elongated before the muscle transplant is taken off, and the arterial anastomoses should be performed before the venous. For reinnervation of the muscle transplant nerve suture is more successful than nerve implantation. Both methods can be combined to make good use of all the potential of reinnervation. The muscular neurotisation should be used only in the face and for sphincter reconstruction. A contralateral source of reinnervation is useful in the face, but it is not in the extremities. The restitution of the original initial tension of the muscle after transplantation is of great importance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

[Reconstruction of grip function in cases of a fingerless or missing hand].

In two cases a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient all fingers of the left hand were amputated at the metacarpo-phalangeal joint level. The second and the third finger were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. The distal and middle phalanx of the transplanted third toe had to be re-amputated because of mummification two weeks after the transplantation and was covered with a groin flap. Good function of the newly formed grip could be demonstrated. The second patient was a 21-year old man with amputation of both hands. Grip reconstruction in the right lower arm was performed by transplantation of the second toe of each foot together with a metatarsal bone and a dorsalis pedis flap. One year after the operation the follow-up study demonstrated good function of the newly formed hand. The patient is able to use his two new fingers during daily life mainly to hold small objects. The sensation and the range of movement of the newly formed right hand are demonstrated and discussed.

Adult↗
PubMed1984

Improvement of continence by myoplasty of the pelvic floor.

The authors report their experiences with sphincter reconstructions by free muscle transplant using a denervated muscle with its blood supply intact. The transplanted muscle is fixed to the remaining functioning sphincter musculature. New muscle fibres grow from this muscle into the transplanted muscle, allowing the reconstructed sphincter to contract voluntarily as well as reflexively. The operative technique depends on the existing sphincter defect. Free muscle transplantation is preferred if the external sphincter is still partially existing. Eight patients were examined 2 years after the reconstruction operation and the result was very satisfactory. Solid and semi-solid stool could be controlled by all patients. Large muscle transplantations carried out after the method reported by Thompson (1971) are followed by an increased intramuscular scar formation, as was shown by our experiments. A denervated muscle transposition with its own blood supply is therefore preferable. The change of innervation allows the transplanted muscle to perform its new function. In the treatment of congenital sphincter malformations, a larger muscle, i.e. transposition of the denervated gracilis muscle, should be used. This operation was performed in 7 cases of incontinence following operations for rectal atresia and in 1 case of extensive posttraumatic destruction of the sphincter apparatus. In only 1 case was continence for solid stool achieved. In 6 patients there was a temporary control of fluid stools, but under stress all patients with complex sphincter malformations soiled.

Adolescent↗