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K H Künzel

Publications and source records attributed to K H Künzel.

17 recordsLinked to original sources
PubMed2005

Arteries in the posterior cervical triangle in man.

Due to frequent changes in the anatomical nomenclature of the arteries in the posterior cervical triangle (lateral cervical region), anatomical and surgical papers relating to these topics are sometimes difficult to understand and are hard to compare. These changes, coupled with improper knowledge of the gross anatomy and nomenclature of the arteries in the posterior cervical triangle, have presented difficulties in musculocutaneous flap planning, especially in plastic and reconstructive surgery. As an illustration of this concern, the term, transverse cervical artery (A. transversa colli [cervicis]), and its associated branches, have been used frequently over the past several decades with different meanings. In an effort to address this nomenclature challenge and to offer a rational basis for arguing specific name changes, a total of 498 neck-halves were investigated in Graz, Innsbruck, and Munich. Lateral neck dissections were carried out to expose the subclavian artery and those branches destined for the posterior cervical triangle, specifically, the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery. The course of these arteries and details of their origins and branching patterns were documented. Several arose either as direct branches or from trunks. The convention used in labeling trunks was similar to that described for other trunk formations in the body (e.g., linguo-facial trunk). Four trunks were observed and named according to the branches that arose from each. A cervico-dorsal trunk gave origin to the superficial cervical and dorsal scapular arteries, and was found in 30% of cases. A cervico-scapular trunk gave rise to the superficial cervical and suprascapular arteries in 22% of cases, and a dorso-scapular trunk provided origins for the dorsal scapular and suprascapular arteries in 4% of cases. A cervico-dorso-scapular trunk gave origin to the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery, and was found in 24% of cases. Each of these trunks, in turn, arose from either the subclavian artery or from the thyrocervical trunk. This labeling convention necessitated omitting the term, transverse cervical artery, because this term has become inherently imprecise and variously used over the years. This study describes a simple, uniform, and rational basis for standardizing the nomenclature of the arteries in the posterior cervical triangle.

Aged↗
PubMed2002

[Computer-assisted drilling of the lower extremity. Technique and indications].

Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. This study reports that, using a non-invasive fixation method (FISCOFIX-Cast), lesions between the ankle- and knee-joints can be precisely localized, registered and treated. Due to the difficult access to lesions especially in the posterior areas of the talus, using conventional arthroscopic methods this procedure is very useful. Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.

Anterior Cruciate Ligament↗
PubMed2001

[Computer-assisted retrograde drilling of osteochondral lesions of the talus].

Treatment principles of osteochondral lesions of the talus usually consist of debridement of the chondral part and methods that attempt to stimulate revascularization of the necrotic bony part of the lesion. The latter is mostly achieved through multiple drilling of the subchondral zone. Dorsomedial talar dome lesions are frequently inaccessible with antegrade drilling techniques. In addition, if the cartilage surface over the bony lesion is still intact, it can be injured by antegrade drilling. To overcome these potential problems, retrograde drilling techniques have been developed using drill guides or intraoperative fluoroscopy. Our proposed method of computer-assisted retrograde drilling is an advancement of these techniques. The use of 3D navigation provides the possibility for placing a guide wire exactly in the center of the lesion defined on preoperative MRI or CT scans. This guide wire can then be overreamed with cannulated reamers followed by retrograde bone grafting of the lesion or allows multiple retrograde drilling of the subchondral plate using a parallel drill guide. We found that computer-assisted retrograde drilling could improve precision, avoid misplacement of guide wires, and reduce the time of surgery and intraoperative fluoroscopy.

Arthroscopy↗
PubMed2000

Sequence analysis of bacterial DNA in the colon and stomach of the Tyrolean Iceman.

The male human body found in an Alpine glacier on September 19, 1991 ("Tyrolean Iceman") has, for the first time in history, given scientists a chance to perform detailed anatomical, histological, and molecular investigations on the organs of a person from the Neolithic Age (5350-5100 B.P.). In the present study, tissue samples aseptically taken from the stomach and the colon of the mummy were utilized for DNA extraction, and the DNA was PCR-amplified, using primer pairs designed to bind to fragments of the 16s ribosomal RNA gene (16s rDNA) of a broad range of bacteria. The PCR products were cloned in plasmid vectors, and the recombinant clones (amplicons) were sequenced. The sequence data were finally used for scanning data libraries containing the corresponding sequences of present-day bacteria, to infer the putative ecophysiology of the ancient ones. The same procedure was repeated on some fragments of grass from the clothing found near the corpse. These fragments were taken as a control of the microbiological situation of the glacier. The results show that the flora of the Iceman's stomach is entirely composed of Burkholderia pickettii, an organism commonly found in aquatic habitats. The colon, on the other hand, contains several members of the fecal flora of humans, such as Clostridium perfringens, C. ghonii, C. sordellii, Eubacterium tenue, and Bacteroides sp. The Iceman's colon, however, was found to contain, rather unexpectedly, also some members of the genus Vibrio. The results are discussed in light of what is known about the preservation of microbial DNA at the Iceman's site and of previous parasitological studies performed on the Iceman himself and on human coprolites.

Animals↗
PubMed2000

Is screw divergence in femoral bone-tendon-bone graft fixation avoidable in anterior cruciate ligament reconstruction using a single-incision technique? A radiographically controlled cadaver study.

Interference screw fixation of patellar tendon bone-tendon-bone grafts for anterior cruciate ligament reconstruction has proven to be a method with high pullout strength if screw divergence is avoided. Twenty-four fresh-frozen cadaveric human knees were used to identify the ideal position for a portal and an optimal knee flexion angle to obtain parallel placement of screw and bone block. On all specimens, anterior cruciate ligament reconstruction was performed using a single-incision technique. In the first part of this study, screw placement was analyzed in the frontal plane. In the second part, screw placement was investigated in the sagittal plane, measuring the additional flexion required between femoral tunnel drilling (at 60 degrees of knee flexion) and screw insertion to obtain parallel screw placement. For both part I and II, image intensification was used. In the third part, femoral screw placement was carried out through a paraligamentous approach and with additional flexion of 10 degrees, 20 degrees, 30 degrees, 40 degrees, 50 degrees, and 60 degrees. This study shows that screw placement with minimal divergence in the frontal and sagittal planes can be achieved by inserting the screw through a nearly central portal and flexing the knee an additional 35 degrees to 40 degrees.

Aged↗
PubMed2000

Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers.

UNLABELLED: We conducted a randomized, controlled, crossover study to determine cervical spine motion for six airway management techniques in human cadavers with a posteriorly destabilized third cervical (C-3) vertebra. A destabilized C-3 segment was created in 10 cadavers (6-24 h postmortem). Cervical motion was recorded by continuous lateral fluoroscopy. The following airway management techniques were performed in random order on each cadaver with manual in-line stabilization applied: face mask ventilation (FM), laryngoscope-guided orotracheal intubation (OETT), fiberscope-guided nasal intubation (FOS-NETT), esophageal tracheal Combitube((R)) (Kendall-Sheridan, Neustadt, Germany) insertion (ETC), intubating laryngeal mask insertion with fiberscope-guided tracheal intubation (ILM-OETT), and laryngeal mask airway insertion (LMA). Afterward, maximum head-neck flexion (FLEX-MAX) and maximum head-neck extension (EXT-MAX) without manual in-line stabilization was performed to determine maximum motion. The maximum posterior displacement of C-3 and the maximum segmental sagittal motion of C2-3 were determined. There was a significant increase in posterior displacement for the FM (1.9 +/- 1.2 mm, P: < 0.01), OETT (2.6 +/- 1.6 mm, P: < 0.0001), ETC (3.2 +/- 1.6 mm, P: < 0.0001), ILM-OETT (1.7 +/- 1.3 mm, P: < 0. 01), LMA (1.7 +/- 1.3 mm, P: < 0.01), FLEX-MAX (3.7 +/- 1.9 mm, P: < 0.0001), EXT-MAX (1.8 +/- 1.7, P: < 0.01), however, not for FOS-NETT (0.1 +/- 0.7 mm). Posterior displacement was less for the ILM-OETT and LMA than for the ETC (both P: < 0.04). There were no significant increases in segmental sagittal motion with any airway manipulation other than with FLEX-MAX (-4.5 +/- 4.0 degrees, P: < 0.01). Posterior displacement was similar to FLEX-MAX for the OETT and ETC; however, it was less for the FM, FOS-NETT, ILM-OETT, and LMA (all P: < 0.01). Posterior displacement was similar to EXT-MAX for all airway manipulations other than for FOS-NETT (P: < 0.001). For cervical motion and the techniques tested, the safest method of airway management in a patient with a posteriorly destabilized C-3 segment is FOS-NETT. LMA devices may be preferable to the ETC. IMPLICATIONS: In the cadaver model of a destabilized third cervical vertebrae, significant displacement of the injured segment occurs during airway management with the face mask, laryngoscope-guided oral intubation, the esophageal tracheal Combitube (Kendall-Sheridan, Neustadt, Germany), the intubating and standard laryngeal mask airway; but not with fiberscope-guided nasal intubation. For cervical motion and the techniques tested, the safest airway technique with this injury is fiberscope-guided nasotracheal intubation. Laryngeal mask devices are preferable to the esophageal tracheal Combitube.

Aged↗
PubMed1998

Histological investigations on the Tyrolean Ice Man.

The 5,200-year-old Tyrolean Ice Man discovered in 1991 in the Otztal Alps is the world's most ancient known human glacier mummy. Histological investigation was aimed at 1) optimizing specimen preparation and 2) documenting the preservation state of (sub)cellular components. Minute pieces of frozen tissue were removed endoscopically from rib bone and cartilage, major blood vessels, oral cavity and alimentary tract, liver, spleen, diaphragm, respiratory system, femoral muscle and nerve, sympathetic trunk, brain, and skin. Double fixation with glutaraldehyde followed by osmium tetroxide and embedding in Epon/Araldite epoxy resins proved to be the method of choice for both light and transmission electron microscopy combined with classical histochemistry. In particular, mild evacuation of the desiccated tissue was determined to be essential to ensure homogeneous infiltration with fixatives and resins; as a result, sections of excellent quality could be obtained with any kind of sample. With regard to the preservation degree of (sub)cellular components, distinct tissue-specific patterns were observed. There were highly intact skeletal and connective tissues proper, however, most interestingly, there were remarkably intact nervous tissue components as well. By contrast, epithelial, muscle, and reticular connective tissues as well as blood had generally disintegrated due to autolysis, freeze/thaw damage, and adipocere formation. For a tentative interpretation of these patterns, we considered general aspects of cryopreservation, such as physicochemical properties of subcellular constituents and tissue physiology.

Adult↗
PubMed1997

Otorhinolaryngologic computer-assisted biopsies of the Iceman.

BACKGROUND: The Iceman is a prehistoric, completely preserved, 5300-year-old male human mummy. OBJECTIVE: To obtain the first biopsy specimens from inside the Iceman while meeting an extended standard of hygiene and following precise intraoperative guidance to the site of biopsy and keeping tissue damage to a minimum. DESIGN: Biopsy specimens from the nose, the maxillary sinus, and the larynx of the Iceman were obtained. Special caution had to be taken while performing the biopsies to not contaminate the Iceman with heavy metals or remnants of microorganisms. SUBJECT: The Iceman, a cadaver kept frozen in a glacier for 5300 years. The Iceman is in an excellent state of preservation and will allow fundamental histological, morphological, and molecular genetic insights into early man. INTERVENTION: The biopsies were planned and executed with the aid of Interventional Video Tomography, a system that guides the surgeon to the target area by combining live video with existing imaging modalities. The system does not need mechanical fixation of the subject (the Iceman) and is barely in physical contact with the subject; thus, it was the ideal tool for guiding the surgeon to the site of the biopsy samplings through a tiny canal into the nose, the maxillary sinus, and the larynx of the Iceman. RESULTS: We have obtained a number of tissue samples by precisely guided 3-dimensional navigation. Unnecessary tissue damage was avoided. CONCLUSIONS: Visual inspection of the extracted mucosa showed typical human cadaver tissue, despite its age, without clinical abnormalities. Currently, the samples are being investigated by various international scientific groups.

Animals↗
PubMed1997

[Wound margin necroses after open calcaneal reconstruction. Anatomical considerations of surgical approach].

Skin and soft tissue necrosis of the heel are the main problems following open reposition and fixation of calcaneal fractures. In order to demonstrate how the classic approaches harm the supplying vessels, the classic medial, lateral, enlarged lateral and bilateral approaches have been simulated in ten lower limbs prepared by arterial latex injection. Bases on anatomic literature and on these findings, we have proposed two modified approaches that minimize damage to the vessels of the adjacent soft tissues yet allow exact reposition of the fractures.

Arteries↗
PubMed1995

Fiber orientation of posterior cruciate ligament: an experimental morphological and functional study, Part 2.

The posterior cruciate ligament (PCL) can be anatomically divided into three bundles: anterolateral, posteromedial, and posterior oblique. The changes in distance between the femoral and tibial attachment sites of these three bundles were measured in 10 human knee specimens with intact ligamental structures. The femoral to tibial distance (and thus the length) of the posterior oblique bundle remained nearly the same throughout flexion between 0 degrees and 90 degrees. The femoral to tibial distance of the anterolateral and the posteromedial bundles distinctly changed throughout the same range of motion. For a truly functional replacement of the PCL, correct isometric placement of the transplant is especially important. Based on the results of the present study, an isometric reconstruction of the PCL is achieved by positioning the graft within the original attachment site of the posterior oblique bundle.

Humans↗
PubMed1989

[Anatomy of the cruciate ligaments in CT].

The morphological foundations of CT-imaging of the cruciate ligaments in 4 different positions of examination are presented comparing roughly identical anatomical sections with CT-scans. Several parts of the cruciate ligaments, such as origin, course and insertion can be viewed in different CT-planes.

Adult↗
PubMed1988

[Arterial blood supply of horseshoe kidneys with special reference to percutaneous lithotripsy].

The arterial blood supply of six horseshoe kidneys has been examined in respect to percutaneous lithotripsy, i.e. puncture of the renal pelvis in its dorsolateral aspect including nephroscopic extraction of renal calculi. The blood supply of horseshoe kidneys is presupposed by evolution. Besides the definitive renal arteries there are accessory arteries which may be regarded as persistent mesonephric arteries. We distinguish between proper accessory arteries entering the horseshoe kidney at its hilum and aberrant accessory arteries which reach either the upper extremities or the zone of fusion. The latter derive form the abdominal aorta or the bifurcation respectively, the common iliac arteries, the left renal artery, the inferior mesenteric artery or the median sacral artery. Despite the variability of the renal arteries we didn't find any larger vessels in the area of puncture. The anatomical investigations showed that there is no increased risk of hemorrhage performing percutaneous lithotripsy on horseshoe kidneys. During the last two years 8 patients with horseshoe kidneys have been operated because of relapsing calculi using this method, showing no intra- or postoperative complications.

Humans↗
PubMed1987

[Alternative surgical method in pseudarthroses of the scaphoid bone. Prospective study].

Follow-up of 197 patients with scaphoid nonunion treated by Russe I and Russe II bone grafting procedures showed that in longstanding cases with pseudarthrosis and in cases with severe necrosis bony union is often not achieved. The reason for this lack of success is the bad vascularity of the damaged scaphoid. In these cases (25 cases performed over 19 months) with an unfavorable operative prognosis we have inserted into the scaphoid after resection of the pseudarthrosis or the necrotic bone, a corticocancellous graft from the iliac crest, isolated on its vascular pedicle. The vascular pedicle has been anastomosed under the microscope to the radial artery and one of the accompanying veins. This procedure guarantees a much better vascularity of the bone graft. Our results in the 25 cases are very encouraging. Possible complications and their avoidance are pointed out. This new operative technique should not replace other common procedures but it might be the treatment of choice in selected cases.

Adult↗
PubMed1986

The ulnar nerve as vascularized nerve transplant. Part I: Anatomy: arterial vascular supply.

The ulnar nerve is supplied basically by the arteries accompanying it in its various locations: in the axillary section, by a branch of the lateral thoracic artery or directly by the axillary artery; in the upper arm, by branches originating from the collateral ulnar superior artery; in the supracondylar section and in the region of the groove for the ulnar nerve, by branches originating from the anastomosis of the collateral arteries and the posterior branch of the recurrent ulnar artery; and in the forearm, by branches of the recurrent ulnar artery and the ulnar artery. Venous return is by the venae comitantes. Since the ulnar nerve possesses a good arterial supply, it may be used with different techniques as a vascularized nerve transplant in traumatic lesions of the brachial plexus, to repair more important missing nerve paths.

Axilla↗
PubMed1985

[The vascularization of the menisci. Morphological basis for the repair].

Degeneration of the knee joint and increase of anterior-posterior tibial displacement are resulting from total meniscectomy, especially in knees with anterior cruciate deficiency. Vascularisation of the meniscus was studied in 12 cadaver knees after latex injection of vessels. Vascularisation of the anterior and posterior horns was found to be much better than that of the body of meniscus. All vessels originated from the popliteal artery, but variably in importance, and formed the perimeniscal and subsynovial network. 11 peripheral meniscus tears (8 freshly injured, 3 ruptures older than 2 months) were repaired by refixation, followed by immobilisation for 6 weeks. Arthroscopy 3 months postoperatively showed complete healing of all tears. Clinical examinations--follow-up for 14 months--showed no signs of rerupture in any of the patients.

Cartilage, Articular↗
PubMedDate not supplied

Man from the Hauslabjoch.

On September 19, 1991, at an altitude of 3,200 m (10,498 feet), the remains of a well-preserved, freeze-dried mummified body of a 3,000 BC, Late Stone Age man, was found on the Austrian-Italian border. Studies conducted at the University of Innsbruck have revealed that these are the remains of a 45-46-year-old male, 45 kg (99 lbs) (living weight) and 160 cm (5 feet, 2 inches) tall. Morphometric, pathophysiologic, paleobotanical, photogrammetric, anthropological, computer tomographic, and other studies have been conducted to determine the living conditions and possible causes of death of this Late Stone Age man.

Animals↗