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Biomedical subjects

R E Horch

Publications and source records attributed to R E Horch.

At least 19 recordsLinked to original sources
PubMed2006

[The importance of vacuum therapy in the treatment of sternal osteomyelitis from the plastic surgeons point of view].

BACKGROUND: Since its introduction in 1997 the vacuum assisted closure therapy has gained widespread and is for its indications international accepted. It is also well established in the treatment of sternal infections a dreaded complication after median sternotomy in cardiac surgery. The well known positive effects of the vacuum therapy act as a dignified cleaning procedure between debridement and plastic coverage or as a temporarily closure method if the first debridement was properly not sufficient. METHOD AND PATIENTS: Between January 2003 and December 2005 twenty eight patients with advanced sternal infection after median sternotomy were treated by radical debridement, vacuum assisted closure therapy and definitive plastic coverage by muscle flaps. In this article three patients are exemplarily introduced. RESULTS: In all patients a sufficient plastic coverage was achieved after radical debridement an vacuum assisted closure therapy. The patients received a pedicaled muscle flap. Stable wound condition with no signs of a recurrent sternal infection were observed in all patients. DISCUSSION: Vacuum assisted closure therapy acts as a link between radical Debridement and definitive plastic coverage in prolonged sternal infection after median sternotomy. Before the invention of V.A.C.(R) dressing changes were obliged every day in patients with deep sternal infection. The V.A.C.(R) therapy reduces the frequency of this painful dressing changes significantly and on this behalf makes life more comfortable for this mostly multi-morbid patients.

Aged↗
PubMed2006

[Optimizing vacuum therapy in extensively undermined wounds].

INTRODUCTION: Extensively undermined wound cavities represent a common surgical problem. By a modified vacuum therapy the healing of such wounds can be accelerated. MATERIALS AND METHODS: Based on our experience in selected cases with wound healing disorders or extremely undermined wounds following degloving injuries or abscess formations the application of topical negative pressure therapy to fix wound margins to the wound ground while at the same time allowing exudates emission with additional drainages is described. RESULTS: In 5 patients we were able to demonstrate the efficacy of vacuum dressing system described here with successful and lasting adaptation of the wound margins to the defect. All wounds were brought to permanent healing. CONCLUSION: Extensive tissue degloving and wound healing disorders after excessive tissue mobilization during plastic surgical defect coverage can be treated successfully with topical negative pressure therapy (TNP). Whereas longterm complete conventional polyurethane foam lining of wound cavities is an effective method and may be necessary in special situations, the application of TNP can lead to a firm adhesion of wound margins in extensive subcutaneous or epi-fascial wounds to the undersurface. To avoid exudate formation in the adjoining tissue TNP can be effectively optimized by the placement of drainage tubes into the surrounding tissue.

Abdominal Wall↗
PubMed2006

[Vacuum-assisted closure as temporary coverage in the "problem zone hand"].

INTRODUCTION: Vacuum therapy of hand defect problematic due to the interdigital folds and in particular due to the small surface. As a temporary cover in staged procedures, e. g. following excision of tumor-suspicious skin alterations at the hand, and/or at the fingers, the application of vacuum therapy results not only in a sterile, temporary cover of the wound, furthermore it promotes wound conditioning and reduction of the wound area as well as lymph and edema reduction. PATIENTS AND METHODS: A 75 year old female patient presented herself with a skin alteration at the right dorsal ring finger and the tentative diagnosis of a Morbus Bowen like lesion was raised. Due to the unclear histological status, a staged procedure with excision of the tumour and temporary defect coverage by means of vacuum therapy until final histological evaluation was indicated. We accomplished the radical excision of the unclear skin tumour at the proximal phalanx under preservation of the synovial sheath of the tendon. Subsequently, the wound was temporarily closed with vacuum therapy. Histological examination revealed the complete removal of a solar keratosis. Finally, after 7 days of vacuum therapy as a sterile dressing, with obvious reduction of wound area and simultaneous decrease of edema, the defect was finally covered with a reversed cross finger flap from the adjacent middle finger. The donor site was covered with a full thickness skin graft harvested from the right forearm. The further course was without complication after flap dissection and complete healing. DISCUSSION: Vacuum therapy represents a usefull procedure for temporary wound coverage. Especially at hand defects, when nerves, tendons or bones following trauma or staged procedures are exposed, vacuum therapy can be successfully applied utilizing the special surgical "hand glove" technique.

Aged↗
PubMed2006

[Interdisciplinary management of complex chronic ulcers using vacuum assisted closure therapy and "buried chip skin grafts"].

HISTORY AND ADMISSION FINDINGS: We report the case of a 68-year-old female patient who was admitted to the hospital with deranged blood sugar levels in a septic condition. Due to complex chronic ulcerations of both feet she was intended for major amputation of both limbs. Clinical findings on admission were a diabetic foot syndrome with stage D IV ulcerations according to the Wagner and Armstrong classification, partially visible tendons and phlegmon of the lower leg. INVESTIGATIONS AND CLINICAL COURSE: Vascular diagnostic revealed arterial occlusive disease in the lower legs without chance of reconstruction. Enterococcus faecalis and Staphylococcus aureus were extracted in swabs from ulcers. After correction of metabolic status and antibiotic treatment radical débridement of all ulcers was carried out and vacuum assisted closure therapy (V.A.C.) was initiated. All wounds showed good granulation tissue after four cycles of V.A.C.-therapy. Interdisciplinary treatment with a plastic surgeon was initiated to accelerate epithelial closure. Using the "Buried Skin Chip" technique in combination with V.A.C.-therapy epithelialisation was completed within four weeks. The patient recovered well and was fully independent on discharge. DISCUSSION AND CONCLUSION: A goal-oriented interdisciplinary setting can achieve preservation of extremities even in septic patients. The combination of buried skin chip grafts and V.A.C.-therapy may be a feasible and promising procedure to achieve accelerated wound closure in those patients.

Aged↗
PubMed2006

[Changing paradigms in reconstructive surgery by vacuum therapy?].

In modern science the changes of scientific paradigm occur constantly and often unnoticed. Effects of new therapy procedures that are not compatible with the prevailing doctrines first lead to contradictory discussions and may then lead to new doctrines depending upon the general perception. Continuous computer-assisted local negative pressure therapy (vacuum assisted closure therapy/V.A.C., topical negative pressure treatment) has led to unexpected and impressing clinical results since its introduction. This has provoked a recognizable change of different therapeutic concepts in reconstructive surgery. Based on a selection of important clinical examples from reconstructive surgery following a current literature research the attempt is undertaken to point out recognizable changes of paradigms within the treatment algorithms that can be discerned after the the introduction of vacuum therapy in recent years.

Brachytherapy↗
PubMed2006

[Vacuum assisted closure (V.A.C.) therapy is an essential tool for treatment of complex defect injuries of the upper extremity].

INTRODUCTION: Complex injuries of the upper extremity remain a therapeutic challenge. The prognosis of the damaged extremity is often limited by soft tissue defects. Vacuum Assisted Closure (V.A.C.) therapy facilitates temporary coverage of soft tissue defects prior to surgical reconstruction. METHODS: In a retrospective study all patients with complex defect injuries of the upper extremity that were treated by V.A.C. prior to reconstruction between August 2003 and September 2005 were analyzed. RESULTS: 7 patients (6 male, 1 female, 14-70 years) were included in the study. The patients suffered from subtotal upper arm (n = 1) and forearm (n = 1) amputation, complex multilevel amputation injury of the forearm (n = 1), slash wound of the forearm with skin defect and discontinuity of all volar structures (n = 1), complex open forearm fractures with skin and soft tissue defects (n = 2), and almost complete necrosis of the flexor compartment following distal radius and proximal ulnar fracture and compartment syndrome (n = 1). Stabile defect coverage was achieved in all patients following V.A.C. therapy by myocutaneous free flaps (n = 2), split thickness skin grafts (STSG) (n = 2), sequential secondary suture (n = 1), and STSG + secondary suture (n = 2). Wound conditions improved significantly under V.A.C. therapy. 5 patients reported pain relief following induction of V.A.C. therapy. Due to reduction of tissue oedema secondary suture was facilitated in 3 patients. DISCUSSION: V.A.C. therapy represents an essential tool for treatment of complex injuries of the upper extremity with extended soft tissue defects. Decreased frequency of dressing changes as well as reduced tissue oedema considerably improved patient's comfort. Posttraumatic compartment syndrome or skin necrosis, which are often associated with macro amputations of the upper extremity, are efficiently treated with V.A.C., and secondary sutures may be performed despite initial skin defects.

Adolescent↗
PubMed2006

[Application of V.A.C.-therapy during plastic surgical treatment of a bifocal Marjolin ulcer].

Marjolin ulcers are scar carcinomas most often found in old instable burn scars, the majority histopathologically characterized as squamous cell carcinomas. Surgical therapy includes radical excision and subsequent defect closure. We report about a 69 year old patient suffering from two scar carcinomas on the right cheek and right chest and abdomen due to an extensive infant burn injury. During a 2 stage procedure, both ulcers were initially excised and resulting soft tissue defects were closed temporarily by applying V.A.C. therapy. During a second procedure defect closure on the right cheek was achieved by using a free radial forearm flap following neck dissection. Additionally, the extensive defect including chest and abdominal wall as well as the flap donor site on the left forearm were covered with split thickness skin grafts and subsequently secured by applying V.A.C. therapy for 5 days. 13 days later, the patient was discharged from our clinic. All skin grafted areas as well as the free flap were stably healed. Our report demonstrates that the application of vacuum therapy is not only useful during temporary closure of large wound sites but also secures healing of large and critical areas grafted with split thickness skin grafts in tumour patients.

Abdominal Wall↗
PubMed2006

[Distal extremity reconstruction for limb salvage in diabetic foot ulcers with pedal bypass, flap plasty and vacuum therapy].

There are numerous factors resulting in tissue damage and foot ulcers in diabetic patients. Critical ischaemia should be routinely excluded and an examination of the limb perfusion must be done in all cases with clinical suspicion of reduced perfusion. Pedal bypass grafting procedures in combination with flap plasty techniques achieve good results in patients with non-healing diabetic ulcers. Timing of the procedure is essential to avoid progression of gangrene. Good results of pedal bypass grafts support an indication at an early stage. Vacuum assisted wound therapy and local wound surgery can be done first to prepare patients with septic foot lesions for two-staged procedures.

Angiography, Digital Subtraction↗
PubMed2006

[Vacuum-assisted closure (V.A.C.) of disastrous wound conditions in Madelung disease].

INTRODUCTION: A 54 year old patient presented with a Madelung disease. Symmetrically fatty deposits were present on both upper arms, at the abdomen and both thighs. Dermatitis was seen in the axillary fold at the skin bearing surfaces. Shoulder movement was impaired. Liposuction of both upper arms has already been performed, but no significant improvement was obtained. METHODS AND RESULTS: We performed a dermolipectomy of both upper arms. Postoperatively the patient suffered from a severe wound dehiscence with fulminant wound infection and septic clinical condition. Because of the large wound surface ((1/3) of the upper arm circumference) anemia occurred and had to be treated with blood transfusions. Wound exsudation caused a general hypoproteinemia. Multiple surgical debridements were necessary in order to clean the wound from necrotic tissue and afterwards moist dressings were applied. Furthermore the patient received intravenous antibiotic treatment. After stabilisation of the general condition of the patient and the wound situation a polyvinyl sponge and a vacuum-sealing were applied and continuous suction was performed (125 mm Hg). This resulted in a significant improvement of the wound situation in regards to wound cleaning, induction of granulation tissue, diminished wound size, reduction of oedema and pain reduction. After four weeks of vacuum therapy defect coverage was possible and split thickness skin grafting was performed. The skin graft was attached to the wound using a vacuum-dressing. After removal of the vacuum dressing on the fifth day the skin graft has completely healed. DISCUSSION: Vacuum therapy is suitable for disastrous wound conditions in order to achieve a defect size reduction, pain reduction and create a clean wound with granulation tissue for further surgical defect coverage using skin grafts or flaps.

Arm↗
PubMed2006

[Modified gloving technique for vacuum therapy in the hand].

INTRODUCTION: During the last 10 years sub-atmospheric pressure dressings (Topical Negative Pressure Therapy = TNP) has become a well accepted standard therapeutic modality in the management of acute and chronic wounds. However, in the hand and the fingers TNP treatment is not as an established method as elsewhere in the body. This is mostly due to difficulties in the technique of sealing wounds near the interdigital folds, especially when the interdigital folds are affected themselves. MATERIALS AND METHODS: Over a period of 36 months we treated 9 extensive open wounds of the hand with the TNP dressing procedure. To optimize the effective sealing procedure several methods of closure were applied: sterile vinyl gloves, split V.A.C. gel-straps and the "Sandwich"-principle. RESULTS: In all cases we were able to achieve a tight vacuum sealing with the use of our vinyl or latex free surgical glove as an aid to cover the interdigital spaces. There was a rapid and complete remission of the symptoms in terms of edema, redness, tenderness and range of motion. The indication spectrum encompassed infection control, temporary coverage of exposed bone or tendons, intermittent irrigation with local antiseptics as well as wound preconditioning before skin grafting or flap coverage. For the definite closure or coverage a second operation was necessary in all cases. CONCLUSIONS: The TNP-dressing can be securely achieved even in wounds encompassing the interdigital folds or adjacent to the in digital spaces with a modified surgical gloving technique to aid the standard sealing foil. It is a suitable principle for the management of severe hand infections with a reduction of clinical symptoms, reduction of the frequency of dressing changes compared to open approaches and a significant amelioration in the quality of life both for patients and health care personnel.

Amputation, Surgical↗
PubMed2006

[Use of vacuum therapy in a huge arterialized venous flap to reconstruct a complete avulsion of a thumb].

Arterialized venous flaps are normally raised from the anterior and distal third of the forearm by integration of a venous pathway. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. Following transposition to the recipient site one vein is linked to a nourishing artery while the other veins are connected to one or more regional veins. The atypical blood perfusion and the delayed opening of intervenous shunts may result in edema, epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. We report the salvage of an atypically raised oversized arterialized venous flap for total soft tissue reconstruction in a complete avulsion of a thumb. By applying V.A.C. therapy atypical perfusion and early intervenous shunt formation was treated successfully, resulting in stable healing and survival of the flap.

Aged, 80 and over↗
PubMed2006

[Reconstruction of tumor induced defects in head and neck surgery with individualized prefabricated three dimensional flaps with the use of continuous vacuum therapy].

Despite recent developments in oncologic head and neck surgery extensive tissue and functional defects following radical tumor resections remains a surgical challenge. Individually prefabricated free flaps to meet the needs of the functional defect can be generated with the help of continuous computer-assisted vacuum therapy. This accelerates the pre-fabrication of three-dimensional composite flaps and enhances therapeutic safety. Changes of the genuine structure of such flaps are induced by implantation of autologous or heterologous transplants alone or in combination with alloplastic materials as a supportive element. Application of vacuum therapy is useful to accelerate the process of pre-fabrication by the induction of angiogenesis. Besides this the continuous removal of wound exudate, possible seroma or haematoma and secondary compression of the different tissue layers improve the modelling of the three-dimensional construct. This article describes the technique of vacuum therapy for the pre-fabrication of three-dimensional pedicled or free flaps for reconstruction of defects after tumor resection in the head and neck area.

Absorbable Implants↗
PubMed2006

[Prevascularisation strategies in tissue engineering].

INTRODUCTION: Experiments on animals have underlined the importance of vascularisation for biointegration and functionality of any given tissue engineering device. The aim of this investigation was to dissect the angiogenetic process in the frame of axial neovascularisation of a xenogenic solid matrix. The ultimate goal of this series of studies is the application of cells onto a prevascularised matrix, with the ambition to enhance cell survival after transplantation in vivo. MATERIALS AND METHODS: We performed a study in the rat with different vascular configurations in an isolation chamber. A disc-formed biogenic hard matrix (9 x 5 mm) was encased into an isolation chamber made of Teflon. In group 1, an arteriovenous fistula (AV loop) between the femoral vessels was microsurgically constructed and was placed around the matrix (n = 15). In group 2, the vascular carrier had the form of an arteriovenous ligated pedicle (n = 15). Evaluation intervals were two, four and eight weeks after implantation. The modes of evaluation included histology, scanning electron microscopy of corrosion casts as well as intravital micro-magnetic resonance imaging (MRI). RESULTS: The arteriovenous loop as vascular carrier revealed a higher capacity for angiogenesis over the bundle configuration. The neo-fibrovascular tissue displayed minimal inflammatory elements but dense vascularisation. Scanning electron microscopy demonstrated a vivid angiogenesis with rapid evolution of the vascular bead into mature, hierarchically organised network. Micro-MRI could be used for serial investigation in terms of flow measurements and detection of thrombosis. DISCUSSION: The presence of a vascular bed prior to cell transplantation might protect against hypoxia-induced cellular death, especially at central portions of the matrix, and therefore ensure physiological function of the device. The generation of vascularised bioartificial tissue substitutes might offer new modalities of surgical reconstruction for use in reparative medicine.

Animals↗
PubMed2005

Reduction mammaplasty for benign phyllodes tumour in an adolescent female--a 13-year follow up.

Phyllodes tumours are rare neoplasms of the female breast, especially among adolescent women. We present the case of a 17-year old female patient with a large benign phyllodes tumour. The patient was treated by one-stage excision with reduction mammaplasty. Symmetry of breast contour and nipple-areola complex position could be restored. At follow-up after 13 years good cosmetic result was maintained and there was no evidence of local recurrence. Standard plastic surgical techniques like reduction mammaplasty might be applied in treating large benign tumours compromising the aesthetic aspect of the breast.

Adolescent↗
PubMed2005

The free vastus lateralis flap for reconstruction in ablative oncologic head and neck surgery.

AIMS: The vastus lateralis muscle is an accessory extensor for the knee suitable as a free myocutaneous flap in reconstructive head and neck surgery. We report the use of this muscle as a flap. METHODS: We have used the free myocutaneous vastus lateralis flap for reconstruction following ablative head and neck tumour surgery in six patients. The clinical outcome, time of surgery for flap preparation and anatomosis, follow-up and functional outcome were analysed. RESULTS: Five of our patients showed a very satisfactory functional and cosmetic outcome. Post-operatively, there was no prolonged immobilisation and no limitation of movement to the hip and knee. No unfavourable side-effects at the donor side were noted. CONCLUSIONS: We find this flap a very useful addition to our free myocutaneous flap armamentarium. It has a specific suitability for replacing large defects.

Aged↗
PubMed2005

[Indications and safety aspects of vacuum-assisted wound closure].

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Contraindications↗
PubMed2005

The composite vastus medialis-patellar complex osseomuscular flap as a salvage procedure after complex trauma of the knee--an anatomical study and clinical application.

BACKGROUND: In the setting of severe perigenicular trauma or complicated endoprosthetic knee surgery, primary knee fusion may be the last resort for salvage of the limp. In this case, the patella looses its destination as an anterior knee stabilizer and can become a substantial donor of bone substance, especially if osseous defects are involved. PATIENTS AND METHODS: 12 formalin fixated cadavers were studied in terms of vascular anatomy, pedicle reliability, arc of rotation and their relation to sex, age, and height. Moreover, the operation was performed on a suitable patient. RESULTS: The quadriceps with the vastus medialis and the patella can be raised from the tibial tuberosity up to the entrance of the osteoarticular branch of the superficial femoral artery into the vastus medialis muscle ca 16 cm (15-19 cm) from the inferior patellar pole. This distance correlated well to the overall height of the cadavers (P=0.009). The vascular prerequisites were always present. In the clinical case, there was a favorable outcome with knee fusion after 4 months, despite of the lateral condylar defect. DISCUSSION: The composite vastus medialis-patellar complex osseomuscular flap can be safely used as a source of vascularized femoral condyle substitute in the setting of primary knee fusion.

Arteries↗