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Biomedical subjects

R G Baumeister

Publications and source records attributed to R G Baumeister.

At least 19 recordsLinked to original sources
PubMed2000

[Possible variations of free autogenous jejunum transplantation for differential reconstruction of the oropharynx].

INTRODUCTION: Resections of extensive tumours, recurrences and radiodermatitides at the neck cause complex defects. Free bowel transplantation enables one-stage reconstruction. PATIENTS AND METHODS: In 35 out of 57 interdisciplinarily treated patients, small-bowel transplantation was performed for reconstruction. Thirty patients received cylinder grafts, five jejunal patch plastics. In four patients neoglottis formations according to Ehrenberger were performed. To cover soft tissue defects, two patients received scapular free flaps, eight patients a jejunal segment, incised at the anti-mesenteric side, the mucosa stripped and covered by a split skin graft. RESULTS AND CONCLUSIONS: Thirty-four grafts were viable. One patient received a successful re-transplantation. One postoperative fistula at the hypo-pharyngojejunostomy was closed by a separated jejunal segment which was primarily used as monitor, two others by pectoral flaps. Separation of a jejunal graft into two or three segments enables restoration of swallowing, voice and covering soft tissue in a one-stage procedure. The whole reconstruction necessitates only one arterial and one venous microanastomosis at the neck.

Adult↗
PubMed1999

[Use of pedicled greater omentum-plasty as thoraco-abdominal defect repair following extensive tumor resection].

Patients suffering from long-untreated malignomas of the chest or abdominal wall may require plastic surgery due to extensive defects after tumor resection. Despite a variety of pedicled or free myocutaneous flaps, there are defects in which these reconstructional options may not be indicated. In these patients, the omental flaps are a valid alternative. Since a secondary split skin graft is mandatory with the omentum flap, antibacterial and granulation-enhancing xerodressings are required for wound bed conditioning. We report one patient in whom the omentum flap was used for coverage of an extensive defect after resection of a widespread basal cell carcinoma at the lateral thorax and abdominal wall. After wound conditioning with silver-impregnated activated charcoal xerodressing (Actisorb) in combination with a hydroactive polymer dressing (Allevyn), secondary skin grafting was performed. In this patient fibrosis and calcification of the omentum led to stable abdominal wall coverage even without the application of a synthetic mesh.

Abdominal Neoplasms↗
PubMed1999

Secondary ischaemia in experimental free flaps--treatment by long acting prostacyclin analogues.

Secondary postoperative ischaemia due to venous occlusion is the most detrimental insult to free microvascular flaps. In an experimental rat free flap model the efficacy of long acting prostacyclin analogues iloprost (Ilomedin) and cicaprost in venous occlusion induced postoperative ischaemia was studied. Free, microvascular groin flaps were transplanted to the neck and the draining veins were temporarily occluded on the first postoperative day for a total of 20 min. In the untreated control group, haemorrhagic flap necrosis occurred. Intravital microscopy after secondary ischaemia revealed flap areas without reperfusion. The functional vessel density was significantly reduced. Reperfused capillaries were tortuous and significantly dilated. After reperfusion the interstitial leakage of macromolecular dextran increased, indicating loss of microvascular endothelial integrity. Intraarterial and intravenous applications of iloprost were able to diminish the ischaemic effects, giving a flap survival rate of 83%. Similar results were obtained by intravenous and enteral administration of cicaprost. Transcutaneous oxygen partial pressure measurements confirmed the viability of the surviving flaps. We conclude that both iloprost and cicaprost are effective in preventing venous occlusion induced failure of free microvascular groin flaps.

Animals↗
PubMed1999

Liposuction technique and lymphatic lesions in lower legs: anatomic study to reduce risks.

Liposuction is a standard procedure in plastic surgery. Especially, lipectomy with suction of the lower extremities has been of greater interest in recent years. Until now, however, there was no definite information about the integrity of epifascial lymph collectors during this procedure. To study the effect of liposuction devices on lymph vessel injury, postmortem lymphatic preparations were done in five human cadavers (10 lower extremities). Conventional liposuction with a blunt 4-mm cannula and a dry technique was used. Adiposuction was performed either in parallel to the extremity axis and, therefore, in parallel to the superfascial lymph vessels or transversally in an 80- to 90-degree angle to the extremity. Careful surgical preparation of the regions followed. A specific macroscopic lymph vessel injury score was applied to differentiate 3 degrees of lymph vessel lesions according to the extravasation of patent blue. In all lower extremities, postmortem lymph flow occurred as indicated by patent blue staining of the lymph vessels. Lymph vessel injury was more severe in areas where liposuction was performed transversally, vertical to the extremity's axis, than in those after a longitudinal procedure. The difference was statistically significant (p < 0.01). The volumes of adipoaspirate and of the compared regions were comparable between both groups, verified by circumference measurements. Longitudinal liposuction of the lower extremities is unlikely to cause major lesions of epifascial lymph vessels and, therefore, should be preferred in comparison to liposuction vertical to the extremity.

Aged↗
PubMed1997

[Examination of the hand and wrist joints with a dedicated low-field MRI device].

Purpose of this study was to evaluate the diagnostic value of a low field dedicated MRI system in hand and wrist imaging. All 308 exams of the hand and wrist, that were performed on a low-field dedicated MRI system (Artoscan, Esaote Biomedica, Italy) in our institution in 1996, and high-field MRI exams performed in addition as part of the diagnostic work-up, were evaluated and correlated to final operative (n = 64) and histologic (n = 12) reports. 90% of all low-field MRI scans stated a diagnosis according to clinical suspicion. In 62% the clinical question was answered, and in 26% additional pathologies were identified. An MR-diagnosis completely different from the clinical suspicion was stated in 2%. High field exams contributed additional information in 6 of 36 patients. In 3 patients a tumor was not shown completely in the limited field-of-view of the dedicated low-field MRI-system. Frequency-selective fat-suppression pulse sequences and a better spatial resolution were the reasons for the additional information obtained in the other three patients. Low-field dedicated MR-imaging is a valuable method in the extensive work-up of the hand and wrist. Osseous, ligamentous and tendinous pathologies are well depicted. Large or infiltrative tumors should be referred to a high-field system.

Adolescent↗
PubMed1997

[Expanding the indications spectrum for breast saving therapy of breast carcinoma by oncoplastic operations].

Esthetically unfavorable results may occur in 15%-20% after breast-conserving therapy for breast carcinoma. With increasing experience, plastic reconstructive techniques have evolved for reconstructing even large parenchymal defects after segmentectomy or in adverse tumor sites with esthetically reliable results. This had led to an expansion in the indication for breast-conserving therapy.

Adult↗
PubMed1996

Microsurgical reconstruction of the lymphatic and nerve system in small bowel transplantation: the rat model, first results.

The goal in tissue transplantation is the restoration of all natural (physiological) communication pathways between the host and the graft. To this end, the effects of microsurgical reconstruction of artery, vein, lymphatic vessel, and nerve during grafting were investigated. Allogenic (MHC class II incompatible) and isogenic orthotopic (graft in functional continuity) small bowel recipients with immediate microsurgical lymphatic and nerve anastomosis were observed clinically as well as by immunological and histological examination. To explain the influence of the lymphatic system in allograft survival, short-term therapy was applied with the immunosuppressant cyclosporin A (10 mg/kg i.m.) for only 5 postoperative days. Average allograft survival ended in the control group after 10 days without any therapy, increased up to 20 days after immunosuppressive therapy (in both groups acute rejection and graft-versus-host disease were seen) and increased further to more than 200 days following lymphatic connection of the host and the graft during allografting. In this group no lymphatic edema of the graft was seen. To determine the optimal location of nerve anastomoses between the host and the graft without irritating the host nerve system, isografts in the same model were investigated. No paralysis of graft neighboring tissues was seen when the last ganglion function, and its following nerve plexus, of the host is saved. Nerve reconstruction must be undertaken after this last crossing of regional nerve fibers before entering the organ. The same rule is effective for organ explantation.

Anastomosis, Surgical↗
PubMed1996

[Choice of procedure in therapy of distal median nerve compression syndrome].

Endoscopic carpal tunnel release is frequently recommended. This technique allows only for division of the retinaculum flexorum, but does not enable the surgeon to address concommitant synovialitis or compression of the motor branch of the median nerve. In 67 patients, we attempted to differentiate the indications for procedures by endoscopic versus open carpal tunnel release. Beside an electrophysiological investigation, sonography of the wrist was performed to evaluate the extent of accompanying tenosynovialitis of the flexor tendons. A possible participation of the thenar branch was examined by electromyography. If there were no additional pathologic findings in the preoperative diagnostic work-up, a simple carpal tunnel release was performed. In all other cases, open surgical release was performed.

Adult↗
PubMed1996

[Lymphoscintigraphy for non-invasive long term follow-up of functional outcome in patients with autologous lymph vessel transplantation].

AIM: Autologous lymph vessel transplantation significantly improves the lymphdrainage in patients with primary and secondary lymphedema. The aim of the present study was to answer the question, whether scintigraphic long-term follow up and semiquantitative evaluation of lymphatic flow could prove the persisting success of this sophisticated microsurgical technique. METHODS: In this study visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients (17 females, 3 males) comparing a preoperative baseline study with postoperative follow up investigations for a period of 7 years. The reason for microsurgical lymph vessel transplantation was in 4 patients a primary and in 16 patients a secondary lymphedema. In 12 cases the transplantation site was at the upper extremity, in 8 cases at the lower limb. RESULTS: In 17/20 patients lymphatic function significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvement of lymph drainage and decrease of a numeric transportindex. In 5 cases the vessel graft could be directly visualized. In these patients with scintigraphic visualization of the vessel graft the transportindex decreases to a significantly greater extent compared to the preoperative baseline study. Only 3 patients did not benefit from microsurgical treatment CONCLUSION: Lymphoscintigraphy combined with semiquantitative estimation of lymphatic transport kinetics has shown to be an easy, reliable and readily available technique to assess lymphatic function before and after autologous lymph vessel transplantation. Thus, the method is not only helpful in planning microsurgical treatment but also in monitoring the postoperative improvement of lymph drainage. Patients with scintigraphic visualization of the vessel graft showed a significant better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding to lymph drainage.

Adult↗
PubMed1994

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation.

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radio-scapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.

Adolescent↗
PubMed1993

Free flap survival improved by prostacyclin analogues.

Free flap transplantations and replantations of extremities are threatened by venous occlusion in the postoperative course. In rats, free autogenous groin flaps were transplanted to the neck using microsurgical techniques. On the first postoperative day, the draining vein of the flap was temporarily clamped. In the control group there was always a total loss of the flaps by haemorrhagic necrosis. The intraarterial flap perfusion by iloprost during the clamping was able to diminish the ischaemic effects; 80% of the flaps survived. The systemic application of iloprost by intravenous infusion reduced the ischaemic effects in a similar way. Serious complications such as intraabdominal bleeding or bleeding in the donor area were seen after intravenous administration. Cicaprost had a similar protective effect on flap ischaemia after intravenous infusion. Flap survival was comparable to iloprost. Severe complications seemed to be less. Prostacyclin analogues were able to diminish damage of secondary ischaemia caused by venous occlusion.

Animals↗
PubMed1993

[Increasing the survival rate of endangered free microvascular tissue transplants using a prostacyclin derivative].

Free flap transplantations and replantations of extremities are threatened by venous occlusion due to haematomas, contusions, and secondary healing of the surrounding tissues. In an experimental investigation in 18 Sprague-Dawley-rats, the influence of the Prostacyclin analogue Iloprost on temporary ischemia by venous occlusion was tested. Free groin flaps were transplanted to the neck of these animals with microanastomoses of the nutrient superficial epigastric vessels to the carotid artery and the jugular vein. On the first postoperative day the vein was temporarily clamped. In the control group there was always a total loss of the flap by haemorrhagic necrosis. The intraarterial flap perfusion by Iloprost was able to diminish the effects of the secondary ischemia. In some cases shortly after the perfusion and always on the next day, positive oxygen pressures were measurable. 80% of the flaps survived.

Animals↗
PubMed1993

[Experimental studies of the no-reflow phenomenon with prostacyclin].

The no-reflow phenomenon is a dreaded complication in free tissue transplantations. After a critical period of warm ischemia, insufficient reflow is observed after vessel anastomosis and opening of the artery. In an experimental study in 72 rats, groin flaps were harvested with the nutrient superficial epigastric vessels and transplanted to the neck using a microvascular technique with anastomoses to the carotid artery and jugular vein. Before transplantation, the isolated flaps were perfused either with saline solution, with Iloprost, with and without heparin, or the nutrient vessels were simply flushed with heparin solution. After saline perfusion, there was no venous reflow, after pure Iloprost perfusion, there was venous return in 26% of the flaps, after Heparin-Iloprost perfusion in 88% and after flushing with heparin alone in 93%. The addition of heparin to Iloprost seems to improve the reflow rate. The most effective protection against a no-reflow phenomenon, however, is flushing the nutrient vessels with a heparin solution.

Anastomosis, Surgical↗
PubMed1992

[Step-plasty for therapy of chronic subcutaneous ruptures of extensor tendons of finger end joints].

A new method for secondary operative treatment of subcutaneous ruptures of the extensor tendons in the DIP-joint region is described. A step-cut incision is performed in the area of the regenerative tissue and the adjacent original tendon. The sutures in the longitudinal incision line compensate the tension and give better anchoring. First results show a tendency to an improved relationship between pre- and postoperative extension lag compared to other methods. Also, the method is an improvement from the aesthetical point of view and in operative practicability.

Adult↗
PubMed1991

[Myocutaneous and fasciocutaneous free flap for covering the lower leg and foot--a comparative study].

A comparison is presented of free myocutaneous flaps, e.g. latissimus dorsi flap, gracilis flap and the inferior gluteal flap, with fasciocutaneous flaps, especially the scapular/parascapular flap, for covering defects of the lower leg and the foot. Myocutaneous flaps are especially suited to cover deep defects with loss of bone and provide a good basis for free bone grafting. Fasciocutaneous flaps are better suited to cover plain defects, having a good blood supply due to the rich epifascial vascular network. They are thinner than the myocutaneous flaps and in extensive defects they do not need additional free skin transplantation in the recipient area.

Foot Injuries↗