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Biomedical subjects

R G H Baumeister

Publications and source records attributed to R G H Baumeister.

5 recordsLinked to original sources
PubMed2006

[Re-intervention after carpal tunnel release].

In the last eight years we performed 63 re-interventions because of recurrent carpal tunnel syndromes. Intact parts of the retinaculum were the reason for persistent symptoms in 38 patients. 21 patients suffered from scar tethering, two patients from circumferential fibrosis of the nerve. In one patient a ganglion and in another patient a direct injury to the median nerve was detected. In 21 patients short incisions were performed in the primary procedures. Since the introduction of endoscopic carpal tunnel release, an open decompression via a short incision is recommended as an alternative. Since then we encounter an increase of necessary operative revisions after short incisions. Optical tools may increase the survey especially in short incisions. In extended teno-synovialitis of the flexor tendons, a longer incision over the wrist enables adequate conditions for a safe teno-synovialectomy. The length of the incision has to be chosen according to the pathologic-anatomic situation, the disposable equipment and the experience of the surgeon.

Adult↗
PubMed2003

[The microsurgical lymph vessel transplantation].

Using advanced microsurgical techniques, single lymph vessels can be safely anastomosed and segments of lymphatics can bridge localized lymphatic blockades which are mostly due to lymphadenectomies. Lymphatic grafts are harvested from the patient's thigh with a length up to about 30 cm. In the case of an axillary blockade they are anastomosed with ascending lymph vessels at the upper arm and lymph vessels at the supraclavicular region. Unilateral oedemas of lower extremities are treated by transferring the grafts via the symphysis and anastomosing them with ascending lymphatics at the affected side. Lymphoedemas of the penis and the scrotum as well as lymphoedemas due to a localized peripheral lymphatic blockade can be treated by lymphatic grafts. In 127 arm oedemas the original difference in volume between the affected and the healthy arm was reduced at two third from 3368 cm (3) to 2567 cm(3) (p < 0.001). After a follow-up period of 2.6 years the volume was reduced to 2625 cm(3) (p < 0.001). The group of patients with a follow-up of at least ten years showed a volume of 2273 cm(3) (p < 0.001). The volume of unilateral lower extremity-lymphoedemas was reduced from 13 098 cm(3) to 10 578 cm(3) (p < 0.001) and showed a volume of 11 074 cm(3) after 1.7 years (p < 0.001) and 10 692 cm(3) after four years (p < 0.001). The original mean volume of the healthy contralateral leg was 9371 cm(3). Bridging localized gaps in the lymphatic system by autologous lymphatic grafts showed long lasting stable results. Starting the treatment of lymphoedemas by conservative procedures, one should not wait too long to ascertain the possibility of a microsurgical reconstruction in order to avoid increasing secondary tissue changes.

Adult↗
PubMed2003

[Planning and monitoring of autologous lymph vessel transplantation by means of nuclear medicine lymphoscintigraphy].

Autologous lymph vessel transplantation significantly improves the lymph drainage in patients with primary and secondary lymphedema. The aim of the present study was to prove whether scintigraphic long-term follow-up could demonstrate the function of autologous lymph vessels and the persisting success of this microsurgical technique respectively. In this study, visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients comparing a preoperative baseline study with postoperative follow-up investigations once a year for a period of seven years. The reason for microsurgical lymph vessel transplantation was a primary (n = 4) or a secondary (n = 16) lymphedema. In 12 cases the transplantation site was at the upper extremity, in eight cases at the lower limb. 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 transport index. In 5/20 cases the vessel graft could be visualized directly. In these patients with scintigraphic visualization of the vessel graft, the transport index decreased to a significantly greater extent compared to the preoperative baseline study. 3/20 patients did not benefit from microsurgical treatment. Lymphoscintigraphy has shown to be an easy, reliable and readily available technique to assess lymphatic function on the long run. Scintigraphic visualization of the vessel graft showed a significantly better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding lymph drainage.

Adult↗
PubMed2002

[Vascularisation of a free jejunal graft at the neck in an insufficient vascular situation].

Free jejunal grafts are the method of choice for one-stage reconstruction of the hypopharynx and the upper esophagus. Prerequisites for a successful free transplantation are a sufficient arterial vascularisation and a corresponding venous drainage. In a 59-year old patient, an esophagectomy was performed because of a proximal esophageal cancer. The passage was primarily reconstructed by a pedicled colon interposition. Necrosis of the cranial graft occurred. After resection of the necrotic bowel, a free jejunal graft was introduced thoraco-cervically. The nutrient vessels of the graft were anastomosed to the upper thyroid artery and the vena thyroid ima. In an operative revision one day postoperatively due to lacking re-capillarisation, the arterial inflow stopped. The superior thyroid artery was cut at its cranial origin at the external carotid artery and microsurgically implanted into the common carotid artery. Hereafter, a venous outflow was re-established. But the critical time of ischaemia was exceeded. In another operative revision, the cephalic vein was exposed at the cranial upper arm, distally cut and anastomosed to the re-implanted superior thyroid artery. After the harvest of a second autogenous jejunal graft, the arterio-venous shunt was cut and the segments were anastomosed to the mesenterial artery and vein. Transpositions of arteries and veins with temporary formation of an arterio-venous shunt may be prerequisites for a sufficient vascularisation and can enable a successful free microsurgical transplantation even in critical vascular situations.

Anastomosis, Surgical↗