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Biomedical subjects

R Horch

Publications and source records attributed to R Horch.

At least 19 recordsLinked to original sources
PubMed2006

[De Quervain's stenosing tendovaginitis--one of the most common conditions affecting the hand].

De Quervain's stenosing tendovaginitis is an inflammation of the first dorsal compartment. It is considered to be one of the most common forms of inflammation of the tendon sheaths. The diagnosis is based on the case history and the clinical examination. Finkelstein's test is pathognomonic. Should conservative treatment not prove successful, the condition is readily amenable to surgical treatment.

Adult↗
PubMed2006

[The transverse rectus abdominis muscle (TRAM) flap. A "second defensive line" in microvascular reconstructions of defects in the head and neck area].

BACKGROUND: The microvascular anastomosed transverse rectus abdominis muscle (TRAM) island flap has been successfully used in plastic surgery for more than 10 years. In reconstructive head and neck surgery, however, it is not yet established. METHOD: We analysed the preparation and anatomical variation in TRAM flaps in an examination of eight cadavers. In a clinical case with complete reconstruction of the nose after nasal ablation and complete loss of a radial lower forearm flap that had been transplanted previously due to a recurrent tumor, the possibility of forming and modeling a TRAM flap is demonstrated. RESULTS: The flap vessels of the TRAM are comparable to the radial forearm flap, and the donor site may be primarily closed. The TRAM proved to be a suitable alternative to close lesions of the head and neck area in selected cases. The myocutaneous TRAM is bulkier than the fascio-cutaneous radial forearm flap. The subcutaneous abdominal fat of the TRAM can be reduced in relation to the vascular distribution of the perforator vessels. If the subcutaneous fat of the flap is reduced, the flap can be shaped and formed well. In the described case, it was used to close the lesion after ablation of the nose and middle face. CONCLUSION: The risk of an iatrogenic lesion of the peritoneal fascia or postsurgical herniation of the abdominal wall is low if several surgical prerequisites are taken into consideration. The myocutaneous TRAM will not replace the fascio-cutaneous radial forearm flap in microvascular head and neck surgery, but the large diameter of the donor vessels and the highly vascularized flap tissue makes it an alternative as a second line procedure in cases of unfavorable wound conditions.

Cadaver↗
PubMed1999

Cultured epidermal keratinocytes on a microspherical transport system are feasible to reconstitute the epidermis in full-thickness wounds.

Research efforts to modify cultured autologous skin transplants for large full-thickness burn wounds and in chronic ulcers have shifted from multilayered differentiated grafts ("sheet" grafts) toward smaller units of basal undifferentiated single cell suspensions in a transport medium and subconfluently covered static carriers. It has been shown that wounds transplanted with single cell suspensions reconstitute the epidermis. However, this technique requires the detachment of the keratinocytes from the culture flasks by enzymatic digestion-digestion that might alter the anchoring proteins of the cells. A new approach might be to circumvent the enzymatic digestion to harvest the keratinocytes. This study reports a technique to culture epidermal cells on spherical microcarriers as a suspension culture and transport vehicle. The spherical microcarrier consists of a 100-microm-diameter collagen-coated dextran carrier (Cytodex 3 Pharmacia) and has been used previously for enzyme production commercially. With this new approach, we seeded the human keratinocytes in a spinner-like system onto microspheres and transplanted these micrografts onto full-thickness wounds on the back of nude mice. After 14 days, we showed a reconstituted epithelium that was multilayered and keratinized compared to control wounds. We believe that this is the first step of a new approach to increase the cell yield for seeding without altering the anchoring proteins by enzymatic steps, leading to a superior transplantation method for keratinocytes.

Adult↗
PubMed1999

[Free microsurgical flap-plasty in reconstructive therapy of diabetic foot ulcer].

The diabetic foot ulcer is a significant clinical problem often resulting in frustranous conservative treatment or early amputation. In certain cases transfer of well vascularized tissue can improve wound healing and lead to a length-spearing therapy. In this study the concept of microsurgical tissue transfer in the treatment of diabetic foot ulcers is introduced. Following a radical debridement and, if necessary a atypical length-spearing amputation the wound is covered by a free transplanted muscle flap followed by a split-thickness skin graft. In six patients treated with this procedure the extremity could be saved. The perioperative mortality was 0%, average hospitalization was 47.6 days. One flap was lost, two vascular revision were necessary. Several necrectomies and skin grafts were performed and one donor side seroma was drained. One hernia was observed after free rectus abdominus transfer. Compared to conservative treatment or amputation this concept leads to a length-spearing therapy and can increase success rates of rehabilitation and quality of life.

Amputation, Surgical↗
PubMed1998

A new method for treating isolated fractures of the os trapezium.

Isolated trapezium fractures are rare events. As standard radiographic methods may fail to diagnose this injury, specific radiographic projections are needed to separate the outline of the trapezium from the other carpal bones. Computed tomography can be helpful in visualizing the true shape of fragments. In this report a vertical and transversal isolated fracture of the trapezium was repaired by using the dynamic Herbert compression screw technique. Open reduction and internal fixation resulted in union with excellent thumb function and joint restoration. A report of this case and the special technique of treatment is combined with a discussion of literature.

Adult↗
PubMed1998

[Surgically-induced angiogenesis as basic principle in treatment ov hypovascularized wounds--the nutritive flap].

Chronic wounds of the lower extremity as a result of diabetes, arteriosclerosis and microangiopathy are of significant clinical relevance, as they result in immobilization, extended hospitalization and cost-intensive treatment. Via transfer of well-vascularized tissue onto chronic wounds as a free transplanted muscle flap, if necessary connected to a venous bypass, angiogenesis is induced and wound healing improved. This concept leads to nonamputational therapy.

Arteriosclerosis↗
PubMed1997

MR imaging of the carpal tunnel.

OBJECTIVE: Investigations were conducted regarding changes of carpal tunnel shape during wrist motion and the variations of space for the median nerve as well as the preoperative signs of carpal tunnel syndrome (CTS) and the postoperative restitution. METHODS: Axial MR images (1.0 T) were performed at the level of the distal radioulnar joint, pisiforme bone and hook of hamate level of 20 wrists of patients with clinical symptoms of CTS and further 20 wrists of volunteers. This was conducted with the wrist in neutral position, 45 degrees extension and 45 degrees flexion. T2-weighted signal intensity of the median nerve were measured in 18 patients pre- and postoperatively. RESULTS: The increase of the cross-sectional area of the median nerve at the pisiform level and the flattening of the median nerve at the hook of hamate level as well as the volar bowing of the flexor retinaculum at the pisiform and hook of hamate level were significantly greater in patients with CTS than in those with normal wrists (P < 0.05-0.001). In postoperative follow-up studies the distal flattening of the median nerve recovered in 94%. The signal intensity of the median nerve on T2-weighted images decreased in 67%. CONCLUSIONS: Flexion at the pisiform and hamate level as well as extension at the pisiform level narrows the space available for the median nerve potential leading to compression of the median nerve. MR imaging is accurate and reliable for diagnosis and postoperative follow-up of CTS.

Adult↗
PubMed1996

[Morphology of the carpal tunnel. Movement studies in patients with constriction symptoms and healthy probands using MR tomography].

The morphological correlation of the phenomenon of increased pressure in the carpal tunnel during wrist flexion and extension--as has been proved though measurements using wick-catheters--was studied in healthy subjects (n = 15) and symptomatic patients with carpal tunnel syndrome (n = 15). Our own measurements using magnetic resonance imaging (MRI) showed that there is a significant reproducible decrease in carpal tunnel diameter when the wrist is held in position of either flexion or extension. During flexion the diameter is decreased at the pisiformes and hamate level as well as it is lowered during extension at the pisiformes level. This might explain the rise in carpal tunnel pressure and thus the consecutive negative influence on the median nerve. Proximal swelling, distal flattening and increased signal intensity of the median nerve as well as the palmar bulging of the flexor retinaculum at the level of the hook of the hamate and at the level of the pisiformes were significantly higher in patients with carpal tunnel syndrome than in normal volunteers (from p < 0.05 to p < 0.001). In post-operative follow-up examinations of 13 patients with no clinic symptoms the distal flattening of the median nerve normalized in 94% within 3 months. The increased signal of the median nerve on T2-weighted images decreased postoperatively in 2/3 of the patients, whereas the motor latency of the median nerve recovered only in 39% of our patients who had 100% partial or complete clinical benefit. These findings imply that postoperative imaging may be helpful for evaluating the success or failure of surgical treatment.

Adult↗
PubMed1996

A new device for safe and easy dilatation of the carpal canal in endoscopic surgical treatment of the carpal tunnel syndrome.

A new slightly bent type of bougie for safe and easy carpal tunnel bougienage prior to endoscopic carpal tunnel decompression is described. The design was developed according to the natural shape of the carpal canal and studied in 6 cadaver forearms with subsequent opening of the dilated carpal canal as well as in 15 endoscopic transverse ligament dissections in patients with carpal tunnel syndrome. The carpal canal bougienage can be performed easier and safer according to the natural anatomical pathway with slightly bent bougies compared to the conventional straight probes.

Carpal Tunnel Syndrome↗
PubMed1995

[Abductor pollicis brevis muscle-plasty for therapy of radial collateral ligament rupture of the thumb base joint].

Untreated radial collateral ligament rupture of the thumb metacarpophalangeal joint may lead to an impairment of thumb function. The treatment is basically similar to ulnar ligament trauma management. Due to the rarity of this lesion, consistent guidelines for therapy have not yet been described. In contrast to fresh injuries a re-fixation of the disrupted ligament usually is not possible when chronic instability has already occurred. Following functional-anatomic considerations a dynamic joint stabilization method has been developed by transposition and thus reestablishing the functional direction of the abductor pollicis brevis muscle. Thus the physiological radial ligament vector is replaced and a functional ligament replacement is achieved through a technically simple procedure.

Collateral Ligaments↗
PubMed1994

Cologne Burn Centre experiences with glycerol-preserved allogeneic skin: Part I: Clinical experiences and histological findings (overgraft and sandwich technique).

In an effort to improve the take of finely meshed autografts a modification of the sandwich technique, as first published by Alexander et al. (1981), was developed. In contrast to the techniques described by other authors, the wound bed is sealed with fibrin glue spray after excision of the burns. Widely meshed autografts are then covered with non-meshed (only scarcely sliced) glycerolized allograft sheets, being fixed with staples. Patients are placed on fluidized beds and are exposed without dressings from the fifth day onwards. Histologically and clinically, it can be assumed that part of the glycerolized allodermis is incorporated. During the weeks after transplantation, a creeping substitution of the allodermis by autologous tissue takes place. This would suggest a co-existence between glycerol-preserved hypo-allergenic allografts and auto-epidermis. Research on the definitive fate of allodermis in cases of sandwich grafting is continuing.

Adult↗
PubMed1994

Phenol burns and intoxications.

Phenol burns and intoxications are life-threatening injuries. Roughly 50 per cent of all reported cases have a fatal outcome. Only a small number of cases have been reported with high serum concentrations after phenol burns who survived. In our own experience a patient with 20.5 per cent total body surface area deep partial skin thickness phenol burns and serum concentrations of 17,400 micrograms/litre survived after immediate and repeated treatment of the scalds with polyethylene glycol (PEG) and silver sulphadiazine. A literature review of experiences with phenol intoxications reveals the advantages of PEG application. Questions on the need for enforced diuresis and haemodialysis as well as the initial treatment procedures are discussed. Advantages of different solutions for local therapy are reported.

Accidents, Occupational↗
PubMed1994

[Treatment of perianal burns with submerged skin particles].

Perianal burn wounds often cannot be cured by conventional split-thickness skin grafting procedures. This is due to the mechanical stress and the enormous bacterial colonization. Transplantation of small skin pieces, submerged into the granulation tissue, is able to produce small epithelial islands within 2 weeks. These enlarge continuously and produce complete epithelialisation in the further course. Own results with 7 burn patients prove that this technique is suitable to epithelialize gluteal and perianal problem wounds with comparatively little expenditure.

Adolescent↗
PubMed1994

Prosthetic vascular graft infection--defect covering with delayed vertical rectus abdominis muscular flap (VRAM) and rectus femoris flap.

Prosthetic vascular graft infection is associated with high rates of morbidity and mortality. When infections lead to an open exposure of vascular prosthesis special techniques may be necessary to cover tissue defects in regions with often very poor circulation/perfusion conditions. Even when there are large tissue defects associated with vascular prosthetic graft infections and exposure of prosthesis local cure can be achieved after radical debridement and defect coverage through transposition of myocutaneous flaps. The cases of two patients with open exposure of prosthesis in the groin who had been successfully treated by delayed vertical rectus abdominis muscular flap (VRAM) or rectus femoris rotation are presented. The contralateral VRAM myocutaneous flap is an excellent alternative if local measures fail to close large groin defects with exposed prosthesis. In addition the delayed flap rotation offers a greater safety in conditioning the vascularity of the flap.

Amputation Stumps↗
PubMed1991

[Can lung function be improved by preoperative respiratory therapy before planned lung resection?].

The influence of an intensive preoperative physiotherapy on pulmonary function is studied in 23 patients suffering from bronchial carcinoma. Daily measurements reveal a significant improvement up to the third and fourth day after beginning of intense breathing exercises. Continued physiotherapy shows a decrease of pulmonary function in the following days. These results show that intensive breathing therapy does not produce any advantage after the third or fourth day.

Adenocarcinoma↗