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Biomedical subjects

U Büchler

Publications and source records attributed to U Büchler.

At least 19 recordsLinked to original sources
PubMed1992

The surgical anatomy of the dorsal carpal branch of the ulnar artery: basis for a neurovascular dorso-ulnar pedicled flap.

In order to design a neurovascular flap from the dorso-ulnar aspect of the midhand for pedicled transfer to adjacent or distant locations, the surgical anatomy of the dorsal carpal branch of the ulnar artery (DCBUA) was studied in 12 cadavers. The DCBUA was identified in all specimens. It originates from the ulnar artery 1.6 to 4.4 centimeters proximal to the ulnar styloid, passing deep to the flexor carpi ulnaris tendon, and spirals superficially to the extensor retinaculum around the ulnar border of the wrist. Its terminal branches supply an undetermined area of skin overlying the ulnar metacarpals and the ulnar hypothenar region, either by direct cutaneous supply (3/12 specimens) or by septo-cutaneous perforators (8/12 specimens). The DCBUA is closely related to the dorsal sensory branch of the ulnar nerve, with which it supplies a common neurovascular territory.

Arteries↗
PubMed1992

[Microsurgical and histological observations in schwannoma of peripheral nerves].

From 1986 to 1991, eight patients with benign schwannomas (neurilemomas) of peripheral nerves underwent tumor resection. In six of eight cases, microsurgical dissection revealed one or several nerve fascicles "disappearing" in the center of the schwannoma. Therefore, these fascicles had to be removed along with the tumor. This observation contradicts the current opinion that enucleation of benign schwannomas is usually straightforward and possible without fascicular damage. Interestingly, the resection of fascicles did not create additional neurological deficits. For functional reasons, partial nerve grafts bridging the resulting fascicular defects were considered appropriate in two cases. Tumors of peripheral nerves should be treated by surgeons familiar with microsurgical operative techniques.

Adult↗
PubMed1991

Retrograde posterior interosseous flap.

A retrospective, continuous clinical series of 36 distally based posterior interosseous island flap procedures is reported. Major anatomic variations precluded the final dissection of the flap on two occasions (6%). Thirty-four patients had septocutaneous or septofascial flap coverage for treatment of acute complex injuries (12), subacute soft tissue defects (10), chronic ulcers (5), or contractures (7). The sizes of the flap islands varied from 1.5 by 4 centimeters to 9 by 11 centimeters. The arc of rotation, centered over the distal radioulnar joint, measured up to 19 centimeters, allowing the flaps to reach the dorsum of the proximal interphalangeal joints. Partial necrosis occurred in seven flaps; four (12%) required additional local or distant flaps. Partial failures were related to bleeding from the pedicle or compression thereof, while other assumed causes of hypoperfusion were not statistically relevant. The flaps remained slightly bulky in about 30% of the patients, but otherwise adapted well to the recipient site and had excellent texture and color match. The donor morbidity was minimal.

Adult↗
PubMed1991

Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius.

Painful radiocarpal arthritis following comminuted fractures of the distal radius may be treated either by total wrist fusion or by procedures which preserve movement. The authors have reviewed 15 patients with such fractures who have undergone radio-scapho-lunate partial arthrodesis. They report the results with an average follow-up of 23.8 months. Pain was abolished in 7 patients and resolved virtually completely in 4 cases. Restored grip strength averaged 49% of the contralateral side. There was considerable limitation of postoperative range of motion which was restricted to an oblique plane extending dorso-radial to palmar-ulnar. Most patients did not report this as a problem. Two cases of non-union were reported as well as a 35.7% incidence of secondary degenerative change in the midcarpal joint. This feature casts doubt on the predictability of outcome of this procedure.

Adult↗
PubMed1990

Traumatic soft-tissue defects of the extremities. Implications and treatment guidelines.

The presence of traumatic soft-tissue defects in the extremity indicates serious damage that may compromise the systems of motion, circulation or sensibility and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft-tissue defects, of which several types may be distinguished. Principles for the selection of various flap procedures are outlined, in accordance with the need for elevation and early motion therapy. The requirements placed on flap tissue are described, such as surface characteristics, ability to restore sensibility, cosmesis, capacity to fill voids in the depth of defects and revascularization of adjacent areas.

Arm Injuries↗
PubMed1990

[Hand surgery. Soft tissue defects].

The presence of soft tissue defects in the hand indicates serious traumatic damage that may compromise the systems involved in movement, circulation or touch and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft tissue defects. Several types are distinguished. Selection criteria for various flap procedures are outlined with reference to the need for elevation of the hand, the necessity for early movement, adequate wound drainage, and range of motion therapy. The characteristics required of flap tissue are described, such as surface characteristics, ability to restore sense of touch, cosmetic appearance, ability to close deep volume defects, and potential for revascularization of adjacent tissue. Finally, commonly used, selected flaps are presented with notes on their advantages, disadvantages, and modifications, the techniques required and the indications for each.

Amputation, Traumatic↗
PubMed1990

[Partial femur head necrosis in adults--results with intertrochanteric osteotomy and revascularization].

Osteotomy and revascularization have both been used for many years in the therapy of partial aseptic necrosis of the femoral head in the adult. We first attempted a combination of the two techniques in 1978. Stress on the necrotic sector was relieved by intertrochanteric osteotomy, and the necrotic part of the bone was revascularized with a pedicled iliac crest bone graft based on the deep circumflex iliac vessels. Long-term results are now available in 45 hips in 38 patients, with a mean follow-up time of 32 months. Clinically, 71% of the hips were rated very good or good, and among those classed as stage II before surgery the results were rated as very good or good in as many as 90%. Subjective evaluation of the hips by the patients confirmed these results: 85% of the hips were judged to be optimal or markedly improved compared with before operation. Radiological evaluation showed further flattening of the femoral head in one case. A segmental collapse of the femoral head, i.e. stage III lesion according to Ficat, occurred in 2 hips with stage II preoperatively. In 6 hips with stage III necrosis preoperatively secondary arthritis developed. Computerized tomograms taken of all 25 hips from which metal implants had been removed showed signs of integration of the graft in 68%. Scintigraphy with 99-Tc-diphosphonate showed a homogeneous uptake in 42.8% and a non-homogeneous uptake in the remaining 57.2% of the cases. So-called photopenia was not observed in any of the hip joints treated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Acute vascular disorder as a complication of replantation and revascularization of the digital area].

This study on vascular complications in digital replantation and revascularization covers the six-year experience of a universitary replantation center. The material comprises 143 patients with 67 replantations and 137 revascularizations. Inadequate circulation was observed in 21.6% of the cases, or 17.6% of the digits. In digital replants, during or following the initial surgery, significant vascular complications were encountered in 28 (42%) of the replanted thumbs and fingers. Of these, seven digits (10.4%) presented with irreparable vascular damage and were amputated without salvage attempts. Single or repeated microvascular revisions saved 13 (two thirds) of the remaining digits. The survival rate of this group was thus raised to 78%. In digital revascularization, the vascular complication rate was much lower. In 137 digits, eight developed complications (6%). One of these was accepted as a failure; of seven reinterventions, five proved successful. The over-all survival rate was 98% in this group. To the factors known to determine survival following replantation and revascularization, those governing the ability to offset vascular complications must be added. In this respect, the analysis of our data revealed additional statistically significant prognostic elements: the decision for or against surgical reintervention, the location of the thrombosis relative to the arterial or venous side, the type of injury and the timing of revisional surgery. Other parameters, such as the age of the patient, the experience of the surgeon, or the type of initial vascular reconstruction were not statistically relevant. In our experience, repeated attempts at microvascular salvage in face of circulatory complications of digital replantations or revascularizations are worthwhile.

Adolescent↗
PubMed1988

Arthrodesis of the proximal interphalangeal joint by solid bone grafting and plate fixation in extensive injuries to the dorsal aspect of the finger.

Eighteen patients with industrial injuries to the dorsum of the proximal interphalangeal joint involving articular destruction and segmental bone loss were treated by primary bone grafting and plating. Rigid arthrodesis and preservation of functional length were obtained in 25 fingers. Of the 25 fingers, 23 fused primarily. Because of technical error, one reconstruction showed delayed consolidation and required secondary grafting before uniting; one arthrodesis became infected and healed by second intention. Additional procedures were flexor tendon repair, nerve grafting, and local or distant flap coverage. The procedure is considered valid for the treatment of extensive skeletal damage to the proximal interphalangeal joint area.

Adolescent↗
PubMed1988

The dorsal middle phalangeal finger flap.

A versatile one-stage neurovascular flap from the dorsum of the middle phalanx of the finger is described. The flap is based on one proper digital artery, the venous network about its adventitia and the dorsal branches of the proper palmar digital nerves bilaterally. The characteristics of the flap include a size up to 3 by 6 cm, an arterio-venous pedicle up to 12 cm in length, an arc of rotation around the superficial palmar arch, discriminative sensibility, and comparably low donor morbidity. The flap may be transposed on its vascular pedicle with or without nerve suture. Furthermore it is ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization. Finally, it may be utilized as a free neurovascular flap.

Adult↗
PubMed1988

[Ring avulsion injuries: improved indications for replantation].

Based on experiences with 12 replantations of ring avulsion injuries, an additional classification of type III avulsions (Urbaniak, 1981) is proposed, according to the level of injury of the neurovascular bundles. If this lies proximally (III P), microsurgical reconstruction is usually straightforward and the prognosis generally good; in distal lesions (III D), however, uncorrectable segmental devascularization can occur, which may be detrimental to survival or ultimate function.

Adolescent↗
PubMed1988

[Snapping palmar drawer phenomenon of the wrist: a physiologic or pathologic study finding?].

In the examination of a wrist, when this is held in neutral position and moderate ulnar deviation, a substantial palmar drawer translation combined with a snap can be elicited. The sign is most evident in about 15 degrees of ulnar deviation, while it is negative in the neutral position, in radial deviation or in maximal ulnar deviation. The translation and the snap have been consistently demonstrated in normal wrists and are therefore considered physiologic. The knowledge of this impressive phenomenon seems important for differential diagnosis when assessing the stability of a wrist; its clinical and cineradiographic picture are described.

Carpal Bones↗
PubMed1987

[Mini condylar plate osteosyntheses of the hand].

The mini condylar plate fixation system is a new method for stable internal metaphyseal bone fixation about the MP and PIP joint areas of the hand. Indications for its use are rigid stabilization of fractures, osteotomies, and bony components of composite tissue transfers. The device should be used in deference to other techniques when early active range of motion is pursued. Its best use is in the face of combined injuries, or osteotomies with tenolysis/capsulotomy. The advantages of this implant's design permit stabilization of small epiphyseal fragments with minimal interference of joint function and perhaps a reduction of irritation of the extensor aponeurosis. Disadvantages include the need for careful preoperative planning because of this implant's small size and unforgiving tolerances of application. The data is included for the first 87 consecutive cases of its use. Despite the institution of range of motion therapy within five days in 77% of the cases, there were no nonunions. Two cases of delayed union were successfully treated by addition of cancellous bone grafts without revision of the fixation devices. Problems included malalignments (three cases), infection (two cases), and soft tissue coverage (four cases). Aseptic necrosis of bone is associated with metacarpal head fractures and is seen with the use of this implant in treating such intraarticular fractures. The final digital performance was analysed but has not been presented because of the multiplicity of the associated joint, tendon, vascular, nerve, and skin involvement.

Amputation, Traumatic↗
PubMed1987

Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries.

The minicondylar plate fixation system is a new method for stable internal metaphyseal bone fixation about the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. Indications for its use are rigid stabilization of fracture, osteotomy, and the bony components of composite tissue transfer. The device should be used in deference to other techniques when early active range of motion is pursued. Its best use is in the face of combined injury or osteotomy with tenolyses/capsulotomy. This implant permits stabilization of small epiphyseal fragments with minimal interference of joint function and perhaps a reduction of irritation of the extensor aponeurosis. Disadvantages include the need for careful preoperative planning because of this implant's small size and unforgiving tolerances of application. The data is included for the first 65 consecutive cases of its use. Despite the institution of range of motion therapy within five days in 77% of the cases, there were no nonunions. Two cases of delayed union were successfully treated by addition of cancellous bone grafts without revision of the fixation devices. Problems included malignments (three cases), infections (two cases), and soft tissue coverage (four cases). Aseptic necrosis of bone is associated with metacarpal head fractures and is seen with the use of this implant in treating such intraarticular fractures.

Bone Plates↗
PubMed1986

Combined osteocutaneous microvascular flap procedure for extensive bone and soft tissue defects in the tibia.

Recent experience with bone healing seems to advocate vascularized bone grafts in cases of large bone gaps or significant scarring, following irradiation, in the presence of low-grade infection, and in congenital pseudarthrosis of the tibia. When extensive bone and skin replacement are needed, the microvascular procedures currently available may not meet specific reconstructive requirements. To augment the advantages of the vascularized fibular graft for tibial substitution (strength, straightness, length, and predictability of vascular supply) with the benefits of free skin, muscle, or musculocutaneous flaps, separate on-demand harvesting of these tissue units and their microvascular combination can be useful in selected cases. In a study of 4 patients, the vascularized fibula was combined with a free latissimus dorsi flap. The procedure was facilitated and shortened by connecting the peroneal vessels to branches of the thoracodorsal or to the scapular circumflex artery and vein outside the operative field. The main supporting vessels of the combined composite tissue block were then anastomosed only to one pair of vessels in the leg.

Adolescent↗