Prof. Dr. med. Robert Hierner (original) (raw)

Papers by Prof. Dr. med. Robert Hierner

Obere Extremität, Mar 1, 2007

Pro Jahr treten in Deutschland etwa 1,000-1,500 posttraumatische Läsionen des Plexus brachialis a... more Pro Jahr treten in Deutschland etwa 1,000-1,500 posttraumatische Läsionen des Plexus brachialis auf. In den meisten Fällen handelt es sich um Motorradunfälle. Durch die Einführung der Helmtragepflicht konnte zwar ein deutlicher Rückgang der schweren Schädel-Hirn-Traumata beobachtet werden, jedoch erhöhte sich der Anteil an schweren Läsionen des Plexus brachialis. Eigenes Patientengut Im Zeitraum von 1981 bis 1999 wurden an der Klinik für Plastische, Hand-und Wiederherstellungschirurgie, Schwerverbranntenzentrum der Medizinischen Hochschule Hannover, 1714 Patienten mit einer Läsion des Plexus brachialis behandelt (Tabelle 1). Bei 1212 Patienten lag eine posttraumatische Plexusläsion vor, weshalb bei 682 Patienten eine frühzeitige operative Revision des Plexus brachialis erfolgte. In 418 Fällen lag eine geburts

Obere Extremität, 2009

Trotz seiner großen anatomischen Konstanz und des geringen Spenderdefektes werden Lappenplastiken... more Trotz seiner großen anatomischen Konstanz und des geringen Spenderdefektes werden Lappenplastiken aus dem Gebiet der A. interossea posterior und anterior klinisch immer noch selten zur Defektdeckung im Handbereich eingesetzt. Gründe dafür sind: 1. Popularität der A.-radialis-Lappenplastik [11, 34], dem Alternativverfahren (die A.-ulnaris-Lappenplastik nach Guimberteau et al. [13] findet bei uns wegen der möglichen ischämischen Schädigung des N. ulnaris keine Anwendung), 2. Angst vor der Präparation des dünnen Gefäβstiels und 3. Zweifel an der Zuverlässigkeit der Blutversorgung, vor allem bei distaler Stielung aus dem Rete carpale dorsalis oder palmaris. Ziel der Arbeit ist es, basierend auf eigenen Erfahrungen und Angaben in der Literatur, die anatomischen Grundlagen der verschiedenen Lappenplastiken darzustellen und aufgrund deren Vor-und Nachteile Vorschläge zur Indikationsstellung für die verschiedenen Lappenplastiken zu formulieren. Anatomische Grundlagen Die Aa. interossea anterior und posterior entspringen etwa in 83% der Fälle aus der A. interossea communis, die ihrerseits meist etwa in Höhe der Tuberositas radii aus der A. ulnaris abgeht. In 17% der Fälle entspringen Aa. interossea anterior und posterior direkt der A. ulnaris [22, 27]. Am Unterarm werden die Arterien und ihre Äste meist von zwei Vv. comitantes begleitet [2, 39, 41].

European Archives of Oto-Rhino-Laryngology, 2012

Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrosp... more Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrospinal fluid (CSF) leak, ascending infection and/or brain tissue prolapse. The transfer of devitalized autologous, allogenic or xenogeneic material is not always sufficient particularly not in larger defects or in the recurrent situation. Here the transfer of vascularised tissue seems to be more appropriate. The anterior skull base with various complex defects of 41 patients was reconstructed in an interdisciplinary setting by vascularised, autologous tissue transfer. Minor defects (\2.5 cm in max. diameter), generally occurring after extended endoscopic skull base approaches (n = 26, among those meningiomas, recurrent CSF fistulas, chordoma, chondroblastoma, metastasis, nasal fistula), were reconstructed by a local, vascularized pedicled mucosal flap of the lower turbinate (n = 3) or septum (n = 23). Patients with major defects ([2.5 cm in max. diameter, n = 15), comprising those with malignoma, meningoencephalocele, aneurysmatic bone cyst and trauma, were repaired by a ''sandwich technique'' with a combination of calvarian split and galea periosteum flap in 10 patients, in one case with a temporalis muscle flap, while in 4 further patients free vascularised radial forearm flaps were used for revision after multiple unsuccessful operations elsewhere. After a mean follow-up time of 30.5 months 38 of the 41 cases were successfully repaired with respect to prevention and treatment of CSF leakage or brain tissue prolapse, only 3 cases needed surgical revision. The reconstruction of the anterior skull base bearing complex lesions is feasible using vascularised, autologous local and also distal tissue transfer in a close interdisciplinary cooperation. Keywords Anterior skull base Á Reconstruction Á Vital tissue transfer Á Vascularised flap Á CSF leak D. Hanggi and I.E. Sandalcioglu contributed equally.

How to Improve the Results of Peripheral Nerve Surgery

Within the last decade contralateral C7-transfer has become a new source of axon donor in complet... more Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions. Ten adult patients with a complete posttraumatic brachial plexus lesion and a follow-up of more than 5 years are analyzed. As shown by GU we are using a two stage procedure with exploration and extraplexuel neurotization of the suprascapular nerve using 1/2 spinal acessory nerve. Depending on the intraoperative findings, the musculocutaneous nerve is neurotized by the phrenic nerve at the time of primary operation or secondarily neurotized by the contralateral C7 root. If the musculocutaneous nerve could be neurotized by the phrenic nerve, C7-transfer is used to reinnervate the median nerve. If ever possible, the vascularized ulnar nerve graft or if not availabe two sural nerves are used. Neurotization of the musculocutaneous nerve was carried out in 6, and of the median nerve in 4 patients. There are 6 patients in the MC group and 4 patients in the Median group. Criterias for evaluation used are: donor site (morbidity, classification), time for recovery, time for autonomization, and functional result. Successful elbow flexion is achieved if muscle power > M3, successful median nerve motor function is achieved if a primitive power grip pattern is achieved. All patients were complaining of temporary paresthesia in the dorsal part of P3 of the thumb, index and middle finger. There was complete sensory at the 3-month postoperative examination. There was no evident clinical motor loss at the donor extremity. A successful elbow flexion, i.e. muscle power > M3 was achieved in all 6 patients after 9-15 months. 4 of 6 patients are able to use this function individually. In the other two patients a start command must be given voluntarily from the contralateral side (contraction of the contralateral latissimus dorsi muscle). A functional primitive grip pattern could be achieved in 1 out of 4 patients after 18 months. In three patients, although there is movement, this mouvement must be judged "academic" at the present state. The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.

European Journal of Plastic Surgery, 2001

The local intramuscular application of botulinum toxin into the triceps, temporarily blocks activ... more The local intramuscular application of botulinum toxin into the triceps, temporarily blocks activity and thus reduces the resistance to the weak but contracting biceps. Six children (2-4 years of age) presenting with severe biceps/triceps co-contractions after nerve regeneration (spontaneous regeneration in three cases, early microsurgical reconstruction in three cases) of an obstetrical brachial plexus lesion, were treated with local injections of 25-50 mouse units (DYSPORT, R) botulinum toxin type A at two sites of the triceps muscle. Botulinum toxin injections were monitored by EMG recordings. Clinical testing (muscle power graded by the British Medical Research Council classification and measurement of the active range of motion, using the Neutral-0-Method) and EMG studies were performed prior to and after injections. Follow-up was at least 18 months. Mean active elbow flexion prior to application was about 50°(range: 20-60°) and muscle power was graded M1 (two cases) to M2 (four cases). Eighteen months after injection, mean elbow flexion was about 100°(range: 80-120°) and muscle power was graded as M2+ (elbow flexion without gravity in one case) to M4 (five cases). On EMG examination, a clear reduction of triceps contractions during biceps activity was observed. Temporary paralysis of the triceps after injection persisted for 16-44 weeks, with an average of 25.3 weeks. In order to achieve a stable elbow flexion at the M4 level, the Botox injection had to be repeated 2-3 times. The average time of treatment took 8-12 months. There was no recurrence of co-contraction in any of the patients after an 18 month follow-up. Moreover, no severe complications occurred. Local injections of botulinum toxin type A represents a new effective nonoperative tool for co-contracture treatment in obstetrical brachial plexus lesions in children.

Der Orthopäde, 1997

A review of the literature reveals that with conventional treatment alone or in combination with ... more A review of the literature reveals that with conventional treatment alone or in combination with secondary muscle/tendon transfer, about 4-43% of cases show incomplete recovery with severe functional and/or aesthetic impairment (group III). If these patients undergo early microsurgical brachial plexus revision, regeneration without significant functional and/or aesthetic impairment (shift from group III to group II) can be achieved in 80-90% of cases. Moreover, microsurgical reconstruction of the brachial plexus increases the possibilities of secondary muscle/tendon transfers. Therefore, provided patient selection is good, severe obstetrical brachial plexus injuries should be scheduled for early microsurgical revision. There is no need to wait for a frustrating spontaneous recovery. Our concept is based on our experience with more than 1100 patients presenting with brachial plexus lesions between 1981 and 1996 and treated in our institution. There were 217 obstetrical brachial plexus lesions, 133 of which were treated conservatively. In 84 cases operative treatment was necessary. Fifty-one cases underwent early revision of the brachial plexus, and secondary tendon transfer was done in 33 patients.

Der Orthopäde, 1997

Elbow flexion plays a key role in the overall function of the upper extremity. In the case of uni... more Elbow flexion plays a key role in the overall function of the upper extremity. In the case of unilateral complete brachial plexus lesion, restoration of elbow flexion will dramatically increase the patient's chances of regaining bimanual prehension. Furthermore, depending on the type of reconstruction, stability of the glenohumeral joint as well as some supination function of the forearm can be restored to a varying degree at the same time. Depending on the level of brachial plexus lesion and/or reinnervation, different reconstructive procedures are available. In order to select the best treatment option for the patient it is necessary to known the extent of the lesion of the brachial plexus and/or ventral upper arm muscles, to time the operation appropriately, to be aware of all treatment possibilities and to recall the special problems of tendon transfer for brachial plexus patients. Our concept is based on our experience with more than 1100 patients presenting a brachial plexus lesion between 1981 and 1996 and treated in our institution. There were 528 operative revisions of the brachial plexus. Some 225 patients underwent secondary muscle/tendon transfers. In 35 patients elbow flexion was reconstructed by bipolar latissimus dorsi transfer (n = 10), triceps-to-biceps transfer (n = 15), modified flexor/pronator muscle mass proximalization (n = 6) and the multiple-stage free functional muscle transfer after intercostal nerve transfer (n = 4).

Tijdschrift voor Geneeskunde, 2005

Tijdschrift voor Geneeskunde, 2004

The posttraumatic reconstruction of the upper limb function is highly important to enable the rei... more The posttraumatic reconstruction of the upper limb function is highly important to enable the reintegration into a professional life and to guarantee the quality of life. Until lately, the results of a reconstruction of the elbow joint were rather disappointing. Recently, however, new possibilities have been developed to enable the restoration of the function of also this joint in case of posttraumatic problems. Here we discuss the percutaneous - arthroscopic assisted osteosynthesis of the radial head, the treatment of the so-called terrible triad of the elbow, the developments in the osteosynthesis of supracondylar humeral fractures, the role of prosthetic surgery in case of posttraumatic problems, including the use of prosthesis-allograft constructions as well as the corrective osteotomies of the elbow. Our reconstructive possibilities have strongly increased by applying these techniques actively supplemented with the new diagnostic possibilities like the magnetic resonance imaging, dynamic x-rays, 3D-reconstructions of the elbow joint and the elbow arthroscopy which is oscillating between diagnosis and therapy. As a general result, malfunctioning and even arthrodesis are often avoided.status: publishe

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2006

Der Unfallchirurg, 2002

Pro Jahr treten in Deutschland etwa 1.000–1.500 posttraumatische Läsionen des Plexus brachialis a... more Pro Jahr treten in Deutschland etwa 1.000–1.500 posttraumatische Läsionen des Plexus brachialis auf. In den meisten Fällen handelt es sich um Motorradunfälle. Durch die Einführung der Helmtragepflicht konnte zwar ein deutlicher Rückgang der schweren Schädel-Hirn-Traumata beobachtet werden, jedoch erhöhte sich der Anteil an schweren Läsionen des Plexus brachialis.

Tijdschrift voor Geneeskunde, 2005

Deutsche Gesellschaft für Chirurgie, 2000

Im Zeitraum von 1981 bis 1996 haben wir 8 Patienten mit einer Avulsion der Haut im gesamten Handb... more Im Zeitraum von 1981 bis 1996 haben wir 8 Patienten mit einer Avulsion der Haut im gesamten Handbereich versorgt. Mit durchschnittlich 5 Operationen eine ausreichende Handfunktion wiederhergestellt werden. Alle Patienten gaben eine Schutzsensibilitat mit der Moglichkeit der Zuordnung des Fingers an. Bei durchschnittlich masiger Beweglichkeit im MP-Gelenkbereich (Ex/Flex: 0–10–60°) bestand eine deutliche Einschrankung im Bereich der PIP-Gelenke. Obwohl Grobgreiffunktionen von allen Patienten durchgefuhrt werden konnten, waren die Feingriff-Funktionen stark eingeschrankt. Alle nachuntersuchten Patienten wurden sich wieder fur eine derartige Rekonstruktion und gegen eine primare Handamputation entscheiden. 2 Patienten tragen bei gesellschaftlichen Anlassen eine asthetische Prothese nach Pillet. Hauptnachteil aller Rekonstruktionen derartiger Verletzungen ist die mangelnde Oberflachensensibilitat, welche nur durch mikrochirurgische Operationen an Teilen der Hand wiederhergestellt werden kann.

Der Orthopäde, 1997

Summary A review of the literature reveals that with conventional treatment alone or in combina... more Summary A review of the literature reveals that with conventional treatment alone or in combination with secondary muscle/tendon transfer, about 4–43 % of cases show incomplete recovery with severe functional and/or aesthetic impairment (group III). If these patients undergo early microsurgical brachial plexus revision, regeneration without significant functional and/or aesthetic impairment (shift from group III to group II) can be

Obere Extremität, Mar 1, 2007

Pro Jahr treten in Deutschland etwa 1,000-1,500 posttraumatische Läsionen des Plexus brachialis a... more Pro Jahr treten in Deutschland etwa 1,000-1,500 posttraumatische Läsionen des Plexus brachialis auf. In den meisten Fällen handelt es sich um Motorradunfälle. Durch die Einführung der Helmtragepflicht konnte zwar ein deutlicher Rückgang der schweren Schädel-Hirn-Traumata beobachtet werden, jedoch erhöhte sich der Anteil an schweren Läsionen des Plexus brachialis. Eigenes Patientengut Im Zeitraum von 1981 bis 1999 wurden an der Klinik für Plastische, Hand-und Wiederherstellungschirurgie, Schwerverbranntenzentrum der Medizinischen Hochschule Hannover, 1714 Patienten mit einer Läsion des Plexus brachialis behandelt (Tabelle 1). Bei 1212 Patienten lag eine posttraumatische Plexusläsion vor, weshalb bei 682 Patienten eine frühzeitige operative Revision des Plexus brachialis erfolgte. In 418 Fällen lag eine geburts

Obere Extremität, 2009

Trotz seiner großen anatomischen Konstanz und des geringen Spenderdefektes werden Lappenplastiken... more Trotz seiner großen anatomischen Konstanz und des geringen Spenderdefektes werden Lappenplastiken aus dem Gebiet der A. interossea posterior und anterior klinisch immer noch selten zur Defektdeckung im Handbereich eingesetzt. Gründe dafür sind: 1. Popularität der A.-radialis-Lappenplastik [11, 34], dem Alternativverfahren (die A.-ulnaris-Lappenplastik nach Guimberteau et al. [13] findet bei uns wegen der möglichen ischämischen Schädigung des N. ulnaris keine Anwendung), 2. Angst vor der Präparation des dünnen Gefäβstiels und 3. Zweifel an der Zuverlässigkeit der Blutversorgung, vor allem bei distaler Stielung aus dem Rete carpale dorsalis oder palmaris. Ziel der Arbeit ist es, basierend auf eigenen Erfahrungen und Angaben in der Literatur, die anatomischen Grundlagen der verschiedenen Lappenplastiken darzustellen und aufgrund deren Vor-und Nachteile Vorschläge zur Indikationsstellung für die verschiedenen Lappenplastiken zu formulieren. Anatomische Grundlagen Die Aa. interossea anterior und posterior entspringen etwa in 83% der Fälle aus der A. interossea communis, die ihrerseits meist etwa in Höhe der Tuberositas radii aus der A. ulnaris abgeht. In 17% der Fälle entspringen Aa. interossea anterior und posterior direkt der A. ulnaris [22, 27]. Am Unterarm werden die Arterien und ihre Äste meist von zwei Vv. comitantes begleitet [2, 39, 41].

European Archives of Oto-Rhino-Laryngology, 2012

Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrosp... more Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrospinal fluid (CSF) leak, ascending infection and/or brain tissue prolapse. The transfer of devitalized autologous, allogenic or xenogeneic material is not always sufficient particularly not in larger defects or in the recurrent situation. Here the transfer of vascularised tissue seems to be more appropriate. The anterior skull base with various complex defects of 41 patients was reconstructed in an interdisciplinary setting by vascularised, autologous tissue transfer. Minor defects (\2.5 cm in max. diameter), generally occurring after extended endoscopic skull base approaches (n = 26, among those meningiomas, recurrent CSF fistulas, chordoma, chondroblastoma, metastasis, nasal fistula), were reconstructed by a local, vascularized pedicled mucosal flap of the lower turbinate (n = 3) or septum (n = 23). Patients with major defects ([2.5 cm in max. diameter, n = 15), comprising those with malignoma, meningoencephalocele, aneurysmatic bone cyst and trauma, were repaired by a ''sandwich technique'' with a combination of calvarian split and galea periosteum flap in 10 patients, in one case with a temporalis muscle flap, while in 4 further patients free vascularised radial forearm flaps were used for revision after multiple unsuccessful operations elsewhere. After a mean follow-up time of 30.5 months 38 of the 41 cases were successfully repaired with respect to prevention and treatment of CSF leakage or brain tissue prolapse, only 3 cases needed surgical revision. The reconstruction of the anterior skull base bearing complex lesions is feasible using vascularised, autologous local and also distal tissue transfer in a close interdisciplinary cooperation. Keywords Anterior skull base Á Reconstruction Á Vital tissue transfer Á Vascularised flap Á CSF leak D. Hanggi and I.E. Sandalcioglu contributed equally.

How to Improve the Results of Peripheral Nerve Surgery

Within the last decade contralateral C7-transfer has become a new source of axon donor in complet... more Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions. Ten adult patients with a complete posttraumatic brachial plexus lesion and a follow-up of more than 5 years are analyzed. As shown by GU we are using a two stage procedure with exploration and extraplexuel neurotization of the suprascapular nerve using 1/2 spinal acessory nerve. Depending on the intraoperative findings, the musculocutaneous nerve is neurotized by the phrenic nerve at the time of primary operation or secondarily neurotized by the contralateral C7 root. If the musculocutaneous nerve could be neurotized by the phrenic nerve, C7-transfer is used to reinnervate the median nerve. If ever possible, the vascularized ulnar nerve graft or if not availabe two sural nerves are used. Neurotization of the musculocutaneous nerve was carried out in 6, and of the median nerve in 4 patients. There are 6 patients in the MC group and 4 patients in the Median group. Criterias for evaluation used are: donor site (morbidity, classification), time for recovery, time for autonomization, and functional result. Successful elbow flexion is achieved if muscle power > M3, successful median nerve motor function is achieved if a primitive power grip pattern is achieved. All patients were complaining of temporary paresthesia in the dorsal part of P3 of the thumb, index and middle finger. There was complete sensory at the 3-month postoperative examination. There was no evident clinical motor loss at the donor extremity. A successful elbow flexion, i.e. muscle power > M3 was achieved in all 6 patients after 9-15 months. 4 of 6 patients are able to use this function individually. In the other two patients a start command must be given voluntarily from the contralateral side (contraction of the contralateral latissimus dorsi muscle). A functional primitive grip pattern could be achieved in 1 out of 4 patients after 18 months. In three patients, although there is movement, this mouvement must be judged "academic" at the present state. The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.

European Journal of Plastic Surgery, 2001

The local intramuscular application of botulinum toxin into the triceps, temporarily blocks activ... more The local intramuscular application of botulinum toxin into the triceps, temporarily blocks activity and thus reduces the resistance to the weak but contracting biceps. Six children (2-4 years of age) presenting with severe biceps/triceps co-contractions after nerve regeneration (spontaneous regeneration in three cases, early microsurgical reconstruction in three cases) of an obstetrical brachial plexus lesion, were treated with local injections of 25-50 mouse units (DYSPORT, R) botulinum toxin type A at two sites of the triceps muscle. Botulinum toxin injections were monitored by EMG recordings. Clinical testing (muscle power graded by the British Medical Research Council classification and measurement of the active range of motion, using the Neutral-0-Method) and EMG studies were performed prior to and after injections. Follow-up was at least 18 months. Mean active elbow flexion prior to application was about 50°(range: 20-60°) and muscle power was graded M1 (two cases) to M2 (four cases). Eighteen months after injection, mean elbow flexion was about 100°(range: 80-120°) and muscle power was graded as M2+ (elbow flexion without gravity in one case) to M4 (five cases). On EMG examination, a clear reduction of triceps contractions during biceps activity was observed. Temporary paralysis of the triceps after injection persisted for 16-44 weeks, with an average of 25.3 weeks. In order to achieve a stable elbow flexion at the M4 level, the Botox injection had to be repeated 2-3 times. The average time of treatment took 8-12 months. There was no recurrence of co-contraction in any of the patients after an 18 month follow-up. Moreover, no severe complications occurred. Local injections of botulinum toxin type A represents a new effective nonoperative tool for co-contracture treatment in obstetrical brachial plexus lesions in children.

Der Orthopäde, 1997

A review of the literature reveals that with conventional treatment alone or in combination with ... more A review of the literature reveals that with conventional treatment alone or in combination with secondary muscle/tendon transfer, about 4-43% of cases show incomplete recovery with severe functional and/or aesthetic impairment (group III). If these patients undergo early microsurgical brachial plexus revision, regeneration without significant functional and/or aesthetic impairment (shift from group III to group II) can be achieved in 80-90% of cases. Moreover, microsurgical reconstruction of the brachial plexus increases the possibilities of secondary muscle/tendon transfers. Therefore, provided patient selection is good, severe obstetrical brachial plexus injuries should be scheduled for early microsurgical revision. There is no need to wait for a frustrating spontaneous recovery. Our concept is based on our experience with more than 1100 patients presenting with brachial plexus lesions between 1981 and 1996 and treated in our institution. There were 217 obstetrical brachial plexus lesions, 133 of which were treated conservatively. In 84 cases operative treatment was necessary. Fifty-one cases underwent early revision of the brachial plexus, and secondary tendon transfer was done in 33 patients.

Der Orthopäde, 1997

Elbow flexion plays a key role in the overall function of the upper extremity. In the case of uni... more Elbow flexion plays a key role in the overall function of the upper extremity. In the case of unilateral complete brachial plexus lesion, restoration of elbow flexion will dramatically increase the patient's chances of regaining bimanual prehension. Furthermore, depending on the type of reconstruction, stability of the glenohumeral joint as well as some supination function of the forearm can be restored to a varying degree at the same time. Depending on the level of brachial plexus lesion and/or reinnervation, different reconstructive procedures are available. In order to select the best treatment option for the patient it is necessary to known the extent of the lesion of the brachial plexus and/or ventral upper arm muscles, to time the operation appropriately, to be aware of all treatment possibilities and to recall the special problems of tendon transfer for brachial plexus patients. Our concept is based on our experience with more than 1100 patients presenting a brachial plexus lesion between 1981 and 1996 and treated in our institution. There were 528 operative revisions of the brachial plexus. Some 225 patients underwent secondary muscle/tendon transfers. In 35 patients elbow flexion was reconstructed by bipolar latissimus dorsi transfer (n = 10), triceps-to-biceps transfer (n = 15), modified flexor/pronator muscle mass proximalization (n = 6) and the multiple-stage free functional muscle transfer after intercostal nerve transfer (n = 4).

Tijdschrift voor Geneeskunde, 2005

Tijdschrift voor Geneeskunde, 2004

The posttraumatic reconstruction of the upper limb function is highly important to enable the rei... more The posttraumatic reconstruction of the upper limb function is highly important to enable the reintegration into a professional life and to guarantee the quality of life. Until lately, the results of a reconstruction of the elbow joint were rather disappointing. Recently, however, new possibilities have been developed to enable the restoration of the function of also this joint in case of posttraumatic problems. Here we discuss the percutaneous - arthroscopic assisted osteosynthesis of the radial head, the treatment of the so-called terrible triad of the elbow, the developments in the osteosynthesis of supracondylar humeral fractures, the role of prosthetic surgery in case of posttraumatic problems, including the use of prosthesis-allograft constructions as well as the corrective osteotomies of the elbow. Our reconstructive possibilities have strongly increased by applying these techniques actively supplemented with the new diagnostic possibilities like the magnetic resonance imaging, dynamic x-rays, 3D-reconstructions of the elbow joint and the elbow arthroscopy which is oscillating between diagnosis and therapy. As a general result, malfunctioning and even arthrodesis are often avoided.status: publishe

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2006

Der Unfallchirurg, 2002

Pro Jahr treten in Deutschland etwa 1.000–1.500 posttraumatische Läsionen des Plexus brachialis a... more Pro Jahr treten in Deutschland etwa 1.000–1.500 posttraumatische Läsionen des Plexus brachialis auf. In den meisten Fällen handelt es sich um Motorradunfälle. Durch die Einführung der Helmtragepflicht konnte zwar ein deutlicher Rückgang der schweren Schädel-Hirn-Traumata beobachtet werden, jedoch erhöhte sich der Anteil an schweren Läsionen des Plexus brachialis.

Tijdschrift voor Geneeskunde, 2005

Deutsche Gesellschaft für Chirurgie, 2000

Im Zeitraum von 1981 bis 1996 haben wir 8 Patienten mit einer Avulsion der Haut im gesamten Handb... more Im Zeitraum von 1981 bis 1996 haben wir 8 Patienten mit einer Avulsion der Haut im gesamten Handbereich versorgt. Mit durchschnittlich 5 Operationen eine ausreichende Handfunktion wiederhergestellt werden. Alle Patienten gaben eine Schutzsensibilitat mit der Moglichkeit der Zuordnung des Fingers an. Bei durchschnittlich masiger Beweglichkeit im MP-Gelenkbereich (Ex/Flex: 0–10–60°) bestand eine deutliche Einschrankung im Bereich der PIP-Gelenke. Obwohl Grobgreiffunktionen von allen Patienten durchgefuhrt werden konnten, waren die Feingriff-Funktionen stark eingeschrankt. Alle nachuntersuchten Patienten wurden sich wieder fur eine derartige Rekonstruktion und gegen eine primare Handamputation entscheiden. 2 Patienten tragen bei gesellschaftlichen Anlassen eine asthetische Prothese nach Pillet. Hauptnachteil aller Rekonstruktionen derartiger Verletzungen ist die mangelnde Oberflachensensibilitat, welche nur durch mikrochirurgische Operationen an Teilen der Hand wiederhergestellt werden kann.

Der Orthopäde, 1997

Summary A review of the literature reveals that with conventional treatment alone or in combina... more Summary A review of the literature reveals that with conventional treatment alone or in combination with secondary muscle/tendon transfer, about 4–43 % of cases show incomplete recovery with severe functional and/or aesthetic impairment (group III). If these patients undergo early microsurgical brachial plexus revision, regeneration without significant functional and/or aesthetic impairment (shift from group III to group II) can be