Publications by authors named "Hugo Kitzinger"

17 Publications

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Sexual dimorphism in the anatomy of the ulnar collateral thumb ligament.

Wien Klin Wochenschr 2019 May 1;131(9-10):216-220. Epub 2019 Apr 1.

, Laudongasse 25, 1080, Vienna, Austria.

Background: Treatment of ruptured ulnar collateral thumb metacarpophalangeal (MCP) joint ligaments (UCL) necessitate a profound anatomic knowledge for optimal surgical repair in order to preserve range of motion and ensure postoperative joint stability. Therefore, knowledge of the angle between the UCL and the longitudinal axis of the first metacarpal bone could be useful.

Methods: In this study 46 ulnar collateral thumb MCP joint ligaments in 15 male and 15 female embalmed anatomic specimens were dissected and the angles between the longitudinal axis of the first metacarpal bone and the proper (PUCL) as well as the accessory ulnar collateral thumb MCP ligament (AUCL) were measured.

Results: In male specimens the angle for the PUCL measured on average 133.5° (±2.35°) and 122.75° (±3.8°) for the AUCL. A significantly different angle was measured for female specimens which showed on average 137.88° (±3.51°) for the PUCL and 128.65° (±4.14°) for the AUCL.

Conclusions: Optimal surgical repair or reconstruction of torn ulnar collateral thumb MCP joint ligaments should aim for an angle of approximately 135° in PUCL and 126° in AUCL in relation to the longitudinal axis of the metacarpal bone. Differences in men and women should be considered if possible.

Level Of Evidence: IV (anatomic study).
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http://dx.doi.org/10.1007/s00508-019-1483-8DOI Listing
May 2019

The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb.

PLoS One 2017 24;12(7):e0181754. Epub 2017 Jul 24.

Medical University of Vienna, Department of Plastic and Reconstructive Surgery, Vienna, Austria.

Purpose And Hypothesis: Although sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL.

Methods: This study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis.

Results: In total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9-90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site.

Conclusions: The results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181754PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524296PMC
September 2017

Patient satisfaction, body image, and quality of life after lower body lift: a prospective pre- and postoperative long-term survey.

Surg Obes Relat Dis 2017 May 11;13(5):882-887. Epub 2017 Jan 11.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Background: Body contouring surgery after massive weight loss remains a fast growing field due to the rising number of postbariatric surgery patients, and it can improve patients' quality of life substantially. Patient expectations in these procedures are very high, but only little is known as to whether these procedures have a long lasting influence on body image, patient satisfaction, and quality of life.

Setting: University hospital, Austria.

Methods: We evaluated 40 consecutive female patients who underwent a lower body lift between 2009 and 2013. Patients took part in a prospective pre- and postoperative questionnaire survey inquiring about their psychological and physical wellbeing. The mean postoperative follow up interval was 61±14 months. We used 2 validated (Body Image Questionnaire and Body Appraisal Inventory) and one self-designed questionnaires (body lift follow-up questionnaire). The postoperative response rate in January 2016 was 72.5%.

Results: Lower body lift significantly reduced dismissive body ratings and increased long-term feelings of attractiveness and self-esteem, and significantly reduced discomfort associated with excess skin. Patients reported feeling happier, more attractive, and more self-confident. The procedure enhanced their physical wellbeing, even years after surgery.

Conclusion: Lower body lift satisfied patients' expectations and improved long-term quality of life. Therefore, it is an essential component in the treatment of patients who have experienced massive weight loss.
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http://dx.doi.org/10.1016/j.soard.2017.01.010DOI Listing
May 2017

Proteomics and transcriptomics of peripheral nerve tissue and cells unravel new aspects of the human Schwann cell repair phenotype.

Glia 2016 12 22;64(12):2133-2153. Epub 2016 Aug 22.

Children's Cancer Research Institute, Vienna, Austria.

The remarkable feature of Schwann cells (SCs) to transform into a repair phenotype turned the spotlight on this powerful cell type. SCs provide the regenerative environment for axonal re-growth after peripheral nerve injury (PNI) and play a vital role in differentiation of neuroblastic tumors into a benign subtype of neuroblastoma, a tumor originating from neural crest-derived neuroblasts. Hence, understanding their mode-of-action is of utmost interest for new approaches in regenerative medicine, but also for neuroblastoma therapy. However, literature on human SCs is scarce and it is unknown to which extent human SC cultures reflect the SC repair phenotype developing after PNI in patients. We performed high-resolution proteome profiling and RNA-sequencing on highly enriched human SC and fibroblast cultures, control and ex vivo degenerated nerve explants to identify novel molecules and functional processes active in repair SCs. In fact, we found cultured SCs and degenerated nerves to share a similar repair SC-associated expression signature, including the upregulation of JUN, as well as two prominent functions, i.e., myelin debris clearance and antigen presentation via MHCII. In addition to myelin degradation, cultured SCs were capable of actively taking up cell-extrinsic components in functional phagocytosis and co-cultivation assays. Moreover, in cultured SCs and degenerated nerve tissue MHCII was upregulated at the cellular level along with high expression of chemoattractants and co-inhibitory rather than -stimulatory molecules. These results demonstrate human SC cultures to execute an inherent program of nerve repair and support two novel repair SC functions, debris clearance via phagocytosis-related mechanisms and type II immune-regulation. GLIA 2016;64:2133-2153.
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http://dx.doi.org/10.1002/glia.23045DOI Listing
December 2016

Hypothenar Hammer Syndrome: Long-Term Results After Vascular Reconstruction.

Ann Plast Surg 2016 Jan;76(1):40-5

From the *Medical University of Vienna, Department for Surgery, Division of Plastic and Reconstructive Surgery, Vienna, Austria; and †Clinic for Hand Surgery, Salzburger Leite, Bad Neustadt/Saale, Germany.

Background: Hypothenar hammer syndrome is a rare vascular lesion of the distal ulnar artery in Guyon tunnel caused by acute or repetitive blunt trauma to the hypothenar eminence. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. The aim of this study was to evaluate the long-term outcomes of patients after surgical reconstruction of the ulnar artery.

Methods: In this retrospective study, the results of 12 patients treated for hypothenar hammer syndrome were evaluated. Preoperative and postoperative examinations of the hand were recorded. Function impairment was assessed with the "Disabilites of the Arm, Shoulder and Hand" questionnaire. Comparisons were also made based on ulnar artery patency versus occlusion. All patients were evaluated for ulnar artery patency as determined by Allen's test and magnetic resonance angiography.

Results: All patients were men with an average age of 42.8 years. In 3 patients, a direct end-to-end anastomosis of the ulnar artery was performed, and 9 patients received a reconstruction with a reverse interpositional vein graft. Nine vascular reconstructions remained patent after a mean follow-up period of 56.9 months. These patients had a complete or at least partial relief of their pain, dysesthesia, and cold intolerance compared with preoperatively. Patients with reoccluded ulnar arteries were statistically significant younger (P = 0.036) than patients with patent ulnar artery. They also had a higher pain level (P = 0.009) and a longer follow-up period (P = 0.036) than those with patent reconstruction. There was a trend for higher functional impairment in patients with reoccluded ulnar artery (P = 0.100). Smoking habits showed no influence on ulnar artery patency.

Conclusions: For patients with symptomatic hypothenar hammer syndrome and failed nonoperative treatment, surgical intervention is a good option. After more than 4.5 years after surgery 9 of 12 vascular reconstructions remained patent (75% patency rate), ensuring an immediate and long-term improvement of symptoms.
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http://dx.doi.org/10.1097/SAP.0000000000000562DOI Listing
January 2016

Post-Bariatric Body-Contouring Surgery: Fewer Procedures, Less Demand, and Lower Costs.

Obes Surg 2015 Jul;25(7):1198-202

Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria,

Background: Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing and placing additional burdens on already strained health care systems. In Austria, medically necessary body contouring is covered by public health care. In a sample of 622 women, we assessed the proportion of patients that underwent post-bariatric surgery at least 2 years after gastric bypass.

Methods: Former bariatric patients were asked whether they had undergone post-bariatric surgery or were planning to do so by structured telephone interviews. For patients who had undergone body contouring, the degree of satisfaction with the results was inquired. Costs for bariatric and post-bariatric procedures were assessed.

Results: Of 622 patients, 93 (14.9 %) had undergone body contouring and 68 (10.9 %) considered a procedure, while 454 (73 %) definitely stated that they did not want plastic surgery. Cost coverage was declined in 7 patients (1.1 %). Plastic procedures (n = 101) included 65 abdominoplasties, 25 lower body lifts without thigh lifts, 7 brachioplasties, and 4 minor procedures. Forty-nine patients were very satisfied with the results, 28 were fairly satisfied, and 16 were not satisfied. Body contouring added about 6 % to the costs of surgical treatment for morbid obesity.

Conclusions: Fewer patients than in other studies expressed a desire for post-bariatric surgery, 15 % actually proceeded to this step. The low demand was neither due to denied coverage nor to unfavourable results of plastic surgery. Additional costs for body contouring were less than expected.
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http://dx.doi.org/10.1007/s11695-014-1493-6DOI Listing
July 2015

Power assisted liposuction to obtain adipose-derived stem cells: impact on viability and differentiation to adipocytes in comparison to manual aspiration.

J Plast Reconstr Aesthet Surg 2014 Jan 3;67(1):e1-8. Epub 2013 Sep 3.

Division of Plastic and Reconstructive Surgery, Department of Surgery, and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Währingergürtel 18-22, 1090 Vienna, Austria.

Background: Adipose-derived stem cells (ASCs) play a key role in tissue engineering approaches and are probably of major importance in the context of autologous fat transfer. A number of different tools for harvesting ASCs-containing fat tissue have been established. Such devices should be easy to handle, time saving, low priced, safe and provide a high amount of viable ASCs in the aspirate. Power-assisted liposuction (PAL) has not yet been described in the literature as a tool for fat harvesting for lipotransfer. Aim of this study was to investigate ASCs' viability in fat tissue harvested using PAL versus manual aspiration (MA).

Methods: Fat tissue was obtained from 9 donors undergoing abdominoplasty. Samples were divided into two sections. Out of each section fat was harvested using either PAL or MA. Number of isolated ASCs was defined, proliferation rate was determined and cell viability was assessed by flow cytometry. The ability of isolated ASCs to differentiate into mature adipocytes was analyzed by gene marker expression.

Results: The number of viable ASCs and the proliferation rates did not significantly differ between PAL and MA but cells harvested using PAL showed significantly higher expression levels of differentiation markers adiponectin, GLUT4 and PPARg.

Conclusion: Our results show that PAL is a feasible method for harvesting fat tissue containing viable ASCs. Quantity and quality of PAL-harvested ASC is similar or even better, respectively, compared to ASCs harvested by MA.
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http://dx.doi.org/10.1016/j.bjps.2013.08.019DOI Listing
January 2014

Using superficial fascial system suspension for the management of the mons pubis after massive weight loss.

Ann Plast Surg 2014 Nov;73(5):578-82

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.

Although an abundance of literature exists regarding frequently lifted body areas, there are few reports about body contouring of the mons pubis. Therefore, this paper describes the first clinical results from a new technique, which surgically lifts the mons pubis using superficial fascial system suspension. Fifty patients underwent a lower body lift, including a superficial fascial system suspension of the mons pubis. After a mean follow-up period of 16.9 months (range, 6-31 months), patients were evaluated by standardized preoperative and postoperative photographs using the Pittsburgh Rating Scale. In addition, all patients completed a Likert-type scale questionnaire pertaining to body satisfaction and other bodily changes. Scores from the Pittsburgh Rating Scale improved significantly (P=0.03) from 2.76 (0.43) [range, 1-3] preoperative to 0.5 (0.59) [range, 0-2] postoperative. Fifteen (30%) of the patients assessed the new contour as very good, 26 (52%) patients as good. Eight patients developed a temporary edema in the mons pubis and 1 patient developed an infected fascia suture granuloma, which had to be removed. A mons pubis lift with the aid of the superficial fascial system is a safe surgical technique, which can easily be integrated in body contouring surgeries of the torso.
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http://dx.doi.org/10.1097/SAP.0b013e31827e29e5DOI Listing
November 2014

Prospective study on harvesting autologous bone grafts from the anterior iliac crest using a new specialized reamer.

Ann Plast Surg 2013 Nov;71(5):566-70

From the *Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; †Handcenter Ravensburg, Krankenhaus St. Elisabeth, Elisabethenstr. 19, 88212 Ravensburg, Germany; and ‡Clinic for Handsurgery Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany.

The iliac crest remains the most frequent donor site for bone harvesting. Despite the surgical access to the iliac crest being relatively simple and the operation being carried out regularly, there are frequent complications. Therefore, a new, manual iliac crest reamer (R group) was compared to the classical harvesting of a corticocancellous bone graft by means of an oscillating saw (Con group) in a prospective study on 80 consecutive patients having hand surgery. Follow-up time was 3 months. Operation time and incidence of hematomas, seromas, and paresthesias in the R group were significantly shorter and less, respectively, than in the Con group. Pain at harvest site measured with the visual analogue scale (VAS) at 5 days, 6 weeks, and 12 weeks postoperatively was significantly less in group R as well. The utilization of the iliac crest reamer allows bone graft harvest in a relatively quick and simple operation with relatively few complications but with the limitation in that the maximum diameter of a bone cylinder that it can harvest is 20 mm.
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http://dx.doi.org/10.1097/SAP.0b013e31824f2500DOI Listing
November 2013

Midcarpal fusion is also indicated in patients with advanced carpal collapse and already highly restricted range of motion preoperatively.

Ann Plast Surg 2014 Mar;72(3):295-8

From the *Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria; and †Clinic for Hand Surgery Bad Neustadt, Bad Neustadt/Saale, Germany.

Although midcarpal fusion is a well-accepted treatment of advanced carpal collapse, 1 question remains unanswered: is this technically demanding procedure worthwhile in wrists with an already highly restricted flexion-extension arc (FEA) of less than 60 degrees preoperatively? Therefore, a retrospective analysis of the records of 142 consecutive patients who had had a midcarpal fusion of the wrist was performed. There were 50 patients in group 1 (FEA < 60 degrees) and 92 patients in group 2 (FEA ≥ 60 degrees) with a mean follow-up of 23 months. Flexion-extension arc preoperatively and postoperatively, pain evaluated by a visual analog scale from 0 to 10 as well as the patients' upper extremity functioning captured with the Disabilities of the Arm, Shoulder and Hand questionnaire were statistically analyzed. Functional range of motion was defined as 5-degree wrist flexion and 30-degree wrist extension. Median wrist flexion before versus after midcarpal fusion was 18 versus 22 degrees and 23 versus 25 degrees for wrist extension in group 1. In group 2, the data were 42 versus 27 degrees and 43 versus 30 degrees, respectively. Midcarpal fusion led to an improvement of FEA in 52% of patients in group 1 but only in 5.4% of patients in group 2. In group 1, the median FEA improved by 122%, whereas the median FEA declined to 69% in group 2. Preoperatively 20% of patients in group 1 and 95% of patients in group 2 reached a functional range of motion for flexion/extension, which changed to 36% in group 1 versus 62% in group 2 postoperatively. The visual analog scale score improved for group 1 from 5.7 to 2.4 and for group 2 from 5.7 to 3.2, respectively. The postoperative DASH score was for both groups 33 points. Our data demonstrate that even in patients with a highly restricted range of motion in advanced carpal collapse, it is still reasonable to perform a midcarpal fusion instead of total wrist fusion.
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http://dx.doi.org/10.1097/SAP.0b013e3182605657DOI Listing
March 2014

After massive weight loss: patients' expectations of body contouring surgery.

Obes Surg 2012 Apr;22(4):544-8

Divison of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Massive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass body changes, and to learn about the expectations and impairments related to body contouring surgery.

Methods: A questionnaire addressing information on the satisfaction of body image, quality of life, and expectation of body contouring surgery following massive weight loss was mailed to 425 patients who had undergone gastric bypass surgery between 2003 and 2009. Of these 425 individuals, 252 (59%) patients completed the survey.

Results: Ninety percent of women and 88% of men surveyed rated their appearance following massive weight loss as satisfactory, good, or very good. However, 96% of all patients developed surplus skin, which caused intertriginous dermatitis and itching. In addition, patients reported problems with physical activity (playing sports) and finding clothing that fit appropriately. Moreover, 75% of female and 68% of male patients reported desiring body contouring surgery. The most important expectation of body contouring surgery was improved appearance, followed by improved self-confidence and quality of life.

Conclusions: Surplus skin resulting from gastric bypass surgery is a common issue that causes functional and aesthetic impairments in patients. Consequently, this increases the desire for body contouring surgery with high expectations for the aesthetic outcome as well as improved life satisfaction.
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http://dx.doi.org/10.1007/s11695-011-0551-6DOI Listing
April 2012

3D video analysis of facial movements.

Facial Plast Surg Clin North Am 2011 Nov;19(4):639-46, viii

Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

This article presents a review of 3D video analysis for use in patients with facial paralysis. The difficulties inherent in quantifying the degree of facial paralysis and the effect of therapeutics that has led to the use of videos and computer-assisted 3D analysis are discussed, which can yield quantifiable results of treatment, allow the description and quantification of facial paralysis, and become a tool in the planning of operative procedures. The authors provide a step-by-step overview of video analysis, and present case studies from two specific techniques they have used in reconstruction surgery.
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http://dx.doi.org/10.1016/j.fsc.2011.07.007DOI Listing
November 2011

The prevalence of body contouring surgery after gastric bypass surgery.

Obes Surg 2012 Jan;22(1):8-12

Department of Surgery, Divison of Plastic and Reconstructive Surgery, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Background: As bariatric surgery has become more popular, more patients are undergoing body contouring surgery after massive weight loss. Many of the surgical procedures performed on the massive weight loss patient are complex and labor-intensive. Therefore, the plastic surgery unit needs to be prepared for a patient's demand. Little literature is available on how frequently patients who have undergone gastric bypass surgery receive body contouring surgery.

Methods: Two hundred fifty-two subjects (out of 425 who were mailed the questionnaire) who had undergone gastric bypass surgery between 2003 and 2009 completed the questionnaire, which obtained information on body image satisfaction and frequency of body contouring surgery after massive weight loss.

Results: Of all patients, 74% desire a body contouring surgery after gastric bypass surgery. Fifty-three patients (21%) have undergone a total of 61 body contouring procedures. The most common were abdominoplasties (59%), followed by lower body lifts (20%). In contrast to a positive judgment of the general aspect of the body image satisfaction after massive weight loss, both genders are unsatisfied with body areas like abdomen/waist, breast, and thighs.

Conclusions: Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring surgery. A huge disparity exists between the number of subjects who desire a body contouring surgery and those who actually received it.
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http://dx.doi.org/10.1007/s11695-011-0459-1DOI Listing
January 2012

Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment.

J Hand Surg Am 2010 Aug 16;35(8):1323-9. Epub 2010 Jul 16.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

Purpose: Syndactyly is the second most common congenital malformation of the hand, and reports of the incidence of web creep after surgery vary. To evaluate our outcomes of simple syndactyly surgical release, we conducted a retrospective analysis of patients treated between January 1965 and December 2007.

Methods: After matching for inclusion criteria, we recruited 19 patients with 26 affected web spaces for clinical examination. Outcomes evaluation included grading of web creep, Vancouver Scar Scale, assessment of complications and subjective patient analysis, range of motion, degree of finger abduction, power, and 2-point discrimination. Mean age at follow-up was 18 years (range, 6-50 y), with a mean age of 4.4 years (range, 7 mo to 15 y) at surgery and mean follow-up of 11.5 years (range, 5-35 y). Surgical management consisted of palmar and dorsal triangular skin flaps for creation of the new commissure, and multiple zigzag incisions for separation of digits. For tension-free closure, full-thickness skin grafts were harvested as needed.

Results: We observed web creep up to the proximal third of the distance between palmar metacarpophalangeal and proximal interphalangeal joint crease in 2 web spaces. All other web spaces had either a soft web equivalent to the contralateral (unaffected) side (n = 13) or no web advancement with thickening of the interdigital space (n = 11). The scar quality as assessed with the Vancouver Scar Scale revealed a height below 2 mm in 24 of 26 web spaces, with close to normal to supple pliability in 20 of 26 web spaces. There were no considerable differences for range of motion, degree of finger abduction, power, or 2-point discrimination between the affected and unaffected sides. In 17 of 24 cases in which full-thickness skin grafts from the groin region were used, patients reported commissural hair growth in the grafted region.

Conclusions: Evaluation of the long-term outcomes of surgical treatment for simple syndactyly at our institution demonstrated a low incidence of web creep. When choosing the groin as a donor area for full thickness skin grafts, we recommend harvesting from the lateral third of the inguinal crease, to avoid esthetic compromise associated with the beginning of hair growth in puberty.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2010.04.033DOI Listing
August 2010

The treatment of hand burns.

Burns 2009 May 25;35(3):327-37. Epub 2008 Oct 25.

Department of Surgery, Vienna Burn Centre, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.

In more than 80% of all burns, the hand is involved. Even if a burned hand does not play a major role for the survival of a patient, its function and aesthetic appearance are of utmost importance for the re-integration into society and professional life. Adequate treatment demands a number of major decisions: necessity of an escharotomy in the early post-traumatic phase, the timing of surgery and the type of wound coverage, as well as immobilization and rehabilitation. Rapid wound closure is of utmost importance, but infection control and the preservation of active and passive motion are also essential for optimal recovery of the injured hand. The treatment of hand burns requires the interdisciplinary teamwork of surgeons, physio- and occupational therapists, psychologists, motivated health care personnel and consequent treatment strategies.
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http://dx.doi.org/10.1016/j.burns.2008.08.004DOI Listing
May 2009

Ulnar shortening osteotomy with a premounted sliding-hole plate.

Ann Plast Surg 2007 Jun;58(6):636-9

Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Background: Ulnar shortening osteotomy represents a common procedure for various ulnar-sided wrist disorders but is still associated with complications like malrotation, angulation, or nonunion because of incomplete closure of the osteotomy gap. We describe the use of a newly developed palmarly placed sliding-hole dynamic compression plate that allows fixation of the ulna before the oblique osteotomy is carried out.

Methods: We performed ulnar shortening osteotomy on 27 consecutive patients. The indication was ulnar impaction syndrome in 25 patients and symptomatic ulnar plus variance secondary to malunited distal radial fracture in 2 patients. The mean preoperative ulnar variance was +2.1 mm (range, +1 mm to +8 mm). All patients were evaluated before and after surgery and graded with the Disability of Arm-Shoulder-Hand (DASH) scoring system.

Results: All 27 osteotomies healed uneventfully over an average of 9.2 +/- 2.1 weeks. The mean postoperative ulnar variance was -2.1 mm (range, -3.1 mm to 0 mm). There were significant improvements in DASH score, pain, and grip strength at an average follow-up of 8.1 months. Six patients complained of plate irritation.

Conclusion: Favorable results suggest that ulnar shortening osteotomy using an oblique osteotomy and a premounted sliding-hole compression plate avoids malrotation and angulation and is associated with satisfactory outcomes. This device does not require an assisting device, which minimizes the surgical exposure of the ulna. Palmar placement of the plate seems to reduce hardware irritation.
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http://dx.doi.org/10.1097/01.sap.0000250835.72396.48DOI Listing
June 2007

Ulnar shortening osteotomy with a new sliding-hole plate.

Tech Hand Up Extrem Surg 2003 Sep;7(3):93-7

Department of Hand Surgery Rhön-Klinikum Bad Neustadt, Germany.

Ulnar shortening osteotomy represents a common procedure for surgical treatment of the ulnar impaction syndrome but is still associated with complications like malrotation, angulation, or malunion because of incomplete closure of the osteotomy gap. Therefore, the authors developed a special 7-hole compression plate that allows fixation of the ulna before the osteotomy is carried out to prevent rotation. With this plate, a shortening of up to 10 mm is possible and the compression holes allow closure of the osteotomy gap. The plate has been used in 23 ulnar shortening cases at their center with good results. The authors describe the technique and report their results of ulnar shortening with this device.
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http://dx.doi.org/10.1097/00130911-200309000-00004DOI Listing
September 2003
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