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Defektdeckung an der ulnaren Handkante, am ulnopalmaren Handgelenk und im Hypothenarbereich durch eine Abductor-digiti-minimi-Muskellappenplastik. Posttraumatische oder postinfektiose Weichteildefekte im Bereich der ulnaren Handkante, des ulnopalmaren Handgelenks und der Hypothenarregion. Osteitis des 5. Mittelhandknochens. Grose Defekte uber 3 × 5 cm, Verletzungen der A. ulnaris oder Verletzungen im Bereich des Gefasstiels. Zunachst Ausmessen des Rotationsradius des M. abductor digiti minimi ausgehend vom Os pisiforme, wobei das distale Lappenende auf Hohe des Grundgelenks lokalisiert ist. Anschliesend ulnare Inzision und Aufsuchen des distalen Muskelansatzes und Absetzen desselben. Praparation des gesamten Muskelbauchs bis zu seinem proximalen Gefasstiel knapp distal des Os pisiforme. Einschwenken und Fixieren des Muskels in den Defekt und abschliesende Defektdeckung durch ein Spalthauttransplantat. Primarer Wundverschluss der Hebestelle. Ruhigstellung mittels palmarer Handgelenkschiene in „Intrinsic-Plus“-Stellung fur 10 Tage und Physiotherapie aus der Schiene heraus. Fettsalbenpflege des Spalthauttransplantats und Kompressionshandschuh nach Mas fur ca. 3 Monate. Bei insgesamt 9 Patienten zuverlassige Defektdeckung bei relativ einfacher Praparation und konstanter Anatomie.

Selbstverletzungen stellen eines der Hauptkriterien der Borderline-Personlichkeitsstorung dar. Dabei bedurfen thermische Verletzungen von Borderline-Patienten der Behandlung des plastischen Chirurgen, der sich aufgrund der komplexen psychiatrischen Storung der Patienten insbesondere bei repetitiven Verletzungen einer sein Fachgebiet uberschreitenden Herausforderung gegenuber sieht. Diese ist nur durch eine multidisziplinare Behandlungsstrategie zu bewaltigen. Anhand von 3 Fallbeispielen soll die Problematik der Behandlung im Spannungsfeld zwischen dem Bestreben nach einer optimalen plastisch-chirurgischen Behandlung der thermischen Verletzung einerseits und der Limitierung dieser Behandlung aufgrund der akuten psychischen Situation der Patienten andererseits dargestellt werden.

Borderline personality disorder (BPD) is a mental illness with a prevalence of 1.5% in Western countries. One of the major characteristics of patients with BPD is self-mutilation of any kind. These patients are especially often seen in our clinic since our institution is collaborating with the department of psychiatry that offers supra-regional specialist inpatient hospital treatment of BPD. Types of self-manipulation are various and include slashing and cutting, burning or freezing, bonebreaking, hitting or incorporation of foreign objects. Due to the difficult-to-treat primary disorder, more wound manipulation or self-injury may occur when tensions continue, even after adequate plastic reconstructive surgical treatment and during hospitalization, which represents a challenge for the plastic reconstructive strategy. We describe special problems associated with plasticreconstructive surgery in the light of BPD and self-mutilation and present our algorithm with a series of recommendations for the treatment of such patients as well as three illustrative case reports.

INTRODUCTION Toxic epidermal necrolysis (TEN) is associated with a high mortality. The need for mechanical ventilation is associated with an increased mortality in TEN patients. This study investigates the impact of the timing of initiation of the mechanical ventilation on the survival of TEN patients. PATIENTS, MATERIALS AND METHODS A retrospective study of 26 TEN patients was carried out. Primary (on admission (group A) and secondary ventilation (>1 day after admission (group B) were analysed for an association with mortality. RESULTS 8 patients did not require mechanical ventilation. 18 patients needed mechanical ventilation. In group A 8 patients with an epidermolytic body surface area (BSA) of 73 ± 16% and a mean SCORTEN of 3.2 ± 1.1 were analysed. In group B 10 patients with an epidermolytic BSA of 76 ± 19% and a mean SCORTEN of 3.8 ± 0.9 were evaluated. Statistical analysis showed an increased mortality in all mechanically ventilated compared with non-ventilated TEN patients (Odds ratio: 2.0; 95% CI: 1.26-3.17 p = 0.013). CONCLUSIONS Mechanical ventilation in TEN patients is associated with an increased mortality rate, but the timing of initiation of mechanical ventilation does not affect the patient survival rates.

Schwere Schadel-Hirn-Traumata, Ruckenmarksverletzungen oder isolierte Gelenkverletzungen konnen mit heterotopen Ossifikationen einhergehen. Im Zusammenhang mit grosflachigen Brandverletzungen stellen periartikulare Knochenneubildungen eine seltene, schwerwiegende Komplikation dar, deren Pathogenese noch unklar ist. In einer retrospektiven Analyse der in den vergangenen 10 Jahren in unserem Zentrum fur Schwerbrandverletzte behandelten 672 Patienten haben wir in 5 Fallen (0,74%) die Problematik der heterotopen Ossifikationen festgestellt.

Background: Free tissue transfer in reconstruction of lower extremity wounds is well established. Controversy surrounds type and regimen of intravenous fluid application during microsurgery. Hemodilution is supposed to influence haemostatic process. Patients and Methods: We performed an analysis of 48 patients treated with a free latissimus dorsi muscle flap to the lower leg for posttraumatic soft-tissue coverage. Postoperative latissimus dorsi muscle flap perfusion was controlled by clinical monitoring. Intraoperative infusion management was evlatuated retrospectively. Results: In 4 of 48 included patients, a complete loss of free latissimus dorsi muscle flap was registered. Concomitant increased saline infusion was detected (4,534 ml versus. 6,125 ml; P = 0.048). Similar findings for relation of total infusion volume to body weight were seen (44 ml/kg versus 69 ml/kg; P = 0.01). No significant colloid infusion was detected. Conclusions: We demonstrate the clinical relevance of extensive intraoperative hyperhydration, which can provoke a complete free flap loss. © 2010 Wiley-Liss, Inc. Microsurgery, 2010.

Die meisten Finger werden wohl beim Handball- oder beim Volleyballspiel „angeknackst“. Aber auch im Haushalt lauern vielfaltige Traumaquellen. So verletzte sich die hier beschriebene Patientin beim Bettenmachen so schwer, dass die Sehne ausriss und sie in der Folge den Finger nicht mehr aktiv strecken konnte.

Objective Obesity is an important predictor of mortality and morbidity during a hospital stay. There is very little data concerning the impact of the BMI on clinical outcomes in obese burn patients. The purpose of this study is to document the general epidemiological aspects of thermal injuries in an obese population and draw attention to topics relating to the management, rehabilitation and prognosis of burns in this emerging subpopulation of patients. Methods All patients >16 years of age admitted to the burn unit between January 2008 and December 2012 and fulfilling the burn center referral criteria were enrolled in the study. SPSS version 20 (SPSS GmbH Software, Illinois, USA) was employed for data analysis. Results Eleven extreme obese patients (men:women, 6:5) had a mean BMI of 38 kg/m 2 . Their incidence in our study was 5.5%. The mean length of stay was 41.5 days, almost twice that of the non-obese. The presence of co-morbidities such as diabetes, hypertension, cardiac disease, or pulmonary disease, the problematic wound healing and the burn wound infection were significantly higher in the obese patients than in the non-obese. The mortality of obese burned patients was 36.4%. Conclusions These facts indicate admission of these patients to a burn care unit for the best possible treatment although they might not always fulfill criteria for admission to burn intensive care unit. Burn centers must be also prepared in terms of special nursing equipment for obese patients.