RESUMEN
Overboarding politcal influence in Germany concerning medical issues has come to a new peak. The report by the IGES Institute published in 2022 made an important contribution in this regard. Unfortunately, only that part of the recommendations of this report were implemented in a new version of the contract for outpatient surgery according to Section 115b SGB V (AOP contract), that called for an expansion of outpatient surgery. In particular, those aspects that are important from a medical point of view for a patient-specific adjustment of outpatient surgery (e. g. old age, frailty, comorbidities) as well as the important structural requirements for outpatient postoperative care were included in the new AOP contract at best in a rudimentary manner. For this reason, the German Society for Hand Surgery felt compelled to give its members a recommendation as to which medical aspects must be taken into account, especially when performing hand surgery operations, in order to ensure the highest level of safety for the patients entrusted to us while performing outpatient surgery. An expert group of experienced hand surgeons and hand therapists who work in hospitals of all levels of care as well as resident surgeons was formed in order to formulate mutually agreed recommendations for action.
Asunto(s)
Especialidades Quirúrgicas , Cirujanos , Humanos , Consenso , Mano/cirugía , Cuidados PosoperatoriosRESUMEN
This case report shows the interdisciplinary treatment of a 28-year-old woman suffering from a pronounced frontal volume defect after severe craniocerebral trauma. The combination of cranioplasty using a polymethylmethacrylate (PMMA) implant, free gracilis muscle flap transfer for soft tissue coverage and serial autologous fat grafting into the muscle flap for subsequent contouring enabled both an adequate and aesthetic reconstruction. This example demonstrates the feasibility of treating increasingly complex composite defects in a multidisciplinary setting, when plastic surgeons are involved.
Asunto(s)
Colgajos Tisulares Libres , Músculo Grácil , Procedimientos de Cirugía Plástica , Tejido Adiposo , Adulto , Autoinjertos , Femenino , Humanos , Prótesis e ImplantesAsunto(s)
Quemaduras/clasificación , Quemaduras/terapia , Cuidados Posteriores , Cicatriz/prevención & control , Conducta Cooperativa , Primeros Auxilios/métodos , Medicina General , Humanos , Comunicación Interdisciplinaria , Derivación y Consulta , Cicatrización de Heridas/fisiología , Infección de Heridas/diagnósticoAsunto(s)
Amputación Traumática/terapia , Traumatismos de los Dedos/terapia , Dedos/inervación , Apósitos Oclusivos , Células Receptoras Sensoriales/fisiología , Amputación Traumática/diagnóstico , Amputación Traumática/fisiopatología , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/fisiopatología , Humanos , Regeneración Nerviosa/fisiología , Cicatrización de Heridas/fisiologíaAsunto(s)
Heridas y Lesiones/diagnóstico , Heridas y Lesiones/etiología , Enfermedad Crónica , Conducta Cooperativa , Pie Diabético/diagnóstico , Pie Diabético/etiología , Diagnóstico Diferencial , Gangrena/diagnóstico , Gangrena/etiología , Humanos , Comunicación Interdisciplinaria , Úlcera por Presión/diagnóstico , Úlcera por Presión/etiología , Factores de Riesgo , Piel/patología , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/etiología , Cicatrización de Heridas/fisiologíaRESUMEN
Reports about congenital symmastia and its surgical treatment are few. We report two patients - a mother and daughter - with congenital symmastia in whom breast and fatty tissue was found to be mobile adhering poorly to the chest wall. Although histological examination showed no abnormality of the tissue bridge between the breasts, ultrastructural investigation of breast tissue (including Cooper's ligaments) showed an abnormal arrangement of collagen fibres. Satisfying aesthetic results were achieved by resection of excess soft tissue in the cleavage area through a submammary incision and fixation of the skin with subcutaneous interrupted sutures to the sternal periosteum.