Eight children, five boys and three girls, aging from 2 to 13 years (M = 9 ± 3) were treated with the "Vienna phrenic pacemaker". Indication for implantation was central alveolar hypoventilation syndrome (CAH) in one case and total ventilatory insufficiency due to high cervical cord or brain stem lesion (SCI) in seven cases. Four electrodes were applied to each phrenic nerve via sternotomy. Both hemidiaphragms were paced synchronously with increasing duty cycles to condition the diaphragms for continuous electrophrenic respiration (EPR). EPR could be performed successfully in all children but one. Four children could achieve chronical EPR, one is in conditioning period. Two patients could not be discharged from hospital due to parental neglect and died after two and three years of intermittent stimulation. Six children could be discharged from hospital, two of them died after one and four years of chronic pacing. In one case tracheotomy could be closed definitively. Ventilatory insufficiency due to CAH and SCI can be treated even in children with diaphragm pacing, provided the indication for implantation, containing medical and social aspects, was made correctly. Diaphragm pacing probably will not lengthen life of severely injured children but it can increase the quality of their life and therefore should be preferred to positive pressure mechanical ventilation. 8 Kindern, 5 Buben und 3 Mädchen im Alter zwischen 2 und 13 Jahren (M = 9 ± 3), wurde ein ,,Wiener Atemschrittmacher" implantiert. Indikation dafür war bei sieben Kindern eine hohe Rückenmarksläsion und bei einem Kind ein zentrales alveoläres Hypoventilationssyndrom (Undine-Syndrom). Nach Sternotomie wurden an beiden Nn. phrenici jeweils vier Stimulationselektroden, zur synchronen Stimulation beider Zwerchfellhälften, positioniert. Im Rahmen eines Trainingsprogrammes erfolgte die Konditionierung des Diaphragmas mit dem Ziel der chronischen elektrophrenischen Beatmung (EPR). Alle Kinder, bis auf eines, konnten erfolgreich elektrophrenisch beatmet werden. Bei vier Kindern konnte das Zwerchfell chronisch, rund um die Uhr, stimuliert werden, ein Kind befindet sich in der Konditionierungsphase. Zwei Kinder konnten mangels elterlicher Fürsorge nicht aus dem Krankenhaus entlassen werden und verstarben nach zwei bzw. drei Jahren intermittierender Zwerchfellstimulation. Sechs Kinder konnten in häusliche Pflege entlassen werden. Zwei dieser Kinder verstarben nach einem bzw. vier Jahren chronischer EPR. Bei einem Patienten konnte das Tracheostoma dauerhaft verschlossen werden. Der Atemschrittmacher ist zur Therapie der Ateminsuffizienz beim Undine-Syndrom oder bei hoher Rückenmarksläsion auch bei Kindern geeignet. Voraussetzung für den erfolgreichen Einsatz des Atemschrittmachers ist die sorgfältige Indikationsstellung unter Beachtung sowohl medizinischer als auch sozialer Aspekte. EPR kann wahrscheinlich die Überlebenszeit von schwerstbehinderten Kindern nicht verlängern, wohl aber deren Lebensqualität deutlich verbessern und sollte daher gegenüber der konventionellen Respiratorbeatmung den Vorzug erhalten.

(2016). Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process—a case report. Acta Orthopaedica: Vol. 87, No. 1, pp. 85-86. doi: 10.3109/17453674.2015.1092064

Background: Non-healing soft tissue defects pose challenges to treating physicians. Microsurgical reconstruction is a treatment option for achieving wound closure and limb salvage. These free tissue transfers are often challenging due to associated risk factors. This study aimed to evaluate microsurgical reconstruction using specialized microsurgical techniques for non-healing spontaneous or post-traumatic soft tissue defects in an elderly, high-risk patient cohort with peripheral artery disease. Methods: A retrospective study was conducted on patients with radiologically confirmed peripheral artery disease who underwent free tissue transfers between 2004 and 2010. Patients were included in whom one of two surgical techniques was used, including a “Y” configuration of the arterial pedicle, employed either as an interposition graft or as an arterial patch, or the use of a saphenous vein graft. Patient demographics, comorbidities, flap/limb survival, and surgical techniques were analyzed. Results: Twenty patients at a mean age of 68 (+/−9.3) years underwent 21 primary flap surgeries. Trauma-derived soft tissue defects were predominant (55%). Latissimus dorsi muscle flaps were most frequently utilized (52.4%). The flap success rate was 90.5% at a 12-month follow-up, with no secondary amputations recorded. The lost flaps were replaced by additional free tissue transfers without further complications. Conclusions: This study demonstrates the feasibility of free tissue transfers in high-risk patients with complex soft tissue defects and vascular calcifications. Thorough preoperative planning and the application of specialized surgical techniques are crucial for favorable outcomes in challenging clinical scenarios.

The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts under certain circumstances. In this study, 41 cases, 28 (68%) men and 13 (32%) women (median age: 40 years), were retrospectively analyzed. Therapy-specific data (flap vascularity [free vs. pedicled] size in cm and configuration [single- vs. double-barrel], mode of fixation [internal/external]) and potential risk factors were ascertained. Indications for reconstruction were osteomyelitis at host site (n = 23, 55%), pseudarthrosis (n = 8, 20%), congenital deformity (n = 6, 15%), traumatic defect, and giant cell tumor of the bone (n = 2, 5% each). Complete healing occurred in 34 (83%) patients after a median time of 6 months. Confounders for prolonged healing were female gender (p = 0.002), reconstruction in the lower limb (p = 0.011), smoking (p = 0.049), and the use of an external fixator (p = 0.009). Six (15%) patients required secondary limb amputation due to reconstruction failure, and one patient had persistent pseudarthrosis at last follow-up. The only risk factor for amputation assessed via logistic regression analysis was preexisting PAOD (peripheral artery occlusive disease; p = 0.008) The free fibula is a reliable tool for extremity reconstruction in various cases, but time to full osseous integration may exceed six months. Patients should be encouraged to cease smoking as it is a modifiable risk factor.

Background: Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous neurological recovery. Humerus derotation osteotomy has been suggested as a possible treatment option to improve arm positioning. However, consensus as to whether humerus derotation osteotomy can successfully restore limb function is missing. Methods: In the present controlled cohort study, we aimed at analyzing global upper extremity kinematics with a 3D-video analysis system in children with shoulder internal rotation contractures secondary to OBPP before, and one year after, humerus derotation osteotomy. Patients under 18 years of age that presented to our center with conservatively treated internal rotation contractures of the shoulder and subsequently underwent humerus derotation osteotomy were included. The unimpaired arm served as a respective control. Results: Pre-operatively, all patients showed severe internal rotation contractures of the shoulder of almost 60° at rest. At the follow-up, the position of the shoulder at rest was greatly shifted to 9° of internal rotation. The patients showed statistically significant improvement in maximum external rotation and abduction of the shoulder, as well as in maximum flexion of the elbow, and the range of motion of pro/supination. The maximum internal rotation of the shoulder, however, was diminished after the osteotomy. Conclusions: Our data indicated that derotational osteotomy is a promising procedure which can be used to correct for internal rotation contractures secondary to OBPP. Moreover, 3D-video analysis proved to be a useful tool that supplies the surgeon with both precise information about the degree of distortion pre-operatively, thus helping to decide on the amount of correction, and secondly, a measurement of the post-operative gain in upper extremity function.