@article{JakubietzGruenertJakubietz2011, author = {Jakubietz, Michael G. and Gruenert, Joerg G. and Jakubietz, Rafael G.}, title = {The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68829}, year = {2011}, abstract = {Background: Intraarticular distal radius fractures can be treated with many methods. While internal fixation with angle stable implants has become increasingly popular, the use of bone graft substitutes has also been recommended to address comminution zones and thus increase stability. Whether a combination of both methods will improve clinical outcomes was the purpose of the study Methods: The study was thus conducted as a prospective randomized clinical trial. 39 patients with unilateral, intraarticular fractures of the distal radius were included and randomized to 2 groups, one being treated with internal fixation only, while the second group received an additional bone graft substitute. Results: There was no statistical significance between both groups in functional and radiological results. The occurrence of complications did also not show statistical significance. Conclusions: No advantage of additional granular bone graft substitutes could be seen in this study. Granular bone graft substitutes do not seem to provide extra stability if dorsal angle stable implants are used. Dorsal plates have considerable complication rates such as extensor tendon ruptures and development of CRPS.}, subject = {Medizin}, language = {en} } @article{JakubietzGruenertJakubietz2012, author = {Jakubietz, Michael G. and Gruenert, Joerg G. and Jakubietz, Rafael G.}, title = {Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term?}, series = {Journal of Orthopedic Surgery and Research}, volume = {7}, journal = {Journal of Orthopedic Surgery and Research}, number = {8}, doi = {10.1186/1749-799X-7-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-133987}, year = {2012}, abstract = {Background: Current surgical approaches to the distal radius include dorsal and palmar plate fixation. While palmar plates have gained widespread popularity, few reports have provided data on long term clinical outcomes in comparison. This paper reports the result of a randomised clinical study comparing dorsal Pi plates and palmar, angle-stable plates for treatment of comminuted, intraarticular fractures of the distal radius over the course of twelve months. Methods: 42 patients with unilateral, intraarticular fractures of the distal radius were included and randomised to 2 groups, 22 were treated with a palmar plate, 20 received a dorsal Pi-plate. Results were evaluated after 6 weeks, 3, 6 and 12 months postoperatively focussing on functional recovery as well as radiological results. Results: The palmar plate group demonstrated significantly better results regarding range of motion and grip strength over the course of 12 months. While a comparable increase in function was observed in both groups, the better results from the early postoperative period in the palmar plate group prevailed over the whole course. Radiological results showed a significantly increased palmar tilt and carpal sag in dorsal plates, with other radiological parameters being comparable. Pain levels were decreased in dorsal plates after hardware removal and failed to show significant differences after 12 months. However, complications such as tendon ruptures were more frequent in the dorsal plate group. Conclusions: Functional advantage of palmar plates gained within the first 6 weeks prevails over the course of a year. Both groups demonstrate further gradual increase of function after 6 months, although dorsal plates did not catch up completely. Improved early postoperative function seems to be the cornerstone for the best possible results. Patients with dorsal plates benefit from hardware removal more than palmar plates in terms of reduction of pain levels. The advantage of palmar plates is a faster functional recovery with lower complication rates. This is especially important in the elderly population. Radiological results did not show a superiority of palmar plates over dorsal plates.}, language = {en} } @article{SchmidtJordanHoelscherDohtetal.2014, author = {Schmidt, Karsten and Jordan, Martin C. and H{\"o}lscher-Doht, Stefanie and Jakubietz, Michael G. and Jakubietz, Rafael G. and Meffert, Rainer H.}, title = {Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo}, doi = {10.1186/s13018-014-0072-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110419}, year = {2014}, abstract = {Background Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc™ and Stratafix™, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model. Methods Forty fresh porcine flexor digitorum profundus tendons were randomized in two groups. A four-strand modified Kessler suture technique was used to repair the tendon either with a 3-0 V-Loc™ or 3-0 Stratafix™ without a knot. Parameters of interest were mode of failure, 2-mm gap formation force, displacement, stiffness and maximum load under static and cyclic testing. Results The maximum load was 42.3 ± 7.2 for the Stratafix™ group and 50.7 ± 8.8 N for the V-Loc™ group. Thus, the ultimate tensile strength was significantly higher for V-Loc™ (p < 0.05). The 2-mm gap occurred at 24.8 ± 2.04 N in the Stratafix™ group in comparison to 26.5 ± 2.12 N in the V-Loc™ group (n.s.). Displacement was 2.65 ± 0.56 mm in the V-Loc™ group and 2.71 ± 0.59 mm in the Stratafix™ group (n.s.). Stiffness was 4.24 ± 0.68 (N/mm) in the V-Loc™ group and 3.85 ± 0.55 (N/mm) the Stratafix™ group (n.s.). Those measured differences were not significant. Conclusion V-Loc™ demonstrates a higher maximum load in tendon reconstruction. The differences in 2-mm gap formation force, displacement and stiffness were not significant. Hereby, the V-Loc™ has an advantage when used as unidirectional barbed suture for knotless flexor tendon repair.}, language = {en} } @article{JakubietzJakubietzMeffertetal.2017, author = {Jakubietz, Michael G. and Jakubietz, Rafael G. and Meffert, Rainer H. and Schmidt, Karsten and Zahn, Robert K.}, title = {Biomechanical properties of first dorsal extensor compartment regarding adequacy as a bone-ligament-bone graft}, series = {Plastic and Reconstructive Surgery Global Open}, volume = {5}, journal = {Plastic and Reconstructive Surgery Global Open}, number = {7}, doi = {10.1097/GOX.0000000000001397}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158851}, pages = {e1397}, year = {2017}, abstract = {Background: Bone-ligament-bone grafts for reconstruction of the scapholunate ligament are a valuable tool to prevent disease progression to carpal collapse. Locally available grafts do not require an additional donor site. The first extensor compartment was evaluated biomechanically regarding its possible use as an autograft. Methods: Twelve native fresh-frozen, human cadaver specimens were tested by applying axial tension in a Zwick Roell machine. Load to failure, transplant elongation, and bony avulsion were recorded. The load to failure was quantitated in newtons (N) and the displacement in length (millimeters). Parameters were set at distinct points as start of tension, 1 mm stretch and 1.5 mm dissociation, failure and complete tear, and were evaluated under magnified visual control. Although actual failure occurred at higher tension, functional failure was defined at a stretch of 1.5 mm. Results: Mean load at 1 mm elongation was 44.1 ± 28 N and at 1.5 mm elongation 57.5 ± 42 N. Failure occurred at 111 ± 83.1 N. No avulsion of the bony insertion was observed. Half the transplants failed in the central part of the ligament, while the rest failed near the insertion but not at the insertion itself. Analysis of tension strength displayed a wide range from 3.8 to 83.7 N/mm at a mean of 33.4 ± 28.4 N/mm. Conclusions: The biomechanical tensile properties of the first dorsal extensor compartment are similar to those of the dorsal part of the scapholunate ligament. A transplant with a larger bone stock and a longer ligament may display an advantage, as insertion is possible in the dorsal, easily accessible part of the carpal bones rather than in the ar{\^e}te-like region adjacent to the insertion of the scapholunate ligament. In this study, 1.5 mm lengthening of the bone-ligament-bone transplant was defined as clinical failure, as such elongation will cause severe gapping and is considered as failure of the transplant.}, language = {en} } @article{JakubietzNickelNeshkovaetal.2017, author = {Jakubietz, Rafael G. and Nickel, Aljoscha and Neshkova, Iva and Schmidt, Karsten and Gilbert, Fabian and Meffert, Rainer H. and Jakubietz, Michael G.}, title = {Long-term patency of twisted vascular pedicles in perforator-based propeller flaps}, series = {Plastic and Reconstructive Surgery Global Open}, volume = {5}, journal = {Plastic and Reconstructive Surgery Global Open}, number = {10}, doi = {10.1097/GOX.0000000000001544}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158870}, pages = {e1544}, year = {2017}, abstract = {Background: Propeller flaps require torsion of the vascular pedicle of up to 180 degrees. Contrary to free flaps, where the relevance of an intact vascular pedicle has been documented, little is known regarding twisted pedicles of propeller flaps. As secondary surgeries requiring undermining of the flap are common in the extremities, knowledge regarding the necessity to protect the pedicle is relevant. The aim of this study was a long-term evaluation of the patency of vascular pedicle of propeller flaps. Methods: In a retrospective clinical study, 22 patients who underwent soft-tissue reconstruction with a propeller flap were evaluated after 43 months. A Doppler probe was used to locate and evaluate the patency of the vascular pedicle of the flap. Results: The flaps were used in the lower extremity in 19 cases, on the trunk in 3 cases. All flaps had healed. In all patients, an intact vascular pedicle could be found. Flap size, source vessel, or infection could therefore not be linked to an increased risk of pedicle loss. Conclusions: The vascular pedicle of propeller flaps remains patent in the long term. This allows reelevation and undermining of the flap. We therefore recommend protecting the pedicle in all secondary cases to prevent later flap loss.}, language = {en} } @article{JakubietzJakubietzMeffertetal.2017, author = {Jakubietz, Rafael G. and Jakubietz, Michael G. and Meffert, Rainer H. and Schmidt, Karsten}, title = {Multiple-level replantation in elderly patients: risk versus benefit}, series = {Plastic and Reconstructive Surgery Global Open}, volume = {5}, journal = {Plastic and Reconstructive Surgery Global Open}, number = {4}, doi = {10.1097/GOX.0000000000001313}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158443}, pages = {e1313}, year = {2017}, abstract = {Multiple-level amputations of the upper extremity represent a surgical challenge generally only attempted in young patients. This case demonstrates a successful replantation in an elderly woman. The postoperative course was complicated by disseminated intravascular coagulopathy most likely due to inadequate resuscitation. Hand trauma is often underestimated in its general severity. Upper extremity amputations need to be handled similar to polytraumatized patients.}, language = {en} } @article{JakubietzMeffertSchmidtetal.2017, author = {Jakubietz, Michael G. and Meffert, Rainer H. and Schmidt, Karsten and Gruenert, Joerg G. and Jakubietz, Rafael G.}, title = {Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft}, series = {Plastic and Reconstructive Surgery Global Open}, volume = {5}, journal = {Plastic and Reconstructive Surgery Global Open}, number = {6}, doi = {10.1097/GOX.0000000000001361}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158057}, pages = {e1361}, year = {2017}, abstract = {Background: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. Methods: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. Results: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. Conclusions: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.}, language = {en} } @article{GilbertJakubietzMeffertetal.2018, author = {Gilbert, Fabian and Jakubietz, Rafael G. and Meffert, Rainer H. and Jakubietz, Michael G.}, title = {Does distal radio-ulnar joint configuration affect postoperative functional results after ulnar shortening osteotomy?}, series = {PRS Global Open}, volume = {6}, journal = {PRS Global Open}, number = {4}, doi = {10.1097/GOX.0000000000001760}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-176265}, pages = {e1760}, year = {2018}, abstract = {Background: Reverse oblique distal radio-ulnar joint (DRUJ) configuration is assumed to show inferior postoperative results in ulnar-shortening osteotomy due to osteoarthritis, as the joint force pressure in the DRUJ may be increased. An evaluation and comparison of the postoperative functional results with regard to clinical and radiographic signs of arthritis among different DRUJ configurations was carried out retrospectively. Methods: Sixty-two patients after ulnar shortening osteotomy were included. The minimum follow-up was 5 years. Preoperative x-rays were assessed for the DRUJ configuration according to the Tolat classification, whereas postoperative radiographs were evaluated with regard to signs of osteoarthritis using the Kallgren-Lawrence-Score. Functional results were evaluated using the disabilities of the arm, shoulder and hand (DASH) and Mayo Wrist Score and measuring range of motion and grip strength. Results: Significantly better functional results were found in patients with parallel configuration of the DRUJ (Tolat type 1 configuration) with regard to DASH score, grip strength, and supination compared with nonparallel configurations. In the Tolat type 1, configurated DRUJ mean DASH score was 9 compared with 18 in the Tolat type 2 and 3 groups. Apart from supination, no differences were observed in range of motion among groups. Conclusion: Although long-term postoperative range of motion failed to display statistically significant differences between DRUJ configurations except for supination, better results regarding grip strength and DASH scores were seen in a parallel-aligned DRUJ configuration. Although onset of osteoarthritis does not seem to become apparent within the observation period, nonparallel aligned configuration predisposes to inferior results.}, language = {en} } @article{JakubietzJakubietzHorchetal.2019, author = {Jakubietz, Rafael G. and Jakubietz, Danni F. and Horch, Raymund E. and Gruenert, Joerg G. and Meffert, Rainer H. and Jakubietz, Michael G.}, title = {The microvascular peroneal artery perforator flap as a "lifeboat" for pedicled flaps}, series = {Plastic and Reconstructive Surgery - Global Open}, volume = {7}, journal = {Plastic and Reconstructive Surgery - Global Open}, number = {9}, doi = {10.1097/GOX.0000000000002396}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202233}, pages = {e2396}, year = {2019}, abstract = {Background: Pedicled perforator flaps have expanded reconstructive options in extremity reconstruction. Despite preoperative mapping, intraoperative findings may require microvascular tissue transfer when no adequate perforators can be found. The free peroneal artery perforator flap may serve as a reliable back-up plan in small defects. Methods: In 16 patients with small soft tissue defects on the upper and lower extremities, perforator-based propeller flaps were planned. The handheld Doppler device was used to localize potential perforators for a propeller flap in close proximity to the defect. Perforators of the proximal peroneal artery were also marked to allow conversion to microvascular tissue transfer. Results: In 6 cases, no adequate perforators were found intraoperatively. In 4 patients, the peroneal artery perforator flap was harvested and transferred. The pedicle length did not exceed 4 cm. No flap loss occurred. Conclusions: When no adequate perforator capable of nourishing a propeller flap can be found intraoperatively, the free peroneal artery flap is a good option to reconstruct small soft tissue defects in the distal extremities. The short vascular pedicle is less ideal in cases with a large zone of injury requiring a more distant site of anastomosis or when recipient vessels are located in deeper tissue planes.}, language = {en} } @article{JakubietzSchmidtBernuthetal.2019, author = {Jakubietz, Rafael G. and Schmidt, Karsten and Bernuth, Silvia and Meffert, Rainer H. and Jakubietz, Michael G.}, title = {Evaluation of the intraoperative blood flow of pedicled perforator flaps using indocyanine green-fluorescence angiography}, series = {Plastic and Reconstructive Surgery - Global Open}, volume = {7}, journal = {Plastic and Reconstructive Surgery - Global Open}, number = {9}, doi = {10.1097/GOX.0000000000002462}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202625}, pages = {e2462}, year = {2019}, abstract = {Background: Although indocyanine-green fluorescence angiography (ICG-FA) has been established as a useful tool to assess perfusion in free tissue transfer, only few studies have applied this modality to pedicled perforator flaps. As both volume and reach of pedicled perforator flaps are limited and tip necrosis often equals complete flap failure, ICG-FA may help to detect hypoperfusion in pedicled flaps. Methods: In 5 patients, soft tissue reconstruction was achieved with pedicled perforator flaps. ICG-FA was utilized intraoperatively to visualize flap perfusion. Results: Three pedicled anterolateral thigh flap flaps and 2 propeller flaps were transferred. ICG-FA detected hypoperfusion in 2 flaps. No flap loss occurred; in 2 cases, prolonged wound healing was encountered. Conclusions: ICG-FA confirmed clinical findings and reliably detected tissue areas with hypoperfusion. A clear cut-off point between nonvital tissue and such that stabilized in the following clinical course could not be found. ICG-FA is a promising technology which could also be used in pedicled perforator flaps.}, language = {en} }