TY - JOUR A1 - Jakubietz, Michael Georg A1 - Jakubietz, Danni Felicitas A1 - Schmidt, Karsten A1 - Jakubietz, Rafael Gregor T1 - Blepharoplastik bei asiatischen Augen JF - Journal für Ästhetische Chirurgie N2 - Die operative Verjüngung des Auges stellt einen der am häufigsten nachgefragten Eingriffe im ästhetischen Spektrum dar. Die multikulturelle Bevölkerungsstruktur bedingt, dass auch „asiatisch“ imponierende Augen behandelt werden. „Asiatische“ Augen sind aber nicht nur bei Asiaten anzutreffen, sondern in unterschiedlicher Ausprägung auch bei Patienten aus dem Nahen und Mittleren Osten. Das asiatische Auge stellt in Bezug auf Verjüngungsmöglichkeiten eine eigene Entität dar. Während die klassische „Korrektur“ des asiatischen Auges eine etablierte und durch eine Vielzahl von verschiedenen Techniken mit vorhersehbaren Ergebnissen verbundene Methode ist, ist eine „verjüngende“ Blepharoplastik des asiatischen Auges komplexer zu bewerten [1, 3, 5, 10]. Die Operationsmethoden für das „asiatische“ Auge sind für jüngere Patienten intendiert, bei denen es überwiegend um die Korrektur des Epikanthus geht. Diese Techniken ziehen eine gewünschte Veränderung des periorbitalen Erscheinungsbildes nach sich, wobei das asiatische Aussehen teilweise zugunsten eines vermehrt „europäischen“ Aussehens beeinflusst wird. Fraglich bleibt, ob eine Veränderung zu einem europäischen Aussehen hin auch bei einem alternden Patienten einer Verjüngung gleichkommt. Prinzipiell imponiert ein derart operiertes asiatisches Auge „künstlich“, eine Tatsache die bei alternden Patienten als noch störender als der Alterungsprozess selbst empfunden werden dürfte. Daher ist der Wunsch nach einer Verjüngung ohne Verlust des typischen asiatischen Erscheinungsbildes des Auges chirurgisch nicht mit der klassischen Technik bei Europäern umzusetzen. Während die Behandlung durch eine klassische Blepharoplastik ein unnatürliches Aussehen zur Folge hat, kann unter Respektierung der asiatischen anatomischen Besonderheiten eine natürlich wirkende Verjüngung erreicht werden. KW - Blepharoplastik KW - asiatische Augen KW - operative Verjüngung Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270189 SN - 1867-4313 VL - 14 IS - 4 ER - TY - JOUR A1 - Jakubietz, Rafael G. A1 - Jakubietz, Danni F. A1 - Horch, Raymund E. A1 - Gruenert, Joerg G. A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - The microvascular peroneal artery perforator flap as a "lifeboat" for pedicled flaps JF - Plastic and Reconstructive Surgery – Global Open N2 - 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. KW - surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202233 VL - 7 IS - 9 ER - TY - JOUR A1 - Jakubietz, Michael G. A1 - Gruenert, Joerg G. A1 - Jakubietz, Rafael G. T1 - The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures N2 - 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. KW - Medizin Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68829 ER - TY - JOUR A1 - Jakubietz, Michael G. A1 - Gruenert, Joerg G. A1 - Jakubietz, Rafael G. T1 - 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? JF - Journal of Orthopedic Surgery and Research N2 - 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. KW - internal fixation KW - intraarticular fractures KW - percutaneous fixation KW - open reduction KW - trial Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133987 VL - 7 IS - 8 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jordan, Martin C. A1 - Hölscher-Doht, Stefanie A1 - Jakubietz, Michael G. A1 - Jakubietz, Rafael G. A1 - Meffert, Rainer H. T1 - Suture material for flexor tendon repair: 3–0 V-Loc versus 3–0 Stratafix in a biomechanical comparison ex vivo N2 - 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. KW - Barbed suture KW - Barbed suture material KW - Flexor tendon repair KW - Knotless tendon repair KW - Stratafix KW - V-Loc Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-110419 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jakubietz, Michael Georg A1 - Gilbert, Fabian A1 - Fenwick, Annabel A1 - Meffert, Reiner Heribert A1 - Jakubietz, Rafael Gregor T1 - Muscle cuff in distal pedicled adipofascial sural artery flaps: a retrospective case control study JF - PRS Global Open N2 - Background: Amputation after open tibial fracture occurs in 3% of cases. The rate increases when flap reconstruction is required. The standard care involves microsurgical tissue transfer although the pedicled reverse sural artery adipofascial flap (PRSAF) is a local alternative in patients endangered by a prolonged operative time. Incorporation of a gastrocnemius muscle cuff in this flap can be used to fill dead space and increase healing potential. Literature shows superior survival rates for both PRSAF and inclusion of a muscle cuff in comparison with the cutaneous version. The aim of the study was to compare the outcome of the PRSAF and the musculoadipofascial version (PRSMAF). We hypothesize that the PRSMAF provides similar lap viability and flap-related complication rates as does the adipofascial version. The muscle component may reduce the long-term osteomyelitis rate. Methods: Patients were evaluated retrospectively after reconstruction with either PRSAF or PRSMAF. Preoperative osteomyelitis, flap survival, complications and osteomyelitis clearance were analyzed. Results: The study shows preliminary results supporting the potential use of the PRSMAF. We compare either 23 PRSMAF or 20 PRSAF flaps. We found no statistically significant differences in flap survival or in complication rate. Conclusions: Although the anatomical situation may sometimes dictate the use of a free flap, a technically less-complicated option may in some cases offer a viable alternative. This study shows that the PRSMAF can serve as an alternative for complex bone defects in the limb, though it does not provide statistical improvement to the PRSAF. KW - muscle cuff Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259875 VL - 9 IS - 3 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jakubietz, Michael Gregor A1 - Gilbert, Fabian A1 - Hausknecht, Franca A1 - Meffert, Rainer Heribert A1 - Jakubietz, Rafael Gregor T1 - Quality of life after flap reconstruction of the distal lower extremity: is there a difference between a pedicled suralis flap and a free anterior lateral thigh flap? JF - Plastic and Reconstructive Surgery - Global Open N2 - Background: Flap reconstruction of the distal lower extremity is challenging. Especially, the concept of perforator surgery has increased available surgical options. Although results are generally judged in terms of objective facts, patients-perceived quality of life has largely remained unexamined. The aim of the study was to compare quality of life after lower extremity reconstruction with pedicled and free flaps. Methods: Patients were evaluated retrospectively after reconstruction of defects of the distal lower extremity either with distally based adipofascial sural flap (pedicled reverse sural flap) or an anterior lateral thigh (ALT) flap. A specific questionnaire was developed to measure the patient’s quality of life, based on short form health survey-12, Dresden Body Image Score-35, Patient Health Questionnaire-4, and XSMFA questionnaires with additional specific questions. Furthermore, results, secondary surgeries, and complications were analyzed. Results: Thirty-seven patients with reconstruction of lower limb defects treated with a pedicled reverse sural flap and 34 patients treated with an ALT flap were included in the study. There was no statistical significant difference in the overall satisfaction with the procedure in the long-term follow-up between both groups, but patients with ALT showed a higher satisfaction with the treatment in the initial postoperative period. Both groups demonstrated approximately similar results in the long term for self-acceptance and vitality. Conclusions: Although anatomic situation may dictate flap choice coverage with free flaps, a less-complicated flap is by no means regarded as an inferior treatment option in patient’s estimation. Despite the intuitive speculation that patients with more advanced reconstruction methods should have better function and subsequently higher quality of life, this assumption was clearly not supported by data in this study. KW - reconstructive surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203940 VL - 7 IS - 4 ER - TY - JOUR A1 - Jakubietz, Rafael G. A1 - Schmidt, Karsten A1 - Bernuth, Silvia A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - Evaluation of the intraoperative blood flow of pedicled perforator flaps using indocyanine green-fluorescence angiography JF - Plastic and Reconstructive Surgery – Global Open N2 - 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. KW - surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202625 VL - 7 IS - 9 ER - TY - JOUR A1 - Jakubietz, Michael G. A1 - Jakubietz, Rafael G. A1 - Meffert, Rainer H. A1 - Schmidt, Karsten A1 - Zahn, Robert K. T1 - Biomechanical properties of first dorsal extensor compartment regarding adequacy as a bone-ligament-bone graft JF - Plastic and Reconstructive Surgery Global Open N2 - 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 arête-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. KW - bone ligament graft Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158851 VL - 5 IS - 7 ER - TY - JOUR A1 - Gilbert, Fabian A1 - Jakubietz, Rafael G. A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - Does distal radio-ulnar joint configuration affect postoperative functional results after ulnar shortening osteotomy? JF - PRS Global Open N2 - 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. KW - distal radio-ulnar joint KW - ulnar-shortening osteotomy Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176265 VL - 6 IS - 4 ER -