Perioperatives Management in der Mikrochirurgie – Konsensus-Statement der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße

Abstract

ZusammenfassungDas perioperative Management in der Mikrochirurgie ist ein wesentlicher Bestandteil einer erfolgreichen rekonstruktiven Chirurgie. Im deutschsprachigen Raum herrschen hierzu keine einheitlichen Konzepte und die individuellen Schemata unterscheiden sich wie in der Expertenbefragung erhoben deutlich voneinander. Im Zuge der 41. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM) im November 2019 in München wurden Konzepte evaluiert, eine Befragung durchgeführt und mithilfe einer Literaturrecherche als Positionspapier zusammengefasst.

Median Nerve Intraneural Lipoma as a Cause of Carpal Tunnel Syndrome: A Case Report and Review of Current Management Principles

“…Many different names and classifications of these lipomatous lesions have been used interchangeably for many years throughout the literature. Broadly these lesions can be classified as extraneural and intraneural depending on the lesions' relationship with native neural tissue (Walter et al 2011). Recently, intraneural lesions were further be broken down into forms depending on their relationship to the fascicle structures: encapsulated intraneural lipoma, (those involving no component of the nerve fascicles and surrounded by its own capsular tissue), and hybrid intraneural lipomas (the components of the mass are found intermixed within the fascicles and contain sctructureal aspects of each of the other nerve lesions).…”

Diagnostical accuracy of hyperspectral imaging after free flap surgery

“…Therefore, microsurgical management aims to continually reduce ischemia-related morbidity and facilitate safe reconstruction [3]. Generally, reconstructive surgery clinics rely on the clinical assessment of visual perfusion control (that is, a recapilarization time of 3 s within the first 72 h) [4]. Different technical devices have been introduced; however, they have several requirements (such as wide availability, neutral cost and personal resources, easy data interpretation, independence from the surgical method, and reliability) [4].…”

“…Generally, reconstructive surgery clinics rely on the clinical assessment of visual perfusion control (that is, a recapilarization time of 3 s within the first 72 h) [4]. Different technical devices have been introduced; however, they have several requirements (such as wide availability, neutral cost and personal resources, easy data interpretation, independence from the surgical method, and reliability) [4]. Hyperspectral imaging (HSI) was first used in human medicine approximately 10 years ago, and subsequently, it has been applied in several scientific areas [5,6].…”

Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

“…The safety and efficacy of the procedure has been demonstrated in multiple examinations as wells as in the absence of adverse effects on the conducted surgery [ 1 ]. The German Speaking Society for Microsurgery of Peripheral Nerves and Vessels recommends the utilization of regional anesthesia techniques in the context of microsurgical reconstructive procedures according to an expert opinion-based consensus statement [ 2 , 3 ]. Derived from the available literature, it is commonly accepted that regional anesthesia has a beneficial influence on perfusion dynamics as well as on local microcirculation [ 4 , 5 , 6 ].…”