Between 1994 and 1997, sixteen patients suffering from necrotising soft tissue infection were tre... more Between 1994 and 1997, sixteen patients suffering from necrotising soft tissue infection were treated at the burn centre of the Division of Reconstructive Surgery, University of Zurich. The case of a 47 year old man is presented: He suffered from a necrotising fasciitis caused by Streptococcal induced Toxic Shock Syndrome (STSS). This example emphasizes the necessity of early diagnosis, priority of surgical intervention, and the antibiotic strategy. Necrotising fasciitis is a serious disease, caused by a variety of bacteria, which shows a high mortality rate, and its frequency was increasing over the last years.
INTRODUCTION A review of the literature on long-term results (> or = 10 years) following radio... more INTRODUCTION A review of the literature on long-term results (> or = 10 years) following radiocarpal arthrodesis as recommended by Gordon and King shows a paucity of data. Regarding the suitability of this procedure for treating radiocarpal arthrosis, especially in younger patients, we collected and evaluated long-term results of this surgical procedure. MATERIALS AND METHODS Five patients (four men, one woman), who were treated between 1978 and 1984 at our institution with a partial radiocarpal arthrodesis as described by Gordon and King were reexamined clinically and radiologically by the same examiner in the year 1990 and again in the year 2000. RESULTS All five patients were very satisfied with the result of the operation. Two patients were completely free of pain, whereas the other three patients reported minor pain in the radiocarpal joint when applying strain. The active range of motion in the operated joint remained constant over the years (mean 60 degrees dorsopalmar, 30 degrees ulnoradial, 162 degrees pro-/supination). Conventional radiological imaging showed proper osseous consolidation in the areas of partial arthrodesis, and slight degenerative intercarpal alterations in the distal radioulnar joint were observed. Complete postprocedural reintegration into the workforce, including manually demanding work, was achieved. CONCLUSIONS The results of the follow-up examinations of these five patients indicate that satisfying long-term results can be achieved after radiocarpal arthrodesis provided that the procedure is correctly indicated and the operation is conducted in a technically proper manner. This method of radiocarpal arthrodesis is likely also appropriate for young manual labourers suffering from painful radiocarpal arthrosis after distal intraarticular fracture of the radius, scaphoid non-union, scapholunar dissociation and Kienbock's disease.
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen, 2008
Burn injuries are a serious threat to individuals with altered consciousness during epilepsy. The... more Burn injuries are a serious threat to individuals with altered consciousness during epilepsy. The objective of this study detailing 33 individuals who sustained scalds or burn injuries during an epileptic seizure, was to clarify typical injury mechanisms, extent, therapy and sequelae of these injuries and thus identify potential preventive measures to protect this special population from thermal trauma. Overall, 16 women and 17 men with a mean age of 39.6 (range: 21 - 76) years were included in this retrospective review. The burned body area averaged 16 % (maximum: 51 %), 30 of the 33 patients (91 %) required burn wound excision and skin grafting. The mean ABSI score was 5.5 (range: 3 to 11) points. Thermal trauma mostly occurred as hot water scalds (n = 19) during showering or bathing in a tub (n = 15), followed by falls during cooking or into open fire. None of our patients was informed about the risk of experiencing severe thermal injuries during epileptic seizures. The length of...
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen, 2004
Several methods have been established for the treatment of bony defects of the lower extremity. T... more Several methods have been established for the treatment of bony defects of the lower extremity. The purpose of this paper is to evaluate the use of a free vascularized fibula graft for these defects in comparison to callotaxis and segmental transport. Retrospective analysis of data from 32 patients treated between 1981 and 1999 at the University Hospital in Zurich, Switzerland with bony defects of the lower extremity. The reconstruction of the bony defect was successful in 80 % with fibula graft, in 94 % with callotaxis and in 83 % with segmental transport. In the group with the fibula transplantation 2.6 re-interventions due to complications had to be performed, in the callotaxis group there were 3.6 and in the segmental transport group 5.2 surgical re-interventions. The time between primary intervention and full weight bearing was 16 months in the fibula transplantation group, 7.6 months in the callotaxis group and 10.7 months in the segmental transport group. The results show tha...
Zeitschrift für Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten : offizielles Organ der Schweizerischen Gesellschaft für Unfallmedizin und Berufskrankheiten = Revue de traumatologie, d'assicurologie et des maladies professionnelles : organe officiel de la Société suisse de médecine de..., 1986
Zeitschrift für Unfallchirurgie und Versicherungsmedizin : offizielles Organ der Schweizerischen Gesellschaft für Unfallmedizin und Berufskrankheiten = Revue de traumatologie et d'assicurologie : organe officiel de la Société suisse de médecine des accidents et des maladies professionnelles, 1991
By means of a retrospective study involving 154 patients with diffuse brain injury, we could show... more By means of a retrospective study involving 154 patients with diffuse brain injury, we could show, that simple factors, like coexisting injuries, pupil abnormalities and the Glasgow coma scale, allow us to assess the prognosis of patients outcome a short time after trauma. This prognosis is further modified by cerebral perfusion pressure and secondary pupil abnormalities. The prognostic value of an EEG and a SEP is the same for both methods and was found to be correct in about 2/3 of all cases.
The frequency of minor closed head injuries is high. These injuries may be complicated by the dev... more The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracran...
Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was l... more Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was linked to a breast implant have been published. Whether there is an etiological relation to the silicone implant or if it is pure coincidence is not evident at this time. We present the case of a 24-year-old female with congenital asymmetric breasts who underwent breast augmentation in our division on the left side and 15 months later had a breast reduction on the other side. Nine years after the first operation we found a suspicious lesion on the side of the breast implant. The histological result of the excisional biopsy showed an aggressive fibromatosis "arising from" the capsule around the silicon implant. We discuss the possible association of breast implant and desmoid tumor of the breast and evaluate the diagnostic and therapeutic options for desmoid tumors of the breast.
Das Kompressionssyndrom der A. circumflexa humeri posterior ist eine seltene Differentialdiagnose... more Das Kompressionssyndrom der A. circumflexa humeri posterior ist eine seltene Differentialdiagnose des Thoracic outlet- und des Hypothenar-Hammer-Syndroms. Die Diagnose setzt eine gründliche Anamnese und eine regelrecht durchgeführte transfemorale Armarteriographie voraus. Wir berichten über einen betroffenen Volleyballspieler, den möglichen Pathomechanismus, der zu diesem Krankheitsbild führt, und die aktuelle Literatur.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2008
Early complete wound closure and thus reduction of excessive scar formation still represent a maj... more Early complete wound closure and thus reduction of excessive scar formation still represent a major clinical challenge in severely burned patients. A novel concept to cover large burn wounds consists of the application of non-cultured epithelial cell suspension within the first days. Herein, we report our experiences with three patients treated with CellSpray XP. According to the amount of cell suspension required, a skin biopsy was harvested and then processed in an external laboratory. Two days later the suspension containing autologous non-cultured keratinocytes was applied using an aerosol system. All wounds healed rapidly and virtually no signs of hypertrophic scarring were observed 6 months later.
Between 1994 and 1997, sixteen patients suffering from necrotising soft tissue infection were tre... more Between 1994 and 1997, sixteen patients suffering from necrotising soft tissue infection were treated at the burn centre of the Division of Reconstructive Surgery, University of Zurich. The case of a 47 year old man is presented: He suffered from a necrotising fasciitis caused by Streptococcal induced Toxic Shock Syndrome (STSS). This example emphasizes the necessity of early diagnosis, priority of surgical intervention, and the antibiotic strategy. Necrotising fasciitis is a serious disease, caused by a variety of bacteria, which shows a high mortality rate, and its frequency was increasing over the last years.
INTRODUCTION A review of the literature on long-term results (> or = 10 years) following radio... more INTRODUCTION A review of the literature on long-term results (> or = 10 years) following radiocarpal arthrodesis as recommended by Gordon and King shows a paucity of data. Regarding the suitability of this procedure for treating radiocarpal arthrosis, especially in younger patients, we collected and evaluated long-term results of this surgical procedure. MATERIALS AND METHODS Five patients (four men, one woman), who were treated between 1978 and 1984 at our institution with a partial radiocarpal arthrodesis as described by Gordon and King were reexamined clinically and radiologically by the same examiner in the year 1990 and again in the year 2000. RESULTS All five patients were very satisfied with the result of the operation. Two patients were completely free of pain, whereas the other three patients reported minor pain in the radiocarpal joint when applying strain. The active range of motion in the operated joint remained constant over the years (mean 60 degrees dorsopalmar, 30 degrees ulnoradial, 162 degrees pro-/supination). Conventional radiological imaging showed proper osseous consolidation in the areas of partial arthrodesis, and slight degenerative intercarpal alterations in the distal radioulnar joint were observed. Complete postprocedural reintegration into the workforce, including manually demanding work, was achieved. CONCLUSIONS The results of the follow-up examinations of these five patients indicate that satisfying long-term results can be achieved after radiocarpal arthrodesis provided that the procedure is correctly indicated and the operation is conducted in a technically proper manner. This method of radiocarpal arthrodesis is likely also appropriate for young manual labourers suffering from painful radiocarpal arthrosis after distal intraarticular fracture of the radius, scaphoid non-union, scapholunar dissociation and Kienbock's disease.
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen, 2008
Burn injuries are a serious threat to individuals with altered consciousness during epilepsy. The... more Burn injuries are a serious threat to individuals with altered consciousness during epilepsy. The objective of this study detailing 33 individuals who sustained scalds or burn injuries during an epileptic seizure, was to clarify typical injury mechanisms, extent, therapy and sequelae of these injuries and thus identify potential preventive measures to protect this special population from thermal trauma. Overall, 16 women and 17 men with a mean age of 39.6 (range: 21 - 76) years were included in this retrospective review. The burned body area averaged 16 % (maximum: 51 %), 30 of the 33 patients (91 %) required burn wound excision and skin grafting. The mean ABSI score was 5.5 (range: 3 to 11) points. Thermal trauma mostly occurred as hot water scalds (n = 19) during showering or bathing in a tub (n = 15), followed by falls during cooking or into open fire. None of our patients was informed about the risk of experiencing severe thermal injuries during epileptic seizures. The length of...
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen, 2004
Several methods have been established for the treatment of bony defects of the lower extremity. T... more Several methods have been established for the treatment of bony defects of the lower extremity. The purpose of this paper is to evaluate the use of a free vascularized fibula graft for these defects in comparison to callotaxis and segmental transport. Retrospective analysis of data from 32 patients treated between 1981 and 1999 at the University Hospital in Zurich, Switzerland with bony defects of the lower extremity. The reconstruction of the bony defect was successful in 80 % with fibula graft, in 94 % with callotaxis and in 83 % with segmental transport. In the group with the fibula transplantation 2.6 re-interventions due to complications had to be performed, in the callotaxis group there were 3.6 and in the segmental transport group 5.2 surgical re-interventions. The time between primary intervention and full weight bearing was 16 months in the fibula transplantation group, 7.6 months in the callotaxis group and 10.7 months in the segmental transport group. The results show tha...
Zeitschrift für Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten : offizielles Organ der Schweizerischen Gesellschaft für Unfallmedizin und Berufskrankheiten = Revue de traumatologie, d'assicurologie et des maladies professionnelles : organe officiel de la Société suisse de médecine de..., 1986
Zeitschrift für Unfallchirurgie und Versicherungsmedizin : offizielles Organ der Schweizerischen Gesellschaft für Unfallmedizin und Berufskrankheiten = Revue de traumatologie et d'assicurologie : organe officiel de la Société suisse de médecine des accidents et des maladies professionnelles, 1991
By means of a retrospective study involving 154 patients with diffuse brain injury, we could show... more By means of a retrospective study involving 154 patients with diffuse brain injury, we could show, that simple factors, like coexisting injuries, pupil abnormalities and the Glasgow coma scale, allow us to assess the prognosis of patients outcome a short time after trauma. This prognosis is further modified by cerebral perfusion pressure and secondary pupil abnormalities. The prognostic value of an EEG and a SEP is the same for both methods and was found to be correct in about 2/3 of all cases.
The frequency of minor closed head injuries is high. These injuries may be complicated by the dev... more The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracran...
Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was l... more Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was linked to a breast implant have been published. Whether there is an etiological relation to the silicone implant or if it is pure coincidence is not evident at this time. We present the case of a 24-year-old female with congenital asymmetric breasts who underwent breast augmentation in our division on the left side and 15 months later had a breast reduction on the other side. Nine years after the first operation we found a suspicious lesion on the side of the breast implant. The histological result of the excisional biopsy showed an aggressive fibromatosis "arising from" the capsule around the silicon implant. We discuss the possible association of breast implant and desmoid tumor of the breast and evaluate the diagnostic and therapeutic options for desmoid tumors of the breast.
Das Kompressionssyndrom der A. circumflexa humeri posterior ist eine seltene Differentialdiagnose... more Das Kompressionssyndrom der A. circumflexa humeri posterior ist eine seltene Differentialdiagnose des Thoracic outlet- und des Hypothenar-Hammer-Syndroms. Die Diagnose setzt eine gründliche Anamnese und eine regelrecht durchgeführte transfemorale Armarteriographie voraus. Wir berichten über einen betroffenen Volleyballspieler, den möglichen Pathomechanismus, der zu diesem Krankheitsbild führt, und die aktuelle Literatur.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2008
Early complete wound closure and thus reduction of excessive scar formation still represent a maj... more Early complete wound closure and thus reduction of excessive scar formation still represent a major clinical challenge in severely burned patients. A novel concept to cover large burn wounds consists of the application of non-cultured epithelial cell suspension within the first days. Herein, we report our experiences with three patients treated with CellSpray XP. According to the amount of cell suspension required, a skin biopsy was harvested and then processed in an external laboratory. Two days later the suspension containing autologous non-cultured keratinocytes was applied using an aerosol system. All wounds healed rapidly and virtually no signs of hypertrophic scarring were observed 6 months later.
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Papers by Walter Künzi