nach oben

Erschienen in:

12.11.2020 | Experimental Study

Preventive effect of trimetazidine against ischemia-reperfusion injury in rat epigastric island flaps: an experimental study

verfasst von: Ovunc Akdemir, Burak Ergün Tatar, Aylin Gökhan, Cansın Şirin, Türker Çavuşoğlu, Oytun Erbaş, Yigit Uyanıkgil, Emel Öykü Çetin, Feng Zhang, William Lineaweaver

Erschienen in: European Journal of Plastic Surgery | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

For plastic surgery, ischemia-reperfusion (I-R) injury is a critical problem that results in partial or total flap necrosis. Trimetazidine (TMZ) is a drug used in the treatment of angina pectoris. This study investigated the effect of TMZ on I-R injury in epigastric island flaps using a rat model.

Methods

Sixteen Sprague–Dawley rats were assigned to two groups, each with eight rats. The sham group comprised of saline-treated rats, while the TMZ group had TMZ-treated rats. An epigastric flap measuring 6 × 4 cm in size was created 30 min after the intraperitoneal administration of either physiological saline or TMZ in both groups. Ischemia was induced on the flaps for 10 h, followed by reperfusion. The flaps were then inset to the original position. Samples were obtained 24 h after reperfusion for biochemical analysis and on day 7 for histopathological analysis. Also, flap survival was evaluated on day 7 using Image-Pro Express.

Results

The TMZ group had a significantly greater flap survival area compared to the sham group. On histopathological examination, the two groups showed significant differences. The TMZ group had a higher epidermal thickness. On biochemical examination, there were significantly higher levels of malondialdehyde and myeloperoxidase activity in the sham group, while the TMZ group showed significantly greater glutathione and nitric oxide levels.

Conclusions

In the present study, TMZ administration was found to reduce I-R injury macroscopically, histopathologically, and biochemically in a rat epigastric island flap model.

Level of evidence: Not ratable.

Rasti Ardakani R, Al-Dam A, Rashad A, Moghadam AS (2017) Effect of systemic antioxidant allopurinol therapy on skin flap survival. World J Plast Surg 6(1):54–61PubMedPubMedCentral

Bozkurt M, Kapi E, Kulahci Y, Gedik E, Ozekinci S, Isik FB, Celik Y, Selcuk CT, Kuvat SV (2014) Antioxidant support in composite musculo-adipose-fasciocutaneous flap applications: an experimental study. J Plast Surg Hand Surg 48(1):44–50PubMedCrossRef

Di Mascio P, Murphy ME, Sies H (1991) Antioxidant defense systems: the role of carotenoids, tocopherols, and thiols. Am J Clin Nutr 53(1):194S–200SPubMedCrossRef

Zhao G, Zhang X, Xu P, Mi J-Y, Rui Y-J (2018) The protective effect of irisin against ischemia-reperfusion injury after perforator flap grafting in rats. Injury 49(12):2147–2153PubMedCrossRef

Liu H, Zhang M, Dong X, Liu Y, Hao Y, Wang Y (2019) Necrostatin-1 protects against ischemia/reperfusion injury by inhibiting receptor-interacting protein 1 in a rat flap model. J Plast Reconstr Aesthet Surg 72(2):194–202PubMedCrossRef

van den Heuvel MG, Buurman WA, Bast A, van der Hulst RR (2009) Review: ischaemia–reperfusion injury in flap surgery. J Plast Reconstr Aesthet Surg 62(6):721–726PubMedCrossRef

Kerrigan CL, Stotland MA (1993) Ischemia reperfusion injury: a review. Microsurgery 14(3):165–175PubMedCrossRef

Petrovics L, Nagy T, Hardi P, Bognar L, Pavlovics G, Tizedes G, Takacs I, Jancso G (2018) The effect of trimetazidine in reducing the ischemia-reperfusion injury in rat epigastric skin flaps. Clin Hemorheol Microcirc 69(3):405–415PubMedCrossRef

Wang WZ, Baynosa RC, Zamboni WA (2011) Update on ischemia-reperfusion injury for the plastic surgeon: 2011. Plast Reconstr Surg 128(6):685e–692ePubMedCrossRef

10.

Ghali S, Butler PE, Tepper OM, Gurtner GC (2007) Vascular delay revisited. Plast Reconstr Surg 119(6):1735–1744PubMedCrossRef

11.

Giunta R, Holzbach T, Taskov C, Holm PS, Konerding MA, Schams D, Biemer E, Gänsbacher B (2005) AdVEGF₁₆₅ gene transfer increases survival in overdimensioned skin flaps. J Gene Med 7(3):297–306PubMedCrossRef

12.

Küntscher MV, Hartmann B, Germann G (2005) Remote ischemic preconditioning of flaps: a review. Microsurgery 25(4):346–352PubMedCrossRef

13.

Wasserberg N, Pileggi A, Salgar SK, Ruiz P, Ricordi C, Inverardi L, Tzakis AG (2007) Heme oxygenase-1 upregulation protects against intestinal ischemia/reperfusion injury: a laboratory based study. Int J Surg 5(4):216–224PubMedCrossRef

14.

Aral M, Tuncer S, Şencan A, Elmas Ç, Ayhan S (2015) The effect of thrombolytic, anticoagulant, and vasodilator agents on the survival of random pattern skin flap. J Reconstr Microsurg 31(07):487–492PubMedCrossRef

15.

Hashimoto I, Nakanishi H, Shono Y, Yamano M, Toda M (2003) The features of thrombus in a microvessel injury model and the antithrombotic efficacy of heparin, urokinase, and prostaglandin E₁. Plast Reconstr Surg 111(7):2307–2314PubMedCrossRef

16.

Buemi M, Galeano M, Sturiale A, Ientile R, Crisafulli C, Parisi A, Catania M, Calapai G, Impalà P, Aloisi C, Squadrito F, Altavilla D, Bitto A, Tuccari G, Frisina N (2004) Recombinant human erythropoietin stimulates angiogenesis and healing of ischemic skin wounds. Shock 22(2):169–173PubMedCrossRef

17.

Hosnuter M, Babucçu O, Kargi E, Altinyazar C (2003) Dual preconditioning: effects of pharmacological plus ischemic preconditioning on skin flap survival. Ann Plast Surg 50(4):398–402PubMedCrossRef

18.

Gökalan Kara I, Kara CO, Özden A, Öçsel H (2001) The effect of trimetazidine on the survival of rat island skin flaps subjected to ischemia-reperfusion injury. Ann Plast Surg 47(2):168–171CrossRef

19.

Lille S, Boyle EM, Schoeller T, Suchy H, Russell RC (1999) Augmentation of cAMP improves muscle–flap survival and tissue inflammation in response to ischemia/reperfusion injury. J Reconstr Microsurg 15(1):37–45PubMedCrossRef

20.

Hong JP, Kwon H, Chung YK, Jung SH (2003) The effect of hyperbaric oxygen on ischemia–reperfusion injury: an experimental study in a rat musculocutaneous flap. Ann Plast Surg 51(5):478–487PubMedCrossRef

21.

Khan A, Ashrafpour H, Huang N, Neligan PC, Kontos C, Zhong A, Forrest CR, Pang CY (2004) Acute local subcutaneous VEGF₁₆₅ injection for augmentation of skin flap viability: efficacy and mechanism. Am J Physiol Regul Integr Comp Physiol 287(5):R1219–R1229PubMedCrossRef

22.

Devynck M-A, Sang KHLQ, Joulin Y, Mazeaud M (1993) Acute membrane effects of trimetazidine in human platelets. Eur J Pharmacol 245(2):105–110PubMedCrossRef

23.

Tetik C, Özden A, Calli N, Bilgihan A, Bostanci B, Yis Ö, Bayramoǧlu H (1999) Cytoprotective effect of trimetazidine on 60 minutes of intestinal ischemia–reperfusion injury in rats. Transpl Int 12(2):108–112PubMedCrossRef

24.

Dehina L, Vaillant F, Tabib A, Bui-Xuan B, Chevalier P, Dizerens N, Bui-Xuan C, Descotes J, Blanc-Guillemaud V, Lerond L, Timour Q (2013) Trimetazidine demonstrated cardioprotective effects through mitochondrial pathway in a model of acute coronary ischemia. Naunyn Schmiedebergs Arch Pharmacol 386:205–215PubMedCrossRef

25.

Grekas D, Dioudis C, Papageorgiou G, Iliadis S, Zilidis C, Alivanis P, Dimitriadou A, Tourkantonis A (1996) Lipid peroxidation after acute renal ischemia and reperfusion in rats: the effect of trimetazidine. Ren Fail 18(4):545–552PubMedCrossRef

26.

Guarnieri C, Muscari C (1993) Effect of trimetazidine on mitochondrial function and oxidative damage during reperfusion of ischemic hypertrophied rat myocardium. Pharmacology 46(6):324–331PubMedCrossRef

27.

Maupoil V, Rochette L, Tabard A, Clauser P, Harpey C (1990) Evolution of free radical formation during low-flow ischemia and reperfusion in isolated rat heart. Cardiovasc Drug Ther 4(4):791–795CrossRef

28.

Özden A, Aybek Z, Saydam N, Çalli N, Saydam O, Düzcan E, Güner G (1998) Cytoprotective effect of trimetazidine on 75 min warm renal ischemia–reperfusion injury in rats. Eur Surg Res 30(4):227–234PubMedCrossRef

29.

Suárez García MJ, Suárez Nieto C, Barthe García P, Gómez Martínez J, Baldo Sierra C (1992) The value of patent-blue and transcutaneous pO₂ in predicting the viability of skin flaps treated pharmacologically. Acta Otorrinolaringol Esp 43(1):55–60PubMed

30.

Suárez Nieto C, Suárez García MJ, Barthe García P (1992) A comparative study on the effect of various pharmacological agents on the survival of skin flaps in the rat. Br J Plast Surg 45(2):113–116PubMedCrossRef

31.

Kokacya MH, Copoglu US, Dokuyucu R, Inanir S, Erbas O (2015) The antipsychotic effects of omega-3 fatty acids in rats. Am J Med Sci 350(3):212–217PubMedCrossRef

32.

Demougeot C, Marie C, Beley A (2000) Importance of iron location in iron-induced hydroxyl radical production by brain slices. Life Sci 67(4):399–410PubMedCrossRef

33.

Bradford MM (1976) A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Anal Biochem 72(1–2):248–254PubMedCrossRef

34.

Ellman GL (1959) Tissue sulfhydryl groups. Arch Biochem Biophys 82(1):70–77PubMedCrossRef

35.

Kim EK, Hong JP (2007) The effect of recombinant human erythropoietin on ischemia–reperfusion injury: an experimental study in a rat TRAM flap model. Plast Reconstr Surg 120(7):1774–1781PubMedCrossRef

36.

Şener G, Jahovic N, Tosun O, Atasoy BM, Yeğen BÇ (2003) Melatonin ameliorates ionizing radiation-induced oxidative organ damage in rats. Life Sci 74(5):563–572PubMedCrossRef

37.

Hillegass LM, Griswold DE, Brickson B, Albrightson-Winslow C (1990) Assessment of myeloperoxidase activity in whole rat kidney. J Pharmacol Methods 24(4):285–295PubMedCrossRef

38.

Ersel M, Uyanikgil Y, Akarca FK, Ozcete E, Altunci YA, Karabey F, Cavusoglu T, Meral A, Yigitturk G, Cetin EO (2016) Effects of silk sericin on incision wound healing in a dorsal skin flap wound healing rat model. Med Sci Monit 22:1064–1078PubMedPubMedCentralCrossRef

39.

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, ESC Scientific Document Group, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes: the task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 41(3):407–477PubMedCrossRef

40.

McCarthy CP, Mullins KV, Kerins DM (2016) The role of trimetazidine in cardiovascular disease: beyond an anti-anginal agent. Eur Heart J Cardiovasc Pharmacother 2(4):266–272PubMedCrossRef

41.

Peng S, Zhao M, Wan J, Fang Q, Fang D, Li K (2014) The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials. Int J Cardiol 177(3):780–785PubMedCrossRef

42.

Belardinelli R, Solenghi M, Volpe L, Purcaro A (2007) Trimetazidine improves endothelial dysfunction in chronic heart failure: an antioxidant effect. Eur Heart J 28(9):1102–1108PubMedCrossRef

43.

Ballestín A, Casado JG, Abellán E, Vela FJ, Álvarez V, Usón A, López E, Marinaro F, Blázquez R, Sánchez-Margallo FM (2018) Ischemia-reperfusion injury in a rat microvascular skin free flap model: a histological, genetic, and blood flow study. PLoS One 13(12):e0209624PubMedPubMedCentralCrossRef

44.

Gürsoy K, Teymur H, Koca G, Isikçi ÖT, Göktaş Demircan FB, Kankaya Y, Koçer U (2020) The effect of astaxanthin on random pattern skin flaps. Ann Plast Surg 84(2):208–215PubMedCrossRef

45.

Yoshida WB, Bueno Pires de Campos E (2005) Ischemia and reperfusion in skin flaps: effects of mannitol and vitamin C in reducing necrosis area in a rat experimental model. Acta Cir Bras 20(5):358–363PubMedCrossRef

46.

Zaccaria A, Weinzweig N, Yoshitake M, Matsuda T, Cohen M (1994) Vitamin C reduces ischemia-reperfusion injury in a rat epigastric island skin flap model. Ann Plast Surg 33(6):620–623PubMedCrossRef

47.

ÇetIn C, Köse AA, Aral E, Çolak Ö, Erçel C, Karabagli Y, Özyilmaz M, Alatas Ö, Eker A (2001) Protective effect of fucoidin (a neutrophil rolling inhibitor) on ischemia reperfusion injury: experimental study in rat epigastric island flaps. Ann Plast Surg 47(5):540–546PubMedCrossRef

48.

Cordeiro PG, Mastorakos DP, Hu Q-Y, Kirschner RE (1997) The protective effect of L-arginine on ischemia-reperfusion injury in rat skin flaps. Plast Reconstr Surg 100(5):1227–1233PubMedCrossRef

49.

Cabbaroğlu D, Songür Kodik M, Uyanıkgil Y, Çeti̇n Uyanıkgil EÖ, Karabey F, Kıyan S (2019) Treatment of contact burn injury with Hypericum perforatum: an experimental study. ETD 58(2):154–160

50.

Cetin E, Yesil-Celiktas O, Cavusoglu T, Demirel-Sezer E, Akdemir O, Uyanikgil Y (2013) Incision wound healing activity of pine bark extract containing topical formulations: a study with histopathological and biochemical analyses in albino rats. Pharmazie 68(1):75–80PubMed

51.

Akdemir O, Hede Y, Zhang F, Lineaweaver WC, Arslan Z, Songur E (2011) Effects of taurine on reperfusion injury. J Plast Reconstr Aesthet Surg 64(7):921–928PubMedCrossRef

52.

Tikhaze AK, Lankin VZ, Zharova EA, Kolycheva SV (2000) Trimetazidine as indirect antioxidant. Bull Exp Biol Med 130(10):951–953PubMedCrossRef

53.

Draper HH, Hadley M (1990) Malondialdehyde determination as index of lipid peroxidation. In: Methods in enzymology, vol 186. Academic Press, pp 421–431

54.

Giakoustidis DE, Giakoustidis AE, Iliadis S, Koliakou K, Antoniadis N, Kontos N, Papanikolaou V, Papageorgiou G, Kaldrimidou E, Takoudas D (2010) Attenuation of liver ischemia/reperfusion induced apoptosis by epigallocatechin-3-gallate via down-regulation of NF-κB and c-Jun expression. J Surg Res 159(2):720–728PubMedCrossRef

55.

Coban YK, Ergun Y, Ciralik H (2007) Depletion of glutathione by buthionine sulfoximine decreases random-pattern skin flap viability in rats. J Surg Res 143(2):247–252PubMedCrossRef

56.

Kuzmicic J, Parra V, Verdejo HE, López-Crisosto C, Chiong M, García L, Jensen MD, Bernlohr DA, Castro PF, Lavandero S (2014) Trimetazidine prevents palmitate-induced mitochondrial fission and dysfunction in cultured cardiomyocytes. Biochem Pharmacol 91(3):323–336PubMedCrossRef

57.

Chen J, Lai J, Yang L, Ruan G, Chaugai S, Ning Q, Chen C, Wang DW (2016) Trimetazidine prevents macrophage-mediated septic myocardial dysfunction via activation of the histone deacetylase sirtuin 1. Br J Pharmacol 173(3):545–561PubMedCrossRef

58.

Monteiro P, Duarte AI, Gonçalves LM, Moreno A, Providência LA (2004) Protective effect of trimetazidine on myocardial mitochondrial function in an ex-vivo model of global myocardial ischemia. Eur J Pharmacol 503(1–3):123–128PubMedCrossRef

59.

Matthijsen RA, Huugen D, Hoebers NT, De Vries B, Peutz-Kootstra CJ, Aratani Y, Daha MR, Tervaert JWC, Buurman WA, Heeringa P (2007) Myeloperoxidase is critically involved in the induction of organ damage after renal ischemia reperfusion. Am J Pathol 171(6):1743–1752PubMedPubMedCentralCrossRef

60.

Schulz R, Kelm M, Heusch G (2004) Nitric oxide in myocardial ischemia/reperfusion injury. Cardiovasc Res 61(3):402–413PubMedCrossRef

61.

Ben Mosbah I, Massip-Salcedo M, Fernández-Monteiro I, Xaus C, Bartrons R, Boillot O, Roselló-Catafau J, Peralta C (2007) Addition of adenosine monophosphate-activated protein kinase activators to University of Wisconsin solution: a way of protecting rat steatotic livers. Liver Transpl 13(3):410–425PubMedCrossRef

62.

Nishida K, Kyoi S, Yamaguchi O, Sadoshima J, Otsu K (2009) The role of autophagy in the heart. Cell Death Differ 16(1):31–38PubMedCrossRef

63.

Khiabani KT, Kerrigan CL (2002) The effects of the nitric oxide donor SIN-1 on ischemia-reperfused cutaneous and myocutaneous flaps. Plast Reconstr Surg 110(1):169–176PubMedCrossRef

64.

Khiabani KT, Kerrigan CL (2002) Presence and activity of nitric oxide synthase isoforms in ischemia-reperfusion-injured flaps. Plast Reconstr Surg 109(5):1638–1645PubMedCrossRef

65.

Schofield ZV, Woodruff TM, Halai R, Wu MC-L, Cooper MA (2013) Neutrophils—a key component of ischemia-reperfusion injury. Shock 40(6):463–470PubMedCrossRef

66.

Grommes J, Soehnlein O (2011) Contribution of neutrophils to acute lung injury. Mol Med 17(3):293–307PubMedCrossRef

67.

El-Benna J, Dang PM-C, Gougerot-Pocidalo M-A (2008) Priming of the neutrophil NADPH oxidase activation: role of p47phox phosphorylation and NOX₂ mobilization to the plasma membrane. Semin Immunopathol 30:279–289PubMedCrossRef

68.

Fialkow L, Wang Y, Downey GP (2007) Reactive oxygen and nitrogen species as signaling molecules regulating neutrophil function. Free Radic Biol Med 42(2):153–164PubMedCrossRef

Titel: Preventive effect of trimetazidine against ischemia-reperfusion injury in rat epigastric island flaps: an experimental study
verfasst von: Ovunc Akdemir
Burak Ergün Tatar
Aylin Gökhan
Cansın Şirin
Türker Çavuşoğlu
Oytun Erbaş
Yigit Uyanıkgil
Emel Öykü Çetin
Feng Zhang
William Lineaweaver
Publikationsdatum: 12.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Plastic Surgery / Ausgabe 2/2021
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-020-01757-2

Neu im Fachgebiet Chirurgie

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Wie sieht der OP der Zukunft aus?

04.05.2024 DCK 2024 Kongressbericht

Der OP in der Zukunft wird mit weniger Personal auskommen – nicht, weil die Technik das medizinische Fachpersonal verdrängt, sondern weil der Personalmangel es nötig macht.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Recycling im OP – möglich, aber teuer

02.05.2024 DCK 2024 Kongressbericht

Auch wenn sich Krankenhäuser nachhaltig und grün geben – sie tragen aktuell erheblich zu den CO₂-Emissionen bei und produzieren jede Menge Müll. Ein Pilotprojekt aus Bonn zeigt, dass viele Op.-Abfälle wiederverwertet werden können.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2021

Response to: “Commentary on: Postoperative monitoring of free flaps using a low-cost thermal camera: a pilot study by Hummelink S, Kruit AS, van Vlaenderen ARW, Schreinemachers MJM, Steenbergen W & Ulrich DJO”

Flexor tendon repair outcomes with fat grafting

“Flap-to-defect” concept for closure of circular skin defects: the ice cream cone flap

Unilateral or bilateral freestyle infra-orbital perforator flap in reconstruction of external soft tissue nasal defects

Comparative analysis of propeller flaps vs. modified perforator-based flaps in foot and ankle reconstruction

Re-exploration in the early postoperative period has a better salvage rate in free flaps

Update Chirurgie