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Second-look laparotomy is not always routinely performed after mesenteric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular disease. We developed a minimally invasive technique, for second-look laparoscopy with the aim of decreasing the operative morbidity. With the patient under general anaesthesia, the old incision is opened at the umbilicus. The running suture in the abdominal wall is lifted with a clamp and the incision line is gently reopened. A trocar with a blunt tip designed for open laparoscopy is then inserted and fixed. Following insufflation of CO2 through the trocar it is possible to explore the entire small bowel and colon. We operated on five patients after bowel resection performed for mesenteric infarction. Second-look laparoscopy was diagnostic in all but one, in whom laparoscopy failed due to massive small bowel dilatation. The technique described here is very promising and deserves further evaluation.

Summary Crush injuries and abnormal pronation and supination are the most common reasons for typical ligament tears in this region. Most of them should be treated conservatively by plaster of Paris and early weight-bearing after exact clinical and X-ray diagnosis. At upper ankle joint, suture of ruptured fibular collateral ligaments should be favoured. For dislocations and fracture dislocations of the Lisfranc type operative reposition and K-wiring is recommended. Our treatment results with fibular collateral ligament ruptures and fracture dislocations of the Lisfranc type are presented.

Summary Amputations suitable for replantation in the distal lower leg and foot are seldom. There is no indication if shortening will exceed 5 cm or loss of sensivity is to be expected. Forefood and toe replantations are to be seen predominantly under aesthetic points of view. Satisfactory results in 10 own cases could be achieved if indications for lower leg replantations were limited to guillotine-type amputations, children and some bilateral lesions. Polytrauma as a rule is not a good indication.

Summary Analysis of 17 cases of delayed arterial embolectomy of the limb (8 to 63 days, average 23 days) gives strong evidence that the results of the operation depend primarily on surgical technique. Direct embolectomy by a local or regional approach is shown to produce better results than conventional balloon catheter embolectomy.

Summary The demonstration of post-traumatic changes and chronic diseases of the shoulder joint is limited by the diagnostic techniques available. Many abnormalities of the shoulder go undiagnosed or are placed empirically in various diagnostic groupings, such as rotator cuff degeneration, tendinitis, subluxation, or old dislocation. Examination of the shoulder joint by arthroscopy has solved many problems in the diagnosis of shoulder complaints and can reveal any intraarticular abnormality. The technique with topographic positioning of the arthroscope in the shoulder joint, identifiable lesions, postoperative evaluations, and possible indications are shown.

In about 10 percent of cases, the “common sprained ankle” hides a rupture of the collateral fibular ligaments. At operation in such cases a torn anterior talofibular ligament is always found, and quite often the calcaneofibular ligament is also ruptured. The resulting instabilities can be detected by a new set for lateral X-rays under strain. Because it is simple and quick to handle, all sprained ankles can now be examined for rupture of the collateral fibular ligament. Die Supinationsdistorsion im oberen Sprunggelenk führt in etwa 10 % zu einer Zerreißung im Außenbandbereich. Intraoperativ wird dann stets eine Ruptur des Lig. fib. tal. ant., nicht selten eine zusätzliche Ruptur des Lig. fib. cal. gefunden. Die resultierenden Instabilitätsgrade lassen sich mit einem Lagerungsblock in der seitlichen. gehaltenen Aufnahmetechnik durch exakte Darstellung des zu beurteilenden tibiotalaren Gelenkspaltes differenzierend nachweisen. Seine einfache und schnelle Handhabung ermöglicht gehaltene Aufnahmen bei jeder Sprunggelenkdistorsion.

Summary The Z-plasty as an exchange of two triangles in a parallelogram has two essential results: the contractural (short) diagonal lengthens and the transverse diagonal shortens. Lengthening and shortening depend on angle size and limb length of the Z-plasty. Mobility of the Z-flaps depends on the length of the flaps base. Combination of multiple Z-plasties results in a total gain in length; transverse shortening and tension run in several parallel vectors and cannot be added together.

Summary Using sound medical diagnostics and immediate individual therapy, we were able to shorten the preoperative time in geriatric patients with hip fractures. Using carefully chosen anesthetics and operative procedures, the mortality of these patients was significantly reduced from 16.7% to 9.8%.

Summary Indications and complications in 291 bronchoscopies, 149 mediastinoscopies and 28 thoracoscopies are shown. Bronchoscopy has a diagnostic and especially a therapeutic value; under local anesthesia it is a safe method. Mediastinoscopy showed no severe complications. Thoracoscopy is a method of low risk and can be performed under local anesthesia. It was used in endotracheal anesthesia for thoracal vagotomy in bronchial asthma.