Treatments

Most of the highly specialized medical care we offer is provided by Sahlgrenska University Hospital. It is located in Gothenburg and is one of the largest hospital in Northern Europe. Sahlgrenska offers all types of highly specialized medical care. We can also offer advanced dental care in collaboration with the Public Dental Service and the Institute of Odontology, University of Gothenburg.

We offer treatment within the following areas:

Cardiothoracic surgery – laser assisted lead extraction
Dermatology – Mohs surgery
Gastroenterology – treatment with gastric pacemaker
Hand surgery – tetraplegic patients
Implant surgery – osseointegration
Neurosurgery – epilepsy surgery
Odontology – maxillofacial surgery
Paediatric cardiac surgery
Plastic surgery – craniofacial surgery
Reconstructive surgery – prostheses
Transplant surgery – solid organs
Transplant surgery – stem cells

Cardiothoracic surgery – laser assisted lead extraction
Cardiothoracic surgery is a surgical treatment of diseases affecting organs inside the thorax. Laser assisted lead extraction is a method to remove pacemaker electrodes.

Development of techniques for lead removal started in the late 1980s. This involved special sheaths made from stainless steel, polypropylene or Teflon™. These sheaths are placed around the lead and the fibrosis is then ablated under fluoroscopic guidance. Locking stylets designed to reinforce the leads were later developed. Since lead fibrosis can be very dense, even calcified, ablation using mechanical sheaths is sometimes very time consuming, and may be unsuccessful. Powered sheaths using laser or electrocautery energy were subsequently developed. The laser energy is emitted from the tip of a fiberoptic sheath, vaporizing the fibrosis. The laser energy has a very short range and does not affect the insulation of leads that are not targeted. We use most of the available methods at the Sahlgrenska University Hospital, selecting a method that is appropriate in each individual case. In particular, we use laser-assisted lead extraction to remove leads.

We performed the first laser assisted lead extraction in Europe in 1996 and have since removed well over 1000 leads in over 600 patients. The clinical success rate, including all extraction methods used, is 97.7%. The major complication rate is 0.9%: the minor complication rate is 1.4%. No death directly related to the extraction procedure has occurred. The normal (median) time for in-hospital care is 3 days. Sahlgrenska University Hospital is the only Swedish referral hospital for laser assisted lead extraction, and we treat patients from many other countries.

Dermatology – Mohs surgery
Mohs surgery is a microscopically controlled surgery used to treat common types of skin cancer. It is a method of obtaining complete margin control during removal of a skin cancer. Mohs surgery allows the removal of a skin cancer with very narrow surgical margin and a high cure rate.

Gastroenterology – treatment with gastric pacemaker
Treatment with gastric pacemaker or electrical stimulation of the stomach of patients with gastroparesis.

Hand surgery – tetraplegic patients
Surgical techniques for restoring or improving upper limb function in tetraplegics. The tendon transfer procedures restore elbow and wrist extension, improve hand grip control, restore joint balance, reduce pain in spasticity and prevent joint contractures.

Patients with tetraplegia living in Sweden are surgically reconstructed and rehabilitated in one centralized unit serving Sweden – Sahlgrenska University Hospital. We perform on a regular basis approximately one tetraplegia reconstruction surgery per week. Approximately 70% of the patients with traumatic tetraplegia undergo reconstructions of arm and hand functions. Optimal timing is when the patient is physically, mentally and socially ready to undergo surgery and the quite demanding postoperative rehabilitation, usually one year after injury at the earliest.

Depending on the specific needs of the individual, several options for reconstruction are available. The most common operation is grip reconstruction. Briefly, this surgery includes tendon transfers to power thumb and finger flexion, adjustment of position of the thumb and during the recent years often combined with reconstruction of opening of the hand. Because of the shift towards more frequent incomplete spinal cord injuries, surgical reconstruction now also includes spasticity operations.

Implant surgery – osseointegration
Implant surgery with direct bone anchorage means that the prosthesis is attached without using a socket. The method is based on the principle of osseointegration, which has been in clinical use for prosthetic replacement of teeth since 1965.

By surgically implanting a titanium screw, known as a fixture, into the residual bone the method produces a direct attachment for the prosthetic limb. The concept of osseointegration entails a direct contact between the fixture and the bone tissue, thereby assuring a stable attachment. The main difference between a conventional socket prosthesis and a bone anchored prosthesis is the absence of a socket, which means the prosthesis always fits, always attaches correctly and is always firmly held in place. The absence of a socket also relieves other problems directly related to the use of a socket, such as heat, chafing and discomfort.

Neurosurgery – epilepsy surgery
Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden.

Odontology – maxillofacial surgery
Maxillofacial surgery is a surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.

Paediatric cardiac surgery
Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon on infants and children.

Plastic surgery – craniofacial surgery
Craniofacial surgery includes congenital malformations, craniofacial tumours and trauma. The congenital malformations entail premature closure of cranial sutures (craniosynostosis) and craniofacial dysostosis (Crouzon, Apert, Saethre-Chotzen, Pfeiffer, Muencke syndromes and others). Many other syndromes or anomalies are treated like Treacher-Collins syndrome, Binder syndrome, hemifacial microsomia, facial clefts and frontonasal dysplasia.

Benign and malignant tumours as well as congenital growths are treated like neurofibromatosis, fibrous dysplasia, dermoid cysts and vascular malformations. Both primary and secondary craniofacial trauma patients are handled.

A consultation will be simplified by providing patient history and examination, photographs of the patient and a three-dimensional CT-scan. The multidisciplinary craniofacial team will provide good care of the patient. Plastic surgeons, neurosurgeons, anaesthetists, oral surgeons, orthodontists, a psychologist and many others are part of the team. The craniofacial unit performs about 150 intracranial operations a year and follows the patients thoroughly often up to adulthood and sometimes thereafter.

The tradition of research parallel to the clinical work has given the Craniofacial Unit an excellent reputation among clinics throughout the world. Fellowships for craniofacial surgeons from different countries are provided at the unit, which has created a network between craniofacial units. The innovative technique of the use of springs in craniofacial surgery was invented by Professor Claes Lauritzen to minimize the operative procedures and to enhance surgical results.

Reconstructive surgery – prostheses
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body. Prostheses are an artificial extension that replaces a missing body part.

Facial disfigurement has an enormous impact on the quality of life for the patient and his family. The reasons for facial defects are congenital malformation, trauma and post tumor surgery. Plastic surgery is not always possible to perform with a good cosmetic result. These patients could be candidates for implant retained cranio-facial prostheses.

The treatment team consists of several professionals including the surgeon and the anaplastologist who is the person manufacturing the prosthesis and its retention elements. Our experience with this goes back to 1979 when the first patient was treated. Since then several hundreds of patients have been fitted with silicone prostheses in our Implant Unit.

The technique we have developed is based on the concept of osseointegration introduced by prof. P-I Brånemark. The clinical implication of this has been used in the treatment of the edentulous jaw, Bone Anchored Hearing Aid – BAHA and in facial defect’s rehabilitation. All these three areas are today world widely accepted treatment modalities.

Over the years a large number of surgeons and anaplastologists have visited our unit. We have conducted more than 50 workshops in Göteborg with more than 650 international participants. Members from our unit have conducted courses, presenting keynote lectures in Europe, North and South America, Middle East, Africa, China, Japan and Australia. Anaplastologist Kerstin Bergström has been awarded several international prices and she has been appointed honorary doctor at the Medical Faculty of the University of Göteborg. She is by many considered as the best anaplastologist in the world today.

Transplant surgery – solid organs
Transplant surgery is the moving of an organ from one body to another or from a donor site on the patient’s own body, for the purpose of replacing the recipient’s damaged or absent organ.

Organ transplantation at Sahlgrenska University Hospital started in 1965 when the first kidney transplantation was performed. Since then over 6500 organ transplantations has been performed at The Transplant Institute at Sahlgrenska University Hospital. The organisation of the transplant unit is unique in that manner that we have a full program for solid organ transplantation including kidney-, liver-, pancreatic-, small bowel, multi visceral, lung-, heart-lung- and heart transplantation. We also perform 50-100 major liver resections for liver tumours.

We have a well qualified staff of certified senior transplant surgeons performing the transplantations including the organ procurement operations. We also have a staff of well qualified internists taking care of the pre-op work-up as well as the follow-up of the transplanted patients.

Organ transplantation can only be offered to Nordic citizens due to the Swedish legalisation of organ donation.
For citizens from outside the Nordic countries, only patients with a related living donor can be treated.

Transplant surgery – stem cells
Transplantation (SCT), using stem cells collected from bone marrow or from peripheral blood, is a standard procedure used to treat leukemia, lymphomas and other malignant and non-malignant blood disorders including aplasti Stem cell c anemia and congenital immunodeficiency diseases.

Sahlgrenska University Hospital offers a complete haematological medical service for adults and children. Adult care is provided by the Section of Haematology and Coagulation at Sahlgrenska University Hospital and pediatric care at the Department of Pediatric Oncology at Queen Silvia´s Children Hospital. Together we constitute the Center for Hematopoietic Cell Transplantation (CHECT) which is EBMT- and NMDP-accreditated and can offer transplants using sibling or unrelated donors. More than 1000 transplants have been performed since 1984. Each year approximately 120 stem cell transplantations are performed in adult patients. We are also one of three Swedish centres for specialist care in haemophilia.

A stem cell transplantation is a procedure, most often used in combination with high-dose chemotherapy, which is more effective than conventional chemotherapy in killing malignant cells. As high-dose chemotherapy also destroys normal blood-producing stem cells in the bone marrow, these cells must be replaced in order to restore blood cell production. In an autologous transplantation, the patient’s own stem cells are given after high-dose chemotherapy, whereas in allogeneic transplantation, stem cells collected from a sibling or an unrelated donor are given to the patient. Recent years, a so called reduced-intensity conditioning treatment before the allogeneic transplant has increasingly been used. This pre-transplant treatment relies more on the donor’s immune system to destroy the cancer cells. Such pre-transplant treatment is less toxic and associated with lower transplant-related mortality, thereby enabling even older adults or patients with less rapidly progressing diseases to be transplanted. However, such pre-transplant regimen is in some cases not as successful as full dose transplants.