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Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- [The interesting case: unilateral hypoplasia of the breast in becker nevus syndrome]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):266-7.
The Becker nevus syndrome is defined by the association of a Becker's nevus with ipsilateral breast hypoplasia and/or musculoskeletal disorders. There are only a few dozen case reports in the literature. We here present the case of a 20-year-old female patient who was treated in our clinic due to a breast asymmetry.
- [Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) - A Rare Complication after Ablation Mammae and Direct Reconstruction with a Free TRAM Flap]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):263-5.
We report a case of a 62 year old woman who presented with Ogilvie's syndrome as a complication of mastectomy with free TRAM flap reconstruction due to angiosarcoma of the right breast. In the acute postoperative period, the patient expired as a result of Ogilvie's syndrome related complications. Several assumptions regarding the causes of Ogilvie's Syndrome as well as current theories about aetiology, diagnosis and therapy are discussed in this case presentation.
- [Is there a Psychological and Physiological Difference between DIEP- and Free TRAM-flap? A Retrospective Patient Survey]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):256-62.
The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological pa-tient satisfaction between DIEP- and free TRAM-flap.To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction.We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9 kg/m² and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG.Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no -difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.
- [Reconstruction of the Vascular Compromised Lower Extremity - Report of the Consensus Workshop at the 35. Meeting of the DAM (Deutschsprachige Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäβe) 2013 in Deidesheim]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):248-55.
As microsurgical reconstruction is now being increasingly performed on patients with critical peripheral perfusion and/or arterial occlusive disease in numerous centres, there is a need for standardisation of interdisciplinary diagnostic approach and treatment regimens in such critically ill patients. In a consensus workshop on reconstruction of the vascular compromised lower extremity during the 35th Annual Meeting of the German working group microsurgery of the peripheral nerves and vessels (DAM) in 2013 in Deidesheim, DAM members together with vascular surgeons and interventional radiologists attempted to establish interdisciplinarily routine pathways for diagnosis and therapy and to consolidate key recommendations for treatment.By reviewing the literature and considering the results of the expert meetings, options and limits of therapy were illustrated and recommendations for successful cooperative treatment formulated.By means of interdisciplinary cooperation, limbs can be salvaged and the quality of live as well as survival of patients with severe peripheral vascular disease improved. Different techniques including angioplasty, bypass surgery and microsurgical free flaps can be applied and individualised concepts allow extremity salvage even in patients with severely compromised limbs. Revascularisation provides the possibility of free flap transfer while the risk for the patients is moderate.The poor general condition of the patient requires a sufficient interdisciplinary preoperative planning. By means of interdisciplinary cooperation, the limbs can be salvaged. This not only improves the quality of life but also increases the survival time of patients with occlusive vascular disease. Different concepts for this group of patients have been developed. Surgical treatment with a distal bypass or recanalisation and free flap not only allow for the coverage of large defects, but also represent a haemodynamic advantage by increased blood flow in the bypass. This is attributed to the additional vascular bed that is transplanted with the free flap. Limb salvage means relevant improvement, however, the initially less demanding procedure of amputation must always be considered.
- Autologous Fat Grafting for Scleroderma-Induced Digital Ulcers. An Effective Technique in Patients with Systemic Sclerosis. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):242-247.
Background: Digital ulcers (DUs) occur in up to 50% of patients with Systemic Sclerosis (SSc). DUs are painful, recurring and lead to functional disability. Management of DUs includes pharmacologic and local therapy, the healing process is slow and the ulcer can become infected or evolve to gangrene. Autologous fat grafting (AFG) is a technique used to promote tissues repair. We used AFG to treat DUs refractory to conventional treatment to enhance healing process. Patients and Methods: We treated 9 SSc patients for a total of 15 ulcers. All 9 patients were treated with iv Iloprost. The purified fat tissue was injected at the border of larger ulcers or at the finger base of smaller DUs. The AFG was performed from 2 to 8 months since the ulcer onset. Results: Complete healing occured in 10 DUs and size reduction ≥50% in 2, within 8-12 weeks. In all but 2 patients the pain improved allowing a reduction of analgesics. In the majority of the cases AFG was able to hasten ulcer healing and to reduce pain and the need of pharmacological therapy. The lack of efficacy on healing and pain reduction was observed when the ulcers were long-lasting, located on legs and with concurrent atherosclerotic macroangiopathy. Conclusions: Surgical resective treatment for finger ulcers in patients affected by SSc is fraught with morbidity and long prolonged recovery. This study introduces a novel minimally invasive approach. The procedure is safe and effective, with short recovery time and local deficient vascularization improvement.
- [Microsurgical Training in Germany - Results of a Survey among Trainers and Trainees]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):234-41.
Reconstructive microsurgery is an essential part of plastic surgery. To live up to the high technical demands of today's sophisticated techniques, a structured microsurgical training is required. However, such curricula are rare in Germany. We therefore evaluated the concepts and requests of trainers as well as trainees regarding an optimal microsurgical training. We found that the demands of both sides to be fairly similar. How-ever, there were factors potentially hindering the implementation of such curricula, foremost the increasing economic pressure. Based on our find-ings, representatives of microsurgical trainers and trainees, together with national societies might be able to establish a national curriculum for microsurgical training. The clinical implementation of such a structured train-ing will require significant personal resources. However, this expenditure seems to be justified by the increasing complexity of techniques, the rising demand of patients and the limited time for -surgical training.
- Midface Lift: Our Current Approaches. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):224-233.
In the last few years, surgery of the ageing face seems to have shifted from tissue uplifting and tightening to mere filling. We do not agree with this trend. We are positive that ageing brings about 2 basic phenomena: on one hand bone and fat volume reduction, whilst on the other a deterioration of the skin lining (elastosis) leading to an increase in its compliance and extension. We therefore deem of the utmost importance to couple soft tissue filling with indispensable tightening and repositioning together with resection of overabundant skin. For what concerns the mid-face area in particular, we suggest to resort to 3 different lifting techniques, according to the kind of defect to be treated. It is important to take the right pulling vector into consideration as well as the need of skin excess removal. The procedures can be tailored to suit any peculiar need such as malar bag, lower lid border malposition, tear trough deformity, etc. Different cases will be taken into consideration as examples of the various indications and techniques.
- [Management of a 4MRGN Acinetobacter baumanii Outbreak in a Burn Unit]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):214-23.
Patients with 4MRGN Acinetobacter baumanii infections in a burn unit represent great challenge. The structured management with 7 involved patients in such a situation is presented. After discovering the infectious trigger a management team is established. An immediate stop for further admissions was announced and all infected room areas and medical equipment were analysed for infection foci. The infected patients were transferred to regional hospitals or a rehabiltation hospital after finishing all surgical procedures. In one case, for whom further operations were needed, a transfer to a separated area of the intermediate care unit (IMC) within the hospital was arranged. The performed analysis of infection foci indicated a bronchoscopy tower to be the infection source. The outbreak was terminated after transferring all patients, final disinfection and subsequent nebulisation with 5-6% hydrogen peroxide within 18 days.
- [Progress in face transplantation]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):206-13.
Vascularised composite allotransplantation (VCA) is utilised for restoration of complex defects. In this context, restoration describes the replacement of destroyed tissue by identical anatomic structures. Up to date, over 150 VCAs including 31 face transplantations have been performed worldwide. Face transplantation is a life giving, rather than life saving procedure that is intended to significantly improve the patient's quality of life. Safe revascularisation as well as aesthetic and functional reintegration are the ultimate goals of face transplantation. The necessary lifelong immunosuppression with potentially life-threatening side effects imposes the need for a very strict risk-benefit ratio assessment and currently limits the indications of face transplantation. Different transplant centres use different protocols for induction and maintenance immunosuppression. Skin is the most immunogenic part of the vascularised composite allograft and has been the focus of intensive research efforts in order to replicate the success of immunosuppressive regimens for solid organ transplantation. Organ preservation during transfer from donor to recipient is another important field of research within VCA. The general public's originally rejecting attitude towards non-lifesaving VCA procedures has changed towards a general acceptance following the publication of promising results after the first cases of face transplantation. Further improvements of surgical techniques and immunosuppressive strategies will be important to drive these young and exciting procedures forward in the future.
- [In Process Citation]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):203-5.