Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- [Persistent Symptoms after Carpal Tunnel Release: the Challenge of Preoperative Planning - a Case Report]. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2016 Aug 25.
- [Cryolipolysis - Scientific Background of a Current Hype in Aesthetic Medicine]. [Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):247-51.
- [Free Microvascular Gracilis Muscle flap for Extremity Salvage in a 94-Year-Old Patient after Gustillo IIIB Lower Leg Fracture: Pushing the Limits in Geriatric Microsurgery]. [Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):244-6.
- [Aplasia cutis congenita]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):239-43.
Aplasia cutis congenita is a rare congenital disorder characterised by the absence of skin. It mostly affects the scalp, but may also involve deeper tissue layers such as bone or dura mater. Bleeding from the sagittal sinus and infections are the most common complications. Numerous case reports have been published, but there is no consensus on therapeutic management, which includes both conservative and surgical treatment.We report on 3 newborns with aplasia cutis congenita solely affecting the skin without involvement of deeper tissue layers. All 3 patients were treated conservatively with fatty gauze being used as a wound dressing. The patients were monitored in tight intervals.In all 3 newborns, the skin defects healed within a few months without any complications.Conservative treatment with fatty gauze represents a reliable therapeutic option in case the disease solely affects the skin.
- [Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):233-8.
Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH).A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared.The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20.Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature.
- [Analysis of Diagnosis Related Groups and their Impact on Health Care in Post Massive Weight Loss Surgery]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):226-32.
Diagnosis Related Groups (DRG) were introduced in Germany as a medico-economic classification system in 2004. In this analysis, we looked at restorative surgery after massive weight loss, focusing on reimbursement of this fee-per-case system in comparison to costs to deduce possible effects on health care over time.First we analysed the algorithms for the relevant DRGs including data about length of stay and reimbursement. Furthermore, we integrated cost data from German reference hospitals of the last 5 years as well as single-centre data from a university hospital.Due to a diagnosis-related algorithm, coding will constantly lead to DRG K07Z. In 2016, a new diagnosis code specific to massive weight loss was introduced, which now leads to DRG J10B. As a result, reimbursement is reduced by more than half. In the cost matrix, staff, general ward, operation theatre and anaesthesia were identified as the main cost drivers. As expected, there was a statistically significant correlation between general ward costs and time of stay in hospital as well as operation theatre costs and incision-suture time. Considering the cost data of the reference hospitals, there was an average excess of EUR 781 per case whereas our own cost data revealed a deficit of EUR 1 700 to 2 700 per case. This is mainly due to the fact that approximately one third of our patient cohort underwent highly elaborate circular body lifts.It has to be questioned whether a newly introduced main diagnosis code can be applied as such without any underlying cost data having been collected in previous years. Given unchanged treatment measures, the main cost drivers identified by us remain the same, which means that there is no rationale for a drop in revenue. In addition to providing incentives for an efficient use of resources and quality optimisation, this system should offer medical service providers a sustainable and realistic possibility to break even.
- [Legal Framework of Autologous Fat Usage in Point-of-Care Treatments in Plastic and Aesthetic Surgery - Risks of Criminal Prosecution and Infringement of Medical Law Due to Pharmaceutical Regulations]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):219-25.
The use of autologous fat, especially for (stem) cell-assisted lipotransfer in plastic and aesthetic surgery, has regularly been regarded as the manufacture and application of so called Advanced Therapy Medicinal Products (ATMP). However, the in-house production of such pharmaceuticals at the point-of-care (PoC) in the surgeon's practice is not permitted without an official manufacturing license. Therefore, before beginning such treatments, a pharmaceutical manufacturing license has to be granted to the surgeon to avoid criminal prosecution and negative consequences due to infringement of professional regulations. Because such a license is linked to compliance with GMP standard, in-house manufacturing of such pharmaceuticals also implies extra technical and personnel expenses. The surgeon is obliged to check that the available autologous fat based applications are in compliance with pharmaceutical legislation. Repeated infringements of pharmaceutical regulations are incompatible with medical reliability - a prerequisite for the license to practice medicine.
- [Sacral Skin Elasticity - Establishing a Non-Invasive Mechanical Method for Measurement]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):212-8.
Some patients with sacral scars, e. g. those developing after pilonidal sinus surgery, report discomfort when sitting or putting strain on the scars. In order to establish objective criteria for the assessment of this kind of discomfort and for the evaluation of scar quality after various types of surgical interventions, it is of interest to provide a method which enables physicians to assess skin quality in the sacral region. For this purpose, we developed a mechanical, non-invasive, fast and cost-neutral method for the measurement of skin distensibility and mobility. We examined a healthy sample of 100 study participants to establish benchmark values for scar-free skin in the sacral region and to identify the factors which impact skin quality, e. g. age, weight and sex.With the participant in a standing position, 4 vertically arranged measurement points, which are exactly spaced in cranial to caudal direction by 10 mm-100 mm-10 mm, are marked in the lumbar and sacral region, respectively. The participant is then asked to bend forward and - with arms and legs fully stretched on both sides - to touch both their patellae with the balls of their hands so that the distance between the measurement points can be measured in this position as well. Then, with the participant standing upright again, another measurement is taken to establish the distance by which the lowest point can be manually moved in cranial direction.The sacral-lumbar skin distension quotient (lumbar skin distension / sacral skin distension×100), which can easily be calculated from the measurements, is independent of age and BMI and has a standard range of about 80-93%. Sacral skin mobility ranges from 11 to 18 mm, but is slightly negatively influenced by a high BMI.By comparing lumbar and sacral skin distension in the same study participant, we are able to obtain intraindividually valid findings about possible changes in skin and scar quality. Owing to the lack of known published data about sacral skin elasticity, the proposed measurement method, while restricted to a number of special cases, seems to be practicable and independent of the patient's general condition. Compared with devices that have been used for the measurement of elasticity in other skin areas, our procedure is generally available and cost-neutral.
- [Perioperative Management in Microsurgery - Consensus Statement of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):205-11.
Perioperative management of microsurgery is not well standardised. Due to a lack of evidence, different regimes are established in different microsurgical centres. However, trends towards less aggressive perioperative interventions can be identified in recent years, since treatment algorithms without systematic evidence are being progressively abandoned. The available evidence on perioperative issues, such as temperature control, fluid resuscitation, blood transfusions, application of vasodilators or - pressors, as well as anticoagulants, were discussed during the consensus conference on perioperative management at the annual meeting of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels. Common basic standards were identified and a consensus was reached that is described in the following manuscript.
- [Need for a German Breast Implant Registry - Pilot Project Breast Implant Template]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Aug; 48(4):199-204.
Scandals concerning breast implants confuse patients, medical doctors and the public. Till now legally binding consequences are missing despite repeated requests. The aim of this study was to establish and implement a breast implant template for our clinic to increase the patient's safety and the assessment of implants in course of time.In January 2013 our clinic started a pilot project with a self-developed digital breast implant template. This digital template is filled out by the surgeon after each breast implant operation. Furthermore, we retrospectively evaluated the data of all patients that underwent breast implant surgery in our clinic since 2000. Till the end of December 2015 we created 408 breast implant forms. The time spent for processing this template and reasons for implantation, explantation or revision have been collected.247 primary augmentations and 161 revisions of breast implants had been performed (n=408 breast implant forms). Main reason for explantation or revision was capsular fibrosis (n=304). The time spent for processing this template for primary implantation was 01:57 min (MW: 01:57±00:49) and for implant revision 02:13 min (MW: 02:13±00:38).The breast implant template optimized the quality of our treatment, revealed possible complications quickly, allowed a valuable tracing of the breast implants and improved the consultation of our patients with regards to different devices and therapies.