- [Concept for a National Implant Registry to Improve Patient Safety]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):320-329
- Since the introduction of silicone implants, several events have led to considerable uncertainty among the patients, public, and users. So far, however, the necessary steps to significantly improving...
Since the introduction of silicone implants, several events have led to considerable uncertainty among the patients, public, and users. So far, however, the necessary steps to significantly improving patient safety have not been taken in any of these cases. Requiring stricter approvals for medical devices, improving monitoring by the regulatory authorities and the revision of the Medical Devices Directive are all initial steps in the right direction towards a change in policy, but are insufficient as an early warning system. After the introduction of registers was announced in the coalition agreement, the German Society of Plastic, Aesthetic and Reconstructive Surgeons (DGPRÄC), in close consultation with the Ministry of Health, has developed a concept which is presented here. The need for a uniform and legally binding central register for breast implants is fully supported by the entire medical profession. According to the concept presented by the DGPRÄC, three data qualities would be applicable: Safety data (mandatory), physician information (voluntary) and research data (optional, except if safety related). The public authorities are creating a unified, secure entry portal for all professional associations concerned. This register is based with the professional associations, and from there the mandatory security data will be forwarded to the public authorities. Decoding of the identity of the patient and doctor would only occur in specifically defined emergency situations such as product recalls. Automated tools in the security database provide early detection of problems, so that rapid clarification is possible in consultation with the professional associations, manufacturers and possibly patients. This concept as proposed by the DGPRÄC has thus far been very positively received in all discussions between the various parties concerned.
- Herausgeber und Verlag bedanken sich für die Unterstützung bei der Qualitätssicherung der Zeitschrift durch die Reviewer und Mitglieder des Beirats im Jahr 2016. Ein herzliches Dank für die Zeit, Mühe und die Kompetenten Gutachten geht an. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):384
- [HaMiPla Best Paper Award - Your Favourites in 2015]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):377-378
- [Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2015/2016]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):370-373
- In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and qualit...
In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRÄC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.
- [Overview and Introduction of a Treatment Concept for Postoperative Care and Mobilisation After Free Flap Transplantation in the Lower Extremity]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):363-369
- Introduction: Free flap transplants for soft tissue reconstruction in the lower extremity are associated with a higher rate of complications compared with other areas. Mobilisation and the resulting ...
Introduction: Free flap transplants for soft tissue reconstruction in the lower extremity are associated with a higher rate of complications compared with other areas. Mobilisation and the resulting hydrostatic pressure put strain on the flaps. In general, these effects are countered by slowly increasing hydrostatic pressure with the leg being compressed by elastic bandages. These postoperative regimes are also called dangling procedures or "flap training", but are not scientifically validated and therefore there is no consensus or guideline leading to a standard treatment regime. The goal of our study was to present an overview of currently performed regimes. Material and Methods: We conducted an email survey by sending a questionnaire to departments for plastic and reconstructive surgery in Germany, Austria and Switzerland, which perform free flap transplantations in the lower extremity. The questionnaire ascertained the starting point and the frequency of the dangling procedures, the introduction of weight-bearing on the operated extremity and the incidence of complications occurring during mobilisation. Results: We included 32 departments and compared them by the number of free flap transplantations performed per year. We found a wide variation between the postoperative treatment regimes. In most departments, flap training is started between the 3(rd) and 7(th) day after surgery and lasts between 5 and 15 min. The intervals with which flap training intensity is increased are inhomogeneous as well. The time until full weight-bearing is exerted on the operated extremity ranges from day 5 to week 3 postoperatively. Complications due to flap training were reported by one third of the participating departments. Conclusion: Elastic compression and patient mobilisation after free flap procedures in the lower extremity are considered to be very important in reducing complications and in protecting the flap from edema and volume overload. This article demonstrates that there is a wide variety in flap training regimes. It aims to help readers evaluate their own regimes and provides guidance for an individualised patient-oriented regime.
- [Analysis of Critically Perfused Tissues by Laser Speckle Contrast Analysis (LASCA) Perfusion Imaging]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):354-362
- Background: The success of tissue transplantation and long-term tissue stability after wound healing depends on sufficient tissue perfusion. Laser Doppler-supported procedures allow for an objective ...
Background: The success of tissue transplantation and long-term tissue stability after wound healing depends on sufficient tissue perfusion. Laser Doppler-supported procedures allow for an objective measurement of relative tissue perfusion. The development of Speckle-based Laser Doppler imaging now enables a real-time representation of tissue perfusion. The perfusion of tissues relevant in plastic surgery such as scars, phalangeal replantations and burn wounds were systematically analysed by Laser Speckle Contrast Analysis (LASCA) imaging. Method: Perfusion of skin, scars, replanted fingers and different burn wound degrees (IIa, IIb and III) were systematically examined by LASCA imaging. Baseline perfusion of control tissue and perfusion values of compromised tissues were quantified and compared. Results: LASCA imaging shows significant differences in baseline perfusion of skin compared to atrophic scars, hypertrophic scars and keloids. Finger replantations with subsequent replantation failure show a characteristic and significant hypoperfusion in line with the expected clinical feature. A significant difference in tissue perfusion is seen in superficial (IIa) and superficial deep (IIb) burns, which are hard to distinguish on clinical examination. Deep burns (III) are characterised by hypoperfusion, which differs significantly from grade IIa and IIb burn wound perfusion, but not from baseline skin perfusion. Furthermore, the characteristic perfusion values of different burn degrees correspond to the varying treatment strategies. Conclusion: LASCA imaging is a robust method of perfusion imaging, which combines high resolution and speed. Hypoperfusion of tissues relevant to plastic surgery such as scars, phalangeal replantations and the different burn degrees (IIa, IIb and III) can be detected by LASCA imaging with high precision. Ease of use and immediate real-time imaging make LASCA imaging a reliable tool for the evaluation of tissue perfusion after plastic surgery procedures, which may influence further treatment decisions.
- [Plastic Surgery in Palliative Care - Report on the Consensus Workshop of the 37th Annual Meeting of the German-language Group for Microsurgery of the Peripheral Nerves and Vessels (DAM) 2016 in Bochum]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):340-345
- Introduction: At the consensus meeting on "Plastic Surgery in the Palliative Situation" at the 37th Annual Meeting of the DAM 2015 in Bochum, treatment options were discussed with oncologists and pal...
Introduction: At the consensus meeting on "Plastic Surgery in the Palliative Situation" at the 37th Annual Meeting of the DAM 2015 in Bochum, treatment options were discussed with oncologists and palliative care anesthesiologists and recommendations were given. Methods: The literature was reviewed and the results of the expert-meeting options and limits of therapy were illustrated. The role of plastic surgery for palliative care patients was pointed out and recommendations given for successful cooperative treatment. Results: A rational combination of chemotherapy and surgery as well as early integration into a palliative care concept prolongs survival and improves the quality of life of patients in the palliative situation. Discussion: Plastic surgeons should regularily attend tumour boards to spread the knowledge of the value of reconstructive procedures in multidisciplinary treatment, in order to enhance the quality of live of the palliative patient. Participation in the preparation of the next treatment guidelines for palliative care would be desirable. Whenever patients are considered in a palliative situation, palliative care anesthesiologists should be involved.
- [Consensus of the Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) on Autologous Fat Grafting]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):337-339
- On occasion of the Munich Plastic Symposium in Munich the board of the Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) together with a group of experts who ...
On occasion of the Munich Plastic Symposium in Munich the board of the Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) together with a group of experts who were also involved in the preparation of the recently published S2K guideline "Autologous Fat Grafting", prepared a consensus statement from a plastic-surgical point of view so to evaluate current spects and taking into account the current legal framework: 1. Autologous Fat Grafting is a long established treatment in plastic surgery and does not differ from other tissue grafts. 2. Mechanical processing of autologous fat does not provide any substantial change tot he tissue. 3. If other treatment methods to enrich progenitor cells of autolous fat i. e. by an enzymatic process have evidence that autologous adipose tissue or cells were substantially changed, classification as a drug could come in question under current german law (application of AMG/ATMP).
- [The Use of a Cytokine Adsorber (CytoSorb) in a Patient with Septic Shock and Multi-Organ Dysfunction (MODS) after a Severe Burn Injury]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016 Dec 08
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- [Autologous Skin Cell Transplantation and Medical Needling for Repigmentation of Depigmented Burn Scars on UV-protected and UV-exposed Skin]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2016; 48(6):346-353
- Background: Burn scars remain a serious physical and psychological problem for the affected people. Both clinical studies and basic scientific research have shown that medical needling can significan...
Background: Burn scars remain a serious physical and psychological problem for the affected people. Both clinical studies and basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient related to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling does not influence repigmentation of large hypopigmented scars. Objective: The goal is to evaluate whether both established methods - needling (improvement of scar quality) and non-cultured autologous skin cell suspension (NCASCS) "ReNovaCell" (repigmentation) - can be combined. So far, 20 patients with mean age of 33 years (6-60 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 94 cm² (15-250 cm²) and was focused on areas like face, neck, chest and arm. Methods: Medical needling is performed using a roller covered with 3 mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, NCASCS is applied, according to the known protocol. The patients have been followed up for 15 months postoperatively. The scars were subdivided into "UV-exposed" and "UV-protected" to discover whether the improved repigmentation is due to transfer of melanocytes or to reactivation of existing melanocytes after exposure to UV or the sun. Results: The objective measures show improved pigmentation in both UV-exposed and UV-protected groups. Melanin increases 1 year after NCASCS treatment in the UV-protected group are statistically significant. Conclusion: Medical needling in combination with NCASCS shows promise for repigmentation of burn scars, even in sun protected scars.