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1.
Handchir Mikrochir Plast Chir ; 55(2): 95-105, 2023 Apr.
Article in German | MEDLINE | ID: mdl-36780931

ABSTRACT

BACKGROUND: Research is an integral part of academic medicine. In plastic surgery, it sets the course for innovations in the specialty. The purpose of this study is to present the research performance of plastic surgeons in Germany for the period 2021/2022 and to compare it with previous periods. MATERIALS AND METHODS: The directors of plastic surgical academic institutions reported all requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was gathered within an established online database. In addition, the DFG´s public database GEPRIS was screened for plastic surgical research grants. Data was also collected regarding research infrastructure and organization at the participating centers. RESULTS: 105 applications were reported to 54 different funding agencies from 20 plastic surgery centers. 37 funding applications were submitted to the major public funding agencies DFG, BMBF, BMWi, BMG, BMVg, G-BA and EU. Of these, 59,5% (22/37) were DFG, 13,5% (5/37) each BMBF and EU, 5,4% (2/37) BMWi, and 2,7% (1/37) each BMG, BMVg, and G-BA applications. The average funding volume of these proposals was 401,515 euros. Approved DFG proposals were most frequently assigned to the review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery (n=10/16, 62,5%). Over time, the research registry shows an increase in the number of proposals in general and those granted. 70,0% (14/20) of participating sites had their own experimental research laboratory, while only 40,0% (8/20) had their own clinical trial center. CONCLUSION: The 2021/2022 Research Funding Report once again highlights the impressive research accomplishments of the plastic surgery community.


Subject(s)
Plastic Surgery Procedures , Surgeons , Surgery, Plastic , Humans , Registries , Esthetics
2.
Tissue Cell ; 78: 101886, 2022 Oct.
Article in English | MEDLINE | ID: mdl-35985248

ABSTRACT

Human adipose stem cells (ASCs) hold great potential for regenerative medicine approaches, including osteogenic regeneration of bone defects, that fail to heal autonomously. Osteogenic differentiation of stem cells is dependent on the stimulation of biophysical factors. In the present study, the effects of hypergravity, hypoxia, and hyperbaric treatment were investigated on adipose stem cell (ASC) metabolic activity, quantified by PrestoBlue conversion, and cell numbers, evaluated by crystal violet staining. Osteogenic differentiation was assessed by alkaline phosphatase (ALP) activity and cresolphthalein staining of calcium deposition. Differentiation was performed for 12 days, which was accompanied by periodical stimulation. Increasing gravity forces up to 50x g did not affect ASC viability, but it enhanced osteogenic markers with a strongest effect between 20 and 30x g. Hyperbaric stimulation at 3 bar decreased ASC cell numbers but increased ALP activity and calcium deposition. Hypoxia at 8 % atmospheric oxygen did not affect ASC proliferation, while cell numbers were reduced at 3 % oxygen. Furthermore, hypoxic conditions produced opposing results on osteogenic markers, as ALP activity increased whereas cresolphthalein staining decreased upon stimulation. These data demonstrated that intermittent short duration of basal physical or chemical impulses interfere with the osteogenic differentiation of ASCs. Our findings could be of specific relevance in ASC based therapies for regenerative medicine and bone tissue engineering approaches.


Subject(s)
Hypergravity , Mesenchymal Stem Cells , Adipose Tissue , Alkaline Phosphatase/metabolism , Calcium/metabolism , Cell Differentiation , Cells, Cultured , Gentian Violet/metabolism , Gentian Violet/pharmacology , Humans , Hypoxia/metabolism , Osteogenesis , Oxygen/metabolism , Phenolphthaleins , Stem Cells/metabolism
3.
J Plast Reconstr Aesthet Surg ; 75(1): 52-60, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34511387

ABSTRACT

BACKGROUND: There is still no consensus regarding the ideal zoning in abdominal-based autologous breast reconstruction using free DIEP or ms-TRAM flaps. In particular, the perfusion pattern of the flap according to the number of perforators used and their location remains controversial. In this study, the perfusion of free DIEP and ms-TRAM flaps is assessed intraoperatively and analyzed with regard to different perfusion patterns. METHODS: A retrospective analysis of 100 free flaps for breast reconstruction was performed. Following complete flap harvest, we used indocyanine green angiography for perfusion analysis. By applying two different contour levels, DIEP flaps with lateral or medial perforators and ms-TRAM flaps were assessed for their respective perfusion patterns. RESULTS: No statistically significant differences were found in the size of the perfusion area between the different flap types when applying the contour level of 20% (p >0.05). For the contour level of 30%, however, statistically significant differences were found between DIEP flaps with medially or laterally located perforators (p = 0.038). Laterally or medially located perforators in DIEP flaps showed no significant differences in their ability to cross the midline (contour level 20%, p = 0.068; contour level 30%, p = 0.058). CONCLUSION: Considering the variability of the perfusion of the abdominal wall and the high sensitivity of indocyanine green angiography for their detection, the abdominal zonings play a minor role. By using intraoperative indocyanine green angiography, a precise and patient-specific free flap surgery for autologous breast reconstruction is possible independent of perforator location.


Subject(s)
Mammaplasty , Myocutaneous Flap , Perforator Flap , Angiography , Epigastric Arteries , Humans , Indocyanine Green , Perfusion , Retrospective Studies
4.
Handchir Mikrochir Plast Chir ; 53(2): 110-118, 2021 Apr.
Article in German | MEDLINE | ID: mdl-32977347

ABSTRACT

BACKGROUND: Since 2015/16 the DGPRÄC collects, evaluates and publishes the research activities of academic sections, departments and clinics for plastic surgery at university hospitals in Germany, in order to raise the awareness of plastic surgical research performance. MATERIALS AND METHODS: The directors of plastic surgical academic institutions were contacted via the DGPRÄC and asked to report any requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was collected in our previously established online database: https://docs.google.com/forms/d/e/1FAIpQLSe6F5xmTyw-k7VKJx_2jkPA4LBXsA0sgBGMrC3rx_4bHj6uzQ/viewform?usp=sf_link. In addition, applications were identified via the DFG's public database GEPRIS. RESULTS: A total of 41 funding applications to the public funding institutes DFG, BMBF, BMWi, BMG and EU were identified. 75.6 % (31/41) of the applications had already been approved at the time of data collection, of which 77.4 % (24/31) were DFG, 9.7 % (3/31) were BMWi, 6.5 % (2/31) were EU and 3.2 % (1/31) were BMBF or BMG applications. The average funding amounted to 358 301 Euro. In 50.0 % (12/24) of the cases, the approved DFG proposals were assigned to the subject review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery. CONCLUSION: The continuous publication of plastic surgical research funding reports submitted by the convention of university plastic surgeons of the DGPRÄC portraits the excellent, collaborative research activity in the field of plastic surgery.


Subject(s)
Plastic Surgery Procedures , Surgeons , Surgery, Plastic , Esthetics , Germany , Humans , Registries
5.
Handchir Mikrochir Plast Chir ; 51(6): 410-417, 2019 Dec.
Article in German | MEDLINE | ID: mdl-31698484

ABSTRACT

Reconstructive microsurgery using free and pedicled flaps has become a reliable method with a high success rate. Preoperative perforator mapping and intraoperative assessment of perfusion might further reduce flap-associated morbidity.There are various techniques for perforator mapping and perfusion measurement, but no guidelines regarding their use. Therefore, an expert panel at the 40th Annual Meeting of the German-Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels (DAM) discussed and critically reviewed the current literature. The consensus statement represents the expert opinion based on the available literature and provides recommendations regarding the use of preoperative perforator mapping and intraoperative perfusion measurement.


Subject(s)
Perforator Flap , Plastic Surgery Procedures , Consensus , Humans , Microsurgery , Peripheral Nerves , Surgical Flaps , Switzerland
6.
Handchir Mikrochir Plast Chir ; 50(6): 414-421, 2018 Dec.
Article in German | MEDLINE | ID: mdl-30536256

ABSTRACT

INTRODUCTION: This report serves to publicize the research of academic institutions for Plastic Surgery within our society DGPRÄC in 2017/2018 and sequels the funding report of 2015/2016. Applications to public, non-public, or industrial funding organizations were evaluated. At the same time, this paper analyses the number of approved DFG applications in Plastic, Thoracic and Vascular Surgery in the GEPRIS system. Contrary to these specialties, Plastic Surgery is not classified as an independent speciality in the subject structure of the DFG review board which results in a lack of transparency concerning Plastic Surgery research work. MATERIALS AND METHODS: Our previously established online database (https://docs.google.com/forms/d/1OaSnHyKTysawiI1ie7kfUxDf7nJP_RiTUJTsnb7Mq_E/edit) for reporting requested/ approved and rejected research applications to public, non-public and industrial funding organizations was continued and evaluated together with applications found in the DFG's public database GEPRIS. RESULTS: Compared to the previous year's report, the number of approved applications from public research organizations (DFG, BMBF, BMWi, EU) was increased from 23 to 27. We identified 19 approved DFG applications from Plastic Surgery, as compared to 9 and 8 applications by Thoracic and Vascular Surgery, respectively. SUMMARY: Taken together, this data emphasizes that our research is at least equal to that of other newly established surgical specialties within the framework of the DFG. Accordingly, we hope to provide further arguments for an adaptation of the DFG review boards subject structure to include Plastic Surgery as an independent specialty as it is for Vascular Surgery and Thoracic Surgery.


Subject(s)
Plastic Surgery Procedures , Registries , Surgeons , Surgery, Plastic , Esthetics
7.
Arch Orthop Trauma Surg ; 138(9): 1323-1331, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29992376

ABSTRACT

INTRODUCTION: Grip strength and load distribution of the hand are important parameters for evaluating hand function. The purpose of this study was to analyze and compare grip force and load distribution of dominant and nondominant hands in right-handed healthy subjects. METHODS: Gripping measurements were performed on 40 healthy right-handed subjects using a cylindrical gripping device. Two different cylinders with circumferences of 150 mm (small cylinder) and 200 mm (large cylinder), respectively, were used for the measurements. Subjects were assigned to either the small or the large cylinder with respect to their hand size. Maximum and mean force applied during three intervals of gripping as well as the percent contribution of each digit, thenar, and hypothenar in relation to the total load applied were acquired. Values of dominant and nondominant hands were compared. RESULTS: Percent contribution of mean grip strength differed for the thumb (p = 0.007), ring finger (p < 0.001), little finger (p = 0.047), and palm (p < 0.001). Comparing the dominant and nondominant side, the dominant hand showed a lower contribution of the thumb, ring finger, and little finger, but a higher contribution of the palm. When analyzing maximum grip, percent contribution of the small fingers was equal between dominant and nondominant side (p = 0.1). Differences between dominant and nondominant thumb, ring finger, and palm persisted (p = 0.007, p = 0.001, p = 0.005, respectively). No differences could be shown for the index finger, middle finger, thenar, and hypothenar when analyzing both mean and maximum force. DISCUSSION AND CONCLUSION: Percent contribution of the thumb and the fingers to total grip strength differed between dominant and nondominant hands with a change in distribution when assessing maximum grip force. In right-handed subjects, thumb and ring finger have important roles during gripping.


Subject(s)
Functional Laterality/physiology , Hand Strength/physiology , Hand/physiology , Adult , Biomechanical Phenomena , Cross-Sectional Studies , Female , Fingers/physiology , Healthy Volunteers , Humans , Male , Middle Aged , Thumb/physiology , Young Adult
8.
BMC Cell Biol ; 18(1): 15, 2017 02 28.
Article in English | MEDLINE | ID: mdl-28245809

ABSTRACT

BACKGROUND: Volumetric muscle loss caused by trauma or after tumour surgery exceeds the natural regeneration capacity of skeletal muscle. Hence, the future goal of tissue engineering (TE) is the replacement and repair of lost muscle tissue by newly generating skeletal muscle combining different cell sources, such as myoblasts and mesenchymal stem cells (MSCs), within a three-dimensional matrix. Latest research showed that seeding skeletal muscle cells on aligned constructs enhance the formation of myotubes as well as cell alignment and may provide a further step towards the clinical application of engineered skeletal muscle. In this study the myogenic differentiation potential of MSCs upon co-cultivation with myoblasts and under stimulation with hepatocyte growth factor (HGF) and insulin-like growth factor-1 (IGF-1) was evaluated. We further analysed the behaviour of MSC-myoblast co-cultures in different 3D matrices. RESULTS: Primary rat myoblasts and rat MSCs were mono- and co-cultivated for 2, 7 or 14 days. The effect of different concentrations of HGF and IGF-1 alone, as well as in combination, on myogenic differentiation was analysed using microscopy, multicolour flow cytometry and real-time PCR. Furthermore, the influence of different three-dimensional culture models, such as fibrin, fibrin-collagen-I gels and parallel aligned electrospun poly-ε-caprolacton collagen-I nanofibers, on myogenic differentiation was analysed. MSCs could be successfully differentiated into the myogenic lineage both in mono- and in co-cultures independent of HGF and IGF-1 stimulation by expressing desmin, myocyte enhancer factor 2, myosin heavy chain 2 and alpha-sarcomeric actinin. An increased expression of different myogenic key markers could be observed under HGF and IGF-1 stimulation. Even though, stimulation with HGF/IGF-1 does not seem essential for sufficient myogenic differentiation. Three-dimensional cultivation in fibrin-collagen-I gels induced higher levels of myogenic differentiation compared with two-dimensional experiments. Cultivation on poly-ε-caprolacton-collagen-I nanofibers induced parallel alignment of cells and positive expression of desmin. CONCLUSIONS: In this study, we were able to myogenically differentiate MSC upon mono- and co-cultivation with myoblasts. The addition of HGF/IGF-1 might not be essential for achieving successful myogenic differentiation. Furthermore, with the development of a biocompatible nanofiber scaffold we established the basis for further experiments aiming at the generation of functional muscle tissue.


Subject(s)
Cell Differentiation/drug effects , Hepatocyte Growth Factor/pharmacology , Insulin-Like Growth Factor I/pharmacology , Mesenchymal Stem Cells/cytology , Muscle, Skeletal/physiology , Myoblasts/cytology , Tissue Engineering/methods , Animals , Biomarkers/metabolism , Cells, Cultured , Coculture Techniques , Collagen Type I/pharmacology , Flow Cytometry , Male , Mesenchymal Stem Cells/drug effects , Mesenchymal Stem Cells/metabolism , Muscle Development/drug effects , Muscle Development/genetics , Muscle Proteins/genetics , Muscle Proteins/metabolism , Muscle, Skeletal/drug effects , Myoblasts/drug effects , Myoblasts/metabolism , Nanofibers/ultrastructure , Polyesters/pharmacology , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats, Inbred Lew , Tissue Scaffolds/chemistry
9.
Hautarzt ; 68(5): 385-392, 2017 May.
Article in German | MEDLINE | ID: mdl-28314878

ABSTRACT

BACKGROUND: Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. OBJECTIVES: The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. MATERIALS AND METHODS: Analysis of current literature, discussion of reviews, incorporation of current guidelines. RESULTS: Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. CONCLUSIONS: Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.


Subject(s)
Burns/surgery , Dermatologic Surgical Procedures/standards , Pediatrics/standards , Practice Guidelines as Topic , Skin Transplantation/standards , Skin/injuries , Adolescent , Burns/pathology , Child , Child, Preschool , Dermatologic Surgical Procedures/methods , Dermatology/standards , Evidence-Based Medicine , Female , Humans , Infant , Infant, Newborn , Male , Pediatrics/methods , Skin/pathology , Skin Transplantation/methods , Treatment Outcome
10.
J Craniomaxillofac Surg ; 45(2): 319-324, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28043755

ABSTRACT

Scalp reconstruction is a challenging task for the reconstructive surgeon. In consideration of the anatomical and cosmetic characteristics, the defect depth and size, an armamentarium of reconstructive procedures ranging from skin grafts over local flaps to free tissue transfer has been described. In this 10-year retrospective study, 85 operative procedures for scalp reconstruction were performed at our department. The underlying entity, defect size/depth, reconstructive procedure, complications, and mean hospital stay were analyzed. In most cases, scalp reconstruction was necessary after oncologic resection (67%) or radiation therapy (16%). A total of 85 operative procedures were performed for scalp reconstruction including local flaps (n = 50), free tissue transfer (n = 18), and skin grafts (n = 17). Regarding the complication rate, we could detect an overall major complication rate of 16.5% with one free flap loss. Briefly, local flaps are an adequate and safe procedure for limited scalp defects. In the case of extensive scalp defects affecting the calvarium, prior multiple surgical interventions and/or radiation, we prefer free tissue transfer.


Subject(s)
Plastic Surgery Procedures/methods , Scalp/surgery , Adult , Aged , Aged, 80 and over , Female , Free Tissue Flaps/surgery , Humans , Male , Middle Aged , Retrospective Studies , Skin Transplantation/methods
12.
Chirurg ; 87(6): 537-50, 2016 Jun.
Article in German | MEDLINE | ID: mdl-27251483

ABSTRACT

Sternal osteomyelitis is a potentially fatal condition following cardiac surgery. Sternal osteomyelitis should be diagnosed as early as possible followed by an interdisciplinary radical debridement. Subsequently plastic reconstructive surgery is necessary for defect reconstruction. This can be achieved by a number of established pedicled and free flap plastic surgery procedures. The choice of flap procedures is based on defect geometry and the individual patient situation, including potential flap donor sites. Smaller defects can generally be reconstructed by pedicled flap transfer. For extensive sternal defects, free flap transplantation is now a well-established therapeutic option. In some patients lacking sufficient recipient vessels, the creation of an arteriovenous (AV) loop as recipient vessel is necessary. In summary, successful therapy of sternal osteomyelitis is based on early interdisciplinary treatment by the various surgical subspecialties.


Subject(s)
Cardiac Surgical Procedures , Osteomyelitis/surgery , Postoperative Complications/surgery , Sternotomy , Sternum/surgery , Debridement , Early Diagnosis , Early Medical Intervention , Female , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Microsurgery/methods , Middle Aged , Osteomyelitis/diagnosis , Osteomyelitis/mortality , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Plastic Surgery Procedures , Surgical Flaps/blood supply , Surgical Flaps/surgery
13.
Plast Reconstr Surg Glob Open ; 4(4): e682, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27200244

ABSTRACT

In free flap surgery, a clinically established concept still has to be found for the reduction of ischemia-related cell damage in the case of prolonged ischemia. Although promising results using extracorporeal free flap perfusion in the laboratory have been published in the past, until now this concept has not yet paved its way into clinical routine. This might be due to the complexity of perfusion systems and a lack of standardized tools. Here, we want to present the results of the first extracorporeal free flap perfusion in a clinical setting using a simple approach without the application of a complex perfusion machinery.

14.
Handchir Mikrochir Plast Chir ; 47(6): 400-7, 2015 Dec.
Article in German | MEDLINE | ID: mdl-26676557

ABSTRACT

BACKGROUND: Very few microsurgical courses have been offered for medical students in Germany to date. To raise early interest in this technique, which is essential for plastic and reconstructive surgery, and to guide eligible medical students to choose plastic surgery as their specialist field, the Department of Plastic and Hand Surgery, supported by the Faculty of Medicine of the Friedrich-Alexander-University of Erlangen-Nuremberg, implemented a microsurgical course for students in 2011. This study describes the implementation of that course and evaluates its impact on the subsequent choice of the participants' specialist fields. MATERIAL AND METHODS: Since the summer of 2011, the microsurgery course for medical students has taken place regularly 3 times per term. It is free of charge for participants and is guided by senior physicians of the Department of Plastic and Hand Surgery together with student tutors from the Faculty of Medicine. The arterial end-to-end anastomosis in the fresh chicken leg is used as a training model. Based on a questionnaire survey the participants were evaluated and statistically analysed regarding their course satisfaction, self-assessment of their own eligibility before and after the course, the anticipated future choice of their medical specialist field and how their choice was influenced by this course. RESULTS: After the successful implementation of the microsurgical course in 2011, a significant number of students were interested in microsurgery. According to the questionnaire, the level of enthusiasm was high among all participants. The self-assessment of microsurgical skills improved significantly after the course compared with the pre-course assessment. In 82% of the participants, the course had a strong positive influence on the future choice of their specialist field. CONCLUSIONS: The regular implementation of a microsurgical course for students in the form described here is practicable and possible without undue personnel and cost of materials. The ongoing interest among students in such an offer is enormous and the satisfaction of the participants is very high. This might be a way to recruit future plastic surgeons by raising early enthusiasm for microsurgery. These future plastic surgeons, in turn, would be given the chance to experience a very fascinating aspect of plastic surgery, which might help them to decide on their specialisation within that field at a later point in their career.


Subject(s)
Curriculum , Education, Medical , Microsurgery/education , Attitude of Health Personnel , Career Choice , Follow-Up Studies , Germany , Humans , Surveys and Questionnaires
15.
Chirurg ; 86(3): 242-50, 2015 Mar.
Article in German | MEDLINE | ID: mdl-25620285

ABSTRACT

Prevention of perioperative and postoperative complications resulting from surgical oncology in the pelvic region remains a major interdisciplinary challenge. With modern interdisciplinary concepts joining forces of various surgical specialties, tumor resection can be sufficiently carried out with wide margins and the patients benefit from reduced morbidity even in complex situations. As an example chronic fistulation and secretion from the presacral cavity and sinus may result as potential sequelae from intra-abdominal and intrapelvic tumor resection, especially when neoadjuvant multimodal therapies have been applied. This can be prevented by simultaneous transplantation of for example transpelvic vertical rectus abdominis myocutaneous (VRAM) flap transfer, while extensive perineal skin and soft tissue defects may also be simultaneously reconstructed. In cases of malignant soft tissue tumors in the pelvic region a staged surgical procedure can be performed with a period of time between tumor resection and reconstruction. Thus, a histological R0 status can be secured prior to plastic reconstruction surgery in order to increase oncological safety. In cases of postresectional exposition of e. g. pelvic or femoral vessels or intrapelvic and intra-abdominal organs simultaneous flap procedure is mandatory.The reconstructive armamentarium of the plastic surgeon should contain not only pedicled but also free microsurgical flaps so that no compromise in terms of the extent of the oncological resection has to be accepted. At the same time perioperative and postoperative complications may be avoided and the patient quality of life can be preserved even in more complex cases.


Subject(s)
Cooperative Behavior , Groin/surgery , Interdisciplinary Communication , Pelvic Neoplasms/surgery , Plastic Surgery Procedures/methods , Postoperative Complications/prevention & control , Postoperative Complications/surgery , Aged , Anus Neoplasms/surgery , Combined Modality Therapy , Female , Fistula/prevention & control , Fistula/surgery , Humans , Male , Microsurgery/methods , Middle Aged , Pelvic Exenteration/methods , Perineum/surgery , Rectal Neoplasms/surgery , Reoperation , Sacrococcygeal Region/surgery , Sarcoma/surgery , Soft Tissue Neoplasms/surgery , Surgical Flaps/surgery
17.
J Cardiovasc Surg (Torino) ; 55(2 Suppl 1): 265-72, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24796921

ABSTRACT

AIM: Treatment of severe wounds remains a surgical challenge in patients with critical limb ischemia (CLI). In some patients with end stage disease a combined arterial and venous vascular bypass together with immediate or subsequent free soft tissue transfer can become necessary to salvage the limb. The aim of this paper was to develop an algorithm of differential approaches of interdisciplinary reconstructions with bypasses and free flaps for leg salvage. METHODS: From our experiences with over 76 patients receiving a vascular bypass and a free microsurgical tissue transfer, we analyzed the various configurations of possible vascular constellations and treatment options. We derived an algorithm for the combined interdisciplinary surgical approach. RESULTS: We found the surgical technique to be one of the main predictors for the final outcome and categorized the various options and vascular configurations in combination with free flaps to salvage extremities. The overall complication rate with more than 20% revisional surgeries is higher than in routine free flap transfer for reconstructions in patient without CLI. We observed 3 failures (4%) with complete flap loss and bypass occlusion and found 3 patients (4%) with initially successful reconstructions to have secondary amputations within 6 to 18 months postoperatively. CONCLUSION: Given the multitude of concomitant diseases in patients with serious wounds and CLI the distinct choice of the individual reconstructive vascular/flap-procedure has to be thoroughly selected. Any treatment decision against revascularization must be made only with proper and adequate diagnosis based on proper and sufficient diagnostic imaging techniques following an interdisciplinary discussion of possible options for limb salvage. Based on our experience with a large series of this type of combined revascularization-flap reconstruction we developed a specific algorithm of surgical variants of bypass-free flap arterial and venous reconstructions that is presented in this paper.


Subject(s)
Ischemia/surgery , Limb Salvage , Lower Extremity/blood supply , Surgical Flaps , Vascular Grafting , Veins/transplantation , Algorithms , Amputation, Surgical , Chronic Disease , Comorbidity , Humans , Ischemia/diagnosis , Patient Care Team , Patient Selection , Reoperation , Risk Assessment , Risk Factors , Surgical Flaps/adverse effects , Time Factors , Treatment Outcome , Vascular Grafting/adverse effects , Wound Healing
18.
Int J Colorectal Dis ; 29(7): 813-23, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24752738

ABSTRACT

PURPOSE: We analysed the outcomes of a series of 100 consecutive patients with anorectal cancer with neoadjuvant radiochemotherapy and abdominoperineal exstirpation or total pelvic exenteration, who received a transpelvic vertical rectus abdominis myocutaneous (VRAM) flap for pelvic, vaginal and/or perineal reconstruction and compare a cohort to patients without VRAM flaps. METHODS: Within a 10-year period (2003-2013) in our institution 924 patients with rectal cancer stage y0 to y IV were surgically treated. Data of those 100 consecutive patients who received a transpelvic VRAM flap were collected and compared to patients without flaps. RESULTS: In 100 consecutive patients with transpelvic VRAM flaps, major donor site complications occurred in 6 %, VRAM-specific perineal wound complications were observed in 11 % of the patients and overall 30-day mortality was 2 %. CONCLUSIONS: The VRAM flap is a reliable and safe method for pelvic reconstruction in patients with advanced disease requiring pelvic exenteration and irradiation, with a relatively low rate of donor and recipient site complications. In this first study, to compare a large number of patients with VRAM flap reconstruction to patients without pelvic VRAM flap reconstruction, a clear advantage of simultaneous pelvic reconstruction is demonstrated.


Subject(s)
Myocutaneous Flap , Pelvic Exenteration , Pelvic Neoplasms/surgery , Pelvis/surgery , Perineum/surgery , Vagina/surgery , Adult , Aged , Aged, 80 and over , Anus Neoplasms/surgery , Chemoradiotherapy , Female , Humans , Male , Middle Aged , Neoadjuvant Therapy , Rectal Neoplasms/surgery , Surgical Wound Infection , Young Adult
19.
J Tissue Eng Regen Med ; 8(3): 176-85, 2014 Mar.
Article in English | MEDLINE | ID: mdl-22740314

ABSTRACT

Bone tissue engineering strategies mainly depend on porous scaffold materials. In this study, novel biphasic calcium phosphate (BCP) matrices were generated by 3D-printing. High porosity was achieved by starch consolidation. This study aimed to characterise the porous BCP-scaffold properties and interactions of osteogenic cells and growth factors under in vivo conditions. Five differently treated constructs were implanted subcutaneously in syngeneic rats: plain BCP constructs (group A), constructs pre-treated with BMP-2 (group B; 1.6 µg BMP-2 per scaffold), seeded with primary osteoblasts (OB) (group C), seeded with OB and BMP-2 (group D) and constructs seeded with OB and pre-cultivated in a flow bioreactor for 6 weeks (group E). After 2, 4 and 6 weeks, specimens were explanted and subjected to histological and molecular biological analyses. Explanted scaffolds were invaded by fibrovascular tissue without significant foreign body reactions. Morphometric analysis demonstrated significantly increased bone formation in samples from group D (OB + BMP-2) compared to all other groups. Samples from groups B-E displayed significant mRNA expression of bone-specific genes after 6 weeks. Pre-cultivation in the flow bioreactor (group E) induced bone formation comparable with group B. In this study, differences in bone distribution between samples with BMP-2 or osteoblasts could be observed. In conclusion, combination of osteoblasts and BMP-2 synergistically enhanced bone formation in novel ceramic scaffolds. These results provide the basis for further experiments in orthotopic defect models with a focus on future applications in orthopaedic and reconstructive surgery.


Subject(s)
Bone Morphogenetic Protein 2/pharmacology , Calcium Phosphates/chemistry , Hydroxyapatites/chemistry , Osteoblasts/cytology , Animals , Biocompatible Materials/chemistry , Bioreactors , Bone Marrow Cells/cytology , Bone and Bones , Durapatite/chemistry , Male , Osteogenesis , Perfusion , Porosity , RNA, Messenger/metabolism , Rats , Rats, Inbred Lew , Tissue Engineering , Tissue Scaffolds , X-Ray Microtomography
20.
Zentralbl Chir ; 138(5): 536-42, 2013 Oct.
Article in German | MEDLINE | ID: mdl-23460106

ABSTRACT

INTRODUCTION: Skin and soft-tissue defects at the ischaemic lower extremity represent a challenging condition. Major amputations can be prevented by optimised surgical therapy. The aim of any intervention is the revascularisation and defect reconstruction of the extremity. METHODS: This article aims to provide a structured overview on up-to-date therapeutic strategies and differentiated indications for certain surgical flaps in combination with bypass surgery for the treatment of chronic "vascular" wounds. RESULTS: Optimised conservative wound therapy, skin grafts, pedicled or microsurgical free flaps in combination with vascular bypasses can be applied to salvage ischaemic extremities. These operations require an interdisciplinary cooperation between vascular surgeons and plastic surgeons. DISCUSSION: These procedures should accordingly only be performed in specialised high-volume centres with significant vascular surgical and microsurgical expertise.


Subject(s)
Connective Tissue/blood supply , Diabetic Angiopathies/surgery , Ischemia/surgery , Leg Injuries/surgery , Leg/blood supply , Microsurgery/methods , Plastic Surgery Procedures/methods , Skin/blood supply , Surgical Flaps/blood supply , Surgical Flaps/surgery , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Arteries/surgery , Combined Modality Therapy , Comorbidity , Cooperative Behavior , Female , Humans , Interdisciplinary Communication , Limb Salvage/methods , Male , Middle Aged , Postoperative Complications/etiology , Risk Factors , Skin/injuries
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