[Reconstruction of large osteochondral defects of the distal femur and proximal tibia : Adaptation of fresh frozen allografts using 3D-printed models]. / Rekonstruktion großer osteochondraler Defekte des distalen Femurs und der proximalen Tibia : Anpassung frisch gefrorener Allografts unter Zuhilfenahme 3D-gedruckter Kunststoffmodelle.

The reconstruction of large osteochondral defects is still a challenge in musculoskeletal surgery. Fresh frozen allografts are a frequently used resource for the treatment of such tissue defects. Furthermore, 3D-printed models enable multiple options in the preoperative planning and intraoperative adaptation of the allografts, so that healing is optimal and the best functional outcome for the patient is achieved.

[Defect coverage after severe soft tissue infections: when and how?] / Defektdeckung nach schweren Weichteilinfektionen: wann und wie?

Severe infections frequently cause large soft tissue defects which require early defect coverage by plastic surgeons. A number of reconstructive treatment options are available, ranging from local flaps to microvascular free flap reconstructions. In this respect it is important that the selection of the optimal reconstructive technique is made based on individual patient characteristics and in a timely manner. Weeks of inpatient treatment with vacuum dressings often delay defect coverage and should be avoided as they burden both the patient and the healthcare system. Therefore, it is in the best interest of patients to receive early treatment by plastic surgeons. This manuscript presents the essential reconstructive treatment approaches based on highly informative case reports of patients from the plastic surgical practice at a university hospital.

[A critical analysis of perception of plastic surgery in Germany]. / Kritische Perzeptionsanalyse der plastischen Chirurgie in Deutschland.

BACKGROUND AND OBJECTIVES: Plastic surgery includes a broad range of activities; however, there are no studies available in Germany which evaluated the specific role plastic surgeons play in providing patient care. The aim of the project was thus to analyze the public and professional perception of plastic surgery in Germany and to what degree the range of activities is appropriately represented. MATERIAL AND METHODS: An anonymous survey inquiring about demographic data and specific knowledge regarding plastic surgery procedures was conducted in various regions in German. Furthermore, factors that potentially influence the state of knowledge and personal perception were collated. The questionnaire was distributed among healthcare professionals and patients in plastic surgery. The statistical evaluation was performed using SPSS software. RESULTS: A total of 2100 people participated in the nationwide survey. While classical aesthetic operations were mostly assigned to plastic surgery, there was no uniformity as to whether other indications, such as reconstructive interventions and hand surgery were assigned to this specialty or not. In this context various factors could be elucidated, such as the place of residence, education and age of the survey participants and the respective knowledge, which influence the perception. CONCLUSION: Plastic surgery in Germany classically consists of the four pillars of general reconstruction, hand surgery, burn management and aesthetic procedures; however, the results of this survey revealed that plastic surgery in Germany is predominantly understood as burn management and aesthetic surgery. As a multidisciplinary specialty, plastic surgery could apparently benefit from a more positive lobby and from a better portrayal of its scope in the media and general public.

Impact of intraoperative use of vasopressors in lower extremity reconstruction: Single centre analysis of 437 free gracilis muscle and fasciocutaneous anterolateral thigh flaps.

BACKGROUND: While complication rates in free tissue transfers have continuously decreased over time due to improved techniques, the intraoperative use of vasopressors and their negative effects on flap microcirculation and patency of the anastomoses remains controversial. To further elucidate this matter, this retrospective study examines the effect of intraoperative vasopressors on free gracilis muscle and free fasciocutaneous anterolateral thigh (ALT) flaps for lower extremity reconstruction. METHODS: A total of 425 patients underwent 437 free flaps for lower limb reconstruction. The series was divided into two groups: use of intraoperative vasopressors (V, n = 318) or no use (NV, n = 119). The data were retrospectively screened for patients' demographics, perioperative details, and surgical complications. RESULTS: The two groups were comparable regarding patient comorbidities. Independently of flap type, there were no significant difference between the groups regarding major complications, i.e. total flap loss (V: 5.35% versus NV: 5.04%, p = 0.899) or revision rate (V: 18.87% versus NV: 12.61%; p = 0.122), or minor complications, i.e. partial flap loss (V: 6.29% versus NV: 5.88%, p = 0.875). CONCLUSION: This study confirms that the usage of intraoperative vasopressors has no influence on free flap survival rate in lower extremity reconstruction. It seems to be no difference between free muscle or fasciocutaneous flaps.

Global aesthetic surgery statistics: a closer look.

INTRODUCTION: Obtaining quality global statistics about surgical procedures remains an important yet challenging task. The International Society of Aesthetic Plastic Surgery (ISAPS) reports the total number of surgical and non-surgical procedures performed worldwide on a yearly basis. While providing valuable insight, ISAPS' statistics leave two important factors unaccounted for: (1) the underlying base population, and (2) the number of surgeons performing the procedures. METHODS: Statistics of the published ISAPS' 'International Survey on Aesthetic/Cosmetic Surgery' were analysed by country, taking into account the underlying national base population according to the official United Nations population estimates. Further, the number of surgeons per country was used to calculate the number of surgeries performed per surgeon. RESULTS: In 2014, based on ISAPS statistics, national surgical procedures ranked in the following order: 1st USA, 2nd Brazil, 3rd South Korea, 4th Mexico, 5th Japan, 6th Germany, 7th Colombia, and 8th France. When considering the size of the underlying national populations, the demand for surgical procedures per 100,000 people changes the overall ranking substantially. It was also found that the rate of surgical procedures per surgeon shows great variation between the responding countries. CONCLUSION: While the US and Brazil are often quoted as the countries with the highest demand for plastic surgery, according to the presented analysis, other countries surpass these countries in surgical procedures per capita. While data acquisition and quality should be improved in the future, valuable insight regarding the demand for surgical procedures can be gained by taking specific demographic and geographic factors into consideration.

Beard reconstruction: A surgical algorithm.

BACKGROUND AND AIM: Facial defects with loss of hair-bearing regions can be caused by trauma, infection, tumor excision, or burn injury. The presented analysis evaluates a series of different surgical approaches with a focus on male beard reconstruction, emphasizing the role of tissue expansion of regional and free flaps. METHODS: Locoregional and free flap reconstructions were performed in 11 male patients with 14 facial defects affecting the hair-bearing bucco-mandibular or perioral region. In order to minimize donor-site morbidity and obtain large amounts of thin, pliable, hair-bearing tissue, pre-expansion was performed in five of 14 patients. Eight of 14 patients were treated with locoregional flap reconstructions and six with free flap reconstructions. Algorithms regarding pre- and intraoperative decision making are discussed and long-term (mean follow-up 1.5 years) results analyzed. RESULTS: Major complications, including tissue expander infection with the need for removal or exchange, partial or full flap loss, occurred in 0% (0/8) of patients with locoregional flaps and in 17% (1/6) of patients undergoing free flap reconstructions. Secondary refinement surgery was performed in 25% (2/8) of locoregional flaps and in 67% (4/6) of free flaps. CONCLUSION: Both locoregional and distant tissue transfers play a role in beard reconstruction, while pre-expansion remains an invaluable tool. Paying attention to the presented principles and considering the significance of aesthetic facial subunits, range of motion, aesthetics, and patient satisfaction were improved long term in all our patients while minimizing donor-site morbidity.

Postoperative negative pressure therapy significantly reduces flap complications in distally based peroneus brevis flaps: Experiences from 74 cases.

BACKGROUND: The distally based peroneus brevis muscle flap is a valuable therapeutic option for coverage of tissue defects around the ankle and the distal lower leg. However, the rate of postoperative flap complications requiring revisional surgery is high due to an impaired venous drainage and oedema formation. The purpose of this study was to evaluate if postoperative negative pressure therapy is able to reduce flap complications. METHODS: From April 2010 until March 2014, we treated 74 patients with distally based peroneus brevis muscle flaps for defect coverage at the lower leg. In four cases, an osteomuscular composite flap has been used to treat partly stability-relevant bone defects. In 43 cases, negative pressure therapy (75mmHg, continuous) with a circular dressing was initiated after the flap procedure for 7 days. In 31 cases no negative pressure therapy was initiated. We retrospectively analysed those two groups of patients. The primary endpoint was the incidence of flap complications with a need for revision surgery, which were classified in three grades. RESULTS: The group treated with negative pressure therapy had significantly less flap complications when compared to the control group (p<0.0001). Concerning the single grades of complication, the negative pressure therapy-group had a significantly smaller rate of skin graft necrosis (Grade 1; p=0.014) and partial flap loss (Grade 2; p=0.002) compared to the control group. There were no statistically significant differences concerning complete flap loss (Grade 3) between both groups. CONCLUSION: Postoperative negative pressure therapy for 7 days reduces flap complications in distally based peroneus brevis flaps.

Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis.

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. LEVEL OF EVIDENCE: IV.

[Four-Corner Fusion using Retrograde Headless Compression Screws]. / Die mediokarpale Teilarthrodese des Handgelenkes mit retrograden kopflosen Kompressionsschrauben.

This article describes our technique of 4-corner fusion using retrograde insertion of headless compression screws.