Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients. / Die distal gestielte Musculus-peroneus-brevis-Lappenplastik zur Defektdeckung an der unteren Extremität bei multimorbiden, schwer kranken Patienten.

BACKGROUND: Reconstruction of lower extremity soft tissue defects is an exceptional surgical challenge, especially in multimorbid, elderly and severely ill patients with their thin and tense local soft-tissue conditions and increased perioperative risk. The distally based peroneus brevis muscle flap (DPBM), a local flap based on the muscular branches of the fibular artery, could pose a pragmatic solution. The objective of this study was to evaluate and quantify DPBM defect reconstruction in the lower leg, especially in elderly, multimorbid and severely ill patients. MATERIAL AND METHODS: The DPBM as a surgical option in defect reconstruction in multimorbid, elderly, severely ill patients (inclusion criteria: at least 3 pre-existing comorbidities, patient age: at least 55 years, ASA status: at least III) was evaluated in a retrospective single-centre study from 01 April 2014 to 31 December 2019. The electronic SAP health records (EHR) were analysed according to 18 criteria, including patient details, extent of multimorbidity, defect characteristics, clinical outcome, and complications. OUTCOME: Ten patients with a mean age of 72.6 years, a mean number of 8.5 pre-existing comorbidities and a mean ASA status of 3.1 met the inclusion criteria. The leading causes of defects, each with exposed tendons, bones, joint capsule, or joint, were chronic ulcers (n = 5) and soft tissue defects resulting from fractures (n = 3). In case of DMPB the success rate was 100% (no partial or total loss) with a short operating time (mean: 103 min) and a brief postoperative length of stay (mean: 11 d). In 2 patients (20%), DPBM surgery had to be discontinued intraoperatively and an alternative technique of defect reconstruction had to be adopted. The reasons included impaired muscle perfusion and fatty degeneration of the peroneus brevis muscle. CONCLUSION: The DPBM flap allows straightforward, fast and safe defect reconstruction in the lower extremity, particularly in elderly, multimorbid and severely ill patients at risk. In patients with inadequate peroneal brevis muscle, however, DMPB surgery should be discontinued intraoperatively and the defect reconstructed using alternative techniques.

[Are autonomous departments better research institutions? Influence of independence on publication performance and study-types in academic Plastic Surgery]. / Sind autonome Kliniken die besseren Forschungsstandorte? Einfluss von Eigenständigkeit auf Publikationsleistung und Studientypen in der akademischen Plastischen Chirurgie.

INTRODUCTION: Despite its increasing acceptance as an autonomous specialty the field of plastic surgery remains underrepresented in terms of independent departments with a dedicated research infrastructure. The objective of this study was to analyze the current quantitative and qualitative publication performance of academic plastic surgery in Germany in order to compare independent departments and subordinate organizational structures regarding their scientific efficiency. MATERIAL AND METHODS: Via a pubmed analysis the publication performance between 2014 and 2015 was analyzed. In a publication content analysis potential differences in the publications' quality were assessed. RESULTS: The majority of publications (81 %) and of the cumulative impact factor (87 %) were created within the independent departments. Top-publications with an impact factor > 5 were published in departments only. The qualitative content analysis displayed a varying research-focus in the different organizational structures. Whereas in departments 50 % of publications were experimental, clinical-experimental or clinical, in subordinate organizational structures a major focus lay on retrospective-statistical work with 24 % in contrast to 10 % in independent departments. SUMMARY: This study demonstrates that the type of organizational structure could be a major influencing factor on the publication performance in German academic plastic surgery. An increased autonomy of an academic plastic surgery unit will most likely improve the publication performance and quality and could lead to a more complex study design.

Long-term subarachnoid catheter placement in the middle cranial fossa of the rat.

Research using rats sometimes requires long-term placement of catheters in the subarachnoid space, the cavity between the arachnoid mater and the pia mater in the brain. These catheters can be used to experimentally induce subarachnoid bleeding by injecting blood or to locally administer drugs or other substances. To date, published techniques for penetrating the subarachnoid space of small experimental animals require the use of inflexible or relatively inflexible catheters. These catheters typically consist of metal or stiff plastic and are used to access the occipital or frontal cranial cavity or to directly access the cisterna magna via the atlantooccipital membrane. However, inflexible catheters are not ideal for long-term placement in the subarachnoid space. In this paper, the authors describe a reliable procedure for long-term catheterization of the subarachnoid cavity of the rat. For this method, personnel insert the catheter and keep it in place in the rat's middle cranial cavity, in the vicinity of the cerebral arterial circle. This new approach allows personnel to repeatedly use the catheter for a period of at least 2 weeks. The catheter, which is well-tolerated by rats, can be used for administering saline solutions and for injecting blood that has not been treated with heparin into the subarachnoid space.