[Perioperative Diagnostics of Peripheral Nerve Lesions and Compression Syndromes: Position Paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels]. / Diagnostik von peripheren Nerven bei Läsionen und Kompressionssyndromen: Positionspaper der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie ­ (DAM).

The treatment of peripheral nerve pathologies requires a rapid and precise diagnosis. However, the correct identification of nerve pathologies is often difficult and valuable time is lost in the process. In this position paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels (DAM), we describe the current evidence for various perioperative diagnostics for the detection of traumatic peripheral nerve lesions or compression syndromes. In detail, we evaluated the importance of clinical examinations, electrophysiology, nerve ultrasound and magnetic resonance neurography. Additionally, we surveyed our members for their diagnostic approach in this regard. The statements are based on a consensus workshop on the 42nd meeting of the DAM in Graz, Austria.

Low Level Laser Therapy--a conservative approach to the burn scar?

Burn scars are known to be difficult to treat because of their tendency to worsen with hypertrophy and contracture. Various experimental and clinical efforts have been made to alleviate their effects but the problem has not been solved. Since patients keep asking for Low Level Laser Therapy (LLLT) and believe in its effectiveness on burn scars, and since former studies show contradictory results of the influence of LLLT on wound healing, this prospective study was designed to objectify the effects of LLLT on burn scars. Nineteen patients with 19 burn scars were treated with a 400 mW 670 nm Softlaser twice a week over 8 weeks. In each patient a control area was defined, that was not irradiated. Parameters assessed were the Vancouver Scar Scale (VSS) for macroscopic evaluation and the Visual Analogue Scale (VAS) for pruritus and pain. Photographical and clinical assessments were recorded in all the patients. Seventeen out of 19 scars exhibited an improvement after treatment. The average rating on the VSS decreased from 7.10+/-2.13 to 4.68+/-2.05 points in the treated areas, whereas the VSS in the control areas decreased from 6.10+/-2.86 to 5.88+/-2.72. A correlation between scar duration and improvement through LLLT could be found. No negative effects of LLLT were reported. The present study shows that the 400 mW 670 nm softlaser has a positive, yet sometimes limited effect on burn scars concerning macroscopic appearance, pruritus, and pain.

Serum cholesterol and triglycerides: potential role in mortality prediction.

The present study was performed in order to evaluate the diagnostic usefulness of serial cholesterol and triglycerides measurements in patients with severe burns. One of the main objective was to find out if these parameters are clinically relevant to determine the morbidity of a burn patient and thereby the patient's outcome. In 220 patients with thermal injuries, cholesterol and triglyceride concentrations were measured daily. Blood samples were drawn immediately upon admission and thereafter daily until patient's discharge or death. For both parameters, a characteristic course was noted: in the group of non-survivors, a decrease of cholesterol prior to death was noted, while survivors, increased prior to discharge. The time courses of both groups (survivors-non-survivors) differed statistically significantly (P=0.0068). An increase in triglycerides was observed in all non-survivors prior to death, but in the group of survivors triglycerides remained more or less unchanged. These time courses also had statistically significant differences (P=0.0004). In our 220 patients, changes in cholesterol (P<0.0001, hazard ratio 1.02) and triglycerides (P=0.0008, hazard ratio 1.01) had comparable capability to predict the severity of a burn trauma and thereby its outcome than the established parameters in the treatment of burns (total body surface area burned, age, inhalation). We consider the serial measurements of cholesterol and triglycerides as clinically relevant to assess the morbidity of a patient and thereby to estimate the patient's outcome. We think that these serial measurements provide useful information for the clinician treating patients with severe burns.

Serum cholinesterase activity in patients with burns.

Serum cholinesterase activities were measured in 300 patients with thermal injuries. The samples were drawn immediately upon admission and thereafter daily until the time of the patients' discharge or death. According to the burn severity a characteristic decrease was noted during the first days. The decline during the first 24 hours as well as its value (measured 24 hours after admission) was found to be correlated with the total body surface area burned. In all patients the decrease in cholinesterase activity persisted for days, but in patients with inhalation trauma this decrease was significantly greater than in patients without lung injury. It seems that serum cholinesterase activity reflects not only the presence of an inhalation trauma. The cholinesterase measurement seems to be also a good method to observe the course of illness after a burn injury. Our data suggest a correlation between cholinesterase activity and morbidity. The inhalation trauma aggravates the thermal trauma.

The use of allogeneic cultivated keratinocytes for the early coverage of deep dermal burns - indications, results and problems.

Since 1995, keratinocytes are grown into cultures and used as allografts for the coverage of deep dermal defects in our burn unit. Donor skin samples are mostly acquired from other burn patients. In addition, special methods of skin preservation allow us the use of skin, which has been taken in redundancy for split thickness skin grafting from nonburned patients.Thirty five patients with deep partial thickness burns in the face were treated since 1996 according to the following concept: Dermabrasion or tangential excision was performed before the 5(th) day following trauma. If viable dermis was present, the wounds were covered with sheets of allogeneic cultivated keratinocytes. In cases of deeper defects, autologous skin grafts were applied. In 23 cases, epithelialisation was achieved within 10 days, in 8 patients, a prolonged duration until complete healing was observed. In 5 faces, coverage of residual defects with skin grafts was necessary. The mentioned problems of wound healing occurred from infection, incomplete excision of burn eschar and a depth of the wound which was retrospectively seen too deep for the treatment with keratinocytes. At follow up, patients were examined clinically and functionally with Frey's faciometer(R), which is an instrument for quantification of mimic movements. In cases of uncomplicated healing, a nearly complete restitution was found.Other indications include deep dermal burns in children and the coverage of early excised wounds in adults, with a reasonable amount of viable dermis remaining, both resulting in a significant reduction of donor-site morbidity. In severely burned adults with limited donor sites, it offers the possibility of immediate definite coverage of large areas.