[Wound management-biology and wound healing disorders]. / Wundmanagement ­ Biologie und Störung der Wundheilung.

Wound healing is one of the most complex biological processes in an organism. It proceeds in three consecutive stages: the exudative, the proliferative, and the reparative phase. For a better understanding of new treatment possibilities, knowledge of the fundamental principles of these phases is required. Depending on the extent, location, bacterial colonization, and stage of a wound, it is important to find the appropriate treatment modality. In the present article, the basic principles of wound healing and disruptive factors are described in preparation for the next part on modern treatment modalities.

Induction of proliferation of basal epidermal keratinocytes by cold atmospheric-pressure plasma.

BACKGROUND: Over the past few decades, new cold plasma sources have been developed that have the great advantage of operating at atmospheric pressure and at temperatures tolerable by biological material. New applications for these have emerged, especially in the field of dermatology. Recently it was demonstrated that cold atmospheric-pressure plasma positively influences healing of chronic wounds. The potential of cold plasma lies in its capacity to reduce bacterial load in the wound while at the same time stimulating skin cells and therefore promoting wound closure. In recent years, there have been great advances in the understanding of the molecular mechanisms triggered by cold plasma involving signalling pathways and gene regulation in cell culture. AIM: To investigate cold plasma-induced effects in ex vivo treated human skin biopsies. METHODS: Human skin tissue was exposed to cold plasma for different lengths of time, and analysed by immunofluorescence with respect to DNA damage, apoptosis, proliferation and differentiation markers. RESULTS: After cold plasma treatment, the epidermal integrity and keratin expression pattern remained unchanged. As expected, the results revealed an increase in apoptotic cells after 3 and 5 min of treatment. Strikingly, an induction of proliferating basal keratinocytes was detected after cold plasma exposure for 1 and 3 min. As these are the cells that regenerate the epidermis, this could indeed be beneficial for wound closure. CONCLUSION: We investigated the effect of cold plasma on human skin by detecting molecules for growth and apoptosis, and found that both processes are dependent on treatment time. Therefore, this approach offers promising results for further applications of cold plasma in clinical dermatology.

[New approach to photoepilation. Diode laser with SHR (Super Hair Removal) compared to alexandrite laser]. / Ein neuer Ansatz in der Laser-Haarreduktion. Diodenlaser mit SHR ("Super Hair Removal") im Vergleich mit dem Alexandritlaser.

BACKGROUND: Photoepilation has been an essential field of application of dermatologic laser therapy for many years. The present article evaluates whether the use of a new operation mode of a long-pulsed diode laser can be effective, nearly painless, with few side effects and independent of the skin type. To this aim, its use has been compared to an established method of photoepilation. MATERIAL AND METHODS: In a controlled prospective study with 18 (♀=12, ♂=6) patients aged between 22 and 58 years, the effects of photoepilation with the long-pulsed alexandrite laser and the long-pulsed diode laser, operated in the Super Hair Removal mode (SHR), were compared. RESULTS: The alexandrite laser is slightly more effective with fair skin types; the SHR mode is clearly more effective with dark skin types. Regarding painfulness, the SHR mode is clearly superior. In terms of speed, the two systems are comparable. The alexandrite laser is more user-friendly because of its light and small handpiece. CONCLUSION: The major advantages of the SHR mode are its effectiveness in dark skin types and its lack of pain. The alexandrite laser is slightly more effective with fair skin types, slightly faster and its handling is considerably more comfortable. None of the two systems has yet brought about a breakthrough with fair hair.

[Indication, technique and clinical out come of the endoscopic assisted forehead and brow lift]. / Das endoskopische Stirn- und Augenbrauen-Lift: Indikationen, Technik und Ergebnisse.

AIMS: The aim of this study was to determine the indication for endoscopic-assisted forehead and brow lift and to present the surgical technique and evaluate clinical outcome. PATIENTS AND METHODS: A total of 61 female patients between 36 and 64 years (s=49.64) were operated from 1999 through 2002 with the endoscopic-assisted forehead and brow lift and were observed pre- and postoperatively and 6 months after surgery. The galea aponeurotic flap was fixed through a bone tunnel (tabula externa) with nonabsorbable sutures in all patients. We measured the distance between the middle of the pupil and the most cranial point of the eyebrow as well as the largest distance between the eyebrow and the hairline intraoperatively and 6 months after surgery. The patients' satisfaction with the outcome of these surgical procedures was determined on a scale from 1 to 10 with 1 as the worst and 10 as the best mark. RESULTS: We found a brow lift of 8.03 mm (s=1.622) on average. The endoscopic forehead and brow lift was indicated up to the maximal distance of 12 cm between the eyebrow and the hairline. The patients' satisfaction with the outcome was registered on average at 6.98 (s=1.36) on our scale. A temporary unilateral weakness of the frontal branch of the facial nerve was the severest complication found postoperatively. CONCLUSION: The endoscopic-assisted forehead and brow lift is a safe and effective method to improve upper face aesthetics. A high grade of patient satisfaction is obtainable. The advantage in using this method is the invisible scar formation. The indication is limited by a high hairline.

[Arthroscopic dorsal ligament plasty using a hydrojet knife in the TMJ]. / Arthroskopische dorsale Kiefergelenkbandstraffung mit Wasserstrahlskalpell Eine experimentelle Studie am Landschwein.

PURPOSE: The aim of the study was the development and proof testing of an arthroscopic dorsal ligament plasty using a hydrojet knife in the pig TMJ before using in man. MATERIAL AND METHODS: The dorsal TMJ ligament of ten pigs (country breed) was irradiated with a hydrojet (diameter 120 microm, working pressure 90 bar) under arthroscopic visualization. Postoperatively the pigs were controlled for 10 weeks before sacrifice. The isolated TMJs were examined by light microscope and the results compared with untreated pig TMJs. The flows over our arthroscopic instruments were measured to exclude the possibility of damaging surrounding structures by pressure. RESULTS: Clinically we found no complications after arthroscopic surgery. Food intake was normal and development of body weight according to the food offered. Histology revealed tissue reorganization connected with increased collagen fibre production. Our calculations showed no pressure higher than 1000 mm water column in the TMJ under our working conditions. CONCLUSIONS: The idea of arthroscopic dorsal ligament plasty using a hydrojet works in pig TMJs. Experience in TMJ arthroscopy is necessary. We found no danger of barotrauma under arthroscopy with the hydrojet. The results indicate dorsal ligament shortening by development of scar formations. In our opinion the method can be used for the therapy of dorsal ligament elongation and disk displacements in the TMJ of man.

[Development, standardisation and evaluation of a model for arthroscopic surgery of the joint. An experimental study in pigs]. / Das Landschwein als Modell für Ausbildung, wissenschaftliche Untersuchungen und Entwicklung neuer arthroskopischer Operationsmethoden am Kiefergelenk.

AIM OF THE STUDY: The aim of this study was to establish a reliable educational model for and a further refinement of arthroscopic surgery in the temporomandibular joint (TMJ). MATERIAL AND METHODS: As a first step, the lateral-medial (length) and anterior-posterior distances (width) of the mandibular head of nine pig cadavers (country breed) of about 30 ( n=3), 60 ( n=3) and 90 kg ( n=3) body weight were measured and compared with findings in 12 adult human cadavers. The best points of access for the arthroscopic and lavage channels using the triangulation technique were determined. As determined by these findings, 15 arthroscopies were performed on eight pig TMJs under general anaesthetic. A control arthroscopy was performed after 2 weeks followed by another clinical follow-up at 4 weeks before the pigs were sacrificed. RESULTS: The TMJ of the pigs between 30 and 60 kg body weight was found to be highly comparable to the human TMJ. The best locations for puncturing the upper joint compartment of the TMJ in pigs were 5.0 cm and 6.1 cm anterior to the tragus on a line drawn along the lower margin of the zygoma. The only complication encountered was a subcutaneous infection treated successfully by antibiotics and incision. CONCLUSIONS: In our opinion, a standard and easily reproducible model is necessary for further studies in arthroscopic TMJ-surgery. The country bred pig represents a good model for educational purposes and for studying further refinements of arthroscopic technique.

[Chemotherapy and radiochemotherapy in tumors of the head-neck area]. / Chemotherapie und Radiochemotherapie bei Tumoren im Kopf-Hals-Bereich.

Standard curative therapy in head and neck cancer, especially in oral cavity carcinoma, consists, so far, of surgery. Until today, chemotherapy using standard drugs has failed to be effective beyond controlling cancer manifestations and palliation of symptoms. The introduction of chemotherapy and radiotherapy as adjuvant treatment, however, may improve overall survival and curative options. A multicentric randomized trial, initiated by DOSAK, has compared results after radical surgery alone with results of combined preoperative radio-chemotherapy followed by radical surgery. The life table analysis substantiated improved survival rates in the group of patients whose treatment included chemotherapy and radiation.

The influence of the muscles of facial expression on the development of the midface and the nose in cleft lip and palate patients. A reflection of functional anatomy, facial esthetics and physiology of the nose.

The further improvement of well-established techniques in primary and secondary cleft surgery requires a detailed and interdisciplinary knowledge and observation of anatomical, functional and developmental problems. An investigation into the macroscopic and microscopic anatomy of the perinasal and perioral muscles and parts of the human nasal septum, as well as into the pathomorphology of ancient skulls with untreated clefts is presented. On this basis an interpretation of clinical findings in untreated newborns compared with surgically treated CLP-patients has been undertaken. The 3D-CT, superimposing photography and coloured experimental settings of nasal airflow complete the visualisation of the anatomical and functional findings.

In vivo evidence for compromised phenylalanine metabolism in vitiligo.

Human epidermal melanocytes and keratinocytes express mRNA for all enzymes involved in de novo synthesis/recycling of the cofactor (6R) L-erythro 5,6,7,8 tetrahydrobiopterin (6BH4) in normal healthy individuals. An enhanced epidermal de novo synthesis was identified in association with decreased epidermal phenylalanine hydroxylase and 4a carbinolamine dehydratase in patients with vitiligo. The latter event leads to an accumulation of the nonenzymatic isomer (7R) L-erythro 5,6,7,8 tetrahydrobiopterin (7BH4) inhibiting phenylalanine hydroxylase (PAH) with an apparent Ki = 10(-6) M. One consequence of decreased epidermal PAH activities would be a build-up of L-phenylalanine. To substantiate this consideration, FT-Raman spectroscopy was utilised to study in vivo total phenylalanine levels at 1004 cm-1 in involved and uninvolved skin of 23 patients with vitiligo, showing in all cases increased levels of phenylalanine in involved compared to uninvolved skin of the same individual. Additionally the peripheral blood L-phenylalanine turnover was determined over time after a single oral loading with L-phenylalanine in 32 patients (100 mg/kg body weight). All patients demonstrated slower kinetics from L-phenylalanine to L-tyrosine, but 41% of the group showed significantly slower kinetics under these conditions. None of the patients presented peripheral hyperphenylalaninemia without loading. Our results demonstrate for the first time a phenylalanine build-up in the involved epidermis of patients with vitiligo. These data support the earlier observation of a defective epidermal pterin metabolism in this disease.

Massive osteolysis (Gorham-Stout syndrome) in the maxillofacial region: an unusual manifestation.

An unusual case of massive osteolysis affecting the left side of the mandible, the maxilla, the zygoma, and the orbit is reported. The disease extended over a period of 25 years. The special feature of this case is that there were, before the osteolysis appeared, enlargement and sclerosis of the maxillofacial bones reaching up to the middle cranial fossa. Histopathologic examination of the affected mandible revealed that the bone was replaced by fibrous tissue.

Applications of the lateral vastus muscle flap.

The lateral vastus muscle flap has the potential to become one of the most appropriate free flaps for reconstructive surgery in the oral maxillofacial area in selected cases. The flap is relatively easy to harvest and gives rise to little donor site morbidity. The quality of the large diameter vessels allows for relatively easy microsurgical anastomosis. Nerve anastomosis is possible, which makes it extremely suitable for tongue reconstruction.

[Prophylaxis of alcohol withdrawal syndrome in prolonged oral and maxillofacial surgery procedures]. / Zur Prophylaxe des Alkoholentzungs-syndroms bei Langzeiteingriffen in der Zahn-Mund-Kieferchirurgie.

Alcohol-addicted patients have a high risk of intercurrent complications during the postoperative period. In addition to the predisposition for infection, alcohol withdrawal syndrome is potentially life-threatening in these patients. However, this concerns only addicts, and definite preoperative diagnosis of addiction therefore is a crucial parameter in assessing the postoperative risks. In our department, 40% of maxillofacial tumor patients with a history of alcohol abuse were assessed as alcohol-addicted according to a complex diagnosis scheme. In these patients, postoperative withdrawal syndrome prophylaxis with continuous, low-dose alcohol infusion is indicated after exclusion of contraindications. If prophylaxis is impossible and differential diagnosis has confirmed a withdrawal syndrome, therapy must take into account the patient's symptoms and the latest neurobiochemical findings on withdrawal-related imbalances in neuronal transmitter systems.

[Anti-oncogram-oriented polychemotherapy in metastasizing squamous cell carcinoma of the skin: impressive partial remission]. / Antionkogramm-orientierte Polychemotherapie bei metastasierendem Plattenepithelkarzinom der Haut: eindrucksvolle partielle Remission.

Metastatic squamous cell carcinoma of the skin is associated with a poor prognosis even after surgical treatment or irradiation. Polychemotherapy can be used as an alternative regimen. We present a 65-year-old male patient with extensive metastatic squamous cell carcinoma of the skin after multiple surgical treatment and radiation. A combination of bleomycin, methotrexate and cisplatin, planned according to the anti-oncogram, resulted in rapid partial remission of the cutaneous metastases over several months.

An aid to the selection of chemotherapy regimens for oral cavity carcinomas. Early results of a study of 5-year survival based on antioncogram selection of anti-cancer drugs.

The antioncogram is an aid to the selection of cytostatic drugs in the treatment of oral cavity carcinomas. In comparison with drug selection based on clinical experience, the antioncogram-oriented choice of the most promising drug in vitro results in improved survival rates.

[Intraventricular application of opiates using implantable pump systems]. / Intraventrikuläre Opiatapplikation mit implantierbaren Pumpsystemen.

Intraventricular catheters and implanted morphium pumps make it possible to effectively treat patients with severe pain from malignant growths. The surgical procedure for our special field is explained in a short summary.