Free Flaps for Skin and Soft Tissue Reconstruction in the Elderly Patient: Indication or Contraindication.

BACKGROUND: Increased lifespan and the improvement of medical treatment have given rise to research in reconstructive procedures in elderly patients. Higher postoperative complication rates, longer rehabilitation, and surgical difficulties remain a problem in the elderly. We asked whether a free flap in elderly patients is an indication or a contraindication and performed a retrospective, monocentric study. METHODS: Patients were divided into two groups (YOUNG 0-59 years; OLD > 60 years). The endpoint was the survival of flaps and their dependence on patient- and surgery-specific parameters using multivariate analysis. RESULTS: A total of 110 patients (OLD n = 59) underwent 129 flaps. The chance of flap loss increased as soon as two flaps were performed in one surgery. Anterior lateral thigh flaps had the highest chance for flap survival. Compared with the lower extremity, the head/neck/trunk group had a significantly increased chance of flap loss. There was a significant increase in the odds of flap loss in linear relation to the administration of erythrocyte concentrates. CONCLUSION: The results confirm that free flap surgery can be indicated as a safe method for the elderly. Perioperative parameters such as two flaps in one surgery and transfusion regimens must be considered as risk factors for flap loss.

Skin Wound Healing: Of Players, Patterns, and Processes.

BACKGROUND: Wound healing of the skin is a very complex biological activity. For a better understanding, an attempt is made to describe and subdivide the different players (cell types and signaling molecules), patterns (different regeneration or repair mechanisms), and processes (division of the overall process into categories, phases, and steps). However, this is always based on different points of view. On the one hand, the temporality of the phases and on the other hand, the dominant activity in each step can play a role. In addition, classifications according to wound theory and wound treatment are possible. SUMMARY: To gain an initial overview of (human) skin wound healing, simple classifications are advantageous for understanding and thus deserve to exist. The complexity of the underlying biology of skin wound healing takes on a multidimensional configuration upon closer examination, in which new actors are constantly being identified, making the events more precise and comprehensible but also significantly confusing when viewed as a whole. From this point of view, the healing process must be categorized so that the observer does not get lost in the multitude of interacting processes. In view of the steadily increasing knowledge, which includes in parallel the physiological as well as the pathophysiological processes of wound healing, the classification according to function in the sense of consecutive and overlapping phases seems the most convenient and considers the corresponding processes more precisely. Despite that many mechanisms and specific cellular functions in wound healing have been identified, many underlying (patho-)physiological processes still remain unknown. KEY MESSAGES: Currently, a substantial part of research activities in medicine is limited to molecular levels, while evidence for therapies currently in use is lacking or newly gained knowledge is quite far from clinical applicability and reality. This article aimed to shed more light on the various classifications of skin wound healing and presents the underlying paradigms starting from simple approaches and ending with more detailed concepts.

Digitalization in Medicine: Are German Medical Students Well Prepared for the Future?

The German healthcare system is facing a major transformation towards digitalized medicine. The aim was to find out the attitude and the degree of preparation of upcoming medical professionals for digital medicine. By means of an online survey, medical students from 38 German faculties were asked about different topics concerning digitalization. Most students (70.0%) indicated that they had not had any university courses on digital topics. Thus, only 22.2% feel prepared for the technical reality of digitalized medicine. Most fear losing patient contact because of digitalized medicine and assume that the medical profession will not be endangered by digitalization. Security systems, data protection, infrastructure and inadequate training are cited as the top problems of digitalization in medicine. Medical students have major concerns about incorrect decisions and the consecutive medicolegal aspects of using digital support as part their treatment plans. Digitalization in medicine is progressing faster than it can currently be implemented in the practical work. The generations involved have different understandings of technology, and there is a lack of curricular training in medical schools. There must be a significant improvement in training in digital medical skills so that the current and future healthcare professionals are better prepared for digitalized medicine.

Experimental Models to Study Skin Wound Healing with a Focus on Angiogenesis.

A large number of models are now available for the investigation of skin wound healing. These can be used to study the processes that take place in a phase-specific manner under both physiological and pathological conditions. Most models focus on wound closure, which is a crucial parameter for wound healing. However, vascular supply plays an equally important role and corresponding models for selective or parallel investigation of microcirculation regeneration and angiogenesis are also described. In this review article, we therefore focus on the different levels of investigation of skin wound healing (in vivo to in virtuo) and the investigation of angiogenesis and its parameters.

[Change of perception of aged male attractiveness by conventional or male facelift: 3D simulation study of a new facelift concept for men]. / Veränderung der Wahrnehmung männlicher Attraktivität im Alter durch Standard- oder männliche Gesichtsstraffung: 3D-Simulationsstudie eines neuen Facelift-Konzeptes für Männer.

BACKGROUND: Facelift is now the fourth most common aesthetic procedure in men. Facial ageing is very different in men and women. Therefore, individual techniques are used since a uniform concept for the surgical facelift in men does not exist. This study aims to evaluate a gender-specific facelift concept especially developed for men. MATERIAL AND METHODS: Women and men (n = 10 each) were subjected to a three-dimensional face scan and a subsequent simulation of a V-shaped lift vector (standard lift) and a new facelift concept especially for men in a double T shape (male lift). In an online survey with 262 participants, the simulated as well as the unchanged images were presented and the attributes masculinity, femininity, attractiveness and youthfulness were queried. Statistical models were used to identify attributes of lifting as well as other factors and differences between the simulations. RESULTS: Facelift changes are generally associated with a significant improvement in the attributes of youthfulness and attractiveness compared with unchanged control faces. As expected, a male lift leads to masculinisation, while a standard lift leads to feminisation, regardless of the sex of the subjects. The male lift led to higher values for the attribute attractiveness in male subjects, as did the standard lift in female subjects. The standard lift developed for women is indeed more suitable for women and is associated with a significantly higher probability for the attribute youthfulness, whereas this is not the case in the newly introduced male lift concept. CONCLUSION: The new facelift concept for male patients is significantly associated with masculinity and attractiveness, while the standard lift suitable for women is associated with significantly higher evaluations of femininity and youthfulness. The results of the SIMALIFT study are the first evidence of the need for a more differentiated, gender-specific approach to facelifting.

Healthcare provision, functional ability and quality of life after proximal femoral fracture - 'ProFem': Study protocol of a population-based, prospective study based on individually linked survey and statutory health insurance data.

INTRODUCTION: Proximal femoral fractures (PFF) are among the most frequent fractures in older people. However, the situation of people with a PFF after hospital discharge is poorly understood. Our aim is to (1) analyse healthcare provision, (2) examine clinical and patient-reported outcomes (PROs), (3) describe clinical and sociodemographic predictors of these and (4) develop an algorithm to identify subgroups with poor outcomes and a potential need for more intensive healthcare. METHODS AND ANALYSIS: This is a population-based prospective study based on individually linked survey and statutory health insurance (SHI) data. All people aged minimum 60 years who have been continuously insured with the AOK Rheinland/Hamburg and experience a PFF within 1 year will be consecutively included (SHI data analysis). Additionally, 700 people selected randomly from the study population will be consecutively invited to participate in the survey. Questionnaire data will be collected in the participants' private surroundings at 3, 6 and 12 months after hospital discharge. If the insured person considers themselves to be only partially or not at all able to take part in the survey, a proxy person will be interviewed where possible. SHI variables include healthcare provision, healthcare costs and clinical outcomes. Questionnaire variables include information on PROs, lifestyle characteristics and socioeconomic status. We will use multiple regression models to estimate healthcare processes and outcomes including mortality and cost, investigate predictors, perform non-responder analysis and develop an algorithm to identify vulnerable subgroups. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (approval reference 6128R). All participants including proxies providing written and informed consent can withdraw from the study at any time. The study findings will be disseminated through scientific journals and public information. TRIAL REGISTRATION NUMBER: DRKS00012554.

Quality of Life in People With Severe Dementia and Its Association With the Environment in Nursing Homes: An Observational Study.

BACKGROUND AND OBJECTIVES: Theoretical models propose the environment as a factor influencing the quality of life (QoL) of nursing home residents with dementia. This study investigates whether the observed QoL differs depending on the type of care unit. RESEARCH DESIGN AND METHODS: DemenzMonitor is an exploratory, observational study involving annual data collection in German nursing homes (2012-2014). For this analysis, we selected residents with a recorded diagnosis of dementia and severe cognitive impairment. QoL was measured with the proxy assessment QUALIDEM. Four care unit types were investigated: large integrated, large segregated, small integrated, and small segregated. RESULTS: We did not find a significant difference between the care units. During the 2 years, the observed QoL was not affected by any of the care unit types in a statistically significant or clinically relevant manner. However, a significant interaction effect between time and care unit types was found. DISCUSSION AND IMPLICATIONS: Structural and organizational characteristics of care units, which in turn have implications for residents characteristics and the quality of care, may influence the QoL of residents. This may explain the interaction we observed.

Severe Agitation in Dementia: An Explorative Secondary Data Analysis on the Prevalence and Associated Factors in Nursing Home Residents.

BACKGROUND: The phenomena of severe agitation is not well understood and often not adequately treated. OBJECTIVE: This article determines the prevalence and associated factors of severe agitation in nursing home residents with dementia. METHODS: Secondary data analysis within an observational study in German nursing homes with n = 1,967 participants. We assessed severity of agitation with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and defined the construct of agitation as a composite score of the NPI-Q items agitation/aggression, disinhibition, and irritability/lability; the dependent variable of severe agitation was considered as being present in residents who scored 'severe' in at least one of these symptoms. A binary logistic regression model was calculated to estimate associations. RESULTS: The prevalence of severe agitation was 6.3% (n = 124). The strongest associations were found for elation/euphoria (OR 7.6, CI 3.1-18.5), delusions (OR 7.3, CI 4.0-13.2), apathy/indifference (OR 2.8, CI 1.7-4.7), anxiety (OR 2.2, CI 1.2-3.8), nighttime behaviors (OR 2.4, CI 1.4-4.2), motor disturbances (OR 2.4, CI 1.4-4.1), and male sex (OR 2.4. CI 1.3-4.2). CONCLUSION: Severe agitation in nursing home residents with dementia is a relevant clinical issue as approximately 70% of residents have a dementia. Residents with elation/euphoria and delusions may have a stronger risk of showing severe agitation. We consider delusions as a possible cause of agitation and therefore a prelude to agitation. Although it might be possible that elation/euphoria follows from agitation, we hypothesize that the residents first experience elation/ euphoria and exhibit agitation afterwards.