[3-dimensional imaging systems: first experience in planning and documentation of plastic surgery procedures]. / 3-dimensionale Bilderfassung: Erste Erfahrungen in der Planung und Dokumentation plastisch-chirurgischer Operationen.

A reproducible 3-dimensional photographic system enables plastic surgeons to perform preoperative planning and helps them to understand the patient's expectations. There are a few systems available that allow a reproducible 3-dimensional scans of the patient with direct simulation of the planned procedure. The Vectra Volumetric 3D Surface Imaging® by Canfield® provides such an option and helps the surgeons to document and compare postoperative changes at different time points. Since January 2011 we are digitally documenting all patients receiving form-modulating procedures in our plastic surgery unit. We present the spectrum of clinical implications and discuss advantages and disadvantages of the system. Furthermore, we have studied the accuracy of the system in comparison to direct measurement in 15 volunteers. The system is especially suited for planning and evaluation of breast augmentation, facial aesthetic and reconstructive surgery as well as volumetric measurements before and after liposuction and lipofilling. Computer-assisted measurements correlate with a median deviation of 2.3% with manually measured distances in the face. We found the user-friendly Vectra® system to be a reliable and reproducible device for planning plastic surgery therapies and for documenting postoperative results.

[Microscope-integrated intraoperative indocyanine green angiography in plastic surgery]. / Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie.

The knowledge of tissue perfusion has not only a prognostic value in microvascular surgery but also the intraoperative detection of malperfusion can lead to a quick surgical intervention. Indocyanine green (ICG) angiography allows a topographic analysis of perfusion and is used to assess lymphatic drainage pathways and to analyse the depth of burn injuries. Integrating the technique into an operating microscope enables visualisation of the flow over microanastomoses and allows the assessment of the transit time of blood flow between arterial and venous anastomosis. Using this method we analysed 11 microsurgical free flaps (3 latissimus dorsi, 3 rectus abdominis, 1 gracilis muscle, 2 radial forearm, 1 ALT, and 1 DIEP flap). The topographic analysis was performed after the assessment of the microanastomoses. We observed no flap loss or partial flap necrosis. The transit time between arterial inflow and venous outflow was 32.8 s on average. Here we observed distinct differences between muscle flaps (27.7 s) on the one hand and fasciocutaneous and perforator flaps (47.5 s) on the other hand. We detected one venous thrombosis by ICG angiography in a case where the clinical patency test was not distinct. Revision was performed immediately. Particularly for intraoperative assessment, ICG angiography is a useful, reliable and safe technique. The integration into the operating microscope allows an "angiographic patency test" and the analysis of the transit time allows the evaluation of blood flow within the flap. Especially when planning perforator flaps the method of ICG angiography provides a new level of safety in flap design by quickly demonstrating the borders of perfusion.

[Treatment of Dupuytren's contracture by means of injectable collagenase: first clinical experiences]. / Die Behandlung der Dupuytrenschen Kontraktur mittels Kollagenase- Erste klinische Erfahrungen.

Recently a minimal invasive therapeutic option by means of enzymatic lysis of Dupuytren's cord was introduced in Europe under the name Xiapex® (Pfizer, Germany).Here we present our first experiences in clinical application with special remarks on complications.In this study 16 injections on 12 Dupuytren's cords in 8 patients were conducted. The average age of the patients was 62.5 (48-74) years. Constitution and application were carried out according to the manufacturer's guidelines. If both the metacarpophalangeal (MP)- and the proximal interphalangeal (PIP) joint were affected, injections were carried out on different points in time. 5 injections were done for contracture of the MPjoint, 4 injections for the PIPjoint, and 3 injections of both, the MP- and PIPjoint. Before the treatment and after 2 weeks the contracture of the treated joint was measured with use of a goniometer for small joints. Side effects and complications were documented as well as whether patients needed - and if yes, for how many days - a pain medication.Total flexion contracture of treated joints could be significantly reduced from 103°±12° to 37°±9°. In MPjoints the flexion contracture was reduced from 47°±8° to 14°±5° and in PIPjoints from 69°±10° to 37°±11° (p<0.05). 5 treated cords showed no signs of complication, recorded local adverse effects were edema (n=5), erythema (n=4) and tearing of skin (n=2). 6 patients needed pain medication for a maximum of 4 days.Treatment with collagenase appears to be an effective and safe therapeutic option for selective cases. Though the procedure ostensibly seems easy, one must emphasize the need for the appropriate application performed only by professionals with a high level of experience both in anatomical knowledge as well as hand surgical know-how to cope potential complications. The value of the new method in relation to the standard partial aponeurectomy and percutaneous needle fasciotomy needs to be ascertained by further research in order to establish a clear indication for each method of treatment.

Cologne burn centre experience with assault burn injuries.

OBJECTIVE: To evaluate demographic and socioeconomic factors associated with assault burn injuries. BACKGROUND: Assault by burning demonstrates a rare but severe public health issue and accounts for unique injury characteristics in the burn intensive care unit (BICU). METHODS: We conducted a retrospective cohort study involving patients with thermal injuries admitted to the BICU of a university hospital. The patient cohort was divided into two groups (ABI group: patients with assault burns, n=41; CONTROL GROUP: population of all other burned patients admitted to the BICU, n=1202). Bivariate and multivariate analyses including demographic and socioeconomic data were used to identify factors associated with assault burns. RESULTS: Forty-one assault-related burn victims were identified in the study period. This represents 3.3% of all significant burns admitted. Comparing battery victims with the control population, assault patients were more likely to be young (mean age 36.2 years vs. 42.2 years) and immigrants (41.5% vs. 15.1%). Furthermore, marital status (65.9% vs. 40.8% singles), employment status (36.6% vs. 9.7% unemployed) and insurance status (41.5% vs. 12.3% social insurance) were significantly different in the bivariate analysis. Logistic regression evaluation identified three variables that were independently associated with assault burns: younger age (< or =25 years) (odds ratio, 2.54 [95% confidence interval, 1.29-5.02]; p=0.007), ethnic minority (odds ratio, 3.71 [95% confidence interval, 1.91-7.20]; p<0.001) and unemployment (odds ratio, 4.02 [95% confidence interval, 2.03-7.97]; p<0.001). CONCLUSIONS: The high incidence of youngsters, unemployment and the great proportion of immigrants in victims of assault might provide several opportunities for community-based psychosocial and occupational programs. A multidisciplinary approach targeting issues specific to the violent nature of the injury and the socioeconomic background of the victims may be of benefit to improve their perspectives for rehabilitation.

Acalculous cholecystitis in severely burned patients: incidence and predisposing factors.

OBJECTIVE: To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients. BACKGROUND DATA: Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns. METHODS: We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n=15; CONTROL GROUP: population of all other burned patients admitted to the BICU, n=1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC. RESULTS: Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients' characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9 kg/m(2) vs. 25.6 kg/m(2)), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0 units vs.13.0 units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC. CONCLUSION: AAC is a rare complication of severely burned patients and may reflect the severity of the patient's general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention.

[Reconstruction of the oral commissure in microstomia patients with deep dermal facial burns: a modified technique]. / Rekonstruktion der oralen Kommissur bei Mikrostomie nach tief dermaler Verbrennung - eine modifizierte Technik.

BACKGROUND: Deep thermal dermal wounds of the oral region with subsequent microstomia are a rare and complex indication for surgical reconstruction of the oral commissure. Apart from functional and mimic aspects, aesthetic expectations are high. Based on converse technique, we performed a reconstruction of the oral commissure in 17 patients. 8 of these needed surgical re-operation due to recurrence and insufficient results. This high rate of complications led to a modification of the surgical procedure. PATIENTS: We present a modified technique which gave good results in our clinic. Based on Fairbank's technique, we altered the technique by covering the soft tissue defect of the lateral lip with an additional rotation flap raised from the mucosa of the enoral lower lip. Resulting scars were thereby shifted to the enoral side of the lower lip which caused less contracture in the region of the oral commissure. RESULTS: Using this modified technique, we were able to achieve a lasting displacement of the oral commissure to the lateral side. Long-term follow-up showed good functional results with no need for additional procedures.