ABSTRACT
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.
Subject(s)
Free Tissue Flaps , Plastic Surgery Procedures , Humans , Aged , Retrospective Studies , Treatment Outcome , ContraindicationsABSTRACT
Decellularized tendon xenografts offer a promising alternative for reconstruction by using ubiquitously available material. This study compares static and centrifugal seeding of avian tendon scaffolds with NIH 3T3 fibroblasts. Incorporation of viable cells was achievable with both techniques, represented by DNA content. Proliferation rate and viability assay showed neither damage by centrifugal force nor superiority of the technique. Cell proliferation after 10 days of culture demonstrated that the scaffold did not hinder 3-D culturing. Confocal laser microscopy revealed structural details as formation of focal adhesions, to provide deeper insight into the process of cell attachment and growth in xenografts.
ABSTRACT
A 46-year-old man presented with clinical signs of nerve compression syndrome of his right ulnar nerve as confirmed by nerve conduction studies. Unexpectedly, clinical examination and magnetic resonance imaging (MRI) revealed a subcutaneous tumor of 5×2 cm above the ulnar groove. Surgical exploration and histopathology of biopsies demonstrated the nerve distended and entrapped into an eosinophilic, inflammatory tissue. This rare condition is consistent with localized eosinophilic fasciitis, with no systemic manifestations. There are reports of isolated forearm versions of the disease. However, none occurred with the entrapment of a peripheral nerve appearing as a peripheral nerve tumor, yet. Consequentially, the presented patient would not have benefitted from further surgical neurolysis or tumor debulking, as eosinophilic fasciitis is an inflammatory and systemic disease. The patient's symptoms decreased spontaneously after 4 weeks of postsurgical treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs). Altogether, this case proved the necessity to regard even rare diseases as a potential cause of entrapment of peripheral nerves. This should lead surgeons to critical, differential diagnostic thinking and suggest that systemic diseases may be encountered during surgery due to their capability to mimic peripheral nerve tumors.
ABSTRACT
OBJECTIVE: The postdoctoral medical lecture qualification (Habilitation) represents the highest academic qualification in Germany, which is successfully completed by approximately 850 candidates in medicine and health sciences per year. However, there is only a limited number of respective academic positions available. In addition, structures in education and society have changed over the last years, challenging the importance of this specific German qualification. The aim of this study was to elicit the opinions of members of German habilitation committees concerning the requirements, processes and the overall importance of the postdoctoral medical lecture qualification. Furthermore we wanted to evaluate potential needs for reforms. METHODS: The online survey was conducted asking for biographic parameters, subjective ratings and potential needs for reforms concerning the postdoctoral medical lecture qualification (PLQ). RESULTS: The PLQ was rated high in significance by 71.3 % of the committee members. According to the medical understanding of the Humboldt triad (research, teaching, patient care), research (94.3 %) and teaching (89.7 %) have been rated as the most important requirements for a PLQ. Asked for the motivation to undertake a PLQ, 91.0 % of the members gave the joy of doing research, 78.2 % the joy of teaching and 65.5 % better career prospects perspectives as their reason. The recognition of a Ph.D. degree as being equivalent to a German PQL was clearly rejected by the survey respondents (58.6 %: no equivalence). The majority is against the abolition of the German PLQ. However, there is a definite desire for reform, preferably concerning internal obstacles such as the dependence on full professors, more transparency in the PLQ process, but also the demand for a federal standard PLQ regulation. CONCLUSION: From the committee members' point of view the German PLQ has still a role to play and, despite controversy, is still regarded as a timely qualification. However, there is clear-cut evidence for local, national and international reforms in order to create equality of opportunity for the candidates and to open up suitable career options.
