Surgical and Oncologic Outcome following Sacrectomy for Primary Malignant Bone Tumors and Locally Recurrent Rectal Cancer.

INTRODUCTION: Bone sarcoma or direct pelvic carcinoma invasion of the sacrum represent indications for partial or total sacrectomy. The aim was to describe the oncosurgical management and complication profile and to analyze our own outcome results following sacrectomy. METHODS: In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively. RESULTS: With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease. CONCLUSIONS: Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases.

[Evidence of modern diagnostic, conservative, and surgical therapy of secondary lymphoedema]. / Evidenz der modernen Diagnostik, der konservativen und chirurgischen Therapie des sekundären Lymphödems.

BACKGROUND: Secondary lymphoedema (SL) is one of the most common and, at the same time, most significant consequences and complications of modern oncological therapy. Although a thorough patient history and physical examination are sufficient to substantiate a suspicion, it is essential to perform functional imaging of the lymphatic system for a targeted diagnosis and determination of severity. For this purpose, techniques such as MR and ICG lymphography as well as ultra-high-frequency ultrasound examinations have been developed and validated in recent years. The selective use of these techniques has allowed for individualized indications and successful stage-dependent treatment using (super)microsurgical techniques to restore regional lymphatic drainage in the context of intensified conservative therapy. METHOD: Systematic review of the literature on the diagnosis and treatment of SL with subsequent analysis and classification of the results into evidence levels according to the Oxford Centre for Evidence-Based Medicine and the GRADE Scale. RESULTS: The established and validated diagnosis of SL includes imaging (ICG fluorescence lymphography, MR lymphography and Tc-99 functional lymphoscintigraphy) in case of a clinical suspicion and in high-risk patients. Complex physical decongestion therapy (CPE) is superior to physical therapy or compression alone. (Super)microsurgery of SL allows for a postoperative reduction in the frequency of CPE, a reduction of erysipelas rates, a volume reduction of the lymphomatous extremity and, if carried out prophylactically, a lower incidence of SL. Suction-assited lipectomy can produce long-term, stable reductions in circumference and an improvement in quality of life. CONCLUSION: Patients with SL benefit from conservative therapy with regular re-evaluation. Patients with a high risk for SL or with clinical deterioration or persistent symptoms under guideline-based conservative therapy can benefit from (super)microsurgical therapy after an individualized functional diagnostic evaluation of the lymphatic system. Excisional dermolipectomies or lympholiposuctions are available and effective for advanced and refractory stages.

Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants-An Accuracy Study of Digital High-Tech Procedures.

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future.

Accuracy of Three-dimensional Scan Technology and Its Possible Function in the Field of Hand Surgery.

Background: Three-dimensional (3D) technology has become a standard manufacturing element in many industries and has gained significant interest in plastic surgery. The 3D scans are widely used for patient communication, virtual surgery planning, and intraoperative tool manufacturing, providing a more comprehensive view of procedures and their outcomes compared with 2D visualization. Methods: We evaluated the performance of six commercially available 3D scanners by acquiring 3D models of a human hand and a 3D-printed replica of a human hand. We performed objective comparisons between the 3D models of the replica using color mapping techniques. Moreover, we compared the results of the human hand 3D scans. Results: We achieved the highest precision with the Artec Space Spider 3D scanner (Artec 3D) when scanning the 3D-printed replica. The SD was ±0.05 mm, and the scan did not have major defects that needed manual correction. On the human hand scan, we achieved the best results using the Artec Eva (Artec 3D), the resulting scan was an accurate digital representation of the scanned human hand. Conclusions: In our study, the Artec Space Spider 3D scanner demonstrated superior precision when scanning a 3D-printed replica, deviating only slightly from the original data, making it an optimal choice for nonmoving objects such as casts or medical instruments. For scanning human hands, the Artec Eva 3D scanner exhibited the highest performance, offering accuracy comparable to the Artec Space Spider, but with the added benefit of being able to scan larger objects.

Evaluation of the ankle function after Achilles tendon resection: a retrospective clinical study.

INTRODUCTION: The Achilles tendon is the strongest tendon in the human body and has the function of plantar ankle flexion. When the tendon is exposed, the peritendineum has been breached and the thick avascular tendon colonized with bacteria, a complete resection of the tendon may be indicated to achieve infection control and facilitate wound closure. The Achilles tendon reconstruction is not mandatory, as the plantar flexion of the ankle joint is assumed by the remaining flexor hallucis longus, flexor digitorum longus and tibialis posterior muscles. Our study aimed to evaluate the impact of Achilles tendon resection without reconstruction on leg function and quality of life. MATERIAL AND METHODS: We retrospectively evaluated all patients who were treated with an Achilles tendon resection between January 2017 and June 2022 in our quaternary institution. After evaluating the data, the patients who survived and were not amputated were contacted for re-evaluation, which included isokinetic strength measurement of both ankle joints, evaluation of the ankle range of motion and collection of several functional scores. RESULTS: Thirty patients were included in the retrospective study, with a mean age of 70.3 years, including 11 women and 19 men. The most frequent cause of the infection was leg ulcer (43.3%), followed by open tendon suture (23.3%). No tendon reconstruction was performed. Fifteen patients could be gained for reevaluation. The average difference in ankle flexion torque on the injured side compared to the healthy side at 30 degrees/second was 57.49% (p = 0.003) and at 120 degrees/second was 53.13% (p = 0.050) while the difference in power was 45.77% (p = 0.025) at 30 degrees/second and 38.08% (p = 0.423) at 120 degrees/second. The follow-up time was between 4 and 49 months and a positive correlation could be determined between the time elapsed from surgery and the ankle joint strength. There was a significant loss of range of motion on the operated side compared to the healthy side: 37.30% for plantar flexion, 24.56% for dorsal extension, 27.79% for pronation and 24.99% for supination. The average Lepillhati Score was 68.33, while the average American Orthopedic Foot and Ankle Score was 74.53. CONCLUSION: The complete Achilles tendon resection leaves the patient with satisfactory leg function and an almost normal gait. Especially in elderly, multimorbid patients, straightforward tendon resection and wound closure provide fast infection control with acceptable long-term results. Further prospective studies should compare the ankle function and gait in patients with and without Achilles tendon reconstruction after complete resection.

Use of a collagen-elastin matrix with split-thickness skin graft for defect coverage in complex wounds.

OBJECTIVE: Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation). METHOD: A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery. RESULTS: Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder. CONCLUSION: Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds.

The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections.

BACKGROUND: Deep sternal wound infection (DSWI) is a rare, yet devastating complication after cardiac surgery. While the surgical treatment always implies the soft tissue and bone debridement, there is little data about this procedure. The aim of our study was to evaluate the impact of the radical sternectomy on the outcome in patients with DSWI and to identify the risk factors which could influence the result. The surgical techniques of piecemeal sternectomy and the newly developed en bloc sternectomy were also evaluated. METHODS: The study was developed as a retrospective cohort study. 86 patients with DSWI who received a radical sternal resection at our institution between March 2018 and December 2021 were included. RESULTS: The average age of the cohort was 67.3 ± 7.4 years, and 23.3% of patients were female. The average length of stay trended shorter after en bloc sternectomy (median 26 days) compared to piecemeal sternectomy (37 days). There were no significant differences between the piecemeal and en bloc sternal resection techniques. Anticoagulant and antiplatelet drugs had no significant influence on bleeding and transfusion rates. Obese patients showed an increased risk for postoperative bleeding requiring reintervention. Transfusion of packed red blood cells was significantly associated with lower hemoglobin values before surgery and ASA Class 4 compared to ASA Class 3. The in-hospital mortality was 9.3%, with female sex and reintervention for bleeding as significant risk factors. Nine patients developed an infection relapse as a chronic fistula at the level of clavicula or ribs, with ASA Class 4 as a risk factor. CONCLUSION: Radical sternectomy is a safe procedure to treat DSWI with compromised sternal bone. Both piecemeal and en bloc techniques ensure reliable results, while complications and mortality appear to be patient-related.

The role of negative pressure wound therapy with instillation and dwell time in the treatment of deep sternal wound infections-A retrospective cohort study.

Background and Aims: Negative pressure wound therapy (NPWT) has gained a central role in the treatment of deep sternal wound infections (DSWIs) after median thoracotomy. Our study aims at proving the safety of using NPWT with instillation and dwell time (NPWTi-d) in the treatment of DSWI. Methods: We retrospectively evaluated the patients who were treated at our institution between March 2018 and November 2021 for DSWI after radical sternectomy using NPWT or NPWTi-d. The NPWTi-d was applied to start the first postoperative day using 75 mmHg negative pressure for 3 h, followed by instillation of sodium hypochlorite <0.08% with a 3-min dwell time. Results: The NPWTi-d group showed a shorter length of stay (29.39 ± 12.09 vs. 39.54 ± 17.07 days; p = 0.049), a shorter elapsed time between the debridement and the flap coverage (7.18 ± 4.27 vs. 11.86 ± 7.7 days; p = 0.003) and less operative or nonoperative dressing changes (1.73 ± 1.14 vs. 2.68 ± 56; p < 0.001). The in-hospital mortality was 8.2%, with no significant differences between the two groups (p = 1). Conclusion: NPWTi-d can be safely employed in the treatment of DSWI. Further prospective randomized studies need to establish the role of NPWTi-d in the control of infection and biofilm as well as in wound healing.

Microbiological study of sternal osteomyelitis after median thoracotomy - a retrospective cohort study.

INTRODUCTION: Deep sternal wound infection is a rare but feared complication of median thoracotomies and is usually caused by microorganisms from the patient's skin or mucous membranes, the external environment, or iatrogenic procedures. The most common involved pathogens are Staphylococcus aureus, Staphylococcus epidermidis and gram-negative bacteria. We aimed to evaluate the microbiological spectrum of deep sternal wound infections in our institution and to establish diagnostic and treatment algorithms. METHODS: We retrospectively evaluated the patients with deep sternal wound infections at our institution between March 2018 and December 2021. The inclusion criteria were the presence of deep sternal wound infection and complete sternal osteomyelitis. Eighty-seven patients could be included in the study. All patients received a radical sternectomy, with complete microbiological and histopathological analysis. RESULTS: In 20 patients (23%) the infection was caused by S. epidermidis, in 17 patients (19.54%) by S. aureus, in 3 patients (3.45%) by Enterococcus spp., in 14 patients (16.09%) by gram-negative bacteria, while in 14 patients (16.09%) no pathogen could be identified. In 19 patients (21,84%) the infection was polymicrobial. Two patients had a superimposed Candida spp. INFECTION: Methicillin-resistant S. epidermidis was found in 25 cases (28,74%), while methicillin-resistant S. aureus was isolated in only three cases (3,45%). The average hospital stay for monomicrobial infections was 29.93 ± 13.69 days and for polymicrobial infections was 37.47 ± 19.18 (p = 0.03). Wound swabs and tissue biopsies were routinely harvested for microbiological examination. The increasing number of biopsies was associated with the isolation of a pathogen (4.24 ± 2.22 vs. 2.18 ± 1.6, p < 0,001). Likewise, the increasing number of wound swabs was also associated with the isolation of a pathogen (4.22 ± 3.34 vs. 2.40 ± 1.45, p = 0.011). The median duration of antibiotic treatment was 24.62 (4-90) days intravenous and 23.54 (4-70) days orally. The length of antibiotic treatment for monomicrobial infections was 22.68 ± 14.27 days intravenous and 44.75 ± 25.87 days in total and for polymicrobial infections was 31.65 ± 22.29 days intravenous (p = 0.05) and 61.29 ± 41.45 in total (p = 0.07). The antibiotic treatment duration in patients with methicillin-resistant Staphylococci as well as in patients who developed an infection relapse was not significantly longer. CONCLUSION: S. epidermidis and S. aureus remain the main pathogen in deep sternal wound infections. The number of wound swabs and tissue biopsies correlates with accurate pathogen isolation. With radical surgical treatment, the role of prolonged antibiotic treatment remains unclear and should be evaluated in future prospective randomized studies.

Pathological study of sternal osteomyelitis after median thoracotomy-a prospective cohort study.

PURPOSE: Osteomyelitis of the sternum may arise either as a primary condition or secondary to median thoracotomy after cardiac surgery, with the latter being decidedly more frequent. Deep sternal wound infections appear as a complication of median thoracotomy in 0.2 to 4.4% of cases and may encompass the infection of the sternal bone. To date, there are no exhaustive histopathological studies of the sternal osteomyelitis. METHODS: Our work group developed a surgical technique to remove the complete infected sternal bone in deep sternal wound infections. We therefore prospectively examined the en bloc resected sternal specimens. Seven standard histological sections were made from the two hemisternums. RESULTS: Forty-seven sternums could be investigated. The median age of the patients in the cohort was 66 (45-81) years and there were 10 females and 37 males. Two methods were developed to examine the histological findings, with one model dividing the results in inflammatory and non-inflammatory, while the second method using a score from 0 to 5 to describe more precisely the intensity of the bone inflammation. The results showed the presence of inflammation in 76.6 to 93.6% of the specimens, depending on the section. The left manubrial sections were more prone to inflammation, especially when the left mammary artery was harvested. No further risk factors proved to have a statistical significance. CONCLUSION: Our study proved that the deep sternal wound infection may cause a ubiquitous inflammation of the sternal bone. The harvest of the left mammary artery may worsen the extent and intensity of infection.

[Evidence-based Research in Plastic and Aesthetic Surgery: Cross-sectional Analysis of Research Papers Between 2019 and 2021]. / Evidenzbasierte Forschung in der Plastischen und Ästhetischen Chirurgie: Querschnittsanalyse von Forschungsarbeiten im Zeitraum 2019­2021.

BACKGROUND: In the field of plastic and aesthetic surgery, continuous international publication is seen annually. However, the publication output is not regularly assessed for its level of evidence. In view of the strong publication activity, a regular assessment of the evidence level of the current publication years is reasonable and was the objective of this work. MATERIAL AND METHODS: We evaluated the Journal of Hand Surgery/JHS (European Volume Journal), the journal Plastic and Reconstructive Surgery/PRS and the journal Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla from January 2019 to December 2021. The authors' affiliation, the type of publication, the number of patients examined and the level of evidence with existing conflicts of interest were considered. RESULTS: A total of 1341 publications were evaluated. Of these, 334 original papers were published in JHS, 896 in PRS, and 111 in HaMiPla. The largest share were retrospective papers (53.5%, n=718). The further distribution was as follows: 18% (n=237) clinical prospective papers, 3.4% (n=47) randomised clinical trials (RCT), 12.5% (n=168) experimental papers and 6.5% (n=88) anatomic studies. The distribution of evidence levels of all studies was as follows: Level I: 1.6% (n=21), Level II: 8.7% (n=116), Level III: 20.3% (n=272), Level IV: 25.2% (n=338), Level V: 2.3% (n=31). In 42% (n=563) of the papers, there was no indication of the level of evidence. Most level I evidence was from university hospitals (n=16) in 76.2% (χ²-test 0.619, >0.05, 95% confidence interval). CONCLUSION: Although RCTs are inappropriate for many surgical questions, well-designed and conducted cohort or case-control studies could improve the evidence base. Many of the current studies tend to be retrospective and do not have a control group. Researchers in the field of plastic surgery should consider using a cohort or case-control design when an RCT is not feasible.

Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap-a case report.

BACKGROUND: Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation. CASE PRESENTATION: We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot. CONCLUSIONS: Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.

[The Impact of Industrial Sponsorship on Research Findings in Randomised Clinical Trials in Plastic and Aesthetic Surgery: a Cross- Section Analysis of the Past 12 Years]. / Der Einfluss von Industrie-Sponsoring auf Forschungsergebnisse randomisierter klinischer Studien in der Plastischen und Ästhetischen Chirurgie: Eine Querschnittsanalyse der letzten 12 Jahre.

BACKGROUND: Industry funding of research studies can cause the results in the field of plastic, reconstructive and aesthetic surgery to be biased towards the sponsors. This paper aims to review randomised clinical trials (RCTs) published by leading international journals in plastic, reconstructive and aesthetic surgery with respect to characteristics and possible industry-friendly conclusions in favour of those funding the study. MATERIAL AND METHODS: Characteristic data and funding of RCTs published by leading international plastic surgery journals from January 2010 to January 2022 were evaluated. The studies were categorised based on their thematic focus and the results in light of the existing funding. RESULTS: A total of 381 RCTs were included in the analysis, 68.5% of which were from a university (n=261). The larger proportion of studies did not disclose any information about the research funding. While 26% (n=98) of the studies analysed were funded by companies, 9.7% (n=37) were funded by universities/the government (p<0.05, 95% confidence interval). The overall focus of private clinics was aesthetics (n=32). Generally, the topic aesthetics (n=153) was funded by industry in 28 of 100 cases (28% industry/private sponsors compared with 9% university/government). Regarding reconstruction/burns/hand surgery, 9.2% of studies were funded by companies/private sponsors. Funding for research by university-based institutions was industry-sponsored in 25% (n=64) of cases. Regarding industry-sponsored studies, 73% (n=71) of the results were product-friendly in their conclusion (p<0.05, 95% confidence interval) and placed their thematic focus on therapeutic drug/product application (n=50, 75%). CONCLUSION: In terms of funding, industry and private sponsors take a leading role both in reconstruction and aesthetics. Nonetheless, the majority of the evaluated studies were not financed by the private sector. In cases where the research was funded by private companies, the results were significantly in favour of the product. Aesthetics as a focus is currently more frequently funded by industry than reconstruction, burn, and hand surgery.

Application of fibrin glue for hematoma prophylaxis in selective aponeurectomy in Dupuytren's disease.

INTRODUCTION: Fibrin glue (FG) can be applied in several surgical procedures at wound closure to reduce postoperative complications such as hematoma formation and wound impairment. The purpose of this study is to assess these preventive surgical benefits in Dupuytren's disease of the hand. PATIENTS AND METHODS: We performed a monocentric retrospective cohort study. All patients who underwent selective aponeurectomy for Dupuytren's disease between 2010 and 2020 were included. Patients were divided into two groups: either receiving or not receiving FG. The primary outcome variables were postoperative bleeding, wound healing impairment, and further pooled postoperative complications. RESULTS: One hundred and thirty-three patients were included in the analysis of which 108 patients were treated with FG, while 24 did not. There was no statistically significant difference in outcomes regarding postoperative bleeding, infections, or revision surgery. However, in the group receiving FG, there was a tendency toward higher wound healing impairment (13%, p = 0.07). The FG group showed a significantly higher pooled complication rate (18.5%, p < 0.02). Complication in general increased with higher Tubiana classification and number of resected cords. Smoking tripled the risk of impaired wound, while cardiovascular comorbidities increased postoperative bleeding by the factor of 11. CONCLUSION: FG did not show a preventive outcome regarding bleeding. The FG group had a tendency for a higher wound healing incidence. Smoking and arterial hypertension correlated with a higher postoperative complication rate. The overall incidence of complications was higher in the FG group. The quality of the surgical intervention as well as accurate hemostasis cannot be corrected by the application of FG.

Complex Functional Posttraumatic Shoulder Reconstruction Using Shoulder Arthroplasty and a Pedicled Innervated Latissimus Dorsi Flap-A Case Report and Literature Review.

BACKGROUND: The shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction. CASE PRESENTATION: We present the case of a 16-year-old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain. CONCLUSION: The pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.

Thumb reconstruction after radical tumor resection using free osteocutaneous lateral arm flap with secondary humerus fracture-a case report.

INTRODUCTION: Malignant diseases with infiltration of bony structures in the area of the phalanges or metacarpals require either amputation or complex reconstruction. The decision for reconstruction means to restore length, mobility, sensibility, stability as well as aesthetics. METHODS: We present a case of complex first ray reconstruction of the left hand using a free osteocutaneous lateral arm flap from the ipsilateral side. The reconstruction was performed after radical resection of an exulcerated squamous cell carcinoma, including the first metacarpal bone, trapezium, partial trapezoid and distal scaphoid as well as partial resection of the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus and flexor carpi radialis tendons. The osteosynthetic restoration was achieved distally by a double wire cerclage and a proximally by temporary K-wire suspension. Moreover, to reconstruct the extensor pollicis longus tendon the ipsilateral palmaris longus tendon was harvested and used. Postoperatively, a secondary humerus fracture occurred, which was initially attended by plate osteosynthesis. The fracture showed delayed healing, which was treated by re-plating and autologous cancellous bone. RESULTS: 12 months postoperatively, the patient showed an excellent outcome with length preservation and good range of motion, sensibility, stability and aesthetic of the thumb. Furthermore, the quarterly tumor aftercare showed no evidence of recurrence. CONCLUSION: This case report showed that the free osteocutaneous lateral arm flap is a reliable solution for the reconstruction of the first ray with a great functional and aesthetic outcome. To prevent a secondary humerus fracture, a preventive plate osteosynthesis simultaneous with the osteocutaneous flap elevation should be considered.

[Plastic and Aesthetic Surgery in Times of Social Media: An Analysis of the Reach and Topic Focus of the Most Successful Channels on YouTube]. / Die Plastische und Ästhetische Chirurgie in Zeiten von Social Media: Eine Analyse der Reichweite und des Themenfokus der erfolgreichsten Kanäle auf YouTube.

BACKGROUND: The use of social media such as Facebook, YouTube and Instagram is becoming an integral part of communication in plastic and aesthetic surgery. The potential reach provides significant opportunities to share information and reach patients. It must therefore be increasingly considered as a modern tool for a new form of publication and as a data and knowledge bank. This work aims to investigate the leading YouTube channels of German plastic and aesthetic surgeons with a view to reach, characteristics and topic focus. MATERIAL AND METHODS: All leading German YouTube channels of specialists in plastic and aesthetic surgery were evaluated. The analysis was based on key figures (country ranking, number of uploads, reach with total views, daily new subscribers; association with university hospital, non-university hospital, private practice) and content with a consecutive classification of the topics of the most successful videos. RESULTS: With the keyword "plastic surgery", 376 German channels were identified, with 8 channels meeting the inclusion criteria. The most successful channels reached a median of 1.342.017 views (IQR 745.455-2.550.682). The daily views on the channels amount to a median of 718 views per channel (IQR 272-1.086). From a total of 290 of the most successful videos, 87% were about aesthetic procedures (n=253). A percentage of 87.5% (7/8) of the most successful channels were from plastic and aesthetic surgeons in private practice. CONCLUSION: The platform YouTube offers an enormous potential of reach for knowledge transfer and marketing. It is primarily used by aesthetic surgeons and here mainly by those from the private practice sector. There is still a lot of potential for expansion regarding the representation of university plastic and aesthetic surgery with all its fields such as reconstruction, hand surgery and burn surgery on this platform.

Personalized approach for complex bilateral calcaneal osteomyelitis and defect reconstruction with bilateral abductor digiti minimi flaps.

Objectives: The best treatment for displaced, intra-articular fractures of the calcaneus remains controversial and it is generally agreed, that there is no single method that is suitable for all patients. Case presentation: Here we report a rare case of bilateral calcaneal osteomyelitis with fistula formation following open reduction and plate fixation via an extensile lateral approach that could be salvaged with an interdisciplinary approach including orthopedic and plastic surgeons. We are not aware of a similar case in the literature. Abductor digit minimi flaps is a well-established procedure in plastic and reconstructive surgery with a minimal functional defect and morbidity at the donor site. This treatment protocol resulted in minimal donor-site morbidity and good bone remodeling in the further course. We believe that it may be of use for complicated courses even with limited resources. Conclusions: Abductor digit minimi flaps is a well-established procedure in plastic and reconstructive surgery with a minimal functional defect and morbidity at the donor site.

Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults.

BACKGROUND: Human fingertips can regenerate functionally and cosmetically excellent skin and soft tissues. Physiological conditions suppress scar formation and are thus a prerequisite for regenerative healing. Self-adhesive film dressings can provide such favorable conditions. The semi-occlusive treatment is superior to surgery. However, standard dressings leak malodorous wound fluid eventually until the wound is dry. Therefore, we developed and tested a silicone finger cap that forms a mechanically protected, wet chamber around the injury. Its puncturable reservoir allows access to the wound fluid for diagnostic and research purposes and the delivery of pro-regenerative drugs in the future. METHODS: Patients >2 years with full-thickness fingertip injuries unsuitable for simple primary closure were randomized to start treatment with either the film dressing or the silicone finger cap. After 2 weeks, we changed to the other treatment. Patients' choice on the preferred treatment after 4 weeks was the primary outcome parameter. Additionally, we monitored adverse events, unplanned visits, tissue gain, functionality, cosmetic outcome, and quality of life. RESULTS: We randomized 11 patients 2 to 72 years to each group. Eighteen to 20 (90%, intention-to-treat) patients preferred the finger cap. All patients were satisfied with the cosmetic outcome, 88.9% had no disturbing sensibility changes, and 73.7% could report no distortion in the finger's daily use. Epithelialization took between 5 weeks for Allen II and up to 9 weeks in Allen IV injuries. There were 19 device-related adverse events under film dressing and 13 under the finger cap. There were neither severe adverse device effects nor unexpected severe adverse device effects. CONCLUSION: Employing the summative or synthetic primary endpoint "patient decision for one or the other procedure," our pseudocross-over-designed RCT succeeded in statistically significantly demonstrating the superiority of the silicone finger cap over conventional film therapy. The finger cap was safe and effective, reaching excellent results on all treated injuries without any need for disinfection, antibiotics, shortening of protruding bones, or treatment of hypergranulations. Distal to the tendon insertions, we did not see any limitations regarding injury mechanism, amputation plane, or patients' age.

Diagnostics and Treatment of Volkmann Ischemic Contracture in a Seven-Year-Old Child.

A 7-year-old boy presented 6 weeks after open reduction and crossed Kirschner wire (K-wire) fixation of a supracondylar humerus fracture. Previous treatments had restored skeletal anatomy without documented complications. However, the patient would not move the entire arm, including his forearm and hand. Any passive movement led to anxious adverse reactions, and there was partial numbness of all fingers. After intensive physio- and occupational therapy supported by nerve stimulation and psychological counseling, anxiety-related functional deficits of the shoulder and elbow resolved to reveal the severe Volkmann contracture of the right hand developed fully. Electroneurography, X-ray, magnetic resonance imaging of the forearm, and ultrasonography showed nonfunctional ulnar and a partially disturbed radial motor nerve distal to the elbow along with damaged flexor muscles of the forearm after compartment syndrome. In addition, damage to the median nerve at the elbow level was diagnosed. After intense conservative therapy, we partially resected fibrotic fascia of the superficial flexor compartment, freed ulnar and median nerves, and performed staircase-like releases of tendons and tenotomies. We achieved a full range of motion of all fingers and markedly improved the range of motion of the wrist. The Disabilities of the Arm, Shoulder and Hand scores for function improved from 80 to 16 at the 2-year follow-up postoperatively, but some impairments of fine motor function persisted. Subtle symptoms of a developing compartment syndrome need to be recognized. Overlooked and untreated, a consecutive Volkmann contracture can turn the extremity nonfunctional. Intensive physical, psychological, and surgical therapy in a specialized center can restore function but requires endurance and perseverance throughout the lengthy recovery.