Bacterial biofilms and capsular contracture in patients with breast implants.

BACKGROUND: It has been hypothesized that bacterial biofilms on breast implants may cause chronic inflammation leading to capsular contracture. The association between bacterial biofilms of removed implants and capsular contracture was investigated. METHODS: Breast implants explanted between 2006 and 2010 at five participating centres for plastic and reconstructive surgery were investigated by sonication. Bacterial cultures derived from sonication were correlated with patient, surgical and implant characteristics, and the degree of capsular contracture. RESULTS: The study included 121 breast implants from 84 patients, of which 119 originated from women and two from men undergoing gender reassignment. Some 50 breast prostheses were implanted for reconstruction, 48 for aesthetic reasons and 23 implants were used as temporary expander devices. The median indwelling time was 4·0 (range 0·1-32) years for permanent implants and 3 (range 1-6) months for temporary devices. Excluding nine implants with clinical signs of infection, sonication cultures were positive in 40 (45 per cent) of 89 permanent implants and in 12 (52 per cent) of 23 temporary devices. Analysis of permanent implants showed that a positive bacterial culture after sonication correlated with the degree of capsular contracture: Baker I, two of 11 implants; Baker II, two of ten; Baker III, nine of 23; and Baker IV, 27 of 45 (P < 0·001). The most frequent organisms were Propionibacterium acnes (25 implants) and coagulase-negative staphylococci (21). CONCLUSION: Sonication cultures correlated with the degree of capsular contracture, indicating the potential causative role of bacterial biofilms in the pathogenesis of capsular contracture. REGISTRATION NUMBER: NCT01138891 (http://www.clinicaltrials.gov).

[Use of the Ilisarow device for correction of extensive Madelung's deformity]. / Anwendung des Ilisarow-Apparates zur Korrektur der ausgeprägten Madelung'schen Derformität.

After a historical review of the Madelung's deformity, an operative technique is presented, using the Ilisarow distractor to correct severe deformities in adolescence. The goal of surgery at this age is the prevention of complications in a later period. These complications include arthrosis, pain, progressive limitation of motion in the wrist, and ruptures of extensor tendons. Our method is useful to do an operative correction - also of big angles - without using an autologous bone graft. Furthermore, the use of Ilisarow techniques allows gradual non-invasive corrections in the first postoperative period, and we can avoid surgery of the distal ulna to maintain the distal radio-ulnar joint. In 1991, three patients were treated in this manner and the results are encouraging.

[Siliconoma and rheumatic symptoms--a familial and a questionable complication of silicone implantation]. / Silikonome und rheumatische Symptomatik--eine bekannte und eine fragliche Komplikation von Silikonimplantaten.

Ruptured silicone-gel filled implants after breast augmentation or reconstruction may cause siliconomas. These lesions frequently develop years later and should be surgically excised. Since the use of modern double lumen implants they do not occur anymore. The possibility of a correlation between silicone implants and the incidence of rheumatologic disorders is critically evaluated by case reports from the world literature. Up to now, no statistically significant cumulation of these disorders in women with silicone implants can be observed.

Retrograde posterior interosseous flap.

A retrospective, continuous clinical series of 36 distally based posterior interosseous island flap procedures is reported. Major anatomic variations precluded the final dissection of the flap on two occasions (6%). Thirty-four patients had septocutaneous or septofascial flap coverage for treatment of acute complex injuries (12), subacute soft tissue defects (10), chronic ulcers (5), or contractures (7). The sizes of the flap islands varied from 1.5 by 4 centimeters to 9 by 11 centimeters. The arc of rotation, centered over the distal radioulnar joint, measured up to 19 centimeters, allowing the flaps to reach the dorsum of the proximal interphalangeal joints. Partial necrosis occurred in seven flaps; four (12%) required additional local or distant flaps. Partial failures were related to bleeding from the pedicle or compression thereof, while other assumed causes of hypoperfusion were not statistically relevant. The flaps remained slightly bulky in about 30% of the patients, but otherwise adapted well to the recipient site and had excellent texture and color match. The donor morbidity was minimal.

Obliteration of the axillary artery after axillary block.

A case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40 ml, with adrenaline 1:200,000). Axillary block was performed using the loss of resistance technique with a blunt needle (45 degrees bevel). The diagnosis was made by palpation of the peripheral pulse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.

[Comments on vascular pedicled nerve transplantation in the area of the upper extremity]. / Anmerkungen zur vaskulär gestielten Nerventransplantation im Bereiche der oberen Extremität.

This article describes the vascular anatomy of several nerves of the upper extremity with a view of their potential use as pedicled, vascularized nerve grafts.

The dorsal middle phalangeal finger flap.

A versatile one-stage neurovascular flap from the dorsum of the middle phalanx of the finger is described. The flap is based on one proper digital artery, the venous network about its adventitia and the dorsal branches of the proper palmar digital nerves bilaterally. The characteristics of the flap include a size up to 3 by 6 cm, an arterio-venous pedicle up to 12 cm in length, an arc of rotation around the superficial palmar arch, discriminative sensibility, and comparably low donor morbidity. The flap may be transposed on its vascular pedicle with or without nerve suture. Furthermore it is ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization. Finally, it may be utilized as a free neurovascular flap.

[Ring avulsion injuries: improved indications for replantation]. / Ringavulsionsverletzungen: Verfeinerte Indikationsstellung zur Replantation.

Based on experiences with 12 replantations of ring avulsion injuries, an additional classification of type III avulsions (Urbaniak, 1981) is proposed, according to the level of injury of the neurovascular bundles. If this lies proximally (III P), microsurgical reconstruction is usually straightforward and the prognosis generally good; in distal lesions (III D), however, uncorrectable segmental devascularization can occur, which may be detrimental to survival or ultimate function.

[Acute compartment syndrome following snake bite]. / Akutes Compartment-Syndrom nach Schlangenbiss.

The experience with snake bites, causing local complications is discussed. Whenever systemic envenomation occurs, antivenin is the treatment of choice. Tissue necroses are treated by early debridement and a possible closed compartment syndrome demands the open fasciotomy.

[Cecostomy in the treatment of large intestine ileus]. / Resultate der Zökostomie in der Behandlung des Dickdarmileus.

Large bowel decompression by simple coecostomy is not generally accepted. As this procedure is our method of choice in all suitable cases, we have checked the results. From 1.11.1971 to 31.3.1979 a coecostomy was performed in 44 patients presenting with uncomplicated colonic obstruction. The operation was done through an ileocoecal muscle split incision without an exploratory laparotomy. The coecum was primarily opened and sutured to the skin. There were 38 carcinomas, one actinic sigmoid stenosis and one pancreatitic stenosis. In four cases further investigations did not show any mechanical bowel obstruction. In 37 patients there was a secondary laparotomy. In 34 patients the stenotic area was resectable. The coecostomy could be closed in 39 cases and was removed with the resected specimen in one case. Overall-lethality was 4/44, the lethality of mechanical large bowel obstruction was 4/40 or 10% respectively. Three patients died of metastatic carcinomas, one patient of thromboembolic complications. The coecostomy always was successful in decompressing the dilated bowel. The morbidity was negligible (one abscess after closure of the stoma with cicatricial herniation later on.