The adipofasciocutaneous gluteal fold perforator flap a versatile alternative choice for covering perineal defects.

AIM: Perineal defects following the resection of anorectal malignancies are a reconstructive challenge. Flaps based on the rectus abdominis muscle have several drawbacks. Regional perforator flaps may be a suitable alternative. We present our experience of using the gluteal fold flap (GFF) for reconstructing perineal and pelvic defects. METHODS: We used a retrospective chart review and follow-up examinations focusing on epidemiological, oncological (procedure and outcome), and therapy-related data. This included postoperative complications and their management, length of hospital stay, and time to heal. RESULTS: Twenty-two GFFs (unilateral n = 8; bilateral n = 7) were performed in 15 patients (nine women and six men; anal squamous cell carcinoma n = 8; rectal adenocarcinoma n = 7; mean age 65.5 + 8.2 years) with a mean follow-up time of 1 year. Of the cases, 73.3% were a recurrent disease. Microscopic tumor resection was achieved in all but one case (93.3%). Seven cases had no complications (46.7%). Surgical complications were classified according to the Clavien-Dindo system (grades I n = 2; II n = 2; IIIb n = 4). These were mainly wound healing disorders that did not affect mobilization or discharge. The time to discharge was 22 + 9.9 days. The oncological outcomes were as follows: 53.3% of the patients had no evidence of disease, 20% had metastatic disease, 20% had local recurrent disease, and one patient (6.7%) died of other causes. CONCLUSIONS: The GFF is a robust, reliable flap suitable for perineal and pelvic reconstruction. It can be raised quickly and easily, has an acceptable complication rate and donor site morbidity, and does not affect the abdominal wall.

Homophilic binding of the neural cell adhesion molecule CHL1 regulates development of ventral midbrain dopaminergic pathways.

Abnormal development of ventral midbrain (VM) dopaminergic (DA) pathways, essential for motor and cognitive function, may underpin a number of neurological disorders and thereby highlight the importance of understanding the birth and connectivity of the associated neurons. While a number of regulators of VM DA neurogenesis are known, processes involved in later developmental events, including terminal differentiation and axon morphogenesis, are less well understood. Recent transcriptional analysis studies of the developing VM identified genes expressed during these stages, including the cell adhesion molecule with homology to L1 (Chl1). Here, we map the temporal and spatial expression of CHL1 and assess functional roles of substrate-bound and soluble-forms of the protein during VM DA development. Results showed early CHL1 in the VM, corresponding with roles in DA progenitor migration and differentiation. Subsequently, we demonstrated roles for CHL1 in both axonal extension and repulsion, selectively of DA neurons, suggestive of a role in guidance towards forebrain targets and away from hindbrain nuclei. In part, CHL1 mediates these roles through homophilic CHL1-CHL1 interactions. Collectively, these findings enhance our knowledge of VM DA pathways development, and may provide new insights into understanding DA developmental conditions such as autism spectrum disorders.

Thermometry of bosonic mixtures in Optical Lattices via Demixing.

Motivated by recent experiments and theoretical investigations on binary mixtures, we investigate the miscible-immiscible transition at finite temperature by means of Quantum Monte Carlo. Based on the observation that the segregated phase is strongly affected by temperature, we propose to use the degree of demixing for thermometry of a binary bosonic mixture trapped in an optical lattice. We show that the proposed method is especially sensitive at low temperatures, of the order of the tunnelling amplitude, and therefore is particularly suitable in the regime where quantum magnetism is expected.

Continuous-variable approach to the spectral properties and quantum states of the two-component Bose-Hubbard dimer.

A bosonic gas formed by two interacting species trapped in a double-well potential features macroscopic localization effects when the interspecies interaction becomes sufficiently strong. A repulsive interaction spatially separates the species into different wells while an attractive interaction confines both species in the same well. We perform a fully analytic study of the transitions from the weak- to the strong-interaction regime by exploiting the semiclassical method in which boson populations are represented in terms of continuous variables. We find an explicit description of low-energy eigenstates and spectrum in terms of the model parameters which includes the neighborhood of the transition point. To test the effectiveness of the continuous-variable method we compare its predictions with the exact results found numerically. Numerical calculations confirm the spectral collapse evidenced by this method when the space localization takes place.

Long-Term Follow-up of Recurrence and Patient Satisfaction After Surgical Treatment of Gynecomastia.

BACKGROUND: "Gynecomastia" is an enlargement of the male breast. Our study aims to assess patient satisfaction as well as evaluate differences in recurrence rates in lipomatous and glandular gynecomastia 10-19 years postoperatively. METHODS: Forty-one gynecomastia patients undergoing surgical treatment from 1997 to 2005 were invited for a follow-up examination 10-19 years postoperatively. Of these, 16 patients presented for a clinical examination. Patient satisfaction was measured with a validated questionnaire [consultation satisfaction questionnaire (CSQ)-9]. Furthermore, photo-material and patient charts were evaluated concerning preoperative macroscopical type of gynecomastia, BMI, and operative technique. RESULTS: Mean follow-up time was 13.8 years (range: 10.5-19 years). Eight patients (50%) had presented with lipomatous and eight patients (50%) with glandular gynecomastia prior to surgery. One of the patients with glandular gynecomastia (12.5%) presented with recurrence at the time of follow-up, while five of the eight patients showing lipomatous gynecomastia (62.5%) presented with recurrence. Interestingly, younger patient groups tend to be more satisfied with the operative treatment of gynecomastia than older patient groups, especially regarding the improvement of self-esteem. CONCLUSIONS: Long-term follow-up results showed that recurrence rates are significantly higher in patients with lipomatous gynecomastia than in patients with glandular gynecomastia, with BMI increase in patients with glandular and lipomatous gynecomastia showing no statistically significant differences. Furthermore, general patient satisfaction and improvement of self-esteem was higher in younger patient groups than older patient groups. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . CLINICAL TRIAL REGISTRATION NUMBER: DRKS00009630.

[Comparison of the Results of Lundborg's and Sirotakova's Resection-Suspension Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis]. / Vergleich der Ergebnisse der Resektions-Suspensionsarthroplastik nach Lundborg und Sirotakova zur Behandlung der Rhizarthrose.

BACKGROUND AND AIMS: The aim of this prospective randomised study was to compare Sirotakova's and Lundborg's methods of resection-suspension arthroplasty using the abductor pollicis longus tendon in the surgical treatment of osteoarthritis of the trapeziometacarpal joint. PATIENTS AND METHODS: Between 2009 and 2012, 38 patients (29 female, 9 male) with symptomatic trapeziometacarpal osteoarthritis (34% stage II, 58% stage III and 8% stage IV according to the Eaton-Littler classification) were randomly allocated to one of the surgical methods (mean age 62.7 years, range 43-85). Preoperatively, the following data were collected: pain intensity (Visual Analogue Scale, VAS; at rest: Lundborg 4.4±1.7; Sirotakova 4.6±2.1), strength (key pinch force Lundborg 8.1 kPa±6.6; Sirotakova 10.4 kPa±10.8), range of motion in the trapeziometacarpal joint (Lundborg 61.64±26.4; Sirotakova 46.67±25.6), Kapandji index (Lundborg 9.42±1.4; Sirotakova 9.33±1.5), distance between the base of the first metacarpal bone and the scaphoid bone as measured by standardised x-ray images (Lundborg 12 mm±1.5; Sirotakova 11.4 mm±3), DASH questionnaire (Lundborg 40.4±13.9; Sirotakova 49.9±23.5). A significant difference between the 2 groups was not found. Patients were examined 3 and 9 months postoperatively. RESULTS: Both resection-suspension arthroplasty procedures led to a statistically significant postoperative reduction of pain, a significant improvement in radial and palmar abduction, a significant gain in quality of life and significant asymptomatic proximalisation of the first metacarpal bone. There was no significant difference in postoperative strength. CONCLUSION: Both methods lead to reliable and satisfying results. Given our findings we cannot generally recommend one method over the other.

Impact of increasing age on breast reduction surgery: A single centre analysis.

BACKGROUND: Women with hypertrophic breasts suffer for physical and psychological reasons. Breast reduction surgery is a safe procedure that can effectively improve symptoms and quality of life. As most studies have been performed in younger women, little is known about complications and long-term patient satisfaction in elderly women. PATIENTS AND METHODS: We analysed complication rates and patient satisfaction in women aged 60 years and older who underwent a bilateral reduction mammaplasty. Patient satisfaction was measured with a validated questionnaire (client satisfaction questionnaire (CSQ)-8). The results obtained were compared to those of a control group including women aged 35 years and younger. RESULTS: Twenty-five women met the inclusion criteria in each group. The mean age in the elderly and young was 65.4 and 23.4 years, respectively. Older women had more comorbidities (35 vs. 9, p < 0.05). The average overall resection weight was 1684.4 g with slightly lower resection weights in younger women (1541 vs. 1828 g; p = 0.34). Eight women in the young group and 11 in the elderly developed minor complications (p = 0.56). Two women in the young group had major complications. Patient satisfaction was significantly higher in older women, with a mean score of 27.3 in the young and 30.3 in the elderly (maximum score of CSQ-8: 32, p < 0.05). CONCLUSIONS: Age is not a contraindication for reduction mammaplasty. Breast reduction surgery is a safe procedure in elderly women and leads to even higher patient satisfaction. Level of evidence: IV.

The attractive lip: A photomorphometric analysis.

BACKGROUND: Throughout literature, there are different parameters defining the ideal shape of the lip and lower third of the face. This study was conducted to clarify what it is that makes lips attractive - and whether there are gender-related differences of an attractive lip and lower third of the face. PATIENTS AND METHODS: Pictures of the lip and chin region of 176 patients were photographed in a standardised way and evaluated by 250 voluntary judges through an internet presentation by means of an analogue Likert scaling system. RESULTS: We found a significant higher ratio of upper vermillion height/mouth-nose distance in frontal-view images of attractive compared to unattractive female (p < 0.001) and male (p < 0.05) perioral regions. Furthermore, the ratio of upper vermillion height/chin-nose distance was significantly higher in attractive than in unattractive female (p < 0.005) and male (p < 0.05) lip and chin regions. The nasolabial angle was significantly sharper in attractive compared to unattractive female perioral regions (p < 0.001). Moreover, attractive female lip and chin regions showed a wider mentolabial angle compared to unattractive female lip and chin regions (p < 0.05). Comparing men and women, we found that attractive female perioral regions showed a higher ratio of lower vermillion height/chin-mouth distance (p < 0.05) and lower vermillion height/chin-nose distance than attractive male perioral regions (p < 0.05). CONCLUSION: We were able to define certain parameters of the lip and lower third of the face that seem to add to the attractivity of female and male individuals and prove that there are gender-related differences in form and shape of an attractive lower third of the face.

The Neuro-spheroid--A novel 3D in vitro model for peripheral nerve regeneration.

BACKGROUND: In order to reduce in vivo animal experiments in peripheral nerve regeneration research, in vitro models are desirable. Common two dimensional (2D) co-culture models lack the complex interactions of three dimensional (3D) physiological structures. The aim of the study was to establish a neuronal 3D spheroidal sprouting assay for peripheral nerve regeneration. NEW METHOD: Spheroids consisting of Schwann cells (SC, 500 cells/spheroid) and NG108-15 cells (NG, 50 cells/spheroid), a hybrid cell line, were formed in hanging drops and were embedded in a 3D collagen matrix. Spheroid sprout lengths were compared to those of the neurites of NG in a 2D co-culture with SC. Lengths were measured using phase contrast images taken every day over 10 days. Additionally we took fluorescence images to visualize the PKH26-labeled NG in both culture systems. RESULTS: Initially thin neurites grew out in both co-cultures, over time the sprouts' diameter in the 3D culture increased. The direct comparison of the sprout length revealed significantly longer neurites in the 3D co-culture from day 7 until day 10 (p<0.001). COMPARISON WITH EXISTING METHODS: Other co-culture models either display processes in 2D or need complex matrices to create 3D structures. Our spheroidal model is easy to establish, highly flexible and nevertheless 3D. CONCLUSIONS: The 3D-Schwann cell-neuron spheroid model shows that by simply transferring a 2D into a 3D co-culture with multiplication of cell-cell contacts, a significant increase of neurite length can be achieved. The model is a relatively simple method for the investigation of neurite development in vitro.

Comparison of the Rubin dermal suspension sutures and total parenchymal reshaping technique with a traditional inverted T-scar reduction mammaplasty technique using a superior pedicle.

UNLABELLED: Adipose patients, especially after massive weight loss, pose a challenge to the breast surgeon due to the major loss of volume and the inelasticity of the skin. Rubin described a suitable mammaplasty technique for these patients involving dermal suspension sutures and total parenchymal reshaping. With this technique, the tissue of the prominent axillary skin fold typically found in patients with massive weight loss is used to increase the upper pole volume of the breast. To prove the effectiveness of this technique, the current study compared it with a traditional inverted T-scar technique using a superior pedicle, as described by Höhler. This technique usually is used for a different patient clientele that requires reduction mammaplasty. However, because none of the difficult aforementioned preconditions are found in this clientele, it leads to the best possible outcome and represents the authors' internal "gold standard" for mammaplasty against which all other techniques must be compared. This study retrospectively analyzed the complication rate, lift effect, and upper pole fullness by chart analysis and photometric analysis of 21 Höhler and 24 Rubin mammaplasties. Despite the more challenging patient clientele in the Rubin groups, both therapies achieved a similar lift effect without significant differences (Höhler 4.8 ± 3.3 cm vs Rubin 6 ± 4 cm). In both groups, the upper pole area increased significantly. The ratio of upper pole-to-lower pole area increased from 1.31 preoperatively to 2.1 postoperatively in the Rubin group, suggesting a redistribution of tissue in favor of the upper pole, and it increased from 1.18 to 1.69 in the Höhler group, indicating an even greater increase in upper pole volume in the Rubin group. In conclusion, the technique described by Rubin, despite the dramatically more difficult soft tissue condition of the patients with massive weight loss, results in an outcome similar to that of a traditional reduction mammaplasty technique in terms of increased upper pole volume. It is suitable and preferable for patients who have a lateral axillary roll deformity and can be applied safely for these patients without increasing the complication rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The aging perioral region -- Do we really know what is happening?

OBJECTIVES: The perioral region is subject to a myriad of different treatments for rejuvenation, many of which are applied without a clear understanding of the underlying physiological processes of perioral aging. The results of these procedures are therefore sometimes not optimal and do not achieve a natural youthful appearance. The aim of this study was to put the results of three investigations into the perioral aging process into relation to clinical application in aesthetic medicine. DESIGN: Three different investigations were performed to evaluate the complex 3-dimensional changes during the perioral aging process. Perioral proportions of 182 standardized subject photographs were measured in a photomorphometric study and correlated to age. In cranial MRI scans of 30 women aged 20-35 and 30 women aged 65-80 relevant anatomical dimensions were measured. Histological cross cuts of the upper lip complex of 20 individuals in two age groups, young (< 40 years, n = 10) and old (> 80 years, n = 10), were analysed. The results were then set into relation to today's lip rejuvenation procedures. RESULTS: All studies showed a statistically significant lengthening of the aging upper lip. The photomorphometric study further showed an increase of prolabium skin at the cost of a decreasing visible upper lip vermilion. The MRI scans showed a decrease in thickness and redistribution towards a length increase but no total volume loss. Histomorphometric analysis revealed statistically significant thinning of the cutis, thickening of the subcutis and a degeneration of elastic and collagen fibers. The orbicularis oris muscle becomes thinner and shows a decrease of the forward curve defining the vermilion border. The results show that the main processes of lip aging are redistribution from thickness to length without total volume loss and a decrease of structural components of the lip, which leads to the decrease of pouting, an inversion of the vermilion and a ptosis of the lip. CONCLUSION: A new and better understanding of the underlying physiological changes of perioral aging is essential and will lead to a better and more specific implementation of perioral rejuvenation procedures which will lead to more natural results.

Refinements in reconstruction of penile skin loss using intra-operative prostaglandin injections, postoperative tadalafil application and negative pressure dressings.

PURPOSE: Penile shaft skin defects represent demanding reconstructive tasks because a high degree of flexibility and stability of the skin grafts are essential to allow regular erections and sexual intercourse. METHODS: A new concept of tailoring skin grafts to the erect penis by intra-operative application of prostaglandin E1 and postoperative stabilisation by negative-pressure wound therapy and pharmacological expansion by tadalafil was tested on four patients with penile shaft skin defects. Graft take, stability, pliability, softness and aesthetic results were evaluated up to at least 12 months postoperatively. The ratio of the skin transplanted area in the non-erect compared to the erect penis (non-erect/erect ratio) and the ratio of the skin transplanted area in the erect penis at 12 months compared to intra-operatively (Post/Pre ratio) was determined to define the amount of graft contraction and flexibility. International Index of Erectile Function (IIEF)-5 scores were evaluated postoperatively. RESULTS: There were no complications. Graft take was 97, 100, 100 and 100%. Stable skin grafts were achieved after 2 weeks. Sexual intercourse was possible at 2-3 months. The Post/Pre ratio was between 81 and 87% and proves comparably mild contracture rates. The non-erect/erect ratio of 50-72% shows how significantly undersized penile shaft skin grafts are when adjusted to the non-erect penis and that an adequate flexibility for erections can be reconstructed. IIEF-5 scores proved regular potency in three patients; one patient was no longer sexually active. CONCLUSIONS: With the new concept of tailoring the skin graft to the erect penis, pharmacological expansion and external stabilisation by vacuum-assisted closure (VAC) dressing the difficult task of penile skin reconstruction can be facilitated, accelerated and the functional and aesthetic outcome improved compared to earlier efforts or to results presented in the literature.

Rho-inhibition by local application of c3-toxin for enhancement of axonal sprouting in a rat end-to-side nerve repair model.

INTRODUCTION: The aim of the presented study was to investigate nerve regeneration after application of C3-Toxin, a Rho-GTPase inhibitor and to correlate morphometry, neurophysiology, and function in an end-to-side peroneal/tibial nerve repair model of the rat. MATERIALS AND METHODS: Twenty rats with a peroneal to tibial end-to-side neurorrhaphy were divided into two groups: 1) control group, 2) C3 fusion toxin group with intrafascicular application of 1 µg/100 µl C3 fusion toxin. Survival time was 8 weeks. Nerve conduction velocities and motor function were analyzed and histomorphological evaluation consisting of measurement of intraneural collagen level, axon count, total nerve area, myelination index, and N-ratio followed. RESULTS: Evaluation of motor function and nerve conduction did not show any statistical differences. Histological analysis revealed higher axon count, thicker myelin sheaths, and higher myelination index in the C3 fusion toxin group (P < 0.001). Comparison of N-ratio and intraneural collagen level were without statistical significance. CONCLUSION: The current study shows that application of C3 fusion toxin leads to higher myelination and increases axonal sprouting.

Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps.

BACKGROUND: We recently established negative pressure wound therapy (NPWT) as a safe postoperative care concept for free muscle flaps; however, the molecular effects of NPWT on free muscle flaps remain elusive. Here we investigated the effects of NPWT on pathological changes associated with ischaemia/reperfusion injury in free flap tissue. METHODS: From July 2008 to September 2010, 30 patients receiving skin-grafted free muscle transfer for defect coverage were randomly assigned to two treatment groups: In one group the skin-grafted free flap was covered by a vacuum dressing (NPWT); in the second group, flaps were covered by conventional petroleum gauze dressings (conv). Biopsies were taken intra-operatively prior to clipping of the pedicle and on postoperative day 5. Samples were analysed by immunohistochemistry for infiltration of inflammatory cells, real-time polymerase chain reaction (RT-PCR) for the analysis of expression levels of interleukin-1ß (IL-1ß) and tumour necrosis factor (TNF)-alpha as markers of inflammation. Histological samples were also examined for interstitial oedema formation, and apoptosis was detected by a terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay. RESULTS: NPWT leads to a significantly reduced tissue infiltration of CD68 + macrophages and reduced expression of the inflammatory cytokines IL-1ß and TNFα. None of these parameters was significantly elevated in the pre-ischaemic biopsies. Furthermore, NPWT reduced the interstitial oedema formation and the number of apoptotic cells in free flap tissue. CONCLUSION: NPWT of skin-grafted free muscle flaps leads to a reduced inflammatory response following ischaemia/reperfusion, resulting in reduced oedema formation improving the microcirculation and ultimately reduced tissue damage. We thereby deliver new insight into the effects of NPWT.

Surgery for Pyodermia fistulans sinifica to circumvent heart transplantation (Case Report).

INTRODUCTION: Pyoderma fistulans sinifica (PFS) is a rare chronic cutaneous and subcutaneous infectious disease and is associated with major physical and psychological morbidity. In this article, we present the case of a young patient affected by severe PFS, who concomitantly suffered severe left-sided cardiac insufficiency and was considered for cardiac transplantation. By radical debridement and skin grafting of all areas affected by PFS, the patient's overall condition rapidly improved and was correlated with a significant and measurable improvement of cardiac function. CASE REPORT: Plastic surgery was consulted on a 32-year-old male by the cardiac intensive care unit with a 2-year history of recurrent pyogenic skin infections of the inguinal and axillary regions. He presented with a dilated cardiomyopathy with an ejection fraction (EF) of 15%, first-degree pulmonary insufficiency and second-degree mitral insufficiency and an overlying myocarditis leading to the picture of severe cardiac insufficiency, making him eligible for heart transplantation. The intention was to eradicate the chronic infective wounds as a preparative prior to cardiac transplantation. Radical debridement of the involved areas and coverage with split-thickness skin grafts took place and led to a significant improvement of the patient's condition. Echocardiography revealed a 266.67% improvement of the EF to 40%. Cardiac transplantation became unwarranted. At 1.5 years postoperatively, the patient is free of disease and has a normal cardiac function. DISCUSSION: PFS is characterised in its early stages by local inflammation with beginning ulceration and can be managed conservatively. In advanced stages, as illustrated in this report, PFS must be considered as the potential source of systemic inflammatory process with significant alterations in multiple-organ systems and must be treated aggressively.

Standard care impact on angioedema because of hereditary C1 inhibitor deficiency: a 21-month prospective study in a cohort of 103 patients.

BACKGROUND: Hereditary angioedema (HAE) due to the deficiency of C1 inhibitor (C1-INH) causes chronically recurrent cutaneous, abdominal and laryngeal angioedema that are disabling and potentially life-threatening. OBJECTIVE: We designed a prospective study to quantify the residual disease in patients with HAE treated according to the existing consensus documents. METHODS: Data were collected from diaries recording occurrence, duration, location and treatment of acute angioedema attacks. A total of 386 semesters properly completed were analyzed. Forty-seven of 103 patients were on prophylactic treatment, 41 with attenuated androgens and six with tranexamic acid. A total of 1532 angioedema attacks (one every 45.3 days) were registered. RESULTS: Peripheral attacks were the most frequent (698), followed by abdominal (503) and combined locations (232), laryngeal edema was less common (99). Patients on prophylaxis with attenuated androgens had 7.7 attacks/year lasting 1.47 days, those on tranexamic acid had 8.1 attacks/year lasting 1.59 days, and those without prophylaxis had 8.9 attacks/year lasting 1.68. Plasma-derived C1-INH was used by 44 patients to treat a total of 376 acute attacks that resolved faster (1.1 day) than those not treated (1.85 day) or treated with tranexamic acid (1.79 day). No adverse events related to C1-INH infusion were reported. CONCLUSION: Our data demonstrate that tranexamic acid is not effective in the treatment of acute attacks and indicate that under the current therapeutic approach, the HAE related disability is effectively but partially reduced. Incomplete success does not appear to depend on limited efficacy of the drugs but on their limited use that can be overcome by implementing specific treatment strategies.

Arcus marginalis release II via endoscopic midface-lift.

Tear troughs in combination with midfacial ptosis may be early and synergistic signs of aging. Premaxillary and suborbicularis oculi fat (SOOF) descent decreases soft tissue volume covering the orbital rim, while prolapsing retroseptal fat actually underscores the resulting tear trough shadow. This volume change precedes skin redundancy. Thus, volume redistribution avoiding external skin incisions is the adequate treatment. De la Plaza's transconjunctival lower lid blepharoplasty is a reliable tool for arcus marginalis release. For patients also requiring an endoscopic midface-lift, even the transconjunctival incision for intraorbital fat compartment realignment can be avoided by performing the release of the lower orbita septum via the buccal mucosa incision.

A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer.

Introduction of the Vacuum-Assisted Closure (V.A.C.) system has revolutionized the approach to a multitude of clinical settings. Yet, its use precludes adequate clinical monitoring of skin-grafted free flaps, thus, making a reliable monitoring system essential if broad clinical application is aspired. In a clinical study, the usefulness of the combination of the V.A.C. and implantable Doppler probe was critically evaluated in patients with microsurgical lower extremity reconstruction. We retrospectively analyzed the usefulness of the implantable Doppler probe in five consecutive patients treated in our department from January to July 2007. Inclusion criteria were lower extremity reconstruction by means of skin-grafted free tissue transfers with subsequent application of the V.A.C. device. Five consecutive patients (four males, one female) with a mean age of 37.8 years (range, 8-58 years) matched the criteria mentioned above. Of note, the two pediatric patients (8-year-old male and 12-year-old female) suffered from significant posttraumatic stress disorder necessitating concomitant psychological care by the Department of Psychiatry. All flaps healed uneventfully displaying no signs of vascular compromise. Interpretation of the Doppler signal was simple and well received by the nursing staff. The combination of V.A.C. and the implantable Doppler probe enhances patient comfort due to a reduction of the number of dressing changes while still allowing continuous free flap monitoring. Interpretation of the signal transmitted by the probe is simple and potentially reduces misinterpretations due to different levels of experience.

Mixtures of strongly interacting bosons in optical lattices.

We investigate the properties of strongly interacting heteronuclear boson-boson mixtures loaded in realistic optical lattices, with particular emphasis on the physics of interfaces. In particular, we numerically reproduce the recent experimental observation that the addition of a small fraction of 41K induces a significant loss of coherence in 87Rb, providing a simple explanation. We then investigate the robustness against the inhomogeneity typical of realistic experimental realizations of the glassy quantum emulsions recently predicted to occur in strongly interacting boson-boson mixtures on ideal homogeneous lattices.