Modelling human burn injuries in a three-dimensional virtual environment.

This paper gives a work-in-progress report on our research project BurnCase, a virtual environment for modelling human burn injuries. The goal of the project is to simplify and improve the diagnosis and medical treatment of burns. Due to the lack of electronic and computational support for current diagnosis methods, enormous variations regarding the approximated size of burned skin regions exist. And although Simplifications like the Rule-Of-Nines-Method ([Weidringer, 2002]), Lund and Browder ([LundBrowder, 1944]) and others try to compensate for these errors, the fact remains that different physicians overestimate the BSA (Body Surface Area) by 20% up to 50%, depending on the different experience and subjectivity of the approximation process. Nevertheless, different supporting mechanisms have been developed to assist the process of burn region transfer so that after transferring all burned regions on the virtual human body, calculations can be applied in order to evaluate standard indices like the ABSI (Abbreviated Burn Severity Index), and Baux ([Baux, 1989]) as well as ICD10 (International Classification of Diseases) diagnosis encoding. The virtual body simulation is based on state-of-the-art 3D computer graphics (OpenGL). Thus a simulation system, providing a graphical user interface, allows surgeons to transfer a patient's burn injury regions onto an appropriate 3-dimensional model. As such, the BurnCase system improves surface determination by calculating region surfaces up to a precision of one cm2. This improves the average variation to less than 5%, limited by the precision of the surface transfer onto the virtual model. The system already allows the transfer of burned regions by using standard input devices. For this purpose different reference models of human bodies have been created in order to receive appropriate results based on measured physical data of different patients. Moreover, an underlying database stores all entered case studies so that it is possible to perform comparisons of burn cases and animation sequences of the healing process of single wounds or whole bodies. When used as centralized burn accident registration service, a huge knowledge base of burn diagnoses and consequent medical treatment will emerge. This knowledge base will allow medical advices and diagnosis support for any kind of burn accidents, and it will consequently improve and support the primary diagnosis process of burn accidents. Thus, an enormous reduction of time and costs of medical burn treatment will be reached.

[Infected abdominal wall and burst abdomen]. / Die infizierte Bauchdecke und der Platzbauch.

Deep wound infection of the abdominal wall and postoperative abdominal wound rupture are dangerous complications of laparotomy that require emergency operative intervention. The wound infection quota after laparotomy is between 5 and 10%. While subcutaneous infections heal without consequences after wound treatment, deep infections of incisional wounds are a problem. The cause is often an intra-abdominal infection. There are some standard operational measures: consistent debridement of the necrotic parts, careful re-exploration of the intra-abdominal site and early fascial closure with special sutures. All other procedures depend on the individual case. Abdominal wall rupture only occurs in 1% of the cases, but the mortality is high (15-45%). Besides local wound factors and the technical aspects, there a many general causes. Abdominal wall rupture also requires emergency operation. Repeated wound closure without further steps is possible in half of the cases. The mass technique should be used. Both deep wound infections and rupture are important complications in the development of incisional hernias.

[Anterior rectum resection and abdominoperineal rectum excision: guidelines for decision making]. / Anteriore Rektumresektion und abdominoperineale Rektumexstirpation: Richtlinien für die Entscheidungsfindung.

Carcinomae of the upper third of the rectum are, almost without exception, and without loss of continence, resectable. The diagnosis of an intact sphincter function is significant in the pre-operative phase, when deciding whether to carry out an anterior rectum resection or an abdominoperineal rectum exstirpation. Concerning tumours as from G3 in the middle and distal thirds, a safety margin of at least 5 cm distal must be kept, thus making an anterior resection impossible. Stage IV tumours whose growth has infiltrated neighbouring organs or the pelvic wall are also not suitable for resection. Should anatomical circumstances such as excessive adipositae, very large carcinomae, narrow pelvis and enlargement of the uterus or prostata prevent the safe dissection of the mesorectum a sphincter-retaining operation is also not indicated. Oncologic safety is of the highest priority when considering such cases.