Emergency pre-hospital care of burn patients.

Intensive care and the surgical therapy of burn injuries have made significant advancements. The immediate care on the scene of the accident, however, is not uniform. There is no 'golden hour' which will decide the further clinical process. The acute estimate of the percentage of the extent of the burns is of little relevance and does not facilitate the admission to a burn unit. The emergency calculation of the volume of intravenous infusion is not advisable. The choice of transport has no discernible impact on the prognosis of the patient. Avoiding hypothermia and perceiving associated trauma can be of crucial prognostic importance in the pre-hospital care of burn patients. Detailed knowledge about the circumstances of the injury is of exceeding importance.

Aetiology and treatment of a previously denervated "tennis" elbow.

The aetiology of the "tennis" elbow is still disputed and treated by numerous different operations. We report 24 patients with treatment-resistant, previously denervated epicondylitis. The revision consisted of complete decompression of the radial nerve from the lateral intermuscular septum to beyond the arcade of Frohse in 24 patients using an anterolateral access. There was a mean period of 31 (10) months between the onset of the condition and the revision. Compared with the preoperative findings, there were improvements in 19 of the 24 patients, with four patients remaining unchanged, and one patient deteriorating. If the condition has been resistant to treatment for some time, complete decompression of the radial nerve is an effective option with few complications compared with further operation on the epicondyle.

Surgical treatment of angiosarcoma of the scalp: less is more.

Angiosarcomas (AS) of the scalp are rare tumors with an extremely poor prognosis mostly affecting elderly patients. Given the special anatomic nature of the blood supply to the scalp, it must be presumed that the tumor has already spread at the time of the initial presentation. We report a simple and fast surgical procedure, which places only a minimum burden on the patient. In 19 patients, we performed a resection of the external table with the defect being covered immediately by a split skin graft. The average stay in hospital amounted to 12.2 days. The postoperative period free of recurrences was 2.7 months on average. The average survival period after resection was 17.5 months. In view of the difficult diagnosis, an often delayed therapy and the rapid formation of metastases, a time-saving procedure with a low rate of complications should be given preference over other reconstructive methods.

Specific C-reactive protein measurements in plastic surgery.

The early detection of postoperative signs of infection can help to obviate serious consequences. C-reactive protein (CRP) is a highly sensitive measure of inflammatory changes. Concise knowledge of standard concentrations of CRP after various operations would allow the differentiation between a physiological rise and the interpretation of CRP as a warning sign. The aim of this study was to establish standard curves for CRP reactivity for common operations in plastic surgery and to assess the validity of CRP as a prognostic indicator of infective complications. Four groups of 30 patients each had either breast reduction, abdominoplasty, submuscular breast augmentation or exchange of breast implants. CRP concentrations were measured once preoperatively and on eight consecutive days postoperatively. CRP peak values were found throughout postoperative days 3 to 5. Concentrations on days 2 and 7 were significantly different from day 4 (p<0.04). Patients who had no sharp decline in CRP after its peak developed complications in their future postoperative course. There was significant correlation between the amount of resected tissue and CRP concentrations (r=0.78, p<0.005). Our results suggest that knowledge of standard alterations in postoperative CRP concentrations increases the early detection of complications. No sharp decline in CRP after day 5 is a warning sign. The use of specific standard curves allows a comparative assessment of actual, individual concentrations of CRP.

Skin cell isolation and expansion for cell transplantation is limited in patients using tobacco, alcohol, or are exhibiting diabetes mellitus.

The aim of this exploratory study was to investigate the isolation and expansion of keratinocytes and fibroblasts from donors with certain medical histories. Biopsies were taken from donors (N=32) falling into one or more of the following categories: a history of heavy smoking and/or alcohol abuse, drug abuse, diabetes mellitus or steroid treatment. Cells from donors who did not fall into any of the above-mentioned categories were used as controls. Proliferation and growth behaviour of cells were analyzed by measurement of passage duration, absorbance (MTT-assay) and light microscopy. Donors with a specific medical history required larger biopsy areas than the control group for isolating a sufficient number of fibroblasts and keratinocytes. Times to confluence were significantly prolonged and absorbances (MTT) were significantly reduced in several donor groups when compared to control cultures. Biopsies from donors with steroid treatment, drug abuse and combined nicotine and alcohol abuse could not be established beyond passage 0 degrees or 1 degree, respectively. We conclude that isolation and expansion of skin cells from donors with certain medical histories may require larger biopsies, prolonged expansion times or may even result in failure. These findings may therefore be of clinical importance in the field of autologous skin cell transplantation.