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Summary Background: Accurate pre-operative or intra-operative labeling of the skin is often necessary to mark exactly the surgical excision lines. Pre-operative “unsterile” permanent skin labeling systems are needed for example for vein and sentinel lymph node surgery; here the dyes must resist two surgical skin disinfection procedures. In contrast, excision borders are labeled during surgery using a “sterile” skin marking system. Methods: Many commercial and non-commercial pre- and intra-operative skin-labeling systems are available, such as autologous patient blood, fluorescence triphenylmethane dyes and commercial skin markers. The available skin marking systems have specific advantages and disadvantages. We review the different labeling systems, offering guidelines to help choose a cost-effective system appropriate for a given surgical procedure. Results: The Edding® permanent markers 400 und 3000 are well suited for preoperative skin labeling and less expensive than commercial skin labeling systems. Autologous patient blood and eosin are well suited for intra-operative labeling and are most cost effective. Eosin Y is widely used and well suited for labeling of dark skin, bone, cartilage, and muscle tissue and spares the expense of expensive commercial skin markers. Conclusion: Knowledge of the many commercial and non-commercial pre- and intra-operative skin labeling systems and their advantages and disadvantages helps to reduce the use of relatively expensive commercial skin markers.

Summary Background: There is increasing evidence that polyphenols, antioxidants from plants such as green tea or grapes, may impair the UV-induced erythema reaction as well as carcinogenesis and metastasis of melanoma and epithelial skin cancer. The UVB-protective potential of wine polyphenols has not been studied so far in humans. Patients and Methods: We tested the influence of local and systemic application of three red wines on the minimal erythema dose (MED) after UVB exposure in 15 healthy male physicians. Baseline MED were determined in all subjects. Irradiation was carried out prior to and immediately following 20 minutes of occlusive application of red wine as well as 12 % alcohol to the back. The systemic effect was tested by ultraviolet irradiation immediately prior to oral intake, Results: There were no topical effects. Wine A also provided no protection sys-temically. Drinking wine B has led to an almost significant rise of MED, while wine C, which had the highest polyphenol content, produced a statistically significant higher MED (p = 0.031). Conclusions: “Wine baths” will not have sun protective properties. A significant rise of the MED following oral intake of the wine with the highest polyphenol content might be due to these substances. Further research is needed to clarify the role of polyphenol content, dose and duration of wine consumption.

Summary Introduction: Local anesthetics supplemented with epinephrine are generally regarded as contraindicated for surgical procedures involving the fingers, toes, penis, outer ear and the tip of the nose [1], but epinephrine is essential if automated tumescence local anesthesia (Auto-TLA) is used. Materials and methods: Infiltration anesthesia supplemented with 1 : 200,000 epinephrine was used from 1985 – 1997 in our department, while Auto-TLA supplemented with 1 : 1.000,000 epinephrine was introduced in 1997 for all surgical procedures involving the ear or nose. During this period, 10,201 patients underwent surgery at these locations. In addition, dermal blood flow was analyzed by acral photoplethysmography (APPG) and laser Doppler flowmetry (LDF) in the right ear lobe of five normal volunteers and during epinephrine supplemented Auto-TLA. Results: Epinephrine-induced complications were not observed in a single patient. Cosmetic skin flap surgery was performed in 4,953 of these patients. Even in patients with extended surgical procedures that took up to one to two hours and that included extensive skin flaps or skin grafts, we observed no increase in complications when compared to procedures performed either under general anesthesia or local anesthesia without epinephrine supplementation. Measuring blood perfusion of the earlobe showed a 69 % reduction of LDF and a 42 % reduction of arterial inflow (APPG) immediately following anesthesia. Conclusion: Epinephrine supplementation of local anesthetics does not block blood perfusion in the ear and did not induce organ, tissue or flap necrosis. Local anesthesia with epinephrine supplementation is therefore safe for acral areas such as the ear or nose. Despite the relatively small influence on blood perfusion, epinephrine supplementation results in a relatively bloodless operating field and longer effectiveness of local anesthesia. The relative absence of blood in the operating field of the ear and nose significantly reduces the duration of surgery and increases the healing rate, as less electrocautery is needed. Zusammenfassung Einleitung: Ein Adrenalinzusatz ist allgemein kontraindiziert bei Anasthesien im Endstromgebiet, insbesondere bei Eingriffen an Fingern, Zehen, Penis, Ohrmuscheln und Nasenspitze [1]. Er ist aber notwendig, wenn man eine automatisierte Tumeszenzlokalanasthesie (Auto-TLA) durchfuhrt. Material und Methode: Seit 1985 wird an der Universitats-Hautklinik in Tubingen bei jedem operativen Eingriff an Ohr und Nase eine Infiltrationsanasthesie mit Adrenalinzusatz 1 : 200 000 bzw. ab 1997 als (Auto-TLA) mit Adrenalinzusatz 1 : 1 000 000 durchgefuhrt. Seit dieser Zeit wurden 10 201 Patienten an diesen Lokalisationen anasthesiert und operiert. Bei funf gefasgesunden Probanden wurde der dermale Blutflus mittels akraler Photoplethysmografie (APPG) und Laser-Doppler-Fluxmetrie (LDF) am rechten Ohrlappchen vor und nach Auto-TLA objektiviert. Ergebnisse: Beim Einsatz der Lokalanasthesie mit Adrenalin kam es zu keiner einzigen adrenalinbedingten Komplikation an Ohr und Nase. Bei diesen Patienten wurde bei 4 953 Fallen eine regionale Hautlappenplastik durchgefuhrt. Auch hier zeigte sich trotz zum Teil mehrzeitiger Operationstechnik und Teil ausgedehnten Hautlappenplastiken oder Hauttransplantationen kein Unterschied hinsichtlich der Komplikationsrate gegenuber einer Narkose oder einer Lokalanasthesie ohne Adrenalinzusatz. Die Objektivierung der Blutperfusion am Ohrlappchen ergab eine Reduktion des LDF um 69 % und des arteriellen Einstromes (APPG) um 42 % unmittelbar nach der Anasthesie. Schlusfolgerung: Durch den Zusatz von Adrenalin in dem Lokalanasthetikum wird die Blutperfusion am Ohr nicht komplett unterbunden. Eine Lokalanasthesie mit Adrenalinzusatz kann daher an Ohr und Nase eingesetzt werden. Der Adrenalinzusatz fuhrt zu einem blutarmen Operationsfeld und zu einer langeren Wirkungsdauer der Lokalanasthesie. Das blutarme Operationsfeld an Ohr und Nase bietet Vorteile hinsichtlich der Zeitdauer des operativen Eingriffes und des Heilungserfolges wegen einer reduzierten Anwendung der Elektrokoagulation von Blutgefasen am Hautrand.