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Das Formen und Umverteilen von Fettgewebe wird mit einer Vielzahl von wechselnden und unterschiedlichen Begriffen bezeichnet.

Die Korrektur von Konturunregelmasigkeiten und Volumendefiziten des Weichteilgewebes stellt nach wie vor eine Herausforderung in der Plastischen Chirurgie dar. Klinische Indikationen zur Rekonstruktion bzw. Substitution von Weichteilgewebe mittels Weichgewebsaquivalenten sind vielfaltig und lassen sich im Wesentlichen in rekonstruktive und kosmetische Indikationen unterteilen. Der Leidensdruck der Patienten ist oft sehr hoch, denn entstellende Deformationen z. B. des Gesichts, der Extremitaten oder der Brust der Frau stigmatisieren, beeintrachtigen soziale Kontakte und fuhren oft zur gesellschaftlichen Isolation sowie zur professionellen und finanziellen Benachteiligung.

As a modern and innovative tool in modern medicine, fat grafting exhibits numerous benefits including wide availability, an easy and inexpensive procedure, unique regenerative capacity through mesenchymal stem cells, and growth factors with a high patient satisfaction rate. But the popularity of fat grafts is accompanied by numerous concerns. Critics note that fat grafts show a high resorption rate and interfere with the radiological detection of breast cancer. Apart from the aforementioned concerns, the carcinogenicity of fat grafts is subject of heated debate. This chapter will illustrate the most important benefits and risks and especially focus on the carcinogenic potential of fat grafts based on the newest literature.

Fat grafting is an established method to treat a multitude of plastic surgical deformities. Autologous fat contains a significant amount of adipocyte-derived stem cells (ASC) and growth factors which promote tissue regeneration and rejuvenation. Through proangiogenic growth factors such as the vascular endothelial growth factor (VEGF), tissue regeneration on the recipient side and graft survival are granted. In the following chapter, the lipofilling procedure in the face, adipocyte-derived stem cells, growth factors and clinical application of fat grafts will be discussed.

The face is a complex anatomical unit characterized by different kinds of tissues contained within a small space. In particular, the repair of peripheral nerve lesions due to bone fractures and/or soft tissue injuries is a major challenge for reconstructive surgeons. Prior to surgical therapy, a detailed analysis of (a) the patient’s history, (b) the physical and neurological examination, (c) the etiology, (d) the localization of the lesion site, (e) the denervation time, (f) the degree of the nerve lesion, and (g) the degree of functional loss is required. The purpose of this chapter is to present the indications and therapeutical options for the treatment of nerve injuries of the face. These include nonsurgical and surgical options. Surgical options include dynamic strategies such as neurolysis, epineural suture repair, nerve grafting, nerve transfer, regional muscle transfer, and microneurovascular free muscle transfer, as well as static strategies such as fascial slings and cosmetic procedures.

Soft tissue coverage in open fractures is a major reconstructive challenge. This requires an effective and determined cooperation between skilled orthopaedic and plastic surgeons in a trauma centre. Primary goals are both limb salvage and restoration of form and function. The current chapter gives a short overview on general principles of surgical decision making. In particular, we present and discuss different aspects regarding the timing of reconstructive surgery comparing early (“fix and flap”) and staged or delayed soft tissue coverage. Finally, we shortly summarize the main characteristics (e.g. vascular anatomy and flap harvesting techniques) of the most commonly used flaps in soft tissue coverage in open fractures. For didactic purposes, we provide pre-, intra- and postoperative pictures of selected clinical cases.

Regeneration in the peripheral nervous system is a major challenge in reconstructive plastic surgery. The goal of the current neuro-tissue engineering concept is the transdifferentiation of bone marrow stromal cells into Schwann cell-like cells in combination with a bioartificial nerve graft on the basis of a specifically designed cylindrical collagen scaffold. The patented cylindrical nerve guides resulted in an advanced interaction with the cells. In-vivo regeneration experiments (Lewis rats) revealed appropriate regeneration with axonal sprouting reaching the distal end of the nerve guide in an orientated manner over a distance of 2 cm within 12 weeks.

Objective: Obesity and the Metabolic Sydrome are correlated with chronic low-grade inflammation characterized by increased plasma levels of proinflammatory mediators. Thus, the induction of inflammation could be used to stimulate adipose tissue formation in tissue engineering approaches. Since nitric oxide (NO) is a key regulator of inflammation and has been demonstrated to have lipogenic properties we investigated the effect of NO and its downstream targets cGMP and cAMP, respectively, on preadipocytes in vitro. Methods: Preadipocytes were isolated from human subcutaneous adipose tissue samples, cultured until confluence, and differentiated by insulin, pioglitazone, dexamethasone, isomethylbutylxanthine, and transferrin. DETA/NO (30–150 μM) was added during proliferation and differentiation. Additionally, the specific guanylyl cyclase inhibitor ODQ, the adenylyl cyclase inhibitor 2′-5′-dideoxyadenosine (ddA), the cGMP/cAMP-analogues 8-Br-cGMP, 8-pCPT-cGMP, and 8-Br-cAMP, and the adenylyl cyclase activator forskolin were applied. Proliferation was evaluated by microscopy and XTT-test, differentiation was assayed by glycerophosphate dehydrogenase (GDDH) activity. Results: DETA/NO in combination with the standard differentiation procedure significantly enhanced maturation of precursor cells to adipocytes (p

Introduction: The use of silicone in scar treatment is well established. Despite numerous studies confirming the efficacy the optimal application is still under investigation. For best results continuous application is essential, yet silicone sheets are highly visible, prominent and often impractical in everyday use. To overcome these difficulties other formulations like creams or gels have been developed. We have investigated the use of a silicone spray for the treatment of scars. Materials and Methods: 20 patients with surgical scars took part in a randomized double blinded study with intrapatient control. Scars were treated half and half with drug vs. control or site matched with identical scars. The control was an identical spray without silicone. Patients applied the spray two times a day for three months, starting on the day of suture removal. A photo documentation, modified VSS, patient satisfaction and possible side effects were investigated at 4, 8 and 12 weeks and a follow up visit at 6 months. Results: During the use of the silicone spray the scar quality and patient satisfaction on a non linear 5 point scale was significantly higher in the study drug. Modified VSS scores were 7 vs. 3 (p=0.001) Patient satisfaction was 4 vs. 2 (p

Formkorrekturen an der oberen Extremitat werden, im Vergleich zu formenden Eingriffen am Stamm oder der unteren Extremitat, seltener durchgefuhrt. Neben den wiederherstellenden Eingriffen nach Verletzung ist die rein asthetische Formung des Oberarms die haufigste Operation, seltener sind asthetische Eingriffe am Unterarm oder an der Hand.

Reconstruction of peripheral nerve lesions remains a major challenge in reconstructive surgery. The aim of this tissue engineering approach is the development of a bioartificial nerve graft on basis of a specifically designed cylindrical collagen scaffold. The developed cylindrical collagen scaffolds resulted in an advanced interaction between Schwann cells and the nerve guide in-vitro. Both in-vitro and in-vivo regeneration experiments revealed appropriate regeneration with axonal sprouting reaching the distal end of the guidance channels in an orientated manner.

Several studies have shown that atypical neuroleptics, e. g. clozapine, cause a significant weight gain. In the treatment with neuroleptics this increase in weight is an unwanted side effect. In tissue engineering of adipose tissue, in contrast, an immitation of the clozapine-induced mechanisms is a promising approach to overcome present hurdles, e. g. low volume. This in vitro study assessed the influence of the neuroleptic drug clozapine and the green tea extract epigallocatechine gallate (EGCG) on preadipocytes. Adipose tissue progenitor cells were isolated from excised human fat tissue, cultured, and differentiated in the presence of clozapine and/or EGCG. Adipogenic conversion was determined by measuring the activity of the glycerophosphate dehydrogenase (GPDH), a molecular marker for fat cell maturation. Intracellular superoxide formation was evaluated by ethidium bromide staining. Our results demonstrate that clozapine promotes preadipocyte conversion to fat cells by generating superoxid anions (GPDH-induktion by 20–30 %, p < 0.01). EGCG effectively inhibits clozapine-enhanced differentiation by 80 % (p < 0.001), in the presence of clozapine by 50–60 % (p < 0.01). The generation of oxidative stress seems to represent a potential pathway to promote the differentiation of preadipocytes on biomaterials. Taking the pathogenesis of obesity, it is especially the drinking of green tea or medication with EGCG which represents a suitable tool to avoid weight gain and neoadipogenesis.

Malnutrition and micronutrients deficiencies can have a severe impact on the outcome of traumatic and surgical wounds [1, 2]. Zinc is the most well known micronutrient playing a central role in wound healing and has been used empirically in dermatologic conditions for centuries [1, 2]. Zinc deficiency impairs processes like DNA synthesis, protein synthesis and cell proliferation, which are all fundamental for wound healing [1, 3]. In addition, the antioxidant and protective activity exerted by zinc supplementation has been recently taken in consideration [4]. By using a 24-hour treatment with peroxide as a model for inflammation-derived oxidative stress (which is a typical condition during wound healing) we have found that zinc supplementation fully protects endothelial cells against peroxide-induced toxicity. Vice-versa zinc depletion increases the cell death rate. We also show that the antioxidant activity of zinc depends on the zinc-mediated increase of the cellular levels of glutathione (GSH), the most abundant endogenously produced antioxidant in eukaryotic cells. Indeed we found that zinc supplementation induces the transcription of glutamate-cysteine ligase (GCL), the enzyme catalysing the rate-limiting step of the de novo synthesis, by activating the translocation of the transcription factor Nrf2. We also observed an antioxidant activity of zinc. In fact, the addition of zinc in the presence of pro-inflammatory cytokines limits the inflammatory response, by reducing the expression of inflammatory genes such as the inducible nitric oxide synthase (iNOS). The identification of the molecular mechanism responsible for the zinc-mediated effects may contribute to the elaboration of new nutritional and/or clinical approaches to promote the wound healing.

Methicillinresistente Staphylokokkus aureus (MRSA)-Stamme sind heutzutage eine haufige Ursache fur schwere nosokomiale Infekte. Ist die alleinige Kolonisation der Patienten noch nicht mit einer erhohten Mortalitat verbunden, stellt eine manifeste Infektion eine lebensbedrohliche Komplikation dar. Schwerbrandverletzte Patienten haben aufgrund des Verlustes der Schutzfunktion der Haut ein erhohtes Risiko, dass die Kolonisation in eine Infektion ubergeht.

Bei den Verbandwechseln von Verbrennungspatienten wurden die lokalen Antiseptika Mafenid® 5% und Lavasept® 0,2% eingesetzt und deren therapeutischer Effekt evaluiert. Die Anwendung der Antiseptika als wassrige Losung erleichtert die Wundinspektion indem es zu keiner sog. Pseudoscharausbildung kommt. Eine gute Wirkung von Mafenid® und Lavasept® gegen gramnegative Keime konnte bestatigt werden. In den EscharBiopsien wurden keine Kriterien fur eine tiefe Wundinfektion festgestellt. Das mikrobiologische Keimspektrum der Wundoberflache war, mit Ausnahme von gehauften PseudomonasNachweisen in der Lavasept® -Gruppe, vergleichbar. Unerwunschte Nebenwirkungen traten durch die Anwendung der Antiseptika nicht auf. Ein hemmender Einflus auf das Zellwachstum konnte in Keratinozytenkulturen fur beide Praparate nachgewiesen werden.

Hintergrund: Die Entwicklung eines autogenen Weichgewebsfullmaterials ist Ziel des soft tissue engineering. Klinische Anwendungen sind v. a. posttraumatische oder idiopathische (Romberg-Syndrom) Defekte des subkutanen Fettgewebes. Ziel der Studie war es kultivierte humane Fettgewebsvorlauferzellen in undifferenziertem Zustand an verschiedene Matrices anzuheften und in immuninkompetente Nacktmause zu implantieren und durch in vitro und in vivo Untersuchung die optimierte Matrixstruktur zu definieren.

Die Plastische Chirurgie, die oft nur als reine Schonheitschirurgie angesehen wird, beinhaltet die Versorgung von Handverletzungen, Verbrennungen sowie wiederherstellende Masnahmen am gesamten Korper. Plastische Chirurgen behandeln nicht nur akute Verletzungen, sondern rekonstruieren auch chronische Defekte und Fehlbildungen. Naturlich werden dabei neben der Wiederherstellung der Funktionen auch asthetische Grundprinzipien berucksichtigt.