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Myositis ossificans traumatica (MOT) describes a benign form of ectopic ossification of soft tissue, most commonly skeletal muscle, that occurs in reaction to trauma. Treatment is indicated if important neurovascular structures are compressed or displaced and in case of functional restrictions that hamper movements of daily life. We report the case of a patient who developed increasing palsy of the left deltoid and biceps brachii muscles 8 weeks after multiple injuries sustained in a car accident. Ultrasound and x-rays pointed towards a calcified mass compressing the left brachial plexus. Four months after the precipitating trauma, the mass was surgically resected. Surgical exploration and histopathology yielded the diagnosis of MOT. At a 3-month follow-up visit, the patient experienced complete functional recovery and has remained recurrence free. To our knowledge, this case represents the first report in which MOT caused complete brachial plexus palsy. The findings support the argument that surgical treatment for MOT does not have to be delayed until 6–12 months after the initial trauma to await full maturation. Clinical symptoms extending to complete palsy can result from posttraumatic ectopic calcification. Early surgical intervention in the case of persistence or deterioration of symptoms is indicated. A full remission of nerve and motor function is possible. Level of evidence: Level V, risk/prognostic study.

Summary Background Recently, breast reconstruction with the greater omentum flap has gained more attention, although it has been only rarely reported in the literature. An unpleasant case presented by us here prompted us to perform a literature search on breast reconstruction with the omentum flap concerning postoperative results and complication rates. Case presentation We here present the case of a 46-year-old woman who presented with severe infection 3 months after omentum flap reconstruction in a distant local hospital. Intraoperative revision showed an inflammatory, completely necrotic flap that had to be removed. Conclusion The literature review shows that the omentum flap can be reasonably used only in one-sided reconstructions of very small breasts. Due to the limited indications, unpredictable flap volume, and our negative experience, we recommend that this type of reconstruction be used with restraint.

Squamous cell carcinoma of the skin (SCC) and basal cell carcinoma (BCC) are common entities, often with a benign course. Tumour biology, however, is different in immunosuppressed individuals, such as organ transplant recipients (OTR). As immunosuppression-sparing protocols have not yet been successfully introduced to the clinics, nonmelanoma skin cancers (NMSCs) will continue to affect a majority of OTR, leading to significant morbidity and mortality. Interdisciplinary treatment including the transplant physician, dermatologist and the plastic surgeon is warranted for optimal patient management. This review focuses on special tumour characteristics and therapeutic requirements among OTR. Recommendations for local treatment and oncoplastic surgery are discussed.

Skin defects of the penile shaft, caused by trauma, infection, or iatrogenically after surgery are commonly treated with skin grafts. A suboptimal postoperative outcome after the use of skin grafts is affected by the trend towards wound bed and skin graft contraction in this often-expanding region. We report on our experience using a new technique for defect coverage of the penile shaft with respect to its elasticity demands during erection and its mechanical demands during sexual intercourse. Furthermore we would like to illustrate the advantages of the application of a dermal substitute together with split-thickness skin grafts compared to the use of split-thickness skin grafts alone. At the follow-up, the patient did not report any impairment during erection or after sexual intercourse. The aesthetic outcome was natural and pleasing. The use of acellular dermal templates together with unmeshed split-thickness skin grafts has proven its superior functional and aesthetic outcome in several demanding regions. With the aid of negative-pressure wound therapy, a single procedure for penile defect coverage is possible. Our reported procedure revealed a natural and pleasing outcome, with no sexual impairment and high patient satisfaction. Level of Evidence: Level V, therapeutic study

Background The number of patients requiring post-bariatric body-contouring after massive weight loss (MWL) is steadily increasing. The management of this demanding clientele of patients is challenging and requires a structured approach. The aim of this article is to provide a detailed overview of the contouring approach to the lower body after MWL practiced at Innsbruck Medical University, Department of Plastic, Reconstructive and Aesthetic Surgery, along with an analysis of the procedures over a 10-year period. Special attention is given to the surgical challenges, such as patients presenting with pre-existing scars in the upper abdomen.

Reconstructed mechanically stressed zones of the lower extremity frequently suffer from problems such as hyperkeratotic edges or chronic ulcerations in the transition zone between conventional thigh skin grafts and normal skin. Defect coverage with skin grafts harvested from the instep region and placed on muscle flaps is not yet an established alternative. This is a retrospective study of a series of 12 clinical applications of soft tissue reconstruction at mechanically exposed zones of the lower extremity. Locally transposed or transplanted muscle flaps were covered with meshed instep skin instead of meshed thigh skin for the purpose to gain a superior stable skin surface and transition zones adjacent to normal skin. There is no ulceration found at follow-up from 6 to 72 months. Only one case presented with delayed graft take. Different thicknesses of the corneal layers of the healed instep versus thigh skin grafts were verified histologically. Instep skin grafts showed substantial durability as well as advantageous aesthetic appearance with respect to texture and coloring. All donor sites healed without notable scars or sensitivity disorders. The instep split skin graft is particularly well suited for defect coverage of muscle flaps transposed or transplanted to mechanically stressed zones of the foot or lower leg. The paramount advantage of transplanted instep skin as compared to thigh skin is given by the feasibility to create a durable graft with a thick horny layer and a stable transition zone at its periphery that is bordering normal skin.

Grose Studierendenzahlen und heterogene Dozierende erschweren einheitliche Kursgestaltungen und die objektive Standardisierung von Prufungen im chirurgischen Fertigkeitstraining. Diese Arbeit zeigt die Vorteile des Einsatzes neuer Medien im „Blended-learning-Konzept“ fur das Fertigkeitstraining im Studiengang Humanmedizin der Universitat Basel. Der studentische chirurgische „Nahtkurs“ wurde nach einem Blended-learning-Konzept mit multimedialer CD, Prasenzveranstaltung und Skills Lab restrukturiert. Die Lernziele des Kurses wurden am Ende der Studienjahre anhand von Posten mit Checklisten im OSCE („objective structured clinical examination“) uberpruft. Die studentische Kursbeurteilung sowie die Prufungsergebnisse vor und nach Einfuhrung des „blended learning“ wurden miteinander verglichen. Sowohl die Beurteilungen der eingesetzten Lehrmittel, des subjektiven Ubungserfolges und des prospektiven Nutzens fur das Wahlstudienjahr (Praktisches Jahr) als auch die Gesamtkursbeurteilung waren nach Einfuhrung des Blended-learning-Konzeptes signifikant hoher als im alten Kursformat. Auch der Anteil an bestandenen Prufungen war mit einem Zuwachs von 10% signifikant im Vergleich zum alten Kurs erhoht. „Blended learning” kann sowohl Wahrnehmung und Leistung als auch die Effizienz des Fertigkeitstrainings und der Betreuungszeit verbessern. Dadurch werden indirekt Ressourcen gespart. Chirurgische Verfahren konnen klar und ubersichtlich vermittelt werden.

Background Patients requiring surgical skin excision after massive weight loss are challenging and require an individualized approach. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars from open gastric bypass surgery in the upper abdomen, which compromise blood supply of the abdominal skin. Methods We propose four different surgical techniques for safe abdominal body contouring in the presence of such scars: (1) a limited abdominoplasty of the lower abdomen is performed, and then contouring is completed by a reversed abdominoplasty with scar positioning in the submammary folds; (2) a one-stage procedure characterized by skin resection in the upper and lower abdomen, in which blood supply of the skin island between the submammary and suprapubic incisions is ensured by periumbilical perforators; (3) a perforator-sparing abdominoplasty with selective dissection of periumbilical abdominal wall perforators to secure flap blood supply and allow complete flap undermining up to the xyphoid process; (4) for patients with extensive excess skin, a modified Fleur-de-Lys abdominoplasty performed in such a way that the old transverse scar is transformed into a vertical scar. Results The treatment of four exemplary patients is described. All techniques yielded good esthetic and functional results through preservation of abdominal blood supply. Conclusion Through an individualized approach, adequate abdominal body contouring can be performed safely, even in the presence of transverse surgical scars in the upper abdomen.

The implementation of laser surface scanning to assess facial symmetry after unilateral face-lift procedures used to reconstruct defects after skin tumor resection is presented. Six patients who had undergone defect reconstruction with a flap raised from the subcutaneous plane were included in the study. Immediate postoperative photographic evaluation confirmed facial asymmetry because of unilateral skin tension. After a minimum follow-up period of 1 year, photographic and laser surface scanning analysis showed restored facial symmetry. In conclusion, laser surface scanning is a promising technology for objectifying results obtained and could be implemented for evaluation of the immediate and long-term effects from rhytidectomy procedures. Subcutaneous flaps without duplication or resection of the superficial musculoaponeurotic system are ideal for unilateral procedures because facial symmetry is restored after 1 year.

The perichondrial cutaneous graft (PCCG), a reliable composite graft that provides stability, is routinely harvested from the anterior conchal bowl. This established PCCG was simplified by using the less conspicuous posterior auricular donor site, which can be closed without the need of cartilage resection for reconstruction with a postauricular interpolated skin island. Patients with basal cell carcinoma of the nose underwent reconstruction of the nose with a PCCG if parts of the tip cartilage or the fibrofatty tissue were resected. The defect surface area was assessed with a template. Follow-up evaluation included assessment of graft survival, donor-site morbidity, nostril stability, and aesthetic outcome. Of the 14 patients included in the study, whose average defect sizes were 2 cm2 (ala) and 2.5 cm2 (tip), 79% showed primary complete healing. Nostril stability was symmetrical 6 months postoperatively, and no contractions or depressed contour had occurred. In one case, a hyperpigmented area resulted in a slightly imperfect color match. All the donor sites healed without deformity or destabilization of the ear. With the use of this new posterior auricular donor site for graft harvest, functional, stable, and aesthetic reconstruction of the nose can be achieved. The graft- and donor-site morbidity rates are very low, and the results are fully satisfying.

Introduction: Chronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. A suitable animal model that replicates the situation in humans is not available. Therefore, the aim of the present work is to present a standardized human wound model and the data of a pilot study of topically applied progenitor cells in a sacral pressure sore. Methods: Three patients underwent cell harvest from the iliac crest at the time of the initial debridement. Forty-eight hours after bone marrow harvest and debridement, the CD34 + selected cell suspension was injected into the wound. With the aid of a laser scanner, three-dimensional analyses of wound morphometry were performed until the defect was reconstructed with a local flap 3 weeks after debridement. Results: Decreases in volume to 60%±6% of baseline on the sham side and to 52%±3% of baseline on the cell side were measured. Histologic work-up revealed no signs of metaplastic, dysplastic, or neoplastic proliferation/differentiation after progenitor cell treatment. CD34 + cells were detected in the biopsies of day 0. Conclusions: The pressure sore wound model allows investigation of the initial 3 weeks after cell-based therapy. Objective outcome analysis in terms of wound volume and histology can be performed without, or with, minimal additional morbidity, and the anatomy of the sacral area allows a control and study side in the same patient. Therefore, this model can serve as a standard for wound-healing studies. Trial registration: ClinicalTrials.gov NCT00535548.

Contraction of the fibrous capsule around an implant after prosthetic breast surgery is a serious complication, which can adversely effect the outcome and spoil the overall result. Textured silicone implants are reported to have reduced rates of capsular contraction, but their exact mechanism, especially at the interface, remains unclear. Over a period of 21/2 years, 94 textured silicone implants were used in augmentation mammoplasty. A follow-up examination was possible in 74 cases. The clinical assessment of results was based on Baker's classification. In addition to the subjective assessment of breast firmness, objective measurements (mamma compliance) were obtained. The average follow-up period was 55.6 weeks. 79.7% of augmented breasts were classified as Baker I, 16.2% as Baker II, 4.1% as Baker III and 0% Baker IV In comparison to previous results reported in the literature, the incidence of capsular contracture obtained with textured implants was significantly lower. All Baker III cases were replacements of the original implant following advanced capsular contraction. The compliance measurements were found to correlate well with Baker's classification. Sixty-one of 72 cases of augmented breasts showed compliance values similar to normal breasts, which ranged between 0.64 and 3.7 cm at D20n. This measurement proves that 82.4% of the augmented breasts are as soft as normal breasts. A partial comparison between our clinical data and histological examination was possible. Firm adhesion of the capsule to the surface of the implant was characteristic of those breasts which showed no capsular contracture, while in breasts showing advanced capsular contraction, implant and capsule were separated by a liquid film. The use of surface textured silicone implants has led to a significantly decreased rate of capsular contraction without having to employ steroids. Close contact between implant and capsule seems to be the most important factor for reduced capsular contraction.

Dermatofibrosarcoma protuberans (DFSP) is an unusual cutaneous neoplasm that originates in the dermis. This tumor belongs to the so-called low grade soft tissue sarcomas. The recurrence rate after simple surgical treatment is very high, and initial radical surgical treatment is indicated. In recurrences, the infiltrative growth often leads to invasion of vital structures and may ultimately lead to amputation of extremities. In the case reported, there was an initial misdiagnosis of dermatofibroma; the lesion recurred and was reported as DFSP. It was resected radically, and the defect was covered by a radial forearm flap. The radial forearm flap offers an effective one-stage method of soft tissue reconstruction which allows early mobilization and rehabilitation. After excision of a recurrence on the margin of the free flap 36 months after the first treatment, a deep infiltrating recurrence 12 months later made amputation necessary. The location of DFSP on the plantar aspect of the foot has not been reported previously. A brief review of the literature is presented.