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BACKGROUND Adipose-derived stem cells are considered as candidate cells for regenerative plastic surgery. Measures to influence cellular properties and thereby direct their regenerative potential remain elusive. Hyperbaric oxygen therapy-the exposure to 100% oxygen at an increased atmospheric pressure-has been propagated as a noninvasive treatment for a multitude of indications and presents a potential option to condition cells for tissue-engineering purposes. The present study evaluates the effect of hyperbaric oxygen therapy on human adipose-derived stem cells. METHODS Human adipose-derived stem cells from healthy donors were treated with hyperbaric oxygen therapy at 2 and 3 atm. Viability before and after each hyperbaric oxygen therapy, proliferation, expression of surface markers and protein contents of transforming growth factor (TGF)-β, tumor necrosis factor-α, hepatocyte growth factor, and epithelial growth factor in the supernatants of treated adipose-derived stem cells were measured. Lastly, adipogenic, osteogenic, and chondrogenic differentiation with and without use of differentiation-inducing media (i.e., autodifferentiation) was examined. RESULTS Hyperbaric oxygen therapy with 3 atm increased viability, proliferation, and CD34 expression and reduced the CD31/CD34/CD45 adipose-derived stem cell subset and endothelial progenitor cell population. TGF-β levels were significantly decreased after two hyperbaric oxygen therapy sessions in the 2-atm group and decreased after three hyperbaric oxygen therapy sessions in the 3-atm group. Hepatocyte growth factor secretion remained unaltered in all groups. Although the osteogenic and chondrogenic differentiation were not influenced, adipogenic differentiation and autodifferentiation were significantly enhanced, with osteogenic autodifferentiation significantly alleviated by hyperbaric oxygen therapy with 3 atm. CONCLUSION Hyperbaric oxygen therapy with 3 atm increases viability and proliferation of adipose-derived stem cells, alters marker expression and subpopulations, decreases TGF-β secretion, and skews adipose-derived stem cells toward adipogenic differentiation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.

Introduction Numerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result. Objectives In the present preliminary report, we introduce a new technique called the three-block L -wing reduction mammaplasty that addresses the aforementioned difficulties. Materials and Methods The three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients. Results Our technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast. Conclusion The three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.

Background: The macrophage migration inhibitory factor (MIF) has been determined as a cytokine exerting a multitude of effects in inflammation and angiogenesis. Earlier studies have indicated that MIF may also be involved in wound healing and flap surgery. Methods: We investigated the effect of MIF in an excisional wound model in wildtype, Mif-/- and recombinant MIF treated mice. Wound closure rates as well as the macrophage marker Mac-3, the pro-inflammatory cytokine tumor necrosis factor α (TNFα) and the pro-angiogenic factor von Willebrand factor (vWF) were measured. Finally, we used a flap model in Mif-/- and WT mice with an established perfusion gradient to identify MIF's contribution in flap perfusion. Results: In the excision wound model, we found reduced wound healing after MIF injection, whereas Mif deletion improved wound healing. Furthermore, a reduced expression of Mac-3, TNFα and vWF in Mif-/- mice was seen when compared to WT mice. In the flap model, Mif-/- knockout mice showed mitigated flap perfusion with lower hemoglobin content and oxygen saturation as measured by O2C measurements when compared to WT mice. Conclusions: Our data suggest an inhibiting effect of MIF in wound healing with increased inflammation and perfusion. In flaps, by contrast, MIF may contribute to flap vascularization.

Rationale Skin breakdown, as in wounds, leads to an electric potential, defined as current of injury with the intent of wound closure. Burn wounds are defined by different zones of perfusion having a direct influence on further therapy (e.g. conservative management or skin grafting). We studied immediate, quantifiable effects of electric stimulation on skin perfusion in burn wounds. Method Wireless Microcurrent Stimulation (WMCS) was utilised as an adjunct therapeutic modality in 10 patients with partial thickness burn wounds. Microcirculation in the skin was quantified with a Laser Doppler (LDI) before and after WMCS treatment. We included a control group of 10 healthy individuals. Results A single application of WMCS significantly increased mean flow, velocity and subsequently, haemoglobin and oxygen saturation in partial thickness burn wounds. In healthy skin these parameters increased, but were far less pronounced than in thermally injured skin. Conclusion This study revealed, for the first time that non-contact WMCS improves blood flow in critically perfused partial thickness burn wounds without disturbing the wound or systemically affecting the patient and may represent a promising adjunct tool in burn treatment, with the potential of faster healing by enhanced perfusion of burn wounds and reduction of the zone of stasis. Level of evidence: III

Healthcare : open access journal 9(6), 616 (2021). doi:10.3390/healthcare9060616 special issue: "Special issue "Minimally invasive techniques and advanced surgical procedures" / special issue editor: Dr. Panagiotis Fikatas, guest editor", Published by MDPI, Basel

Cartilage tissue has a limited capacity for healing with the consequence that patients are often treated symptomatically until they become candidates for osteotomy or total joint replacement. Alternative biological therapies, for example, application of platelet-rich plasma and implantation of chondrocytes and mesenchymal stem cells, have emerged as a new treatment modality to repair articular cartilage. In addition, autologous fat transfer is performed for treatment of cartilage defects, example given, in osteoarthrosis, but several questions regarding basic biochemical properties of the transplant remain unanswered. Bone morphogenetic protein 4 (BMP4), matrix metalloproteinase (MMP)-8, cartilage oligomeric matrix protein (COMP), and chitinase-3-like protein 1 (CHI3L1) have been shown to be involved in chondrogenic regeneration and represent potential therapeutic agents for cartilage repair. However, no study regarding naturally occurring levels of these soluble factors in transplanted adipose tissue has yet been performed.To investigate the influence of age, body mass index, donor site, and sex on the concentration of BMP4, MMP-8, COMP, and CHI3L1 in freshly aspirated adipose tissue, their content was measured by means of enzyme-linked immunosorbent assay readings.There were significant quantities of BMP4, MMP-8, COMP, and CHI3L1 (23.6, 249.9, 298.0, and 540.6 pg/mg, respectively) in the lipoaspirate harvested for transplantation. There was no correlation between the content of soluble factors and the patients' age or body mass index. Furthermore, the sex did not affect the amount of the investigated factors. However, there were significantly lower contents of BMP4, COMP, and CHI3L1 found in lipoaspirates harvested from the abdomen compared with nonabdominal donor sites.Naturally occurring differences in the concentrations of the investigated soluble factors will favor certain donor sites for autologous fat transfer in the field of cartilage repair. Thus, increasing knowledge will enable researchers and clinicians to make autologous fat transfer procedures more reliable and efficient for treatment of articular cartilage defects.

Auch wenn der uberwiegende Teil asthetisch-plastischer Eingriffe an Frauen vorgenommen wird, stellen Manner eine relativ konstante Quote, wohingegen sich bei ihnen eine Verschiebung der durchgefuhrten Eingriffe beobachten lasst. Insbesondere die Volumentherapie mit Fillern und autologem Fett, die jeweils spezifische Eigenschaften, Vor- und Nachteile mit sich bringen, erfreuen sich zunehmender Beliebtheit.

Breast cancer is among the most commonly diagnosed cancers in the world, affecting one in eight women in their lifetimes. The disease places a substantial burden on healthcare systems in developed countries and often requires surgical correction. In spite of this, much of the breast cancer pathophysiology remains unknown, allowing for the cancer to develop to later stages prior to detection. Many women undergo reduction mammaplasties (RM) to adjust breast size, with over 500,000 operations being performed annually. Tissue samples from such procedures have drawn interest recently, with studies attempting to garner a better understanding of breast cancer’s development. A number of samples have revealed nascent cancer developments that were previously undetected and unexpected. Investigating these so-called “occult” findings of cancer in otherwise healthy patients may provide further insight regarding risk factors and countermeasures. Here, we detail occult findings of cancer in reduction mammaplasty samples provided from a cohort of over 5000 patients from 16 different institutions in Europe. Although the majority of our resected breast tissue specimens were benign, our findings indicate that there is a continued need for histopathological examination. As a result, our study suggests that preoperative imaging should be routinely performed in patients scheduled for RM, especially those with risk factors of breast cancer, to identify and enable a primary oncologic approach.

Fat grafting is as a unique regenerative filler with soluble factors and progenitor cells that may remodel scar tissue in an easy yet effective way. A combination of microfat grafting, lipococoncentrate injection, scar subcision, and platelet-rich plasma supplementation may be used to treat the majority of facial scars. The lipoconcentrate technique condenses the lipoaspirate to a progenitor cell-rich fluid of low volume by a combination of centrifugation and emulsification steps. In this article, the authors' methods for scar treatment by fat grafting are discussed. Choice of technique for facial scars, precise indications, and contraindications are introduced.

This chapter will mainly concentrate on basic principles for biopsy and excision of the primary tumour as well as lymph nodes and finally the reconstruction of malignant cutaneous tumours. Special reconstructive techniques for localized skin cancers of the respective body parts as well as the detailed surgical management of lymph nodes will be introduced in the following chapters. As the title of this chapter already suggests, cutaneous melanomas (CMs) are regarded as a special entity within the groups of malignant skin tumours due to their specific pathogenesis and treatment. They resemble the most feared malignant tumour with considerable morbidity and mortality.

Tissue expansion is based on a dynamic process of nature in which vital tissue responds to continuous mechanical stress load. The capability to gain or lose weight during pregnancy for instance demonstrates the skin ability to develop independently. Tissue expansion has a significant implication in different ethnic societies throughout the world. Enlarged lips of Ethiopian Mursi women or elongated necks of Padauang women attest the exotic aesthetics associated with tissue expansion [1]. Tissue expansion represents the medical application of this normal physiologic process for reconstructive purposes and has already provided to be a reliable principle in plastic and reconstructive surgery [2, 3].

The performance of a transparent absorbent adhesive wound dressing (TAAWD) was observed over 7 days in five plastic surgery clinics across Germany. The study included 47 diverse postoperative linear wounds and donor sites with dry or minimal exudate levels. Data on ease of application and removal, adhesive strength, skin compatibility, conformability to the body, visual wound inspection and parameters of wound assessment were collected and analysed. At the end of the observation period, 100% of wounds were recorded as healing with no reported complications. Clinicians considered that the new dressing had predominantly met clinical needs in 89% of cases. The dressing was shown to be skin friendly, easy to apply, adhere and conform to the skin while protecting the wound and allowing the patient to shower. Due to its transparency, the dressing enabled direct wound surveillance without potential disruption to the wound and healing process.

This prospective case study presents a new method for the treatment of oversized and therapy-resistant keloids of the neck and ears employing intralesional excision combined with intralesional cryosurgery. The keloids were excised in an intralesional approach, and the remaining base and lateral margins of the scar tissue were frozen using intralesional cryoneedles. After complete thawing of the frozen tissues, the margins of the scar were approximated and sutured. The follow-up period extended over 18–24 months. Over a period of 12 months, the scars gradually flattened with no hypopigmentation. No signs of recurrence of the keloids were seen. Intralesional excision of oversized and therapy-resistant keloids combined with intralesional cryosurgery could well be an additional tool to the plastic surgical armamentarium, for treating this group of patients. Level of Evidence: Level IV, therapeutic study.

Background: Although chemical antiseptics are the most basic measure to control wound infection and frequently come into contact with subcutaneous adipose tissue, no studies have evaluated their toxicity on adipose tissue and its cell fractions. In the present study, the effects of five different antiseptics on adipose-derived stem cells were evaluated. Methods: Human adipose-derived stem cells were harvested from healthy donors. Adipose-derived stem cell viability was measured after treatment with different concentrations of antiseptics over 5 days. Furthermore, the effect on the proliferation, adipogenic differentiation, and apoptosis/necrosis of adipose-derived stem cells was analyzed. Finally, the mRNA expression of the stem cell markers CD29, CD34, CD73, CD90, and CD105 was detected. Results: Octenisept and Betaisodona significantly reduced cell proliferation and differentiation and led to considerable adipose-derived stem cell necrosis. Octenisept decreased stem cell viability at the lowest concentrations tested, and all stem cell markers were down-regulated by Octeniseptr and Betaisodona. Lavasept and Prontosan both led to reduced stem cell viability, proliferation, and differentiation, and increased apoptosis/necrosis, although the effects were less pronounced compared with Octenisept and Betaisodona. Adipose-derived stem cells survived treatment with mafenide acetate even at high concentrations, and mafenide acetate showed minimal negative effects on their proliferation, adipogenic differentiation, cell death, and stem cell marker expression. Conclusions: Mafenide acetate may be regarded as a feasible antiseptic for the treatment of wounds with exposed adipose tissue because of its low adipose-derived stem cell toxicity. Lavasept and Prontosan are possible alternatives to mafenide acetate. Octenisept and Betaisodona, by contrast, may be used only in highly diluted solutions.

In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRAC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.

Hintergrund: Die autologe Fetttransplantation ist eine in letzter Zeit zunehmend verbreitete operative Prozedur und umfasst die Entnahme, Bearbeitung und Transplantation von Fettgewebe sowie die fachgerechte Nachsorge. Dieser operative Eingriff ist ein Verfahren, das sowohl nach traumatischem, krankheits- oder altersbedingtem Volumenverlust der Weichteile als auch zur Weichteilaugmentation eingesetzt werden kann. Aufgrund der zunehmenden Anwendung aber noch bisher wenig definierten Variablen in der Fettgewinnung, Indikationsstellung und Art der Transplantation in der rekonstruktiven und asthetischen Chirurgie besteht ein groses Interesse an der Entwicklung einer Leitlinie. Methodik: In einer Konsensuskonferenz im Rahmen eines nominalen Gruppenprozesses der anwendenden Fachgesellschaften wurden alle im Delphi-Verfahren strittigen Punkte diskutiert und mit starken Konsens (>95%) beschlossen. Die Literatur der letzten 10 Jahre in den gangigen medizinischen Informationsportalen und Datenbanken wurde abgefragt, studiert und unter Berucksichtigung auch wichtiger alterer Arbeiten entscheidende Aussagen der Leitlinie belegt. Ergebnisse: Unter Einschluss aller relevanten Fachgesellschaften wurden hinsichtlich nachfolgender Punkte konsensbasierte Empfehlungen in Form dieser Leitlinie formuliert. 1. Definition, 2. Indikation/Kontraindikation, 3. Praoperative Masnahmen, 4. Entnahmetechniken, 5. Bearbeitungstechniken, 6. Transplantation, 7. Nachsorge, 8. Aufbewahrung und Lagerung, 9. Effizienz, 10. Dokumentation, 11. Bewertung der Sicherheit. Zusammenfassung: Klare Indikationsstellung und fachliche Expertise sind Grundvoraussetzung um die autologe Fetttransplantation durchzufuhren. Der Erfolg dieses operativen Eingriffs ist abhangig vom Einsatz der richtigen Methoden sowie der speziellen Instrumente und Materialen. Aufgrund der niedrigen Rate an postoperativen Komplikationen und Spatfolgen ist die autologe Fetttransplantation als sicheres Verfahren in der rekonstruktiven und asthetischen Medizin anzusehen. Teile dieses Artikels sind wortlich aus der Leitlinie entnommen 1

The Vectra X3 3-dimensional face scanner allows us to visualise the erythema of superficial layers of skin in addition to its regular scanning functions. The aim of our study was to find out whether changes we provoked in the circulation of the skin would be registered and displayed by the face scanner. We measured the circulation in the skin of the cheeks of 20 volunteers with a face scanner, a laser Doppler device, and a skin pigmentation analyser before and after the application of a nitric oxide cream. The results were compared in terms of grey tones, local concentrations of haemoglobin, and erythema. All methods showed significant changes (p0.001) before and after application of the cream. The study proved that the Vectra X3 recognises changes in skin circulation and displays them in a simple and evident way.

Background One increasingly important trend in plastic, reconstructive, and aesthetic surgery is the use of fat grafts to improve cutaneous wound healing. In clinical practice, lipoaspirates (adipose tissue harvested by liposuction) are re-injected in a procedure called lipofilling. Previous studies, however, mainly evaluated the regenerative effect of isolated adipocytes, adipose-derived stem cells, and excised en bloc adipose tissue on keratinocytes, whereas no study to date has examined the effect of lipoaspirates. Objectives The authors aimed to investigate differences in the regenerative property of en bloc adipose tissue and lipoaspirates on keratinocytes. Methods Human keratinocytes, lipoaspirates, and en bloc adipose tissue from 36 healthy donors were isolated. In vitro proliferation, differentiation, migration, stratification, and wound healing of keratinocyte monolayers were measured. Furthermore, secreted levels of VEGF, bFGF, IGF-1, MMP-9, and MIF were detected by ELISA. Results Migration, proliferation, and wound healing of keratinocytes were increased by lipoaspirates. Interestingly, the effect of lipoaspirates on keratinocyte proliferation was significantly higher than by en bloc adipose tissue after 5 days. The differentiation of keratinocytes was equally attenuated by lipoaspirates and en bloc adipose tissue. Stratification of keratinocyte layers was enhanced by lipoaspirates and en bloc fat when compared to controls. Lipoaspirates secrete higher levels of bFGF, whereas higher levels of VEGF and IGF-1 are released by en bloc adipose tissue. Conclusion We show that lipoaspirates and en bloc adipose tissue have a regenerative effect on keratinocytes. One reason for the higher effect of lipoaspirates on keratinocyte proliferation may be the secretion of different cytokines. [10.1093/asj/sjw076][1] [1]: /lookup/doi/10.1093/asj/sjw076

In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients' characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients.

An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.

Background Although fat grafting has emerged as a major force in plastic, reconstructive, and aesthetic surgery, some questions regarding its reliability and regenerative potential remain unanswered. Objectives The authors examined the influence of three anatomic areas on various lipoaspirate properties to identify the most appropriate harvest site for fat-grafting procedures. Methods Lipoaspirates from 25 healthy patients were harvested from the abdomen, inner thigh, and knee. The authors measured the content of soluble factors in the lipoaspirate followed by the assessment of the yield, adipogenic differentiation, proliferation of stromal vascular fraction (SVF) cells, and the percentage of adipose-derived stem cells (ASC) in the SVF. The results also were correlated with the age and body mass index of the donors. Results Lipoaspirates from the abdomen showed significantly higher concentrations of matrix metalloproteinase (MMP)-9 compared with the knee. The content of basic fibroblast growth factor (b-FGF), platelet-derived growth factor (PDGF)-BB, and insulin-like growth factor (IGF)-1 tended to be highest in the abdomen but did not reach statistical significance. Vascular endothelial growth factor (VEGF)-A and bFGF-2 contents both correlated negatively with age in lipoaspirates from at least two different anatomic areas. Conclusions The authors' results indicate that the abdomen may be a slight favorite over the inner thigh and knee because of its richer content of soluble factors. However, because only the difference of MMP-9 content actually reached statistical significance and because no differences in SVF characteristics were observed, a decision primarily based on other criteria appears to be justifiable.

Hintergrund: Der Fachbereich der Plastischen Chirurgie weist eine deutlich zunehmende Bandbreite der Forschungsaktivitat in den vergangenen Jahrzenten auf. Im Vergleich zu anderen Fachdisziplinen scheint es gleichzeitig an zentraler Koordination in den unterschiedlichen Forschungsbereichen zu fehlen. Bis dato fehlt es hier auch an einer umfangreichen, regelmasigen Auswertung der Forschungsaktivitat. Diese Studie dient einer Ubersicht der deutschen, universitaren Forschungsaktivitat im Bereich der Plastischen Chirurgie. Material und Methoden: Wir fuhrten eine retrospektive Analyse im 5-Jahresintervall (01/2010–12/2014) von PubMed gelisteten Publikationen deutscher, universitarer Kliniken fur Plastische Chirurgie durch. Es erfolgte fur jede Universitat (n=11) eine statistische Auswertung der folgenden Parameter: Verteilung des Forschungsschwerpunktes, Anzahl der Publikationen, jahrliche kumulative Impact-Summe (IS) und Impact-Factor (IF). Ergebnisse: Fur den o. g. Zeitraum wurden insgesamt n=904 Publikationen ausgewertet. Ein Ranking der akademischen Kliniken ergab sich wie folgt: Anzahl an Publikationen: 1. MH-Hannover 178 (jahrlicher Durchschnitt x=36/Median x=34); 2. Universitat Erlangen 115 (x=23/x=23); 3. Bergmannsheil Bochum 90 (x=18/x=19). Die durchschnittliche IS ergab: 33,51 (SD 11,088, p Schlussfolgerung: Basierend auf dieser umfangreichen Auswertung scheint eine zentrierte, periodische Auswertung der aktuellen Forschungsaktivitat in Zukunft nutzlich. Datenauswertungen sollten sowohl auf europaischer als auch auf internationaler Ebene begonnen und auf andere chirurgische und medizinische Disziplinen ubertragen werden.

The reconstruction of peripheral nerve injuries is clinically challenging, and today, the autologous nerve transplantation is still considered as the only gold standard remedy for nerve lesions where a direct nerve coaptation is not possible. Nevertheless, the functional merits of many biomaterials have been tested as potential substitutes for the autologous nerve transplant. One of the strategies that have been pursued is the combination of bioengineered nerve guides with cellular enrichment. In this present study, we combined the previously evaluated collagen-based and microstructured nerve guide Perimaix with olfactory ensheathing cell enrichment. Rat sciatic nerve defects of 20 mm were either bridged by a cell-seeded or nonseeded nerve guide or an autologous nerve transplant. Animals were monitored for 12 weeks for structural and functional parameters. Seeded cells survived on Perimaix, and following implantation aligned along the microstructured Perimaix framework. Axonal densities within the cell-seeded nerve guides were higher than in the nonseeded nerve guides and were comparable to the autograft. Additionally, cell-seeding had local beneficial effects on myelination within the nerve guide, as myelin sheath thickness was enhanced when compared with the empty scaffold. Nevertheless, for bridging the nerve gap of 20 mm, both the cell-seeded as well as nonseeded scaffolds were equally efficient regarding the functional outcome, which did not differ between the autograft, seeded or nonseeded groups. Our data demonstrate that olfactory ensheathing cell enrichment has local effects on nerve regeneration in combination with the Perimaix nerve guide. Surprisingly, for traversing the lesion gap, additional cell-seeding is not crucial.

During the last three decades, tissue engineering and reconstructive surgery have become standard therapeutic options in the world of medicine. Several biomaterials, either alone or in combination with cultured cellular products, have been introduced to compensate for the scarcity of autologous donor tissue or to improve healing in a variety of surgical specialties, for example, abdominal/visceral surgery, plastic surgery, and cardiovascular surgery. Many of these biomaterials are of porcine origin. It is well known that Islam has prohibited the consumption of porcine or any of its products. With Muslims accounting for 23% (1.6 billion) of the global population, a thorough review of the implications of porcine-derived tissue-engineered products in surgery seems necessary. In life-threatening conditions as well as severe diseases, the use of porcine-derived products is permissible if similar non-porcine-derived materials are not available. In this case, the use of porcine-derived products represents a necessity and is allowed. Therefore, this distinction between sole need and necessity has great importance not only for the medical community but also for researchers in biotechnology and industry who may consider alternatives to porcine-derived materials.

Many bioartificial nerve guides have been investigated pre-clinically for their nerve regeneration-supporting function, often in comparison to autologous nerve transplantation, which is still regarded as the current clinical gold standard. Enrichment of these scaffolds with cells intended to support axonal regeneration has been explored as a strategy to boost axonal regeneration across these nerve guides Ansselin et al. (1998). In the present study, 20 mm rat sciatic nerve defects were implanted with a cell-seeded microstructured collagen nerve guide (Perimaix) or an autologous nerve graft. Under the influence of seeded, pre-differentiated mesenchymal stromal cells, axons regenerated well into the Perimaix nerve guide. Myelination-related parameters, like myelin sheath thickness, benefitted from an additional seeding with pre-differentiated mesenchymal stromal cells. Furthermore, both the number of retrogradely labelled sensory neurons and the axon density within the implant were elevated in the cell-seeded scaffold group with pre-differentiated mesenchymal stromal cells. However, a pre-differentiation had no influence on functional recovery. An additional cell seeding of the Perimaix nerve guide with mesenchymal stromal cells led to an extent of functional recovery, independent of the differentiation status, similar to autologous nerve transplantation. These findings encourage further investigations on pre-differentiated mesenchymal stromal cells as a cellular support for peripheral nerve regeneration.

Background The spontaneous reinnervation of free flaps, such as deep inferior epigastric perforator (DIEP) flaps, is not fully understood, and few publications have investigated this issue. The aim of this study was to examine spontaneous reinnervation following breast reconstruction with autologous DIEP flaps without an additional nerve transfer. Methods In a retrospective clinical study, 18 female patients were investigated for a mean of 49.59 months (range, 12–88 months) following breast reconstruction with a unilateral DIEP flap. Five sensory modalities were tested: pressure perception, dynamic two-point discrimination, sharp-blunt discrimination, hot and cold discrimination, and vibration perception threshold (VPT). The measurements were performed on the reconstructed breast, flap surrounding transition zone, healthy contralateral breast, and the donor site. For a more precise analysis all breasts have been divided into five different segments (mediocranial, laterocranial, mediocaudal, laterocaudal, and reconstructed nipple–areola complex, if present). Additionally, tissue oxygen saturation and tissue hemoglobin were measured by laser Doppler spectroscopy. Results Spontaneous reinnervation of at least one modality tested was observed in all DIEP flaps ( n = 18). This sensitive recovery increases over the postoperative period. The maximum difference between the controls and DIEP flaps was observed in cold perception, whereas the least difference was observed in the VPT. Regarding the different segments, we observed better sensitive recovery in the cranial parts of the DIEP flaps and the transition zone. Conclusion This study provides certain predictions for patients and surgeons, when and to which extent spontaneous reinnervation can be expected.

Zur chirurgischen Intervention im Gesichtsbereich gehoren profunde Kenntnisse der Anatomie. Das Gesicht kann nach dem SCALP-Prinzip in 5 Schichten aufgeteilt werden. Eine Besonderheit des Gesichts ist die Existenz des superfiziellen muskuloaponeurotisches Systems (SMAS), das die Dermis mit den darunter liegenden mimischen Muskeln verbindet und die Grundlage fur die exakte Ubertragung von Gesichtsausdrucken bildet. Es besteht aus einem Netzwerk an Kollagenfasern, elastischen Fasern, Myo- und Adipozyten. Das muskuloaponeurotische System trennt die oberflachlichen von den tiefen Fettkompartimenten, die das Gleiten der Gesichtsmuskeln ermoglichen. Nebeneinander lokalisierte Fettkompartimente werden durch sog. „retaining ligaments“ separiert. Die Lokalisation und das Volumen dieser Kompartimente andern sich im Alter. Der Gesichtsschadel ist als knochernes Grundgerust fur die Gesichtsweichteile ebenfalls den Alterungsprozessen durch Knochenresorption unterworfen. Die 7 „danger zones“ – potenzielle Gefahrenzonen – beschreiben potenzielle Nervenschadigungsareale, die bei chirurgischen Eingriffen berucksichtigt werden mussen.

Meningococcal ( Neisseria meningitides ) septicemia is a feared diagnosis in febrile infants presenting with a petechial rash. Despite a good susceptibility to penicillin which usually results in an assumed bacterial clearance from blood cultures early on; extensive organ damage often mandates a prolonged period of aggressive supportive therapy. In this context, overall outcomes can dependent on specific, organ-related complications and thus should be anticipated. In the reported case, a rare sudden occurrence of early-onset compartment syndrome of all extremities highlights muscle ischemia as a possible cause of unresponsiveness to intensive care treatment despite assumed bacterial clearance. Among other conclusions, the presented case mandates a close monitoring of both clinical and laboratory features of muscle damage as a standard measure of care designed to trigger emergency surgical decision making. Most importantly, we anticipate a likely significant improvement of long-term outcomes based on the notion of meningococcal sepsis-induced compartment syndrome in infants being an under-diagnosed entity.

Gender-specific differences in the outcome of patients with burn injury have been recognized in the past with female patients being at a higher risk of mortality. We hypothesized that early post-burn interleukin-6 (IL-6) cytokine levels may contribute to the different gender-specific outcome. We retrospectively examined 94 burned patients who were treated in the Burn Intensive Care Unit at the University Hospital Aachen. Age, gender, presence of inhalation injury, depth, TBSA, and clinical outcome were documented. Serum samples for IL-6 analysis were collected within 24 hours posttrauma. The relationship between IL-6 levels, gender, survival, and abbreviated burn severity index score was investigated. Male patients (64.9%; n = 61) presented a higher median TBSA (26%) than female patients (20%). The mortality rate of male patients (27.9%; n = 17) and female patients (21.2%; n = 7) was similar. Deceased patients had significant higher TBSA (P = 0.0005) and IL-6 levels (P = 0.0007) than burn survivors. A moderate correlation between IL-6 levels and abbreviated burn severity index score was observed (r = 0.554; P < 0.0001). While TBSA showed a significant influence on IL-6 levels (P = 0.0003), gender did not (P = 0.7395) and inhalation injury indicated a minor influence (P = 0.0780). Only TBSA and age presented a significant influence on mortality (P = 0.0028 and P = 0.0031, respectively). All patients with burn trauma were characterized by elevated IL-6 levels with higher TBSA values resulting in more pronounced levels. Deceased patients had higher initial IL-6 serum levels reflecting higher TBSA and severity. In contrast to other defined trauma mechanisms, gender had no significant influence on postburn IL-6 serum levels and mortality in our patient population.

The umbilicus’ configuration and position are essential to the aesthetic appearance of the abdomen. Absence or deformity of this cavitation draws unwanted attention and may lead to emotional distress. The author discusses the aesthetic importance of the umbilicus throughout the course of history to modern and various techniques of umbilicoplasty.

BACKGROUND A variety of therapeutic procedures for treating keloids have been previously reported, with varying success and recurrence rates. As a monotherapy, intralesional cryosurgery has yielded convincing clinical results. OBJECTIVE We combined intralesional cryosurgery with the application of topical silicone gel sheeting. MATERIALS AND METHODS In this retrospective study, which was conducted between 2008 and 2012, 21 patients with 32 keloids were enrolled. Twenty-five lesions were treated with intralesional cryotherapy combined with postoperative silicone gel sheeting (the cryotherapy + silicone group), and 7 keloids were treated with intralesional cryotherapy alone (the cryotherapy group). The scar volume reduction was assessed, and the patients' subjective and objective parameters were evaluated. Additionally, patient satisfaction was estimated using a modified Gorney Gram scale (0-3). RESULTS In all cases (n = 32 for both groups), a significant keloid volume reduction was observed. The patients' subjective complaints were significantly improved, whereas the combined therapy showed slightly better results in hardness (p < .0012), pain (p < .0233), and discomfort (p < .0029), whereas monotherapy achieved higher satisfaction scores in redness (p < .0220) and pruritus (p < .0206), although these differences were not significant between the treatment modalities. CONCLUSION The results of this study support the use of combined intralesional cryosurgery followed by the application of silicone gel sheeting to treat refractory keloids.

Objective Acute phlebitis due to peripheral vein catheter use is frequently observed in clinical practice, and requires surgical therapy in severe cases. In this retrospective study, we aimed to increase awareness, evaluate current treatment options, and develop recommendations to optimize treatment outcomes. Methods A total of 240 hospitalized patients with a diagnosis of upper extremity phlebitis from 2006 to 2011 were evaluated in terms of initial clinical features, parameters, co-morbidities and treatment regimes. Severity of phlebitis was graded according to the Baxter scale by assessing clinical symptoms such as pain, erythema, induration, swelling, or palpable venous cord (grade 0–5). Patients were divided in two subgroups: conservative ( n = 132) and operative ( n = 108) treatment. Results Surgical intervention rates and severity were higher for cannula insertion in the cubital fossa region than for cannula insertion in the forearm and hand region ( p < 0.05). Baxter scale grades were higher in the surgical treatment group than in the conservative treatment group (4.47 vs. 2.67, respectively). Conclusions The cubital fossa region is vulnerable to severe phlebitis and is not recommended as the first site of choice for cannulation. Phlebitis of Baxter scale grade 4 or 5 should be considered for early surgical intervention.

Hintergrund: Die Hand stellt als Tast- und Greiforgan den mit Abstand differenziertesten Abschnitt des Bewegungsapparats dar. Das Spektrum von Handgelenksverletzungen reicht von Bagatellschaden bis hin zu komplexen Traumata mit gleichzeitigem Verlust von funktionellen Aspekten, woraus enorme volkswirtschaftliche Kosten resultieren. Die therapeutische Wiederherstellung des Gleichgewichts zwischen der Belastbarkeit und der tatsachlichen Beanspruchung eines Gelenks ist die Voraussetzung fur eine lebenslange und storungsfreie Funktion eines Gelenks. Material/Methode: Im Rahmen eines Literaturreviews zu Modellansichten respektive Theorien zur Biomechanik der Handwurzel wurden die Gefundenen dahingehend analysiert, ob sie sich zur Abbildung klinischer Fragestellungen im Zusammenhang mit pathologischen Veranderungen und zur computerunterstutzten Therapieplanung/-simulation entsprechender therapeutischer Masnahmen eignen. Ergebnisse: Obgleich die Ruckfuhrung der Biomechanik eines Gelenks in seinen Normalzustand ein Schlusselfaktor fur eine erfolgreiche Therapie zur Wiederherstellung einer ungestorten Gelenkfunktion ist, existieren zum jetzigen Zeitpunkt lediglich simplifizierte Modellansichten respektive Theorien zur Biomechanik der Handwurzel basierend auf Approximationen durch technische Ersatzgelenke. Bis zum jetzigen Zeitpunkt existiert kein validiertes biomechanisches Handgelenksmodell. Schlussfolgerung: Eine valide biomechanische Modellierung und Simulation und damit Pradiktion zur systematischen Planung therapeutischer Masnahmen ist anhand veroffentlichter Modellansichten respektive Theorien zur Biomechanik der Handwurzel bisher nicht moglich. Im Hinblick auf die auftretenden komplexen klinischen Problematiken sollen daher geeignete computerunterstutzte Planungs- und Simulationsmodelle entwickelt werden.

Objective. Recent advances in adipose cellular biology have repopularized autologous fat grafting as a method widely used in both reconstructive and aesthetic surgery. This review aims to summarize our current knowledge on autologous fat grafting emphasizing harvesting techniques and processing methods as well as current trends and approaches. Methods. A thorough search of earlier and recent literature until October 2013 was conducted using the terms autologous fat grafting, autologous fat transfer, lipoaspirate, lipoinjection, fat harvest, and lipotransfer in PubMed and ClinicalTrials.gov databases, and relevant English- and German-language articles were included. Results. Findings were categorized in a step-by-step approach of the fat grafting procedure into indications, selection of donor site, techniques for harvesting, processing, and reimplantation of autologous fat. Conclusions. Further in-depth knowledge will provide definite answers on fat graft survival; demonstrate safe methods to increase cell viability, grafting outcome predictability; and reliability; enhance safety; and strengthen the scientific and clinical establishment of this increasingly promising method.

Clinics and practice 6(4), 879 (2016). doi:10.4081/cp.2016.879, Published by Page Press, Pavia

The supraclavicular artery perforator (SAP) flap is a versatile flap for the reconstruction of head and neck defects. Recently, the authors have modified the SAP flap by using an anterior branch of the transverse cervical artery. The anterior SAP flap allows the harvest of a tissue island in the deltopectoral fossa, which is even thinner, is more pliable, and shows a superior color match to the face and neck compared with the original SAP flap. Pre-expansion increases flap size considerably, enabling the coverage of extended defects without the need of microsurgery.

Background: The application of a new approach is presented, percutaneous aponeurotomy and lipofilling, which is a minimally invasive, incisionless alter native to traditional flap reconstructions. Methods: The restrictive subdermal cicatrix and/or endogenous aponeurosis is punctured, producing staggered nicks. Expansion of the restriction reconstructs the defect and creates a vascularized scaffold with micro-openings that are seeded with lipografts. Wide subcutaneous cuts that lead to macrocavities and subsequent graft failure are avoided. Postoperatively, a splint to hold open the neomatrix/graft construct in its expansive state is applied until the grafts mature. Thirty-one patients underwent one to three operations (average, two) for defects that normally require flap tissue transfer: wounds where primary closure was not possible (n = 9), contour defects of the trunk and breast requiring large-volume fat grafts (n = 8), burn contractures (n = 5), radiation scars (n = 6), and congenital constriction bands (n = 3). Results: The regenerated tissue was similar in texture and consistency to the surrounding tissues. Wider meshed areas had greater tissue gain (range, 20 to 30 percent). There were no significant wound-healing issues, scars, or donorsite morbidities. Advancement tension was relieved without flap undermining or decreased perfusion. Conclusions: Realizing that, whether scar or endogenous fascia, the subdermal aponeurosis limits tissue stretch and/or its three-dimensional expansion, a minimally invasive procedure that expands this cicatrix into a matrix ideally suited for fat micrografts was developed. Grafting this scaffold applies tissueengineering principles to generate the needed tissue and represents a regenerative alternative to reconstructive flap surgery. (Plast. Reconstr. Surg. 132: 1280, 2013.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

We report a novel, minimal invasive technique for the treatment of symptomatic arthritis of the carpometacarpal (CMC) joint of the thumb, here termed Cell-Enriched Liposaspirate Arthroplasty (CELA). For CELA, autologous fat tissue was harvested using standard liposuction technique followed by an extra-corporal cellular enrichment step. Finally, 1 ml of cell-enriched lipoaspirate was injected into the CMC-joint. Following CELA, the treated patient became pain free within five weeks with a follow-up of 12 months. We conclude that CELA performed on selected cases of arthritis of finger joints such as the basal joint of the thumb has the potential to greatly reduce or delay the necessity for more invasive procedures which tend to improve symptoms of pain at the cost of grip strength and range-of-motion.

Summary Background Biocompatible scaffolds as dermal substitutes are used commonly in soft tissue reconstruction and tissue-engineering approaches. The combination of these scaffolds with mesenchymal stem and stromal cells would have additional benefits in multilayer soft tissue reconstruction. In addition, the use of lipoaspirate may be beneficial for this purpose containing high levels of regenerative cells and relevant growth factors. However there are many factors, which may impact the lipoaspirate content of isolated cells, cell behaviour and growth factors. There is a lack of data as to whether fat-harvesting procedures using different cannulas of small diameter will impact these parameters, which are relevant not only for tissue engineering but also for clinical outcome. Methods Abdominal liposuctions were performed on 10 patients using the conventional fat harvesting by the Coleman cannula (3 mm, one-hole blunt tip) and the micro-fat-harvesting technique by the st'RIM cannula (2 mm, multi-perforated hole blunt tip) on contralateral area. Lipoaspirate contents of insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) were measured by enzyme-linked immunosorbent assay (ELISA). The in vitro viability of lipoaspirates was tested by the alamarBlue™ assay. Adipose-derived stem/stromal cells (ASCs) were isolated and the yields determined. Furthermore, ACSs were seeded on collagen elastin matrices (Matriderm™) and cell migration/adhesion rate was examined by the alamarBlue™ assay and visualised by two-photon microscopy. Results Conventionally obtained lipoaspirates were found to contain significantly higher concentrations of IGF and VEGF, but not PDGF or bFGF. No significant effects on the yields of ASCs or the in vitro viability of lipoaspirates obtained from different cannula sizes were observable. However, the viability and migration of isolated ASCs obtained from micro-harvested lipoaspirates were significantly higher. Moreover, a significant high adherence rate of isolated ASCs from the micro-fat-harvesting technique onto matrices was observed. Conclusion The different sizes and surface/volume ratios of pieces of fatty tissue obtained by using different cannula sizes may be responsible for the observed differences and effects. Thus, micro-fat harvesting may be more suitable for tissue-engineering and -regenerative approaches using ASCs and collagen elastin matrices.

The late-stage clinical course, histopathologic analysis, and surgical salvage procedures after eventful cosmetic injection of hydroxyethylmethacrylate particles suspended in hyaluronic acid (DermaLive, marketed through Dermatech, Paris, France and Novamedical GmbH, Langenfeld, Germany) have been studied. The study was designed to present modified treatment guidelines, report results, and draw conclusions regarding the future management of patients with late-stage DermaLive complications.The study consulted and reviewed 21 patients with late-stage complications after facial implantation of DermaLive. Histology samples from excisional biopsies followed by radical surgical excision procedures were obtained and analyzed for nine patients.The treated zones included nasolabial folds, forehead and glabella, lips, and the perioral and zygoma regions. The late-onset period between injection and first symptoms averaged 17.5 months. Lesions were mostly symptomatic, with discomfort, pain, swelling, and edema. Clinical aspects included bulging, palpable nodules, erythema, and scar formation. A positive correlation between patient age and the delay period was found. All surgically treated patients recovered well. The initial conservative measures achieved only partial success, whereas all nine surgically treated patients (43 %) demonstrated complete relief of their clinical symptoms.Soft tissue augmentation with DermaLive led to a series of severe delayed adverse reactions. Sclerosing DermaLive granulomas demonstrated low success rates with conservative measures, whereas early radical surgical excision achieved good results.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The etiology of long-lasting adverse reactions to gel fillers used in cosmetic surgery is not known. Bacterial infection and immunological reaction to the product have been suggested. Methods We performed a case-control study, with 77 biopsies and 30 cytology specimens originating from 59 patients with adverse reactions to polyacrylamide gel, and 54 biopsies and 2 cytology specimens from 28 control subjects with no adverse reactions. Samples from 5 patients and 4 controls could not be investigated for presence of bacteria owing to limited material. Samples from the remaining 54 patients and 24 controls were systematically examined for the presence of bacteria by culture, 16S rRNA gene sequencing, Gram stain, and fluorescence in situ hybridization. Results Bacteria, mostly normal skin bacteria such as Staphylococcus epidermidis and Propionibacterium acnes, were identified in bacteriologically investigated samples from 53 of 54 patients (98%), and in none of the 24 controls (0%). The bacteria were lying in small clusters, which in symptomatic lesions were detected up to 5 years postinjection. Conclusions Commensal bacteria of low virulence are capable of producing long-term infection in the presence of polyacrylamide filler in cosmetic surgery, possibly due to a biofilm mode of growth. Adequate skin preparation and use of sterile technique in these procedures are mandatory, but antibiotic prophylaxis prior to injection of nondegradable gels like polyacrylamide should be explored as well.

Die intensivmedizinische Versorgung Schwerbrandverletzter muss sich an den unterschiedlichen Phasen der Verbrennungskrankheit orientieren. In diesem Sinne mussen operative und nicht-operative Masnahmen koordiniert werden. Nachdem im ersten Teil des Beitrags (Operative Therapie und Intensivmedizin bei Schwerbrandverletzten – Teil 1: die ersten 24 Stunden, AINS 9/12) die initiale Wundversorgung und die intensivmedizinischen Therapie erlautert wurden, geht der 2. Teil des Beitrags nun auf die anschliesende langdauernde rekonstruktive Phase ein. In diesem Zeitraum ist der weitere kalkulierte Ausgleich des Flussigkeitsdefizits bzw. anhaltender Flussigkeitsverluste durch zerstorte Haut ebenso essenziell wie die Wiederherstellung der Integritat des Integuments und die Modulation der metabolischen Konsequenzen. Besonderes Augenmerk ist auf die Prophylaxe und Therapie lokaler und systemischer Infektionen zu richten.Chirurgisch steht neben dem Ziel der Defektdeckung die Vermeidung von Lokalkomplikationenim Vordergrund, wie sie z.B. durch uberschiesende Narbenbildung entstehen konnen.

Summary Fordyce spots are ectopic sebaceous glands, ranging between 2 and 3 mm in diameter. These benign lesions are most frequently located in the oral mucosa and the genital skin. Especially in the male genital region they can cause itching, discomfort during sexual activities and are aesthetically unpleasant. So far, a variety of therapeutic procedures have been reported with varying success and recurrence rates. In the present retrospective study ( n = 23 patients between 2003 and 2011), we present our surgical approach by means of the micro-punch technique. Using this effective method, we achieved very satisfactory functional and cosmetic results. There were no signs of recurrence during postoperative observations from 12 up to 84 months (median = 51.3 months).

Background: Macrophage migration inhibitory factor (MIF) was firstly described in the 1960s as a pleiotropic cytokine affecting a variety of immune cells. Different physiological functions mainly involving inflammatory reactions such as chemokine-like function and regulating systemic stress responses have been reported. Objective: In several clinical studies the use of MIF as a biomarker has been investigated promising support for diseases with an inflammatory aspect such as sepsis, systemic infections and autoimmune diseases. This article in detail reviews clinical data and evaluates the function as biomarker focusing on inflammatory and autoimmune diseases. Conclusion: Recent studies suggest MIF to be a marker for different inflammatory diseases and might serve as therapeutic target in the future.

An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.

Die intensivmedizinische Versorgung Schwerbrandverletzter muss sich an den unterschiedlichen Phasen der Verbrennungskrankheit orientieren. In diesem Sinne mussen operative und nicht operative Masnahmen koordiniert werden. Die initiale Wundversorgung umfasst zunachst die topische Behandlung weniger schwer verbrannter Hautareale sowie das operative Debridement schwerverbrannter Regionen. Die ersten 24 Stunden der intensivmedizinischen Therapie sind v.a. der hamodynamischen Stabilisierung durch kalkulierten Ausgleich des Flussigkeitsdefizits gewidmet. Neben der Kreislaufstabilisierung steht dabei das Ziel im Vordergrund, eine Zunahme der Odembildung im Wundgebiet und damit eine Zunahme der Gewebeschadigung soweit wie moglich zu vermeiden. Im weiteren Verlauf der Versorgung steht von chirurgischer Seite eine moglichst rasche Deckung der schwer verbrannten Hautareale mit Spalthauttransplantaten im Zentrum der Bemuhungen, die intensivmedizinische Behandlung zielt auf eine Vermeidung von Komplikationen wie Infektionen und beatmungsassoziierte Lungenschadigungen ab. In diesem Sinne sind lungenprotektive Beatmungstrategien, die Nutzung von Sedierungs- und Entwohnungsprotokollen, ein fruhzeitiger enteraler Kostaufbau und eine adaquate Physiotherapie wichtige Bausteine der Therapie.

Fibromata pendulantia kommen haufig in Form kleiner filiformen Sackchen mit schmaler Basis („skin tags“) im Bereich des Halses, in den Achselhohlen und Leistenbeugen vor. Bisher wurden flachenhafte Fibromata pendulantia chirurgisch (scharfer Loffel, Schere, Skalpell) oder mit einem Laser entfernt. Im vorliegenden Fall mit dem Krankheitsbild einer Pseudoacanthosis nigricans mit flachenhaften Fibromata pendulantia im Bereich der Achselhohlen eines adiposen Patienten stellen wir die Versajet-Hydrochirurgietechnik als Alternativmethode vor. Durch einen Hochdruckstrahl wird hierbei gleichzeitig Gewebe entfernt und die Wunde ausgespult.