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Background:  Since 2015/16 the DGPRÄC collects, evaluates and publishes the research activities of academic sections, departments and clinics for plastic surgery at university hospitals in Germany, in order to raise the awareness of plastic surgical research performance., Materials and Methods:  The directors of plastic surgical academic institutions were contacted via the DGPRÄC and asked to report any requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was collected in our previously established online database: https://docs.google.com/forms/d/e/1FAIpQLSe6F5xmTyw-k7VKJx_2jkPA4LBXsA0sgBGMrC3rx_4bHj6uzQ/viewform?usp=sf_link. In addition, applications were identified via the DFG's public database GEPRIS., Results:  A total of 41 funding applications to the public funding institutes DFG, BMBF, BMWi, BMG and EU were identified. 75.6 % (31/41) of the applications had already been approved at the time of data collection, of which 77.4 % (24/31) were DFG, 9.7 % (3/31) were BMWi, 6.5 % (2/31) were EU and 3.2 % (1/31) were BMBF or BMG applications. The average funding amounted to 358 301 Euro. In 50.0 % (12/24) of the cases, the approved DFG proposals were assigned to the subject review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery., Conclusion:  The continuous publication of plastic surgical research funding reports submitted by the convention of university plastic surgeons of the DGPRÄC portraits the excellent, collaborative research activity in the field of plastic surgery., Competing Interests: Die Autoren geben an, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Although a large number of adult women worldwide are affected by lipedema, the physiologic conditions triggering onset and progression of this chronic disease remain enigmatic. In the present study, a descriptive epidemiologic situation of postoperative lipedema patients is presented., Methods: The authors developed an online survey questionnaire for lipedema patients in Germany. The survey was conducted on 209 female patients who had been diagnosed with lipedema and had undergone tumescent liposuction., Results: Most of the participants (average age, 38.5 years) had noticed a first manifestation of the disease at the age of 16. It took a mean of 15 years to accomplish diagnosis. Liposuction led to a significant reduction of pain, swelling, tenderness, and easy bruising as confirmed by the majority of patients. Hypothyroidism [n = 75 (35.9 percent) and depression [n = 48 (23.0 percent)] occurred at a frequency far beyond the average prevalence in the German population. The prevalence of diabetes type 1 [n = 3 (1.4 percent)], and diabetes type 2 [n = 2 (1 percent)] was particularly low among the respondents. Forty-seven of the lipedema patients (approximately 22.5 percent) suffered from a diagnosed migraine. Following liposuction, the frequency and/or intensity of migraine attacks became markedly reduced, as stated by 32 patients (68.1 percent)., Conclusions: Quality of life increases significantly after surgery with a reduction of pain and swelling and decreased tendency to easy bruising. The high prevalence of hypothyroidism in lipedema patients could be related to the frequently observed lipedema-associated obesity. The low prevalence of diabetes, dyslipidemia, and hypertension appears to be a specific characteristic distinguishing lipedema from lifestyle-induced obesity.

Background and Objectives: Plastic surgery includes a broad range of activities; however, there are no studies available in Germany which evaluated the specific role plastic surgeons play in providing patient care. The aim of the project was thus to analyze the public and professional perception of plastic surgery in Germany and to what degree the range of activities is appropriately represented., Material and Methods: An anonymous survey inquiring about demographic data and specific knowledge regarding plastic surgery procedures was conducted in various regions in German. Furthermore, factors that potentially influence the state of knowledge and personal perception were collated. The questionnaire was distributed among healthcare professionals and patients in plastic surgery. The statistical evaluation was performed using SPSS software., Results: A total of 2100 people participated in the nationwide survey. While classical aesthetic operations were mostly assigned to plastic surgery, there was no uniformity as to whether other indications, such as reconstructive interventions and hand surgery were assigned to this specialty or not. In this context various factors could be elucidated, such as the place of residence, education and age of the survey participants and the respective knowledge, which influence the perception., Conclusion: Plastic surgery in Germany classically consists of the four pillars of general reconstruction, hand surgery, burn management and aesthetic procedures; however, the results of this survey revealed that plastic surgery in Germany is predominantly understood as burn management and aesthetic surgery. As a multidisciplinary specialty, plastic surgery could apparently benefit from a more positive lobby and from a better portrayal of its scope in the media and general public.

Background: The treatment of complex patients with chronic wounds, such as pressure ulcers, is often not adequately reimbursed in patients with need for daily intensive care due to multimorbidity and chronic co-diagnoses. The present study analyses revenues, principle cost factors as well as possible complications., Methods: We analysed 51 patients with the DRG principle diagnosis of decubitus stage III and IV, treated in our maximum care clinic in 2014 and 2015. Duration of stay, count of surgical procedures as well as frequency and type of complication were analysed. Costs and revenues per patient were calculated and compared to the mean costs stated by the institute of revenue and costs calculations (InEK)., Results: In 25 of 51 cases, the costs exceeded the revenues, which was due to an excessively long stay at the hospital, complications or a large number of operative procedures. On average, the patients could not be treated cost-efficiently at our clinic., Conclusion: The treatment of most multimorbid patients with decubital ulcers is often not adequately reimbursable within the German DRG system. A strict treatment algorithm with a reduced number of operations and intensive patient care are helpful approaches, but may not be sufficient to reduce cost-intensive complications. It seems important to re-evaluate the current DRG codes for these cases., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Advanced cutaneous squamous cell carcinoma (aSCC) is an area of unmet medical need and no treatment standards are established. Recently, an anti-PD-1 inhibitor received FDA breakthrough therapy designation. The aim of the study was to describe the clinical course, therapeutic management and prognosis of aSCC under real-life conditions., Patients and Methods: In a retrospective study performed in 24 German and Austrian hospitals and doctor's offices, patient and tumour characteristics of patients diagnosed with aSCC between January 1, 2010 and December 31, 2011 and their disease course was documented. Advanced SCC comprised either locally advanced SCCs (laSCC) or metastatic SCCs (mSCC) with any kind of metastatic spread., Results: Data of 190 patients with aSCC were analysed. Median age at time of diagnosis of aSCC was 78 years. LaSCC was diagnosed in 76 patients (40%), 114 patients (60%) had mSCC. Once diagnosed with laSCC, most patients (59%) did not receive any therapy, whereas in 92% of mSCC patients at least one type of therapy was performed. Only 32 patients (29 mSCC, 3 laSCC) received systemic antitumour therapies, mostly EGFR inhibitor-based regimens. Mean duration of response was short (17-months laSCC patients, 3-months mSCC patients). Only 2 patients achieved a complete response, 27% had a partial response, 43% disease stabilisation. At diagnosis of aSCC, ECOG status was 0-1 in most patients. Non-malignant comorbidities influenced the decision on SCC-specific therapy in 39 patients (21%)., Conclusions: Our data show the high medical need for efficient and tolerable antitumour therapies and demonstrate that despite older age and comorbidities, most patients can be expected to be fit for treatment. This study provides a historical context for emerging aSCC treatments., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Currently available patient-reported outcome measures are limited in the field of sex reassignment surgery (SRS). Standardized questionnaires deliver high evidence data on satisfaction of male-to-female (MTF) transgender patients but do not allow any modification in their clinical application. We therefore designed a prospective study using self-developed indication-specific questionnaires to evaluate the aesthetic, functional, and sexual outcomes of MTF patients undergoing SRS., Methods: Forty-nine adult MTF transgender patients who underwent two-stage SRS were eligible for study inclusion between September 2012 and January 2014. Forty patients (= N) ultimately filled out both parts of the questionnaire sets: 1 day before the first stage (T0) and 6 months after the second stage of SRS (T1). These questionnaires focused on demographic characteristics, the satisfaction with aesthetic and functional results, and sexuality., Results: Patients rated their surgical satisfaction of most items with mean scores above 7 on a 0-10-point scale. Many items evaluating everyday life activities improved significantly after SRS compared to T0 (p < 0.01). All but one patient (97.5%) reported no regrets about having undergone surgery, and the majority recommended it to other patients with gender dysphoria. Femininity and sexual activity increased significantly postoperatively (p < 0.01). Satisfaction with intercourse and orgasm was high: 6.70 and 8.21, respectively, on a 0-10 scale., Conclusion: Satisfaction with the cosmetic outcome, as well as the functional and sexual outcomes, reveal positive effects of SRS using the combined technique on transgender patient lives. Nevertheless, standardized and validated SRS-specific questionnaires are lacking., Level of Evidence Iv: 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: Although it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage., Methods/design: This is a large, prospective, randomized, double-blind, multi-center study, funded by the German Federal Ministry of Education and Research, and fully approved by the designated ethics committee. The trial, which is to investigate the effects of EPO in severely burned patients, is in its recruitment phase and is being carried out in 13 German burn care centers. A total of 150 patients are to be enrolled to receive study medication every other day for 21 days (EPO 150 IU/kg body weight or placebo). A follow-up of one year is planned. The primary endpoint of this study is the time until complete re-epithelialization of a defined skin graft donor site is reached. Furthermore, clinical parameters such as wound healing, scar formation (using the Vancouver scar scale), laboratory values, quality of life (SF-36), angiogenic effects, and gene- and protein-expression patterns are to be determined. The results will be carefully evaluated for gender differences., Discussion: We are seeking new insights into the mechanisms of wound healing in thermally injured patients and more detailed information about the role EPO plays, specifically in these complex interactions. We additionally expect that the biomimetic effects of EPO will be useful in the treatment of acute thermal dermal injuries., Trial Registration: EudraCT Number: 2006-002886-38, Protocol Number: 0506, ISRCT Number: http://controlled-trials.com/ISRCTN95777824/ISRCTN95777824.

One hundred years after the first description of autologous fat transplantation, this technique is receiving renewed attention. Initially, critically reviewed by plastic surgery societies, particularly those in the United States, the transfer of autologous fat was recently addressed at the September 2009 annual meeting of the German Society of Plastic Reconstructive and Aesthetic Surgeons in Hannover. In this consensus meeting, the panel reviewed both the current status of autologous fat transfer as well as established data concerning this evolving practice. In Germany, autologous fat transplantation is regulated by the Law on Tissue Transfer and Processing (Gewebegesetz). In an effort to facilitate future comparisons it is mandatory to describe harvesting, processing and reinjection techniques in detail. The consensus panel concluded that fat should be harvested using low vacuum settings and then transplanted in thin layers (Evidence V). Quantification of transplanted fat can best be performed by MRI (Evidence level III). Limited clinical studies are available with only some reaching a level of evidence II. At present, risk associated with autologous fat transplantation is considered to be minor. Tumor induction by autologous fat grafting is not proven. New techniques like stem cell enriched fat grafts may offer new promise for the Plastic and Reconstructive Surgeon., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

Plastic surgery has passed through a very positive evolution in the last decades on the solid fundament of constantly developing academic plastic surgery. Aim of this paper is an objective evaluation of the current status of academic plastic surgery regarding research topics, currently available ressources and scientific outcome based on a questionnaire. The return rate of the questionnaire in academic departments was 92%. Main topics in research besides wound healing were topics from regenerative medicine such as tissue engineering, biomaterials, genetherapy and angiogenesis with the main focus on skin and fat tissues. In the past five years a total of 25 million Euros of third party research grants were raised. Research relied mainly on interdisciplinary research facilities. Regarding the scientific outcome more than 200 scientific papers were published in basic science research journals having an impactfactor higher than two. These results clearly demonstrate that plastic surgery is scientifically highly productive in academic surroundings where independent departments are established. Considering that independent units of plastic surgery exist in a relatively small number of all 36 university hospitals in germany, it has to be claimed for further independent departments so to provide adequate research facilities for further evolution of academic plastic surgery.

An analysis of costs and profit and an evaluation of the different cost parameters was performed in our burn centre, which treated 50-80 patients per year between 1991 and 1995. The cost-profit relationship (costs 3.7-4.6 million DM/year, profit 3.8-5.0 million DM/year) is balanced. The main cost parameters are staff costs (1.3-1.9 million DM/year), costs for medical treatment (1.5-1.8 million DM/year), and costs for internal services (0.6-0.9 million DM/year).

The treatment of patients with severe burn injuries is expensive and belongs in the hands of specialized burn centres. In our burn centre 257 patients were treated from 1991 to June 1995 (between 50 and 60 patients per year except for 1993 with 77 patients). Patients were evaluated according to the ABSI score (mean 7) and had mortality of around 15%. The costs range between 3.7 and 4.8 million DM per year, the profit lies in the same range. The costs are divided into staff costs (1.4-1.8 million DM per year), costs for medical treatment (1.5-1.9 million DM per year) and costs for internal services (600,000-900,000 DM per year) such as laboratory examinations (247,000-386,000 DM per year) and blood bank (100,000-215,000 DM per year), the main factors in this category. The different fields of costs and profit are compared in this analysis. Possible ways of reducing costs are pointed out, and the question of effectiveness of therapy is discussed. Conclusions from this analysis are limited by the individuality of each case with different clinical courses, the great number of influencing factors and the comparably small numbers of patients.

The prerequisites for an integrated quality management system for hospitals were developed as a result of considerations regarding the necessity of an appropriate quality-assurance system for the intensive care sector. The basis for a dynamic quality-assurance system on the documentational level is a comprehensive data base containing patient files unlimited in terms of time and data technology. The necessary hardware and software structure will be provided by consistent application of a client-server architecture. Permanent surveillance of existing quality objectives within the scope of an economic close-loop system requires a system with flexible query mechanisms. Informational data access from all hierarchical level within the hospital organization is facilitated by the data warehouse concept, a data base system with subject-oriented, integrated, time-variable, and persistent data.

The revised survey involves the years 1991 and 1992 and includes 41 university and major civil hospitals. As in the years 1989 and 1990, replantation activity in the year 1991 still declined, whereas in 1992 we registered a sharp increase in replantations, especially in Germany. In numbers, 856 were reported for 1991 (72 macro- and 784 microreplantations), and 1091 in 1992 (85 macro- and 1006 microreplantations). A considerable number of amputation cases (617) were rejected mainly due to lack of operative manpower capacity.