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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.

Results of earlier investigations have demonstrated impaired function of polymorph-nuclear cells (PMN) in previously irradiated tissue. This study was designed to examine the effect of local oxygen pressure (pO2) on neutrophil function in irradiated tissue. By choosing a pig model of irradiated and non-irradiated high perfusion wound environment (i.e. musculo-cutaneous (MC) flap) vs. a poor perfusion wound environment (i.e. random pattern (RP) skin flap), the effect of different pO2 levels on neutrophil phagocytosis and respiratory burst (H2O2 production) were measured at 6, 12, and 16 weeks after irradiation. In both kinds of irradiated flaps, pO2 levels and neutrophil function were significantly lower (RP

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.

Immediate breast reconstruction using silicone implants has proven to be an effective and safe method. Disadvantageous are the two-stage procedure with expander and implant and the visibility of the oblique mastectomy scar. Using a skin-sparing mastectomy technique with a periareolar incision only, preparation of a muscle flap containing Mm. obliquus externus, serratus anterior und pectoralis major and a special wound closure, excellent reconstruction results with almost invisible scars may be achieved in just one operative setting.

Aesthetically unfavorbale results may occur in 15 to 20% after breast conserving therapy for breast carcinoma. With increasing experience, plastic reconstructive techniques were developed allowing reconstruction of even large parenchymal defects after segmentectomy or at unfavorable tumor sites with aesthetically dependable results. This has led to an expansion in the indication of breast conserving therapy.

Esthetically unfavorable results may occur in 15%–20% after breast-conserving therapy for breast Carcinoma. With increasing experience, plastic reconstructive techniques have evolved for reconstructing even large parenchymal defects after segmentectomy or in adverse tumor sites with esthetically reliable results. This had led to an expansion in the indication for breast-conserving therapy.

Esthetically unfavorable results may occur in 15%-20% after breast-conserving therapy for breast carcinoma. With increasing experience, plastic reconstructive techniques have evolved for reconstructing even large parenchymal defects after segmentectomy or in adverse tumor sites with esthetically reliable results. This had led to an expansion in the indication for breast-conserving therapy.

The free TRAM flap for breast reconstruction offers superior blood flow and a lower donor defect morbidity than the pedicled flap. In the immediate setting, it is much easier to dissect the recipient vessels, because the thorco-dorsal vessels are not encased in a scarred post-mastectomy bed, which adds to the advantage of the free flap. The operative technique, the results and complications of nine patients having received a free TRAM for immediate breast reconstruction between 5/95 and 3/96 are reported.

Reconstructive surgery has become an integral part of primary breast cancer therapy in patients requiring total mastectomy. State-of-the-art reconstructions with autogenous tissue are transverse rectus abdominis (TRAM) flap procedures. Superior aesthetic results in terms of both appearance and consistency, seem to outweigh the disadvantages of impaired abdominal wall competence and donor site scars. The "free," microvascular TRAM flap may be the way to minimize abdominal wall weakness, since only a little portion of the rectus abdominis muscle must be sacrificed. Despite all discussions, breast reconstruction using silicone (gel) implants is a safe and reliable method and will be in the future. However, not every patient may be the right candidate for silicone reconstruction. Advantages of using silicone implants include (relatively) simple technique, short operation time, and no donor site morbidity. In patients suffering from breast-conserving therapy failures, plastic surgery has to address skin and parenchymal loss in an irradiated environment. Oncoplastic surgery, such as volume shrinking or volume replacement techniques, are useful for immediate reconstruction in breast-conserving therapy.

A 40 year old female was operated because of pulmonary leiomyomatous hamartoma. Despite repeated surgical resection therapy during the following years she developed recurrent multiple hamartoma. The indication for multiple surgery only included compression of central vessels or rapid growth of the hamartomas. The history of hysterectomy--as in our patient--is common for patients with multiple leiomyomatous pulmonary hamartoma. However, revision of the histological slides revealed no hint of uterine leiomyosarcoma. Therefore, a primary pulmonal (and recurrent) multiple hamartosis seems obvious.

Seit der Verselbstandigung der Plastischen Chirurgie als eigenes Fach bestehen Befurchtungen, insbesondere von Seiten der Chirurgie, das es zu einer volligen Loslosung kommt. Aber gerade das Fach Plastische Chirurgie ist durch das grose Spektrum rekonstruktiver Moglichkeiten pradestiniert fur eine enge Kooperation. Der heutige Patient akzeptiert nicht mehr einen verstummelnden Eingriff, sondern erwartet eine komplette Wiederherstellung, moglichst wie vor der Operation. Aus diesem Grunde sollten vermehrt plastisch-chirurgische Abteilungen und Kliniken geschaffen werden, anstatt einzelne Techniken aus dem Gebiet fur eigene begrenzte rekonstruktive Moglichkeiten herauszubrechen.

Die naturliche Resistenz von chirurgischen oder traumatischen Wunden gegenuber pathogenen Keimen ist primar abhangig von dem unspezifischen Immunsystem, also der ungestorten Funktion phagozytierender Zellen [1]. Dieses Prinzip gilt auch fur Eingriffe in bestrahltem Gewebe, die durch eine auffallig hohe postoperative Komplikationsrate belastet sind.