Search

Abstract: Major burn injuries provoke a profound stress response marked by extreme hypermetabolism and impaired immune function. The physiological alterations to glucose, protein and lipid metabolism can be detected even years after the inciting burns injury and when untreated can lead to profound wasting, fatty liver, and even death. Therapeutic strategies which target these physiological disturbances are of paramount importance. Treating burn injuries begins with active cooling, to minimize loss of heat and water, and nutrition, to counteract the extensive catabolism. Providers should follow the strict guidelines published to ensure caloric requirements are met in adult and pediatric patients, with supplementation as indicated. Several pharmacotherapies have proven beneficial in helping to counteract and reverse these physiological changes by lowering insulin resistance, slowing catabolism, and minimizing loss of lean body mass. The most promising drugs include anabolic agents such as insulin, recombinant human growth hormone (rhGH), insulin-like growth factor 1 (IGF-1), metformin, beta-blockers, oxandrolone, and fenofibrate. Surgery is a necessary adjunct, either in the acute phase to debride compromised soft tissue and prevent compartment syndromes, but also in the chronic setting to release contractures and fibrotic strictures which may impair function. This narrative literature review provides a synopsis of our understanding of the hypermetabolic response to burn injury and discusses the different treatment options aiming to control postburn hypermetabolism and ultimately improve patient outcomes.

This study aimed to compare the histomorphology of the elbow capsule and its ligaments to gain a better understanding of the clinically relevant biomechanical stabilization. Eleven human elbows were dissected including the joint capsule with its anterior (AJC) and posterior (PJC) parts, the annular ligament (AL), the radial collateral ligament (RCL) and the ulnar collateral ligament with its anterior (AUCL), posterior (PUCL) and transverse (TUCL) parts. Hematoxylin-Eosin and Elastica van Gieson as conventional histology stainings were applied to determine collagenous and elastic fiber arrangements in transmission and polarization light microscopy. The radial collateral ligament and the anterior part of the ulnar collateral ligament showed significantly more densely packed parallel fiber arrangement than the anterior joint capsule, the posterior joint capsule, and the posterior part of the ulnar collateral ligament (p 0.02, respectively). The PUCL had significantly more mixed tight and loose parallel arrangements than the PJC, the annular ligament, the RCL, the AUCL and the transverse part of the ulnar collateral ligamentp 0.02, respectively), while the PJC showed significantly more interlaced mixed tight and loose fiber arrangement than the AL, the RCL and the AUCL (p 0.003, respectively). The AJC had a significantly higher amount of elastic fibers as compared to the AL, the RCL, the AUCL and the TUCL in fascicular regions (p 0.04, respectively), while the AUCL had significantly lesser elastic fibers than the AJC and the PJC (p 0.004, respectively). The densely packed parallel fiber arrangement and few elastic fibers of the AUCL, RCL, and AL indicate a strong biomechanically stabilizing function. The fiber arrangement of the PUCL and the TUCL with few elastic fibers support the medial elbow stabilization. Crimping and elastic fibers provide the viscoelasticity of the joint capsule.

Zusammenfassung Hintergrund: Der Ultraschall ist in der Diagnostik der skapholunären Bandläsion (SL-Band) noch nicht etabliert. Ziel war es, ein standardisiertes Untersuchungsverfahren zur Darstellung und Kriterien zur Beurteilung des SL-Bandes zu entwickeln. Patienten und Methoden: Es wurden prospektiv 40 Patienten (70 Hände) sonographisch untersucht und mit Arthroskopie oder Magnetresonanztomographie (MRT) verglichen. Betrachtet wurden die Darstellbarkeit desSL-Bandes, der SL-Abstand im Seitenvergleich sowie ein Methodenvergleich von MRT und Arthroskopie zur Sonographie durchgeführt. Geprüft wurde auf Unterschiede und Übereinstimmung. Es wurden Cut-off-Werte für den SL-Abstand für eine Läsion bestimmt und alle Parameter zur Erstellung eines Scores verwendet. Ergebnisse: Ein intaktes Band erscheint als hyperechogene, fibrilläre Struktur und zeigt bei Verletzung Banddiskontinuitäten oder einen hypoechogenen Raum. Ein intaktes Band war dorsal in 89,6 % und palmar in 83,3 % darstellbar. Der Abstand für ein intaktes Band betrug dorsal/Mitte/palmar 5/2/5,1 mm (Bereich 3,2–6,7/0,9–4/3,1–7,8 mm), bei Läsion 6,4/3/6,3 mm (5–9,4/2–6,2/4–9,3 mm). Linke und rechte Hand unterschieden sich bei intaktem Band maximal um 2,1/1,1/1,8 mm, im Mittel um 0,4/0,2/0,2 mm und bei Verletzung um 1,2/0,9/1,1 mm. Radial- und Ulnarduktion zeigten physiologische, z. T. jedoch unvorhersehbare Abstandswerte. Als Cut-off-Werte für eine Läsion wurden dorsal (Sensitivität/Spezifität) 5,05 mm (0,95/0,60), Mitte 1,95 mm (1/0,62) und palmar 6,15 mm (0,55/0,85) ermittelt. Der erstellte sonographische SL-Band-Score besitzt eine hohe AUC (Area under the curve) von 0,93, eine Sensitivität von 85 % und eine Spezifität von 90 %. Schlussfolgerung: Die Parameter erlauben, v. a. kombiniert als Score, eine Aussage zur Intaktheit des SL-Bandes. Die Sonographie kann somit als Diagnostikum und Screeningmethode für eine SL-Bandläsion empfohlen werden und sollte als Routineinstrument etabliert werden. Perspektivisch muss durch große Fallzahlen eine Überprüfung und Anpassung der Kriterien erfolgen.

To investigate the dynamic aspects of elbow stability, we aimed to analyze sensory nerve endings in the ligaments and the capsule of elbow joints.The capsule with its anterior (AJC) and posterior (PJC) parts, the radial collateral ligament (RCL), the annular ligament (AL), and the ulnar collateral ligament with its posterior (PUCL), transverse (TUCL) and anterior parts (AUCL) were dissected from eleven human cadaver elbow joints. Sensory nerve endings were analyzed in two levels per specimen as total cell amount/ cmFree nerve endings were the predominant mechanoreceptor in all seven structures followed by Ruffini, unclassifiable, Golgi-like, and Pacini corpuscles (p ≤ 0.00001, respectively). Free nerve endings were observed significant more often in the AJC than in the RCL (p 0.00002). A higher density of Ruffini endings than Golgi-like endings was observed in the PJC (p = 0.004). The RCL contained significant more Ruffini endings than Pacini corpuscles (p = 0.004). Carbonic anhydrase II was significantly more frequently positively immunoreactive than choline acetyltransferase in all sensory nerve endings (p 0.05). Sensory nerve endings were significant more often epifascicular distributed in all structures (p 0.006, respectively) except for the AJC, which had a pronounced equal distribution (p 0.00005).The high density of free nerve endings in the joint capsule indicates that it has pronounced nociceptive functions. Joint position sense is mainly detected by the RCL, AUCL, PUCL, and the PJC. Proprioceptive control of the elbow joint is mainly monitored by the joint capsule and the UCL, respectively. However, the extreme range of motion is primarily controlled by the RCL mediated by Golgi-like endings.

Im Vordergrund der Behandlung von Mittelhandfrakturen steht die funktionelle Wiederherstellung der Handfunktion. Die Wahl der zur Verfugung stehenden Therapiemasnahmen ist neben der radiologischen Ausgangssituation abhangig vom klinischen Erscheinungsbild. In der Regel werden stabile und primar nicht dislozierte Frakturen, bei denen keine Rotationsfehler, eine Achsenabweichung oder eine Verkurzung vorliegen, einer fruhfunktionellen Ubungsbehandlung zugefuhrt. Instabile, dislozierte Frakturen oder Frakturen bei Vorliegen einer Gelenkbeteiligung werden in den meisten Fallen reponiert und osteosynthetisch stabilisiert. Eine Sonderstellung nehmen Frakturen des 1. Mittelhandknochens ein. Die in der Regel instabilen Basisfrakturen werden operativ behandelt. Dies gilt auch fur Mittelhandfrakturen, bei denen begleitende Weichteilverletzungen vorliegen.

Zusammenfassung Hintergrund Seit 2015/16 werden Forschungsanträge aus Sektionen, Abteilungen und Kliniken für Plastische Chirurgie an den Universitätskliniken Deutschlands durch die Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) gesammelt, ausgewertet und 2-jährlich veröffentlicht. Ziel ist es, dadurch die Forschungsleistung der Plastischen Chirurgen in Deutschland öffentlich sichtbar zu machen, um eine Stärkung der akademischen Forschungsstruktur in Deutschland zu erreichen. Material und Methoden Die Leiter der universitären Einrichtungen wurden über den Verteiler der DGPRÄC kontaktiert und um Mitteilung der beantragten, in Begutachtung befindlichen, abgelehnten und geförderten Projekte jeglicher öffentlicher, nicht-öffentlicher, industrieller oder anderer Förderinstitute in die eigens dafür erstellte online Datenbank gebeten: https://docs.google.com/forms/d/e/1FAIpQLSe6F5xmTyw-k7VKJx_2jkPA4LBXsA0sgBGMrC3rx_4bHj6uzQ/viewform?usp=sf_link. Zusätzlich wurden Anträge über die öffentliche Datenbank der Deutschen Forschungsgemeinschaft (DFG), dem Geförderte Projekte Informationssystem (GEPRIS), identifiziert. Ergebnisse Eine Gesamtzahl von 41 Förderanträgen aus den öffentlichen Förderinstituten DFG, BMBF, BMWi, BMG und EU konnte identifiziert werden. 75,6 % (31/41) der Anträge waren zum Zeitpunkt der Datenerhebung bereits bewilligt, davon waren 77,4 % (24/31) DFG-, 9,7 % (3/31) BMWi-, 6,5 % (2/31) EU- und je 3,2 % (1/31) BMBF- und BMG-Anträge. Das durchschnittliche Fördervolumen entsprach 358 301 Euro. Die bewilligten DFG-Anträge waren in 50,0 % (12/24) der Fälle ausschließlich bzw. unter anderem dem Fachkollegium 205–27 Orthopädie, Unfallchirurgie, rekonstruktive Chirurgie zugeordnet. Schlussfolgerung Mithilfe der vorgelegten Forschungsförderungsberichte des Konvents der leitenden universitär tätigen Plastischen Chirurgen der DGPRÄC erfolgt die Veröffentlichung der exzellenten gemeinschaftlichen akademischen Forschungsleistung in unserem Fachgebiet.

Intra-abdominal compartment syndrome (ACS) is a devastating complication in burn patients with a high mortality. Apart from high-volume resuscitation as known risk factor, also mechanical ventilation seems to influence the development of ACS. The TIRIFIC trial is a retrospective, matched-pair analysis. Thirty-eight burn patients with ACS were matched for burned total body surface area (TBSA), age and mechanical ventilation (MV). In contrast to the already published part I addressing fluid resuscitation as a risk factor, the parameters analyzed in part II were maximum and average PEEP and peak pressure levels as well as serum lactate levels and prokinetic therapy. For subgroup-analysis the ACS-group was split up into an early-onset and late-onset ACS-group according to the median time between burn trauma and ACS. The groups were analyzed with a two-sided Mann-Whitney-U-test with significance set at p < 0.05. In the ACS-group all ventilation pressures (maximum and average PEEP and peak pressure levels) were significantly increased compared to control. The subgroup-analysis showed significantly increased maximum PEEP and peak pressure levels in early- and late-onset ACS-groups versus control. However, the average ventilation pressure levels were only increased in the early-onset ACS-group (average PEEP p = 0.0069; average peak pressure p = 0.05). The TIRIFIC trial showed significantly increased ventilation pressures in the ACS group in general as a surrogate parameter to support early diagnostics. Especially, maximum PEEP levels and peak pressures are significantly increased in both, early- and late-onset ACS. As an addition to the actual WSACS guidelines we suggest IAP measurement in mechanically ventilated burn patients if ventilating pressures are rising continuously without a clear pulmonary or otherwise identifiable reason.

Zusammenfassung Hintergrund Seit der Erstbeschreibung einer lokoregionären Lappenplastik zur Nasenrekonstruktion im 6. Jahrhundert v. Chr. durch den indischen Arzt Sushruta Samhita sind diese ein fester Bestandteil in der Wiederherstellungschirurgie geworden. Neben der konsequenten Weiterentwicklung chirurgischer Operationsmethoden wurden die zu Grunde liegenden physikalischen Messmethoden des Lappenmonitoring in den letzten Dekaden stetig weiterentwickelt. Das Hyperspektralimaging (HSI) stellt eine neue quantitative Messmethode zur Beurteilung der Gewebeperfusion dar. Ziel Das Ziel dieser Arbeit ist die Evaluation des HSI als Monitoringverfahren nach lokoregionärer Defektdeckung. Patienten und Methode Bei insgesamt 16 Patienten wurde nach gefäßgestieltem Gewebetransfer die Sauerstoffsättigung, der Hämoglobingehalt sowie der Wassergehalt von Haut, Monitorinsel und nekrotischen Lappenarealen am 1. bis 7. postoperativen Tag gemessen. Die erhobenen Daten wurden statistisch deskriptiv ausgewertet und grafisch ausgearbeitet. Ergebnisse Das HSI zeigte einen erhöhten Hämoglobingehalt, eine Abnahme der Sauerstoffsättigung sowie des Wassergehaltes in den nekrotischen Lappenarealen im Vergleich zur vitalen Monitorinsel und zur gesunden Haut. Monitorinsel und vitale Hautareale wiesen eine nahezu identische Werteverteilung auf. Schlussfolgerung HSI erlaubt die sichere, kontaktfreie und sofortige Bestimmung der Gewebeperfusion von transferierten Gewebearealen bei Patienten nach lokoregionärer Defektdeckung. Daher erscheint die Verwendung von HSI im Rahmen des postoperativen Lappenmonitorings sinnvoll.

Introduction: If tensionless nerve coaptation is not possible, bridging the resulting peripheral nerve defect with an autologous nerve graft is still the current gold standard. The concept of conduits as an alternative with different materials and architectures, such as autologous vein conduits or bioartificial nerve conduits, could not replace the nerve graft until today. Chitosan, as a relatively new biomaterial, has recently demonstrated exceptional biocompatibility and material stability with neural lineage cells. The purpose of this prospective randomized clinical experiment was to determine the efficacy of chitosan-based nerve conduits in regenerating sensory nerves in the hand. Materials and methods: Forty-seven patients with peripheral nerve defects up to 26 mm distal to the carpal tunnel were randomized to receive either a chitosan conduit or an autologous nerve graft with the latter serving as the control group. Fifteen patients from the conduit group and seven patients from the control group were available for a 12-month follow-up examination. The primary outcome parameter was tactile gnosis measured with two-point discrimination. The secondary outcome parameters were Semmens Weinstein Monofilament Testing, self-assessed pain, and patient satisfaction. Results: Significant improvement (in static two-point discrimination) was observed six months after trauma (10.7 ± 1.2 mm; p < 0.05) for chitosan-based nerve conduits, but no further improvement was observed after 12 months of regeneration (10.9 ± 1.3 mm). After six months and twelve months, the autologous nerve graft demonstrated comparable results to the nerve conduit, with a static two-point discrimination of 11.0 ± 2.0 mm and 7.9 ± 1.1 mm. Semmes Weinstein Filament Testing in the nerve conduit group showed a continuous improvement over the regeneration period by reaching from 3.1 ± 0.3 after three months up to 3.7 ± 0.4 after twelve months. Autologous nerve grafts presented similar results: 3.3 ± 0.4 after three months and 3.7 ± 0.5 after twelve months. Patient satisfaction and self-reported pain levels were similar between the chitosan nerve conduit and nerve graft groups. One patient required revision surgery due to complications associated with the chitosan nerve tube. Conclusion: Chitosan-based nerve conduits are safe and suitable for bridging nerve lesions up to 26 mm in the hand. Tactile gnosis improved significantly during the early regeneration period, and functional outcomes were similar to those obtained with an autologous nerve graft. Thus, chitosan appears to be a sufficient substitute for autologous nerve grafts in the treatment of small nerve defects in the hand.

Ultrasound has not yet been established in the diagnostic workup of scapholunate ligament lesions. We aimed to develop a standardised examination procedure to visualise and evaluate the SL ligament.Forty patients (70 hands) were examined prospectively with ultrasonography and the results were compared with arthroscopy and MRI findings. We studied the visibility of the SL ligament and the SL distance on side-to-side comparison and performed a method comparison between MRI/arthroscopy and ultrasound, testing for distinction and accordance. Cut-off values for the SL distance indicating a lesion were determined and all parameters were used for developing a score.An intact ligament appears as a hyperechogenic, fibrillary structure and shows discontinuity or a hypoechogenic space when injured. An intact ligament was visible dorsally in 89.6 % and palmarly in 83.3 %. The SL distance for an intact ligament was 5/2/5.1 mm for the dorsal/middle/palmar aspect (range 3.2-6.7/0.9-4/3.1-7.8 mm) and 6.4/3/6.3 mm (range 5-9.4/2-6.2/4-9.3 mm) for a lesion. The difference between the right and left hand with an intact ligament was a maximum of 2.1/1.1/1.8 mm, an average of 0.4/0.2/0.2 mm; in case of an injury, the maximum difference was 1.2/0.9/1.1 mm. Distance values for radial and ulnar deviation were physiological but partly unpredictable. The cut-off values determined for a lesion are 5.05 mm for the dorsal aspect (sensitivity/specificity 0.95/0.60), 1.95 mm for the middle (1/0.62) and 6.15 mm for the palmar aspect (0.55/0.85). The created sonographic SL ligament score has a high AUC (area under the curve) of 0.93, a sensitivity of 85 % and a specificity of 90 %.The parameters, especially when combined to a score, allow to state whether the SL ligament is intact or not. Ultrasound can, therefore, be recommended as a diagnostic and screening method for an SL ligament lesion und should be used as a routine tool. The criteria must be checked from a perspective with high case numbers.Der Ultraschall ist in der Diagnostik der skapholunären Bandläsion (SL-Band) noch nicht etabliert. Ziel war es, ein standardisiertes Untersuchungsverfahren zur Darstellung und Kriterien zur Beurteilung des SL-Bandes zu entwickeln.Es wurden prospektiv 40 Patienten (70 Hände) sonographisch untersucht und mit Arthroskopie oder Magnetresonanztomographie (MRT) verglichen. Betrachtet wurden die Darstellbarkeit desSL-Bandes, der SL-Abstand im Seitenvergleich sowie ein Methodenvergleich von MRT und Arthroskopie zur Sonographie durchgeführt. Geprüft wurde auf Unterschiede und Übereinstimmung. Es wurden Cut-off-Werte für den SL-Abstand für eine Läsion bestimmt und alle Parameter zur Erstellung eines Scores verwendet.Ein intaktes Band erscheint als hyperechogene, fibrilläre Struktur und zeigt bei Verletzung Banddiskontinuitäten oder einen hypoechogenen Raum. Ein intaktes Band war dorsal in 89,6 % und palmar in 83,3 % darstellbar. Der Abstand für ein intaktes Band betrug dorsal/Mitte/palmar 5/2/5,1 mm (Bereich 3,2–6,7/0,9–4/3,1–7,8 mm), bei Läsion 6,4/3/6,3 mm (5–9,4/2–6,2/4–9,3 mm). Linke und rechte Hand unterschieden sich bei intaktem Band maximal um 2,1/1,1/1,8 mm, im Mittel um 0,4/0,2/0,2 mm und bei Verletzung um 1,2/0,9/1,1 mm. Radial- und Ulnarduktion zeigten physiologische, z. T. jedoch unvorhersehbare Abstandswerte. Als Cut-off-Werte für eine Läsion wurden dorsal (Sensitivität/Spezifität) 5,05 mm (0,95/0,60), Mitte 1,95 mm (1/0,62) und palmar 6,15 mm (0,55/0,85) ermittelt. Der erstellte sonographische SL-Band-Score besitzt eine hohe AUC (Area under the curve) von 0,93, eine Sensitivität von 85 % und eine Spezifität von 90 %.Die Parameter erlauben, v. a. kombiniert als Score, eine Aussage zur Intaktheit des SL-Bandes. Die Sonographie kann somit als Diagnostikum und Screeningmethode für eine SL-Bandläsion empfohlen werden und sollte als Routineinstrument etabliert werden. Perspektivisch muss durch große Fallzahlen eine Überprüfung und Anpassung der Kriterien erfolgen.

Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and severe skin and mucosal reactions that are associated with high mortality. Despite the severity, an evidence-based treatment protocol for SJS/TEN is still lacking. Method: In this systematic review and meta-analysis, the PubMed database was searched using the following terms: [Stevens–Johnson syndrome] OR [toxic epidermal necrolysis] AND [therapy] OR [treatment] over a 20-year period (1999–2019) in the German and English language. All clinical studies reporting on the treatment of SJS/TEN were included, and epidemiological and diagnostic aspects of treatment were analysed. A meta-analysis was conducted on all comparative clinical studies that met the inclusion criteria. Results: A total of 88 studies met the inclusion criteria, reporting outcomes in 2647 patients. Treatment was either supportive or used systemic corticosteroid, intravenous immunoglobulin, plasmapheresis, cyclosporine, thalidomide or cyclophosphamide therapy. The meta-analysis included 16 (18%) studies, reporting outcomes in 976 (37%) patients. Systemic glucocorticoids showed a survival benefit for SJS/TEN patients in all analyses compared with other forms of treatment. Cyclosporine treatment also showed promising results, despite being used in a small cohort of patients. No beneficial effects on mortality could be demonstrated for intravenous immunoglobulins. Conclusion: Glucocorticoids and cyclosporine may be tentatively recommended as the most promising immunomodulatory therapies for SJS/TEN, but these results should be investigated in future prospective controlled trials.

The analysis of ligamentous mechanoreceptors is difficult due to a high amount of unclassifiable mechanoreceptors, which result from incomplete visualization through limited microscopic techniques.The method was developed using dorsal intercarpal ligaments and dorsal regions of the scapholunate interosseous ligament from human cadaver wrists. Consecutive 70 µm thick cryosections were stained with immunofluorescence markers for protein S100B, neurotrophin receptor p75 (p75), protein gene product 9.5 (PGP 9.5) and 4',6-diamidino-2-phenylindole (DAPI). 3D images of sensory nerve endings were obtained using a confocal laser scanning microscope. Experimental point spread functions (PSF) were used to deconvolve images. Sensory nerve endings were localised in each section plane and classified according to Freeman and Wyke. Finally, confocal data was visualized as 3D-images.The method produced excellent image quality, revealing detailed three-dimensional structures. The created 3D-model of sensory nerve endings could be analyzed in all three dimensions, augmenting visualization of the form and immunoreactive pattern of sensory nerve endings. Deconvolution with experimentally measured PSFs aided in enhancing image quality.Using a triple immunofluorescent staining method allows to visualize the structure of sensory nerve endings more precisely than techniques with serial analysis of different monostaining of neural markers. Imaging in three dimensions enhances morphologic details, which are limited in 2D-microscopy.3D-triple immunofluorescence produces high quality visualization of mechanoreceptors, thereby improving their analysis. As an elaborate technique, it is ideal for defined research questions concerning the microstructure of sensory nerve endings.

We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.

Hair is a defining feature of mammals and has critical functions, including protection, production of sebum, apocrine sweat and pheromones, social and sexual interactions, thermoregulation, and provision of stem cells for skin homeostasis, regeneration, and repair. The hair follicle (HF) is considered a “mini-organ,” consisting of intricate and well-organized structures which originate from HF stem and progenitor cells. Dermal papilla cells are the main components of the mesenchymal compartments in the hair bulb and are instrumental in generating signals to regulate the behavior of neighboring epithelial cells during the hair cycle. Mesenchymal-epithelial interactions within the dermal papilla niche drive HF embryonic development as well as the postnatal hair growth and regeneration cycle. This review summarizes the current understanding of HF development, repair, and regeneration, with special focus on cell signaling pathways governing these processes. In particular, we discuss emerging paradigms of molecular signaling governing the dermal papilla-epithelial cellular interactions during hair growth and maintenance and the recent progress made towards tissue engineering of human hair follicles.

Carbon monoxide (CO) is a toxic, color-, taste- and odorless gas with fatal consequences if undetected. Intoxication caused by CO is frequent possibly leading to a high morbidity and mortality. The disease involves multiple organ systems without a typical clinical presentation. The clinical picture is furthermore unrelated to levels of carboxyhemoglobin - the routine biomarker. Therefore the diagnosis and treatment can be very demanding. This article in detail reviews epidemiology, symptoms, diagnosis and the therapy of this multidisciplinary challenge.

Objective: Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Mortality rates can reach 20–25% in adults but are reduced with early intervention. To identify optimal treatment regimens, to better understand the patient cohort affected, and to help identify key risk factors for mortality, we report our experience with the treatment and management of SJS/TEN patients. Methods: A retrospective review of consecutive patients with SJS and/or TEN admitted to a single burns centre in Germany, between 2008 and 2018, was conducted. The primary outcomes of demographics, clinical course, treatment and patient-reported outcomes were recorded and compared with a control group of patients with burns without a diagnosis of SJS/TEN. Results: A total of 23 patients with SJS/TEN met the inclusion criteria: 17 (74%) with TEN; four (17%) with SJS/TEN overlap; and two (9%) with SJS. Of the patients, 14 (61%) were female and nine (39%) were male. Patient age ranged from 32–78 years (mean: 52 years). A matched cohort of 23 patients with burns served as the control group. All patients received standard of care with a multidisciplinary team. Compared with the control group, SJS/TEN patients had higher mortality rates (n=6, 26% versus n=8, 35%, respectively). The average age of death was 69 years in SJS/TEN patients versus 63 years in control group patients. Age and SCORTEN scores were significant predictors of mortality. Conclusions: SJS and TEN are rare but extreme reactions of the skin and mucosa, associated with high disease mortality rates. This 10-year single-centre retrospective review contributes to the bank of information for reviews evaluating the management of SJS/TEN patients.

Background The assessment of thermal burn depth remains challenging. Over the last decades, several optical systems were developed to determine burn depth. So far, only laser doppler imaging (LDI) has been shown to be reliable while others such as infrared thermography or spectrophotometric intracutaneous analysis have been less accurate. The aim of our study is to evaluate hyperspectral imaging (HSI) as a new optical device. Methods Patients suffering thermal trauma treated in a burn unit in Germany between November 2019 and September 2020 were included. Inclusion criteria were age ≥18 years, 2nd or 3rd degree thermal burns, written informed consent and presentation within 24 h after injury. Clinical assessment and hyperspectral imaging were performed 24, 48 and 72 h after the injury. Patients in whom secondary wound closure was complete within 21 days (group A) were compared to patients in whom secondary wound closure took more than 21 days or where skin grafting was indicated (group B). Demographic data and the primary parameters generated by HSI were documented. A Mann Whitney-U test was performed to compare the groups. A p-value below 0.05 was considered to be statistically significant. The data generated using HSI were combined to create the HSI burn index (BI). Using a logistic regression and receiver operating characteristics curve (ROC) sensitivity and specificity of the BI were calculated. The trial was officially registered on DRKS (registration number: DRKS00022843). Results Overall, 59 patients with burn wounds were eligible for inclusion. Ten patients were excluded because of a poor data quality. Group A comprised 36 patients with a mean age of 41.5 years and a mean burnt body surface area of 2.7%. In comparison, 13 patients were allocated to group B because of the need for a skin graft (n = 10) or protracted secondary wound closure lasting more than 21 days. The mean age of these patients was 46.8 years. They had a mean affected body surface area of 4.0%. 24, 48, and 72 h after trauma the BI was 1.0 ± 0.28, 1.2 ± 0.29 and 1.55 ± 0.27 in group A and 0.78 ± 0.14, 1.05 ± 0.23 and 1.23 ± 0.27 in group B. At every time point significant differences were demonstrated between the groups. At 24 h, ROC analysis demonstrated BI threshold of 0.95 (sensitivity 0.61/specificity 1.0), on the second day of 1.17 (sensitivity 0.51/specificity 0.81) and on the third day of 1.27 (sensitivity 0.92/specificity 0.71). Conclusion Changes in microcirculation within the first 72 h after thermal trauma were reflected by an increasing BI in both groups. After 72 h, the BI is able to predict the need for a skin graft with a sensitivity of 92% and a specificity of 71%.

Hyperspectral imaging (HSI) is a new device for monitoring microcirculation. The aim of this study is to describe hyperspectral imaging after free tissue. We assessed 22 patients from our department who underwent hyperspectral imaging monitoring. Four parameters were measured: tissue oxygenation, tissue hemoglobin index, deep tissue near-infrared perfusion index, and water distribution. Measurements were taken from normally perfused flaps, areas of locally impaired perfusion, and complete flap malperfusion daily within the first 7 days. Statistical differences were determined using Student’s t tests. Receiver operating characteristic curves were illustrating the reliability of each parameter. Ten free anterolateral thigh flaps and eight free latissimus dorsi flaps were included. One flap was subsequently lost. Of 184 total measurements, 119 were taken in normally perfused flap areas, 63 in areas of locally impaired perfusion due to partial flap necrosis, and 2 were taken of a flap without perfusion due to arterial occlusion. In the latter case, tissue oximetry and tissue hemoglobin index were 3% (normally perfused flaps 37.5±12.6% (p

Since pedicle flaps were first described by the Indian physician Sushruta Samhita in the 6th century B. C., they have become an integral part of reconstructive surgery. As more and more research has been conducted into the underlying physical principles, flap monitoring has developed steadily in the last few decades. Hyperspectral Imaging (HSI) is a new quantitative measuring method for assessing the perfusion of the underlying tissue.This study aims to evaluate HSI as a monitoring method for pedicle flaps.In 16 patients who had undergone reconstructive surgery, oxygen saturation, haemoglobin and water concentration of the locoregional flap, necrotic flap areas as well as intact skin were measured on postoperative days 1 to 7. Subsequently, the data were statistically described and graphically illustrated.HSI revealed increased haemoglobin concentration and decreased oxygen and water concentration in necrotic flap areas compared with the monitor island and healthy skin. The distribution of the values collected from the vital skin areas and the monitor island was almost identical.HSI allows for safe, immediate, non-contact measurement of tissue perfusion of transferred tissue areas in patients after pedicle flap surgery. The use of HSI may improve postoperative flap monitoring.Seit der Erstbeschreibung einer lokoregionären Lappenplastik zur Nasenrekonstruktion im 6. Jahrhundert v. Chr. durch den indischen Arzt Sushruta Samhita sind diese ein fester Bestandteil in der Wiederherstellungschirurgie geworden. Neben der konsequenten Weiterentwicklung chirurgischer Operationsmethoden wurden die zu Grunde liegenden physikalischen Messmethoden des Lappenmonitoring in den letzten Dekaden stetig weiterentwickelt. Das Hyperspektralimaging (HSI) stellt eine neue quantitative Messmethode zur Beurteilung der Gewebeperfusion dar. ZIEL: Das Ziel dieser Arbeit ist die Evaluation des HSI als Monitoringverfahren nach lokoregionärer Defektdeckung.Bei insgesamt 16 Patienten wurde nach gefäßgestieltem Gewebetransfer die Sauerstoffsättigung, der Hämoglobingehalt sowie der Wassergehalt von Haut, Monitorinsel und nekrotischen Lappenarealen am 1. bis 7. postoperativen Tag gemessen. Die erhobenen Daten wurden statistisch deskriptiv ausgewertet und grafisch ausgearbeitet.Das HSI zeigte einen erhöhten Hämoglobingehalt, eine Abnahme der Sauerstoffsättigung sowie des Wassergehaltes in den nekrotischen Lappenarealen im Vergleich zur vitalen Monitorinsel und zur gesunden Haut. Monitorinsel und vitale Hautareale wiesen eine nahezu identische Werteverteilung auf.HSI erlaubt die sichere, kontaktfreie und sofortige Bestimmung der Gewebeperfusion von transferierten Gewebearealen bei Patienten nach lokoregionärer Defektdeckung. Daher erscheint die Verwendung von HSI im Rahmen des postoperativen Lappenmonitorings sinnvoll.

Zusammenfassung Hintergrund Durch den Verlust der natürlichen Hautbarrierefunktion und folglich reduzierter Immunkompetenz infolge eines Plasmaverlustes sowie zahlreichen intensivmedizinischen Interventionen sind Verbrennungspatienten besonders gefährdet für Infektionen. Studiendesign Systematische Übersichtsarbeit Methoden In einer systematischen Übersicht der deutsch- und englischsprachigen Literatur zwischen 1990 und 2018 werden epidemiologische und diagnostische Aspekte sowie der therapeutische Einsatz von Antibiotika bei Infektionen von Verbrennungspatienten in klinischen Studien analysiert. Ergebnisse Insgesamt erfüllten 53 randomisiert kontrollierte klinische Studien die Auswahlkriterien. Untersucht wurden verschiedene Arten/Applikationsformen der antibiotischen Prophylaxe bei Verbrennungswunden: Topisch, systemisch (generell), systemisch (perioperativ), nicht absorbierbare Antibiotika (= selektive Darmdekontamination), lokal (inhaliert) und jegliche Applikationsformen versus Kontrolle. Die frühe „Postburn-Prophylaxe“ wurde bei Patienten mit geringgradiger Verbrennung (sechs Studien) und Patienten mit schwerer Verbrennung (sieben Studien) untersucht. Die antimikrobielle Prophylaxe zeigte keine präventive Wirksamkeit des toxischen Schocksyndroms bei geringgradigen Verbrennungen, ist aber bei Patienten mit schweren Verbrennungen und der Notwendigkeit einer mechanischen Beatmung nützlich. Die perioperative Prophylaxe (= Metaphylaxe) wurde in zehn Studien untersucht. Schlussfolgerung Der Nutzen für eine längerfristige systemische antibiotische Prophylaxe bei der Mehrheit von Verbrennungspatienten ist nicht evident. Leichte Infektionen in stabilem klinischen Zustand sind engmaschig zu beobachten, während bei schwerer Infektion die internationalen Sepsis-Leitlinien und das Tarragona-Prinzip empfohlen werden.

ZusammenfassungDie Begutachtung ist ein Bestandteil der ärztlichen Tätigkeit. Da die Subspezialisierung in der Medizin stetig fortschreitet, sind die Gutachterkollektive für spezielle gutachterliche Fragestellungen häufig klein. Der ärztliche Gutachter hat Tatsachen im Vollbeweis und Zusammenhänge mit hinreichender Wahrscheinlichkeit zu bewerten. In der Begutachtung für die gesetzliche Unfallversicherung spielt in der Erörterung der Haftungsbegründung die Frage nach Vorerkrankungen/Schadensanlage eine wesentliche Rolle. Gelegenheitsursachen bzw. Bagatellverletzungen müssen erkannt werden, weil sich daraus eine Versicherungsrelevanz ergibt.Ein Versicherter mit einer akralen, nicht arteriosklerotischen Durchblutungsstörung (Thrombangiitis obliterans) erlitt einen Arbeitsunfall mit einem Haut-Weichteildefekt, in dessen Folge eine Fingeramputation erforderlich wurde. Das Vorliegen einer Gelegenheitsursache konnte nach gefäßmedizinischer Begutachtung widerlegt werden. Der handchirurgische Gutachter empfahl eine Minderung der Erwerbsfähigkeit von 25 von 100. Der Unfallversicherungsträger folgte der Entscheidung der ärztlichen Gutachter.

Objective: To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting. Method: A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms ‘nutrition’ OR ‘metabolism’ AND ‘burn injury’ OR ‘burns’. There was no limitation on the year of publication. Results: A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript. Conclusion: Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.

Zusammenfassung Hintergrund Dieser Bericht baut auf dem Forschungsförderungsbericht aus dem Jahr 2015/2016 auf und dient der Bekanntmachung der akademischen Forschungsleistung an Universitätskliniken der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) für 2017/2018. Berücksichtigt wurden dabei Anträge auf Forschungsförderung bei öffentlichen, nicht-öffentlichen, oder industriellen Förderinstituten. Gleichzeitig soll dieser Beitrag die Anzahl der genehmigten Anträge bei der Deutschen Forschungsgemeinschaft (DFG) aus der Plastischen Chirurgie, Thorax- und Gefäßchirurgie gegenüberstellen. Innerhalb dieser jüngeren selbständigen chirurgischen Fachgebiete wird das seit 1993 eigenständige Fachgebiet Plastische Chirurgie in der Fächerstruktur der DFG Fachkollegien immer noch nicht separat geführt, sondern dem Fachkollegium Orthopädie und Unfallchirurgie zugeordnet. Dies führt dazu, dass die Anträge nicht fachspezifisch begutachtet werden. Material und Methoden Die bereits etablierte online Datenbank (https://docs.google.com/forms/d/1OaSnHyKTysawiI1ie7kfUxDf7nJP_RiTUJTsnb7Mq_E/edit) zur Meldung beantragter/ genehmigter und abgelehnter Forschungsförderungen öffentlicher, nicht-öffentlicher und industrieller Förderinstitutionen wurde fortgeführt und gemeinsam mit den Anträgen aus der öffentlichen Datenbank der DFG, das Geförderte Projekte Informationssystem (GEPRIS), ausgewertet. Ergebnisse Im Vergleich zum letzten Beobachtungszeitraum von 2015/2016 nahm die Anzahl genehmigter Anträge aus öffentlichen Einrichtungen (DFG, BMBF, BMWi, EU) von 23 auf 27 zu. Aus den chirurgischen Fachgebieten Thorax- und Gefäßchirurgie waren jeweils 9 bzw. 8 DFG Anträge im GEPRIS dokumentiert, wohingegen 19 Bewilligungen von Anträgen der Plastischen Chirurgie identifiziert wurden. Schlussfolgerung Durch die vorliegende Auswertung konnten wir zeigen, dass das Aufkommen an Anträgen aus dem Fachgebiet der Plastischen Chirurgie denen der anderen eigenständig geführten Fachgebiete entspricht, wobei sogar eine höhere Anzahl zu verzeichnen ist. Vor diesem Hintergrund ist die gegenwärtige Subsummierung seitens der DFG, auch im Hinblick auf eine öffentlich nachvollziehbare Vergabe der Fördersummen, nicht zu akzeptieren.

Zusammenfassung Hintergrund: Ziel der vorliegenden Arbeit war es, Einflussfaktoren für den Verlust von Lappen nach plastischer Rekonstruktion von septischen Hautweichteildefekten bei Osteitis der unteren Extremität mit freiem mikrovaskulären anterolateralen Oberschenkellappen (ALT) oder Latissimus dorsi (LD)-Lappen zu identifizieren. Material und Methoden: Zwischen 2004 und 2013 wurden aufgrund von septischen Hautweichteildefekten bei Osteitis der unteren Extremität 27 Patienten mit LD-Lappen und 45 Patienten mit ALT-Lappen rekonstruiert und deren anthropometrische, prä- und intraoperative Parameter retrospektiv statistisch ausgewertet. Ergebnisse: Die Lappen-Überlebensrate betrug für den LD 81,5 % und für den ALT 82,2 %. Major-Komplikationen resultierten sowohl bei LD-Lappen (p = 0,01) als auch bei ALT-Lappen (p Schlussfolgerung: Das Gelingen der Lappenplastik bei Osteitis der unteren Extremität wurde trotz geringer Patientenzahl mit vorbestehenden Diabetes mellitus, mit einer ursächlichen akuten Osteomyelitis und Major-Komplikationen beeinflusst, so dass die optimale Behandlung beider Parameter und eine präzise mikrochirurgische Anastomosentechnik Grundvoraussetzungen für die erfolgreiche plastische Hautweichteilrekonstruktion sind.

Despite the development of modern intensive care and new antimicrobial agents, the mortality of patients with severe sepsis and septic shock remains high. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by the intravascular release of proinflammatory cytokines and other vasoactive mediators, with concurrent activation of innate immune cells. The Wnt signaling pathway plays a critical role in the development of multicellular organisms. Abnormal Wnt signaling has been associated with many human diseases, ranging from inflammation and degenerative diseases to cancer. This article reviews the accumulating evidence that the Wnt signaling pathway plays a distinct role in inflammation and sepsis.

Objective: Experimental tests of non-invasive multi- or hyperspectral imaging (HSI) systems reveal the high potential of support for medical diagnostic purposes and scientific biomedical analysis. Until now the use of HSI technologies for medical applications was limited by complex and overly sophisticated systems. We present a new and compact HSI-camera that could be used in normal clinical practice. Method: We assessed the use of the HSI system on the hands of 10 healthy volunteers, looking at control parameters, and those following venous occlusion, arterial occlusion and reperfusion, including tissue oxygenation, tissue haemoglobin index, perfusion in 4–6mm depth=near infrared spectroscopy (NIR), and tissue water index. Pseudo colours used ranged from 0% (blue) to 100% (red). We also assessed differences in the wounds of three patients. Results: The results show good potential in all parameters in the healthy volunteers, which had high conformity with validated reference oximetry measurements. In three wounds, different levels of oxygenation were identified in the wound area, although interpretation of these results is complex. In Cases 2 and 3, following the application of a micro capillary dressing, improvements were seen in perfusion and reduction of the tissue water index (TWI). Conclusion: The camera system proved to be quick, flexible and yielded data with high spatial and spectral resolution. These data will be used to perform a power analysis for a randomised controlled study.

Anhand eines reprasentativen Falls, der in unserem Zentrum fur Schwerbrandverletzte behandelt wurde, sollen der ausgepragte Schweregrad eines Waterhouse-Friderichsen-Syndroms und die Komplexitat des langwierigen Behandlungsverlaufes illustriert werden. Spezielles Augenmerk soll hier auf den neuen Therapieansatz mithilfe des CytoSorb®-Adsorber gelegt werden.

Zusammenfassung Hintergrund Die körperdysmorphe Störung, englisch „body dysmorphic disorder“ (BDD), gilt als Unterform der somatoformen Störungen. BDD kann sich in wahnhaftem Erleben, einer übermäßigen Bewertung und Beschäftigung des äußeren Erscheinungsbildes, insbesondere dem Gesicht äußern. Vorläufige Ergebnisse legen nahe, dass Personen mit BDD nicht von plastisch-chirurgischen Behandlungen profitieren, so dass durch ästhetische operative Eingriffe häufig sogar eine Aggravation ihrer Symptome resultiert. Somit ist die Identifikation von Anzeichen für ein BDD entscheidend, ob ein Patient plastisch-ästhetisch operiert werden sollte. Diese Übersichtsarbeit erläutert die oft schwierige Diagnostik der BDD, indem sie die aktuelle Literatur zu dessen Screening zusammenfasst. Studiendesign Systematische Übersichtsarbeit Methoden Es wurde eine elektronische Suche in der deutsch- und englischsprachigen Literatur durchgeführt, um alle Screening-Instrumente für die BDD zu identifizieren. Es werden die spezifischen Entwicklungs- und Validierungsprozesse beurteilt, ob die Screening-Instrumente einen positiven prädiktiven Wert für die BDD haben. Ergebnisse Sechs verschiedene Screening-Instrumente wurden für die BDD identifiziert. Davon wurden nur zwei in einem kosmetischen Rahmen evaluiert: der „Body Dysmorphic Disorder Questionnaire–Dermatology Version“ (BDDQ-DV) und der „Dysmorphic Concern Questionnaire“ (DCQ). Der Einfluss auf die subjektiven Ergebnisse nach einem plastisch-ästhetischen Eingriff wurde nur für den DCQ gemessen. Schlussfolgerung Die begrenzte Verfügbarkeit von validierten Screening-Instrumenten für die BDD in der plastischen Chirurgie steht in bemerkenswerten Gegensatz zu der vermeintlich hohen Prävalenz der Erkrankung von 2,4 %. Unter den derzeit verwendeten Screening-Tools scheinen die BDDQ-DV und der DCQ am besten geeignet zu sein. Weitere Forschungsbemühungen zur Etablierung besserer Screeningmethoden für die BDD in der plastischen chirurgischen Patientenpopulation und zur Untersuchung der Auswirkungen von BDD auf Behandlungsergebnisse sind notwendig.

ZusammenfassungNervenverletzungen mit schwerem Weichteilschaden sind selten und bedürfen einer komplexen, individualisierten Behandlungsstrategie, um die resultierenden medizinischen und sozioökonomischen Folgen möglichst gering zu halten. Da bisher eine einheitliche systematische Evidenz fehlt, werden abhängig vom individuellen Erfahrungstand der versorgenden Mikrochirurgen uneinheitliche Therapiestandards angewendet. Um beste Voraussetzungen für deren weiteren Heilungsverlauf zu schaffen, wurden in einem Konsensusworkshop der 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) Konsensusempfehlungen von einer Expertengruppe erarbeitet. Diese beinhalten die Aspekte Zeitpunkt der Nerven- und Weichteilversorgung, Versorgungsstrategien, sowie Rehabilitation und Heilverfahrenssteuerung.

Background: Hyperspectral Imaging (HSI) has a strong potential to be established as a new contact-free measuring method in medicine. Hyperspectral cameras and data processing have to fulfill requirements concerning practicability and validity to be integrated in clinical routine processes. Methods: Calculating physiological parameters which are of significant clinical value from recorded remission spectra is a complex challenge. We present a data processing method for HSI remission spectra based on a five-layer model of perfused tissue that generates perfusion parameters for every layer and presents them as depth profiles. The modeling of the radiation transport and the solution of the inverse problem are based on familiar approximations, but use partially heuristic methods for efficiency and to fulfill practical clinical requirements. Results: The parameter determination process is consistent, as the measured spectrum is practically completely reproducible by the modeling sequence, in other words, the whole spectral information is transformed into model parameters which are easily accessible for physiological interpretation. The method is flexible enough to be applicable on a wide spectrum of skin and wounds. Examples of advanced procedures utilizing extended perfusion representation in clinical application areas (flap control, burn diagnosis) are presented.

The aim of this study was to evaluate the morphology of the six different parts of the interosseous membrane (IOM) in 11 human cadaver forearms, including the distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC), and the proximal oblique cord (POC). Hematoxylin-eosin and Elastica van Gieson stained slices were used to investigate the tissue morphology. The DOB and DOAC were absent in one IOM and the POB in two IOMs, respectively. The CB and DAB were longer than all other structures except for each other. The DOAC was longer than the DOB. The DAB, CB, and PAB, were broader than the DOB, DOAC, and POC. No significant differences were observed regarding structure thickness. All structures were found to consist of densely packed parallel collagen fiber arrangement. The DOB and POC had a higher amount of elastic fibers in the fascicular collagen tissue than the other structures. Elastic fibers were more often equally distributed throughout the structures than condensed epifascicular or at the insertion into bone. The tight parallel collagen composition within the different structures reflects the central stabilizing role of the IOM in the forearm. The higher amount of elastic fibers within the DOB and POC can be attributed to their location close to the distal and proximal radioulnar joints, respectively. Here elastic fibers allow adaption to forearm rotation, whereas the structures of the central part of IOM have less elasticity reflecting the predominant stabilizing function.

The human interosseous membrane (IOM) is a fundamental stabilizer during forearm rotation. To investigate the dynamic aspects of forearm stability, we analyzed sensory nerve endings in the IOM. The distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC) and the proximal oblique cord (POC) were dissected from 11 human cadaver forearms. Sensory nerve endings were analyzed at two levels per specimen as total cell amount/mm(2) after immunofluorescence staining with low‐affinity neurotrophin receptor p75, protein gene product 9.5, S‐100 protein and 4′,6‐diamidino‐2‐phenylindole on an Apotome microscope, according to Freeman and Wyke’s classification. Sensory nerve endings were significantly more commonly found to be equally distributed throughout the structures, rather than being epifascicular, interstitial, or close to the insertion into bone (P ≤ 0.001, respectively). Free nerve endings were the predominant mechanoreceptor in all six structures, with highest density in the DOB, followed by the POC (P ≤ 0.0001, respectively). The DOB had the highest density of Pacini corpuscles. The DOAC and CB had the lowest amounts of sensory innervation. The high density of sensory corpuscles in the DOB, PAB and POC indicate that proprioceptive control of the compressive and directional muscular forces acting on the distal and proximal radioulnar joints is monitored by the DOB, PAB and POC, respectively, due to their closed proximity to both joints, whereas the central parts of the IOM act as structures of passive restraint.

Objective: Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. Methods: A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. Results: There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). Conclusion: Attempted suicide by self-inflicted burns represents

The objective evaluation of scattering tissue and the discrimination of tissue types is an issue that cannot be solved with colour cameras and image processing alone in many cases. Examples can be found in the determination of freshness and ageing of meat, and the discrimination of tissue types in food technology. In medical applications tissue discrimination is also an issue, e.g. in wound diagnostics. A novel hyperspectral imaging setup with powerful signal analysis algorithms is presented which is capable of addressing these topics. The spectral approach allows the chemical analysis of material and tissues and the measurement of their temporal change. We present a method of hyperspectral imaging in the visible-near infrared range which allows both the separation and spatial allocation of different tissue types in a sample, as well as the temporal changes of the tissue as an effect of ageing. To prove the capability of the method, the ageing of meat (slices of pork) was measured and, as a medical example, the application of the hyperspectral imaging setup for the recording of wound tissue is presented. The method shows the ability to discriminate the different tissue components of pork meat, and the ageing of the meat is observable as changes in spectral features. An additional result of our study is the fact that some spectral features, which seem to be typical for the ageing of the meat, are similar to those observed in the necrotic tissue from wound diagnostics in medicine.

Fluid management is one of the anticipated risk factors for intra-abdominal compartment syndrome (ACS). Since fluid requirements depend on the burned total body surface area (TBSA), an independent analysis is necessary to adapt resuscitation protocols and prevent this life-threatening complication. A retrospective multicenter study with matched-pair analysis was conducted in four German burn centers, including 38 burn patients with ACS who underwent decompressive laparotomy. Potential risk factors were analyzed, such as resuscitation volume, total fluid intake, mean fluid administration per day, fluid balance, and blood transfusion. The ACS group and control were compared with a two-tailed Mann-Whitney U test (P < .05). The ACS group was split up into an early and late ACS group for statistical subgroup analysis. Total fluid intake, fluid balance, and the total volume of colloids showed no significant difference in the ACS group (mean TBSA 50%) versus control (mean TBSA 49%). The subgroup analysis showed significant higher total resuscitation volume, fluid administration per kilogram body weight, and fluid balance in the first 24 hours in the late-onset ACS group. This study shows a different risk factor profile for early-onset ACS in the first 4 days after trauma and late-onset ACS. Herein, fluid therapy is a fundamental risk factor for late-onset ACS. In early-onset ACS, fluid administration contributes significantly to the development of intra-abdominal hypertension, but other risk factors seem to turn the balance for the development of early-onset ACS in burn patients.