Search

This study investigates the correlation between the Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after medial thigh lift in formerly obese patients.A single-institution retrospective review of patients undergoing medial thigh lift between 2009 and 2019 after massive weight loss. Data on demography, comorbidities, surgery, and postoperative outcome were extracted from patients' charts. Patients were grouped into EOSS categories. Complications were classified into minor and major. Logistic regression analysis was performed to determine the association between risk factors and complications.One hundred and eight patients were included in the study. Complications occurred in 76 (70%) of the patients, most of which were minor (60/108, 56%). Complications increased with increasing EOSS stage, and all EOSS 3 patients had complications. Classification as EOSS 2 or 3 significantly associated with occurrence of postoperative complications (OR 99.3, p0.001) as well as minor and major complications individually (OR 3.1 and 6.5, p0.05). This effect was independent of body mass index (BMI), maximum BMI loss, type of weight loss, volume of liposuction, weight of resected tissue, and type of surgery.EOSS is a robust and independent predictor for postoperative complications in medial thigh lift surgery after massive weight loss.

Background Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction. Methods In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008–2018 were reviewed. Results 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear. Conclusion The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.

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.

BackgroundThree-dimensional (3D) scanning is an established method of breast volume estimation. However, this method can never be entirely precise, since the thoracic wall cannot be imaged by the surface scanner. Current methods rely on interpolation of the posterior breast border from the surrounding thoracic wall. Here, we present a novel method to calculate the posterior border and increase the accuracy of the measurement.MethodsUsing principal component analysis, computed tomography images were used to build a statistical shape model (SSM) of the thoracic wall. The model was fitted to 3D images and the missing thoracic wall curvature interpolated (indirect volumetry). The calculations were evaluated by ordinary least squares regression between the preoperative and postoperative volume differences and the resection weights in breast reduction surgery (N=36). Also, an SSM of the breast was developed, allowing direct volumetry. Magnetic-resonance images (MRI) and 3D scans were acquired from 5 patients in order to validate the direct 3D volumetry.ResultsVolumetry based on a SSM exhibited a higher determination coefficient (R2=0,737) than the interpolation method (R2=0,404). The methods were not equivalent (p=0.75), suggesting that the methods significantly differ. There was no influence of BMI on the correlation in either method. The MRI volumetry had a strong correlation with the 3D volumetry (R2=0,978).ConclusionThe SSM-based method of posterior breast border calculation is reliable and superior to the currently used method of interpolation. It should serve as a basis of software applications aiming at calculation of breast volume from 3D surface scanning data.

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. 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. 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. 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. 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. 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. 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. 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.

Perineal defects following the resection of anorectal malignancies are a reconstructive challenge. Flaps based on the rectus abdominis muscle have several drawbacks. Regional perforator flaps may be a suitable alternative. We present our experience of using the gluteal fold flap (GFF) for reconstructing perineal and pelvic defects. We used a retrospective chart review and follow-up examinations focusing on epidemiological, oncological (procedure and outcome), and therapy-related data. This included postoperative complications and their management, length of hospital stay, and time to heal. Twenty-two GFFs (unilateral n = 8; bilateral n = 7) were performed in 15 patients (nine women and six men; anal squamous cell carcinoma n = 8; rectal adenocarcinoma n = 7; mean age 65.5 + 8.2 years) with a mean follow-up time of 1 year. Of the cases, 73.3% were a recurrent disease. Microscopic tumor resection was achieved in all but one case (93.3%). Seven cases had no complications (46.7%). Surgical complications were classified according to the Clavien-Dindo system (grades I n = 2; II n = 2; IIIb n = 4). These were mainly wound healing disorders that did not affect mobilization or discharge. The time to discharge was 22 + 9.9 days. The oncological outcomes were as follows: 53.3% of the patients had no evidence of disease, 20% had metastatic disease, 20% had local recurrent disease, and one patient (6.7%) died of other causes. The GFF is a robust, reliable flap suitable for perineal and pelvic reconstruction. It can be raised quickly and easily, has an acceptable complication rate and donor site morbidity, and does not affect the abdominal wall.

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.

ZusammenfassungDie Brustrekonstruktion mit freiem Gewebetransfer vom Unterbauch als (muskelsparende) TRAM oder DIEP Lappenplastik stellt das Standardverfahren der autologen Brustrekonstruktion dar. Durch operative Fortschritte ist es gelungen die Hebedefektmorbidität durch muskelsparende bzw. perforatorbasierte Techniken zu minimieren. Hier stellt sich die Frage, in wie weit dies als ein notwendiger Standard angesehen werden kann oder ob auch Lappenplastiken mit Muskelanteilen (MS-TRAM) noch als zeitgemäß anzusehen sind. In einem Konsensusworkshop der 3 Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) wurde die Datenlage kritisch geprüft und durch eine Expertengruppe ein Konsensus erarbeitet. Dieser beinhaltet neben den aktuellen Daten zu Lappensicherheit und Hebedefektmorbidität aus der Literatur auch ein aktuelles Meinungsbild der Expertengruppe bzgl. verschiedener technischer Details des operativen Vorgehens.

BACKGROUND Liposarcoma constitute about 13% of all soft tissue sarcoma and are associated with a high risk of metastases. As the preoperative differentiation between benign and malign lipomatous tumors is restricted to magnetic resonance imaging, computed tomography and biopsy, we performed a miRNA array to distinguish dedifferentiated liposarcoma patients from healthy controls and lipoma patients. METHODS Blood samples of patients with dedifferentiated liposarcoma, healthy controls and lipoma patients were collected. Whole blood RNA was extracted and samples of patients with dedifferentiated liposarcoma (n= 6) and of healthy donors (n= 4) were analyzed using an Affymetrix GeneChip miRNA Array v. 4.0. qRT-PCR was carried out to confirm the most differentially expressed miRNA; being further analyzed in an independent cohort of healthy controls as well as in lipoma patients. RESULTS As shown by the microarray, two miRNAs (miR-3613-3p, miR-4668-5p) were shown to be significantly upregulated (fold change: > 2.5; p< 0.05) in patients with dedifferentiated liposarcoma (n= 6) as compared to healthy controls (n= 4). miR-3613-3p was further validated by qRT-PCR to be significantly upregulated in dedifferentiated liposarcoma patients compared to an independent cohort of healthy controls (n= 3) and lipoma patients (n= 5). CONCLUSION We identified a specific whole blood miRNA (miR-3613-3p) that may serve to distinguish between dedifferentiated liposarcoma patients and healthy controls, thus potentially serving as a specific biomarker for dedifferentiated liposarcoma.

Zusammenfassung Hintergrund Die Resektion großer Weichteilsarkome erfordert die Rekonstruktion mit freiem Gewebstransfer. Hierbei stellt die Selektion geeigneter Anschlussgefäße einen entscheidenden Faktor für den operativen Erfolg dar. Patienten Wir berichten über vier Fälle mit sehr großen Tumoren und mit besonders komplexem anatomischem Bezug: zwei Sarkome in der Leiste mit Infiltration der Gefäß-Nervenstraße und zwei Sarkome in der Flanke mit ausgedehnter thorakoabdomineller und viszeraler Beteiligung. In allen Fällen erfolgten interdisziplinäre Operationen innerhalb eines multimodalen Therapieansatzes. In zwei Fällen wurde ein anterolateraler Oberschenkellappen (ALT) und in zwei ein myokutaner Latissimus Dorsi (LD) Lappen zur Defektdeckung benutzt. In allen Fällen erfolgte eine epifasziale Verlagerung der tiefen inferioren epigastrischen Gefäße zum mikrochirurgischen Gefäßanschluss. Ergebnisse Die durchschnittliche Operationszeit betrug 694 ± 149 Minuten. Das mittlere Resektatgewicht war 3069 ± 1267 g. Drei Lappenplastiken heilten primär ein, in einem Fall kam es zu einer Spitzennekrose, welche operativ behandelt wurde. Schlussfolgerung Die Verlagerung der tiefen inferioren epigastrischen Gefäßen nach epifaszial stellt in dieser selektionierten Gruppe eine gute Option zum Anschluss freier Lappen dar. Aufgrund der oberflächlichen Lage ist die Durchführung der Anastomose erleichtert. Insbesondere bei großen Defekten mit bestrahltem Lager erweitert diese technische Modifikation die rekonstruktiven Optionen.

“Gynecomastia” is an enlargement of the male breast. Our study aims to assess patient satisfaction as well as evaluate differences in recurrence rates in lipomatous and glandular gynecomastia 10–19 years postoperatively. Forty-one gynecomastia patients undergoing surgical treatment from 1997 to 2005 were invited for a follow-up examination 10–19 years postoperatively. Of these, 16 patients presented for a clinical examination. Patient satisfaction was measured with a validated questionnaire [consultation satisfaction questionnaire (CSQ)-9]. Furthermore, photo-material and patient charts were evaluated concerning preoperative macroscopical type of gynecomastia, BMI, and operative technique. Mean follow-up time was 13.8 years (range: 10.5–19 years). Eight patients (50%) had presented with lipomatous and eight patients (50%) with glandular gynecomastia prior to surgery. One of the patients with glandular gynecomastia (12.5%) presented with recurrence at the time of follow-up, while five of the eight patients showing lipomatous gynecomastia (62.5%) presented with recurrence. Interestingly, younger patient groups tend to be more satisfied with the operative treatment of gynecomastia than older patient groups, especially regarding the improvement of self-esteem. Long-term follow-up results showed that recurrence rates are significantly higher in patients with lipomatous gynecomastia than in patients with glandular gynecomastia, with BMI increase in patients with glandular and lipomatous gynecomastia showing no statistically significant differences. Furthermore, general patient satisfaction and improvement of self-esteem was higher in younger patient groups than older patient groups. 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 . Clinical Trial Registration Number: DRKS00009630.

Vascularization is essential for bone development, fracture healing, and bone tissue engineering. We have previously described that coculture of primary human osteoblasts (hOBs) and human umbilical vein endothelial cells (HUVECs) improves differentiation of both cell types. Investigating the role of microRNAs (miRNAs) in this system, we found that miR-126 is highly upregulated in hOBs following coculturing with HUVECs. In this study we performed miR-126 gain-of-function and loss-of-function experiments in hOBs followed by microarray analysis in order to identify targets of miR-126. The transcript cluster IDs were sieved by applying cut-off criteria and by selecting transcripts which were upregulated following miR-126 downregulation and vice versa. The calmodulin regulated spectrin associated protein 1 (CAMSAP1) mRNA was confirmed to be differentially regulated by miR-126. Using the luciferase reporter assay it was demonstrated that CAMSAP1 is directly targeted by miR-126. In this study, we show that miR-126 and CAMSAP1 directly interact in hOBs. This finding has potential implications for tissue engineering applications. J. Cell. Biochem. 118: 1756-1763, 2017. © 2016 Wiley Periodicals, Inc.

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/Ziel: Ziel dieser prospektiv-randomisierten Studie war der Vergleich der Resektions-Suspensionsarthroplastik mit der Sehne des M. abductor pollicis longus nach Sirotakova und Lundborg zur Behandlung der Daumensattelgelenksarthrose. Patienten und Methoden: Von 2009 bis 2012 wurden den beiden Behandlungsmethoden 38 Patienten (29 weiblich, 9 mannlich) mit symptomatischer Rhizarthrose (34% Stadium II, 58% Stadium III und 8% Stadium IV nach Eaton-Littler) randomisiert zugeteilt (Durchschnittsalter 62,7 Jahre, min. 43, max. 85). Praoperativ wurden folgende Daten erhoben: Schmerzintensitat (visuelle Analogskala, VAS; in Ruhe: Lundborg 4,4±1,7; Sirotakova 4,6±2,1), Kraft (Schlusselgriffkraft Lundborg 8,1 kPa±6,6; Sirotakova 10,4 kPa±10,8), Bewegungsumfang des Daumensattelgelenks (Lundborg 61,64°±26,4; Sirotakova 46,67°±25,6), Kapandji-Index (Lundborg 9,42±1,4; Sirotakova 9,33±1,5), Abstand Metakarpale I Basis – Skaphoid anhand von standardisierten Rontgenbildern (Lundborg 12 mm±1,5; Sirotakova 11,4 mm±3), DASH-Score (Lundborg 40,4±13,9; Sirotakova 49,9±23,5). Beide Gruppen unterschieden sich statistisch nicht voneinander. Die Patienten wurden 3 und 9 Monate postoperativ nachuntersucht. Ergebnisse: Beide Resektions-Suspensionsarthroplastiken fuhrten postoperativ zu einer signifikanten Schmerzreduktion, zu einer signifikanten Verbesserung der radialen und palmaren Abduktion, zu einem signifikanten Zugewinn an Lebensqualitat (DASH-Score) und zu einer signifikanten asymptomatischen Proximalisierung des Metakarpale I. Bezuglich der postoperativen Kraft ergab sich kein signifikanter Unterschied. Schlussfolgerung: Beide Operationsmethoden fuhren zu zuverlassigen und zufriedenstellenden Operationsergebnissen. Anhand der vorliegenden Studienergebnisse kann eine klare Empfehlung fur eine der beiden Methoden nicht ausgesprochen werden.

It is a common complication to develop a secondary lymphedema after surgery or radiation, for example, after axillary lymph node dissection due to breast cancer and current therapies are mainly symptomatic. Since these surgical procedures result in both, loss of adipose tissue and loss of lymphatic nodes and vessels, tissue engineering could be a new promising approach, to create an adipose tissue substitute comprised with a lymphatic network. We have conducted co-culture experiments to investigate the effects of human adipose-derived stem cells (ASCs) on human lymphatic endothelial cells (LECs) in terms of gene expression profile, proliferation, migration, and tube formation in vitro. In this respect, both cell types were co-cultured either indirectly or directly with or without the recombinant growth factor VEGF-C. Indirect co-cultures were performed with the aid of a transwell chamber. In case of direct co-culture, immunomagnetic separation by CD31 magnetic beads allowed examination of the LEC population. Direct and indirect co-culture of ASCs induced mRNA expression of lymphatic marker genes, proliferation, and migration by LECs without affecting tube formation. Thus, we have shown that co-culture of ASCs with LECs might be a feasible approach that could be used in cell-based tissue engineering therapies to heal or improve a secondary lymphedema. J. Cell. Biochem. 117: 2620-2629, 2016. © 2016 Wiley Periodicals, Inc.

This report serves to publicize the research of academic institutions for Plastic Surgery within our society DGPRÄC in 2017/2018 and sequels the funding report of 2015/2016. Applications to public, non-public, or industrial funding organizations were evaluated. At the same time, this paper analyses the number of approved DFG applications in Plastic, Thoracic and Vascular Surgery in the GEPRIS system. Contrary to these specialties, Plastic Surgery is not classified as an independent speciality in the subject structure of the DFG review board which results in a lack of transparency concerning Plastic Surgery research work.Our previously established online database (https://docs.google.com/forms/d/1OaSnHyKTysawiI1ie7kfUxDf7nJP_RiTUJTsnb7Mq_E/edit) for reporting requested/ approved and rejected research applications to public, non-public and industrial funding organizations was continued and evaluated together with applications found in the DFG's public database GEPRIS.Compared to the previous year's report, the number of approved applications from public research organizations (DFG, BMBF, BMWi, EU) was increased from 23 to 27. We identified 19 approved DFG applications from Plastic Surgery, as compared to 9 and 8 applications by Thoracic and Vascular Surgery, respectively.Taken together, this data emphasizes that our research is at least equal to that of other newly established surgical specialties within the framework of the DFG. Accordingly, we hope to provide further arguments for an adaptation of the DFG review boards subject structure to include Plastic Surgery as an independent specialty as it is for Vascular Surgery and Thoracic Surgery.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.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.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.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.

Coculturing of bone-forming and blood vessel-forming cells is a strategy aimed at increasing vascularity of implanted bone constructs in tissue-engineering applications. We previously described that the coculture of primary human osteoblasts (hOBs) and human umbilical vein endothelial cells (HUVECs) improves the differentiation of both cell types, leading to the formation of functional blood vessels and enhanced bone regeneration. The objective of this study was to further delineate the multifaceted interactions between both cell types. To investigate the proteome of hOBs after cocultivation with HUVECs we used stable isotope labeling by amino acids in cell culture, revealing 49 significantly upregulated, and 54 significantly downregulated proteins. Amongst the highest regulated proteins, we found the proteins important for osteoblast differentiation, cellular adhesion, and extracellular matrix function, notably: connective tissue growth factor, desmoplakin, galectin-3, and cyclin-dependent kinase 6. The findings were confirmed by enzyme-linked immunosorbent assays. We also investigated whether the mRNA transcripts correlate with the changes in protein levels by quantitative real-time reverse transcription polymerase chain reaction. In addition, the data was compared to our previous microarray analysis of hOB transcriptome. Taken together, this in-depth analysis delivers reliable data suggesting the importance of coculturing of hOBs and HUVECs in tissue engineering.

Background Neovascularization plays an important role in tissue engineering applications. In animal models, it was demonstrated that implantation of endothelial progenitor cells (EPCs) from cord blood led to the formation of a complex functional neovasculature, whereas EPCs isolated from peripheral blood (pbEPCs) showed a limited vasculogenic potential, which may be attributed to age-related dysfunction. Growth differentiation factor 11 (GDF11) was recently identified as a rejuvenation factor, which was able to reverse age-related dysfunction of stem cells. Therefore, we hypothesized that GDF11 may improve the vasculogenesis-related phenotype of pbEPCs. Materials and methods pbEPCs were isolated from adult peripheral blood. Transforming growth factor (TGF)-β type-I receptor expression was analyzed by immunostaining. pbEPCs were treated with recombinant GDF11 for various time periods. Thereafter, phosphorylation of Smad2/Smad3, adhesion, proliferation, cell survival, migration, and in vitro sprout formation was investigated. Results pbEPCs express the TGF-β type-I receptors ALK4 and ALK5, but not ALK7. Treatment of pbEPCs with recombinant GDF11 resulted in activation of the Smad2/Smad3 pathway and in increased migration, which was inhibited by the TGF-β1 superfamily type-I activin receptor-like kinase inhibitor SB431542, demonstrating that the TGF-β receptor-Smad2/Smad3 pathway is involved in GDF11 induced migration. Moreover, in vitro sprout formation was increased as well by GDF11 treatment. However, other parameters such as adherence, proliferation, and apoptosis were not affected by GDF11. Conclusions This study provides evidence that GDF11 improves vasculogenesis-related growth parameters in pbEPCs and may represent a therapeutic option to ameliorate the angiogenic and vasculogenic properties of pbEPCs.

Die digitale Volumentomografie (DVT) stellt eine neue Moglichkeit der Schnittbildgebung in der Handchirurgie dar. Die Methode hat in der letzten Dekade eine weite Verbreitung in der Kopf-Hals-Bildgebung gefunden und ist in diesem Bereich ein etabliertes Standardverfahren, fur das eine, im Vergleich zur Computertomografie (MDCT), niedrigere Strahlenexposition beschrieben wird. Wir berichten uber 24 Monate klinische Erfahrung mit dem Einsatz der Methode in einer handchirurgischen Universitatsklinik. Die DVT wird bezuglich ihrer Technik sowie ihrer klinischen Eignung anhand von exemplarischen Falldarstellungen vorgestellt und evaluiert. Weiterhin werden ihre Vor- und Nachteile diskutiert und in den Kontext der aktuellen Literatur gesetzt.

Wiederherstellung der aktiven Handgelenksstreckung, Daumenstreckung und Langfingerstreckung durch Muskeltransposition. Irreparable periphere Radialisparese. Erkrankungen peripherer Nerven, Muskel-/Sehnenverletzung. Internal Splint bei hoher Radialisparese. Reversible distale Radialisparese. Fehlen geeigneter Donor-Muskeln, spastische Parese. Fehlende passive Gelenkbeweglichkeit. Narbige Weichteilverhaltnisse. Spendermuskel mit eingeschrankter Funktion. Reinnervierte Muskelsehneneinheiten. Progressive Muskel- oder Nervenerkrankung. Mangelnde Compliance. Transposition von M. flexor carpi ulnaris, M. palmaris longus und M. pronator teres. Sehnendurchflechtung von M. pronator teres mit M. extensor carpi radialis brevis, M. extensor digitorum communis mit M. flexor carpi ulnaris. Sehnendurchflechtung von M. extensor pollicis longus mit M. palmaris longus nach Mobilisation aus 3. Strecksehnenfach und Umlagerung. Durchflechtungen nach Pulvertaft. Ruhigstellung fur 3 Wochen in Entlastungshaltung in palmarer Unterarmschiene. Anschliesend Schiene zur Nacht fur weitere 2 Wochen. Intensive krankengymnastische Nachbehandlung fur 4–6 Wochen mit Beginn ab der 3. postoperativen Woche. Die beschriebene motorische Ersatzplastik kam in einem Zeitraum von 14 Jahren in 12 Fallen zur Anwendung. In 9 Fallen lag eine hohe Radialisparese vor. In Ubereinstimmung mit der aktuellen Literatur kann die beschriebene motorische Ersatzplastik als zuverlassiges Verfahren angesehen werden.

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test. Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS). Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

Nachwuchssorgen in chirurgischen Disziplinen sind ein zunehmend diskutiertes Thema. Einerseits erscheinen jungen Arztinnnen und Arzten die beruflichen Perspektiven weniger attraktiv als die der Vorgangergeneration. Andererseits haben sich die Anspruche an die sogenannte „work-life-balance“ geandert und ohne Zweifel steigt der Anteil der Frauen in der Medizin. Wenngleich die Plastische Chirurgie insgesamt innerhalb der chirurgischen Disziplinen momentan noch weniger von diesem Problem betroffen zu sein scheint, ist die Sicherung eines qualifizierten akademischen Nachwuchses in der Plastischen Chirurgie eine Voraussetzung fur die Weiterentwicklung dieses Fachgebietes. Das traditionelle Modell des Mentoring und die Rolle des coaching als Hilfestellung fur den Auszubildenden, seine Absichten und Ziele zu erreichen, wird diskutiert. Im vorliegenden Artikel wird versucht, aus der Sicht der Leitenden Universitatschirurgen in der Plastischen Chirurgie eine Analyse des Ist-Zustandes zu erheben und die spezifischen Per­spektiven fur die akademische Nachwuchsforderung vor dem Hintergrund einer oftmals einseitigen und oberflachlichen Perzeption des Berufsbildes zu beleuchten.

Health care systems in many countries are confronted with increasing economic limitations. Thus, complex microsurgical procedures and extensive rehabilitation programs are poorly compensated. However, this case demonstrates a dramatic reduction of socioeconomic expenses by allowing a potential radiocarpal amputee to return to work for another estimated 30 years.

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 (DGPRÄC) 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.

Coverage of a soft tissue defect at the hand with a pedicled fasciocutaneous flap.Primary or secondary skin and soft tissue defects of the hand of less than 15×5 cm.Absent posterior interosseous artery. Absent anastomosis between posterior and anterior interosseous arteries. Defects smaller than 3×3 cm; they should be closed through mobilization of the surrounding tissues.Marking of flap. The first skin incision is done at the ulnar side of the marked flap and deepened to the fascia of the extensor carpi ulnaris muscle. Dissection of the intermuscular septum while preserving the perforating skin vessels of posterior interosseous artery. Incision at the radial side and dissection of the intermuscular septum from radial without injuring the motor branches of the radial nerve. Ligation of the posterior interosseous artery distal to the motor branches. Detachment of the pedicle through coagulation of the branches going to muscles and bone. Detachment of the intermuscular septum from ulnar. Exposure of the communication with the anterior interosseous vessels. Spreading and tensionless suturing of flap into the defect. Avoid kinking of defect. Primary closure of the site of harvesting or coverage with full or split thickness skin graft.During a period of 3.5 years this technique was used in 10 patients. The average time to healing: 15.9 days. Average duration of follow-up: 19.1 months. All flaps were incorporated. The only complication was a venous congestion in the flap in 2 patients.

Background Microvesicles are small vesicles expressing specific antigens from their cells of origin. Elevated levels of microvesicles have been shown to be associated with coagulation disorders as well as with different types of malignancies. This study aims to evaluate a possible correlation of different microvesicle subpopulations with a positive history of venous thromboembolism (VTE) in patients with soft tissue sarcoma. Methods Annexin V - positive microvesicles, leukocyte (CD45-positive), platelet (CD61-positive), activated platelet (CD62P-, CD63-positive), endothelium-derived (CD62E-positive) and tissue-factor (CD142-positive) microvesicles were identified in the peripheral blood of patients with soft tissue sarcoma (n = 39) and healthy controls (n = 17) using fluorescence-activated cell sorting (FACS). Results Both the total amount of Annexin V-positive microvesicles and levels of endothelium-derived (CD62E-positive) microvesicles were shown to decrease significantly after tumor resection (n = 18, p = 0.0395 and p = 0.0109, respectively). Furthermore, the total amount of Annexin V – positive microvesicles as well as leukocyte (CD45-positive) and endothelium-derived (CD62E-positive) microvesicles were significantly higher in patients with grade 3 (G3) soft tissue sarcoma (n = 9) compared to healthy controls (n = 17) (p = 0.0304, p = 0.0254 and p = 0.0357, respectively). Moreover, patients with G3 soft tissue sarcoma (n = 9) presented higher levels of Annexin V-positive and endothelium-derived (CD62E-positive) microvesicles compared to patients with grade 2 (G2) soft tissue sarcoma (n = 8) (p = 0.0483 and p = 0.0045). Patients with grade 1 (G1) soft tissue sarcoma (n = 3) presented with significantly lower levels of platelet (CD61-positive) microvesicles than patients with G3 soft tissue sarcoma (n = 9) (p = 0.0150). In patients with a positive history of VTE (n = 11), significantly higher levels of activated platelet (CD62P- and CD63-positive) microvesicles (p = 0.0078 and p = 0.0450, respectively) were found compared to patients without a history of VTE (n = 28). Conclusion We found significantly higher levels of Annexin V-positive and endothelium-derived (CD62E-positive) microvesicles to be circulating in the peripheral blood of patients with G3 soft tissue sarcoma compared to patients with G2 soft tissue sarcoma. Furthermore, we showed that high counts of activated platelet-derived microvesicles correlate with the occurrence of VTE. Thus, the detection of these microvesicles might be an interesting new tool for early diagnosis of soft tissue sarcoma patients with increased risk for VTE, possibly facilitating VTE prevention by earlier use of thromboprophylaxis. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3515-y) contains supplementary material, which is available to authorized users.

The aim of this prospective randomised study was to compare Sirotakova's and Lundborg's methods of resection-suspension arthroplasty using the abductor pollicis longus tendon in the surgical treatment of osteoarthritis of the trapeziometacarpal joint.Between 2009 and 2012, 38 patients (29 female, 9 male) with symptomatic trapeziometacarpal osteoarthritis (34% stage II, 58% stage III and 8% stage IV according to the Eaton-Littler classification) were randomly allocated to one of the surgical methods (mean age 62.7 years, range 43-85). Preoperatively, the following data were collected: pain intensity (Visual Analogue Scale, VAS; at rest: Lundborg 4.4±1.7; Sirotakova 4.6±2.1), strength (key pinch force Lundborg 8.1 kPa±6.6; Sirotakova 10.4 kPa±10.8), range of motion in the trapeziometacarpal joint (Lundborg 61.64±26.4; Sirotakova 46.67±25.6), Kapandji index (Lundborg 9.42±1.4; Sirotakova 9.33±1.5), distance between the base of the first metacarpal bone and the scaphoid bone as measured by standardised x-ray images (Lundborg 12 mm±1.5; Sirotakova 11.4 mm±3), DASH questionnaire (Lundborg 40.4±13.9; Sirotakova 49.9±23.5). A significant difference between the 2 groups was not found. Patients were examined 3 and 9 months postoperatively.Both resection-suspension arthroplasty procedures led to a statistically significant postoperative reduction of pain, a significant improvement in radial and palmar abduction, a significant gain in quality of life and significant asymptomatic proximalisation of the first metacarpal bone. There was no significant difference in postoperative strength.Both methods lead to reliable and satisfying results. Given our findings we cannot generally recommend one method over the other.

Although a multitude of proposed forehead rejuvenation procedures have been described, long-term and systematic morphometric evaluation is rare. There are no studies comparing endoscopic forehead lifts and transpalpebral browpexy techniques according to their efficacy in raising and reshaping the brow.In a retrospective study, standardized photographic documentations of patients undergoing an endoscopic forehead lift or a transpalpebral browpexy were morphometrically analyzed. Five measurements were taken to evaluate brow height, and two measurements were taken to describe the change in brow shape.Fifty-six and 29 patients, respectively, in the two groups were analyzed up to 5 years postoperatively. Morphometric evaluation proved a significant elevation of the total brow and an improvement in brow shape for the endoforehead group, whereas the brow position after the transpalpebral browpexy significantly descends, despite an improvement in subjective aesthetic outcome. An additional blepharoplasty after the endoscopic forehead lift does not lower the brow significantly.The efficacy of the endoforehead lift is supported by extensive, systematic, and long-term data, and its superiority over transpalpebral approaches has been proven. The descent of the brow after transpalpebral browpexy is most likely caused by a decrease of frontalis hyperactivity after the simultaneously performed blepharoplasty. Further studies need to evaluate its effect compared with blepharoplasty alone.Therapeutic, III.

The perioral region is subject to a myriad of different treatments for rejuvenation, many of which are applied without a clear understanding of the underlying physiological processes of perioral aging. The results of these procedures are therefore sometimes not optimal and do not achieve a natural youthful appearance. The aim of this study was to put the results of three investigations into the perioral aging process into relation to clinical application in aesthetic medicine.Three different investigations were performed to evaluate the complex 3-dimensional changes during the perioral aging process. Perioral proportions of 182 standardized subject photographs were measured in a photomorphometric study and correlated to age. In cranial MRI scans of 30 women aged 20-35 and 30 women aged 65-80 relevant anatomical dimensions were measured. Histological cross cuts of the upper lip complex of 20 individuals in two age groups, young (40 years, n = 10) and old (80 years, n = 10), were analysed. The results were then set into relation to today's lip rejuvenation procedures.All studies showed a statistically significant lengthening of the aging upper lip. The photomorphometric study further showed an increase of prolabium skin at the cost of a decreasing visible upper lip vermilion. The MRI scans showed a decrease in thickness and redistribution towards a length increase but no total volume loss. Histomorphometric analysis revealed statistically significant thinning of the cutis, thickening of the subcutis and a degeneration of elastic and collagen fibers. The orbicularis oris muscle becomes thinner and shows a decrease of the forward curve defining the vermilion border. The results show that the main processes of lip aging are redistribution from thickness to length without total volume loss and a decrease of structural components of the lip, which leads to the decrease of pouting, an inversion of the vermilion and a ptosis of the lip.A new and better understanding of the underlying physiological changes of perioral aging is essential and will lead to a better and more specific implementation of perioral rejuvenation procedures which will lead to more natural results.

Following the clinical observation of high rate of ruptures of breast implants of the French manufacturer Poly Implant Prothèse (PIP), the French Health Products Safety Agency (Afssaps) removed these products from the market in March 2010. Physical and toxicological tests confirmed the use of silicone of improper quality both for the shell and the gel filling. Until now (12/2011), no acute toxicity or mutagenicity could be observed, but 20 cases of malignancies occured in carriers of PIP-prostheses. By means of a clinical example, we summarize the official recommendations of the Afssaps and its German equivalent, the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) for diagnosis and treatment in women with PIP breast implants. Furthermore, we intend to raise awareness for the fact that the German GfE Medizintechnik and the Dutch manufacturer Rofil distributed the identical product with a different label. Supplementary, the medical and medico-legal aspects of the "PIP scandal" are discussed.Aufgrund unzulässig hoher Rupturraten von Brustimplantaten des französischen Herstellers Poly Implant Prothèse (PIP) nahm die französische Aufsichtsbehörde für Medizinprodukte (Afssaps) diese Produkte im März 2010 aus dem Handel. Laboruntersuchungen bestätigten die Verwendung von minderwertigem Silikonmaterial für Hülle und Füllung der Implantate, eine akute Toxizität oder Mutagenität konnte bisher nicht nachgewiesen werden, jedoch sind mittlerweile (12/2011) bei insgesamt 20 Trägerinnen von PIP-Implantaten Krebserkrankungen aufgetreten. Anhand eines klinischen Falles sollen hier die aktuellen Empfehlungen der Afssaps sowie des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM) zusammengefasst werden. Ebenfalls soll darauf hingewiesen werden, dass identische Produkte vom niederländischen Hersteller Rofil sowie der Firma GfE Medizintechnik unter anderer Bezeichnung in den Handel gebracht wurden. Ergänzend sollen die sich aus dem „PIP-Skandal“ ergebenden medizinischen und medizinrechtlichen Konsequenzen erörtert werden.

Objectives: MTA1 is known to be responsible for independent nucleosome remodelling and deacetylase complexes with ability to regulate divergent cellular pathways. However, additional biological functions have, up to now, remained largely unexplored. The present study was initiated to investigate involvement of MTA1 in osteogenic differentiation of immortalized human mesenchymal stem cells (MSCs). Materials and methods: MSCs were examined for expression of MTA1 and stably transfected clones expressing shRNA to MTA1 were generated. Cells were grown under osteogenic and non-osteogenic conditions. Effects of silencing on cell proliferation, calcium deposition and alkaline phosphatase (ALP) activity were studied. mRNA expression of bone sialoprotein (BSP), osteopontin (OSP), runt-related transcription factor 2 (Runx2), osteocalcin (OC), collagen type I (Col1A) and ALP were analysed. Results: Transfected cells showed reduction in proliferation and significant increase in calcium deposition and expression of osteogenic marker genes, BSP, OSP, Runx2, OC and Col1A, when they were grown under osteogenic conditions. Under non-osteogenic conditions, expression of BSP and OSP were also markedly upregulated, whereas expression of osteogenic marker genes, Runx2, OC and Col1A, was almost unaffected. Expression of ALP was slightly suppressed under non-osteogenic conditions but significantly increased under osteogenic differentiation conditions, as assessed by enzyme activity and mRNA expression assays. Conclusions: Our data collectively suggest that endogenously produced MTA1 constrains osteogenic differentiation of MSCs and that targeting of this molecule may provide a novel strategy for enhancing bone regeneration.

The increasing importance of evidence-based medicine (EBM) is the result of an increasing demand for a rational decision-making process in healthcare. It has been demonstrated that 15-40% of decisions made in healthcare do not have a solid scientific basis. This is particularly problematic in times of limited financial resources, when reimbursement increasingly depends on how "evidence-based" a particular treatment is. Application of EBM principles in plastic surgery is therefore no longer an option. This, however, requires a basic understanding of the existing levels of evidence. In the present article, principles of EBM will be presented. The importance of randomized controlled trials and systematic reviews for plastic surgery will be highlighted along with a discussion of the quality of the plastic surgical literature based on results of recent systematic analyses. The plastic surgical community has appreciated the need for higher quality clinical studies. Improvement of the quality of reporting is, however, critical.

One of the most demanding areas in plastic surgery is reconstruction of the smile in the setting of facial palsy. A multitude of surgical techniques and approaches have been proposed with variable success rates. The most frequently applied treatment algorithm is a two-stage approach with placement of a cross-facial nerve graft (CFNG) initially and subsequent free functional muscle transfer. As this approach has several limitations, the authors have performed single-stage reconstructions utilising the motor nerve to the masseter as the donor nerve. Four patients underwent this single-stage reconstruction for facial palsy between July 2007 and May 2008. In all patients free functional transfer of the gracilis muscle was performed using the motor nerve to the masseter as the donor nerve. Outcome measures were functional result as well as patient satisfaction. The intraoperative as well as postoperative course was uneventful in all patients. In only one patient we encountered a small area of delayed wound healing which was amenable to conservative treatment. In all patients voluntary contraction of the gracilis muscle was visible after a mean period of 2.5 months. All patients displayed a high level of satisfaction with the functional result. Utilising the motor nerve to the masseter muscle as a donor nerve allows single-stage microsurgical reconstruction of the smile in the setting of facial palsy with reproducible results.

Platelet-derived growth factor (PDGF) receptor signaling plays an important role in the regulation of proliferation and migration of skeletal cells such as osteoblasts or mesenchymal stem cells (MSCs). However, involvement of these receptors in the process of osteoblastic differentiation of MSCs is still a matter of debate. The aim of our study was to examine the role of PDGF receptor signaling in osteogenic differentiation of human MSCs. For this purpose, we performed PDGF receptor stimulation as well as inhibition experiments. Inhibition experiments were carried out with Tyrphostin AG1296, a potent and specific inhibitor of PDGF receptor activity. As expected, Tyrphostin AG1296 treatment caused a concentration-dependent decrease in fetal calf serum and PDGF-BB-induced proliferation of MSCs and effectively inhibited PDGF-BB-induced phosphorylation of extracellular-regulated kinase 1/2. However, PDGF receptor inhibition had no significant effect on osteoblastic differentiation of MSCs, as evaluated histochemically by von Kossa, Alizarin-Red, and osteocalcin stainings. Moreover, mineralized matrix production, as assayed by quantitative Ca(2+)-measurements, was also not modulated by Tyrphostin AG1296 treatment. These results were noticeable irrespective of whether MSCs were grown under nonosteogenic or osteogenic differentiation conditions. Similarly, PDGF-BB treatment of MSCs in receptor stimulation experiments also failed to modulate mineralization. However, expression of alkaline phosphatase was suppressed by Tyrphostin AG1296 treatment at later stages of osteogenesis but not in the early stages, as assessed by enzyme activity and mRNA expression assays. Expression of other osteogenic marker genes such as osteocalcin, runt-related transcription factor 2, osteopontin, collagen type I, and bone sialoprotein was almost unaffected in our perturbation studies. From these experiments, we conclude that PDGF receptor signaling sustains proliferation without affecting osteogenic differentiation of MSCs.

With the advent of bariatric surgery, body contouring has grown to a new speciality in plastic surgery. Following massive weight loss, patients generally have skin redundancy on the trunk, buttocks, breast, upper arms, thighs and face, leading to a poor quality of life and social acceptance. This condition motivates many patients to consult a plastic surgeon to address these problems. Thus, plastic surgery has become an integral part of the surgical treatment of the morbidly obese. The aim of post-bariatric plastic surgery should be to restore a normal body image of the patient with as few surgeries as possible and with a tolerable risk. This article addresses different plastic surgery procedures that can be successfully applied in order to correct various body contouring deformities. Patient selection, technical details, pre- and postoperative care, possible complications and expected results are all discussed.

A novel therapeutic approach for the treatment of bone defects is gene therapy assisted bone tissue engineering using bone marrow stromal cells (hBMSC). The aim of this study was to investigate the influence of human epidermal growth factor (hEGF) on proliferation and alkaline phosphatase (AP) activity of primary hBMSC in vitro. hBMSC cultures were achieved by explantation culture of bone chips. Following exposure to 0-10 ng recombinant hEGF (rhEGF)/ml cell numbers were determined by automated cell counting and cell bound AP activity was measured spectrophotometrically. hBMSC were transfected with hEGF plasmids and the proliferative effect was studied by cocultivation of transfected and untreated cells using porous cell culture inserts. The persistence of hEGF expression even after cell transfer was studied by the generation of possibly osteogenic constructs introducing transfected hBMSC in fibrin glue and bovine cancellous bone. The maximum increase in proliferation (156 +/- 7%) and AP activity (220 +/- 34%) was detected after exposition to 10 ng rhEGF/ml. In the separation chamber assay transfected cells produced hEGF concentrations up to 3.6 ng/ml, which induced a mean proliferation increase of 93% which could be significantly inhibited by a neutralizing hEGF antibody. Further, EGFsecretion of transfected hBMSC in 3D-culture was verified. Recombinant and transgenic hEGF stimulate proliferation of primary hBMSC in vitro. Lipotransfection of hBMSC with hEGF plasmids allows the transient and site directed delivery of biologically active transgenic hEGF. The introduction of mitogenic, angiogenic and chemoattractive factors in gene therapy assisted bone tissue engineering is discussed by the example of EGF.

Aesthetic surgery is one pillar of plastic surgery. Thus, not surprisingly, journals exist that focus predominantly on advances within this subspecialty. However, rarely has the process of systematic reviewing that identified randomized controlled trials (RCTs) and controlled clinical trials (CCTs) been conducted within this subspecialty. All original articles published in Aesthetic Plastic Surgery were analyzed to identify all RCTs and CCTs. The proportion of RCTs and CCTs in all original articles was determined, and the quality of reporting was assessed on the basis of established quality items. Additional parameters were investigated including reporting of statistically significant differences, type of institution, and country affiliation of the first author. Of the 1,048 original articles analyzed, 11 (1%) and 24 (2.3%) articles met the inclusion criteria for RCTs and CCTs, respectively. Only two studies were single blinded, whereas only one study reported on successful double blinding and appropriate allocation concealment. Notably, these trials were RCTs. Participant dropout was reported in one study. Statistically significant differences were reported in 18 trials, 6 of which were RCTs. The annual publication of RCTs has increased over the past 5 years. North America and Europe contributed a total of 28 controlled trials (80%). Controlled trials are being conducted in aesthetic surgery at a strikingly low rate. However, a recent increase in published RCTs reflects the recognition that performing outcome studies is pivotal in moving practice toward a foundation based on assessment by outcome. The quality of reporting, however, needs improvement.

It is a common complication to develop a secondary lymphedema after surgery or radiation, for example, after axillary lymph node dissection due to breast cancer and current therapies are mainly symptomatic. Since these surgical procedures result in both, loss of adipose tissue and loss of lymphatic nodes and vessels, tissue engineering could be a new promising approach, to create an adipose tissue substitute comprised with a lymphatic network. We have conducted co-culture experiments to investigate the effects of human adipose-derived stem cells (ASCs) on human lymphatic endothelial cells (LECs) in terms of gene expression profile, proliferation, migration, and tube formation in vitro. In this respect, both cell types were co-cultured either indirectly or directly with or without the recombinant growth factor VEGF-C. Indirect co-cultures were performed with the aid of a transwell chamber. In case of direct co-culture, immunomagnetic separation by CD31 magnetic beads allowed examination of the LEC population. Direct and indirect co-culture of ASCs induced mRNA expression of lymphatic marker genes, proliferation, and migration by LECs without affecting tube formation. Thus, we have shown that co-culture of ASCs with LECs might be a feasible approach that could be used in cell-based tissue engineering therapies to heal or improve a secondary lymphedema. J. Cell. Biochem. 117: 2620-2629, 2016. © 2016 Wiley Periodicals, Inc.

Einleitung/Zielsetzung: Aufgrund Ihrer einfachen Zugänglichkeit und biologischen Vielseitigkeit besitzen mesenchymale Stammzellen aus Fettgewebe (ADSCs) vielversprechende Eigenschaften hinsichtlich vielfältiger klinischer Anwendungen. So wurde zur Verbesserung der klinischen Ergebnisse[zum vollständigen Text gelangen Sie über die oben angegebene URL], 46. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 20. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)