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Zusammenfassung Einleitung Das Erscheinungsbild des Bauchnabels nach DIEP-Lappenplastik oder Abdominoplastik spielt eine wesentliche Rolle bei der ästhetischen Wahrnehmung (1). Obgleich der Nabel keine Funktion hat, besteht kein Zweifel an der Bedeutung, die die Nabelform für das Selbstwertgefühl der Patientinnen gerade nach einer Brustkrebserkrankung hat (2). In der vorliegenden Studie haben wir zwei der bevorzugten in der Literatur beschriebenen Techniken an 72 Patientinnen hinsichtlich des ästhetischen Ergebnisses, der Komplikationen und der Sensibilität verglichen: das kaudale Läppchen (kuppelförmige Form) und die querovale Form des Nabels. Patienten und Methode Zweiundsiebzig Patientinnen, die zwischen Januar 2016 und Juli 2018 eine DIEP-Lappenplastik zur Brustrekonstruktion erhielten, wurden in dieser Studie retrospektiv erfasst. Es wurden zwei Techniken zur Nabelrekonstruktion verglichen: die querovale Nabelform und die Umbilikoplastik unter Verwendung eines kaudalen Läppchens, welche in einer kuppelförmigen Form des Bauchnabels resultiert. Um die ästhetischen Ergebnisse zu vergleichen, wurde eine Evaluation durch die Patientinnen und eine Bewertung durch drei unabhängige Plastische Chirurg*innen mindestens 6 Monate postoperativ durchgeführt. Patientinnen und Chirurg*innen wurden gebeten, das allgemeine Erscheinungsbild des Nabels, einschließlich der Narbenbildung und der Form, mit einer Punktzahl zwischen 1 und 6 zu bewerten (1=Sehr gut, 2=gut, 3=befriedigend, 4=ausreichend, 5=mangelhaft, 6=ungenügend). Des Weiteren wurde die Sensibilität des Nabels durch Befragung der Patientinnen und das Auftreten von Wundheilungsstörungen untersucht. Ergebnisse Beide Techniken zeigten ähnliche Werte der ästhetischen Zufriedenheit (p=0,49) im Rahmen der Selbsteinschätzung durch die Patientinnen. Die Plastischen Chirurg*innen bewerteten die Technik mit kaudalem Läppchen als signifikant besser gegenüber der Nabelplastik mit querovaler Form (p=0,042). Beim kaudalen Läppchen traten mehr Wundheilungsstörungen auf (11,1%) im Vergleich zum querovalen Nabel. Dies war jedoch nicht signifikant (p=0,16). Eine operative Revision war nicht erforderlich. Beim Nabel mit kaudalem Läppchen zeigte sich eine Tendenz zur Verbesserung der Sensibilität (60% gegenüber 45%), die jedoch nicht signifikant war (p=0,19). Schlussfolgerung Die Patientenzufriedenheit zeigte ähnliche Ergebnisse für die beiden Methoden der Umbilikoplastik. Beide Techniken wurden im Durchschnitt mit einem guten Ergebnis bewertet. Andererseits bewerteten die Chirurg*innen die Umbilikoplastik mit kaudalem Läppchen als ästhetisch ansprechender.

ZusammenfassungDie Rotation eines anatomischen Implantates kann einen vorzeitigen Implantatwechsel erforderlich machen. Ob eine störende Formveränderung rotationsbedingt ist, lässt sich klinisch nicht immer sicher sagen. Der hochauflösende Ultraschall kann helfen, die genaue Implantatausrichtung zu bestimmen. Die Richtungsmarkierungen von anatomischen Implantaten werden durch die Hersteller jedoch sehr uneinheitlich umgesetzt. Ohne genaue Kenntnis der zu erwartenden Bildgebung ist eine eindeutige Diagnostik daher nicht möglich. Ziel dieser Arbeit ist eine abgrenzende Darstellung der Bildgebung gängiger Implanatmarken im hochauflösenden Ultraschall. Methoden Zur Simulation einer authentischen Darstellung erfolgte die Untersuchung von anatomischen Implantaten durch eine auf 1,5–2 cm ausgedünnten Bauchhaut, die im Rahmen einer klassischen Abdominoplastik gewonnen wurde. Verglichen wurden Implantate der Firmen Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech und Sebbin. Dabei erfolgte die Dokumentation der Markierungspositionen und -abmessungen in der Ultraschalldiagnostik. Ergebnisse Durch Platzierung und Form ist unter den verwendeten Implantaten grundsätzlich eine eindeutige Zuordnung der Ausrichtung und Herstellerfirma möglich. Die Bodenplatte war bei allen Fabrikaten klar darstellbar. Beim Hersteller Polytech ist die sichtbare Strukturänderung jedoch auf ein sehr kleines, zentrales Areal begrenzt. Auch die Darstellung der Bodenplatte sowie die Implantathülle lassen Schlüsse auf den Hersteller zu.Zusammenfassung Im hochauflösenden Ultraschall ist eine schnelle und zuverlässige Diagnostik der Implantatausrichtung möglich. Auch die Herstellerfirma ließ sich in diesem Rahmen eindeutig zuordnen. Dabei kann auch ein Umkippen (flip over) sicher festgestellt werden. Die hier zusammengefasste Katalogisierung der Markierungen ermöglicht sowohl den Hersteller zu identifizieren als auch die Implantatausrichtung sicher zu bestimmen.

Zusammenfassung Abstrakt Einleitung Tranexamsäure (TXA) ist ein antifibrinolytisches Medikament, das zur Therapie von Blutungen als auch zur Blutungsprophylaxe verwendet werden kann. Die Anwendung in der plastischen und rekonstruktiven Chirurgie ist bisher äußerst begrenzt. Unseres Wissens fehlen bisher veröffentlichte Daten zur topischen Anwendung von TXA bei subkutaner Mastektomie transidenter Patienten. Methoden Es erfolgte eine retrospektive Datenanalyse von Patienten, die eine subkutanen Mastektomie bei Frau-zu-Mann Transidentität erhielten. Insgesamt wurden 22 Patienten mit topisch applizierter TXA behandelt, während 29 Patienten als Vergleichsgruppe dienten. Primärer Endpunkt war die Menge der Wundsekretion in den ersten 48 h nach der Operation. Sekundäre Endpunkte waren die Dauer der Drainage und das Auftreten von Nachblutungen. Ergebnisse Innerhalb der ersten 48 h zeigte sich in der Gruppe der TXA Patienten eine durchschnittliche Menge von 97±50 ml im Vergleich zu 180±111 ml in der Kontrollgruppe (p Diskussion Es zeigte sich eine signifikante Reduktion der Fördermenge über die Drainage innerhalb der ersten 48 h sowie über den Gesamtzeitraum nach topischer Applikation von TXA. Des Weiteren kam es zu einer Verkürzung des Zeitraums mit einliegender Drainage bei den mit TXA behandelten Patienten. Die vorliegende Studie konnte einen signifikanten Vorteil für die topische Anwendung von TXA bei subkutaner Mastektomie bei Frau-zu-Mann transidenten Patienten zeigen.

ZusammenfassungPhylloides-Tumore (PT) der Brust werden anhand der Konstellation definierter histologischer Parameter als benigne, borderline und maligne klassifiziert. Die chirurgische Exzision ist die primäre Therapie, aber die Notwendigkeit zur Einhaltung bestimmter Sicherheitsabstände wird für alle drei Kategorien kontrovers diskutiert. Ziel der Arbeit ist eine kritische Stellungnahme zur bestehenden Empfehlung zu Sicherheitsabständen der Resektion.In unserem Brustzentrum wurden retrospektiv anhand der histopathologischen Dokumentationen von 1999 bis 2018 alle Patientinnen mit Phylloides-Tumoren identifiziert und die Fälle insbesondere hinsichtlich des Auftretens von Rezidiven und Multizentrizität ausgewertet.Insgesamt wurde bei 66 Patientinnen die Diagnose eines PT gestellt. Dabei handelte es sich in 38 Fällen um benigne, in 15 um borderline und in 13 um maligne Tumore. Lokalrezidive traten bei einem benignen PT, 7 borderline und 5 malignen PT auf. Zwei initiale borderline PT zeigten dabei eine Progression zu malignen PT. Multizentrizität trat in etwa 20 % der borderline und malignen PT aber nur bei 5 % der benignen PT auf.Die Resektionsgrenzen bei Phylloides-Tumoren sollten abhängig von Dignität und Rezidivierung gewählt werden. In Frage zu stellen ist vor allem, ob ein Sicherheitsabstand bei benignen PT einzuhalten ist. Bei einem Auftreten von Rezidiven von borderline oder malignen PT sollte die Indikation zur Mastektomie eher großzügig gestellt werden.

Zusammenfassung Einleitung Das Internet hat sich in den letzten Jahrzehnten zu einer der wichtigsten Informationsquellen für Patienten entwickelt. Wie gut sind die Möglichkeiten, sich im Internet über eine Brustrekonstruktion zu informieren? Wie präsent ist die Plastische Chirurgie mit ihrem Spektrum an modernen rekonstruktiven Möglichkeiten in Deutschland? Methoden Insgesamt wurden 35 Homepages der universitären Brustzentren in Deutschland bezüglich Erwähnung einer Zusammenarbeit mit einem Plastischen Chirurgen bzw. einer Abteilung für Plastische Chirurgie und deren Verlinkung, Angaben bezüglich rekonstruktiver Möglichkeiten wie der Implantatrekonstruktion, Eigengeweberekonstruktion mit gestielten und freien Lappenplastiken sowie Lipofilling analysiert. Ergebnisse Auf 49 % der Homepages wird ein Plastischer Chirurg bzw. eine kooperierende Abteilung erwähnt, 20 % beinhalten eine direkte Verlinkung. Auf 91 % der Seiten wird die Möglichkeit einer Brustrekonstruktion beschrieben, auf 80 % der Webseiten die Verwendung von Eigengewebe im Allgemeinen. In 51 % der Fälle wird ein freier Gewebetransfer erwähnt, wobei nur 23 % die Verfahren wie DIEP-Lappenplastik, TMG oder I-GAP genauer beschreiben. Nur zwei Zentren verwenden hierzu detaillierte Abbildungen. Bei sechs Internetauftritten (17 %) wird lediglich eine Rekonstruktion mit gestieltem TRAM Lappen beschrieben. Eine Rekonstruktion mit Silikonimplantat wird auf 71 % der Websites erwähnt. Die Möglichkeit eines Lipofillings wird in 31 % erörtert. Diskussion In etwa der Hälfe der Webauftritte universitärer Brustzentren ist keine Zusammenarbeit mit einem Plastischen Chirurgen ersichtlich. Die Informationen über den freien Gewebetransfer zur Brustrekonstruktion weisen große Lücken auf.

ZusammenfassungDie Rekonstruktion des Mamillen-Areola-Komplexes (MAK) ist ein ästhetisch und psychosozial bedeutender letzter Schritt bei der Rekonstruktion der Brust. Während die Rekonstruktion der Mamille unter Anwendung verschiedener Techniken in zahlreichen Publikationen untersucht wurde, gibt es unseres Wissens nur wenige Studien zu den Langzeitergebnissen nach Rekonstruktion der Areola. Daher untersuchen wir in dieser Studie die Langzeitergebnisse nach Rekonstruktion der Areola bei Frauen mit autologer Brustrekonstruktion. Im Zeitraum von 2014 bis 2016 führten wir in unserer Klinik bei 126 Patientinnen eine Rekonstruktion des MAK durch. Die Areola wurde durch Vollhauttransplantation aus der Leiste oder den oberen Augenlidern rekonstruiert. Insgesamt wurden 27 Frauen mit einem medianen Alter von 52 ± 8,6 Jahren nach einem medianen Zeitraum von 1,7 ± 0,7 Jahren in Bezug auf Farbveränderungen, Größenveränderungen und Zufriedenheit mit dem Rekonstruktionsergebnis der MAK untersucht. Die Ergebnisse zeigen ein deutliches Ausbleichen bei guter Zufriedenheit der Patientinnen mit dem Gesamtergebnis. Wir beobachteten eine durchschnittliche Größenzunahme der neuen Areolen um 13,9 % bei Vollhauttransplantation aus der Leiste und 34,6 % bei Vollhauttransplantation aus den oberen Augenlidern. Die Patientinnen sollten präoperativ über Ausbleichen und Größenveränderungen der neuen Areola informiert werden.

Tactile sensibility plays a critical role in medicine, especially in surgical practice. In order to prevent surgical site infections and protect the surgeon, the use of surgical gloves is standard practice. However, wearing these might affect the sensibility of the hand disadvantageously, especially in disciplines that require precision work.We evaluated the influence of six different glove types, as well as gloves wearing habits (double gloving, over- and undersized gloves) on tactile sensibility using two-point-discrimination and Semmes-Weinstein monofilament testing in 27 non-surgeons.There were significant differences regarding tactile sensibility of gloved compared to bare hands and between different types of gloves. While undersized gloves and double gloving did not affect tactile sensibility, oversized gloves were associated with a significant deterioration of the sensibility of the hand in the Semmes-Weinstein monofilament test.This study demonstrates that surgical gloves negatively affect the sensibility of the hand and show significant differences between different types of gloves.

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

Phyllodes tumours (PTs) of the breast are classified as benign, borderline and malignant based on the constellation of defined histological parameters. Surgical excision is the primary therapy, but the need to maintain certain safety margins is still controversially discussed for all three categories.This paper aims to provide a critical opinion on the existing recommendation on safety margins for resection.In our breast centre, all patients with phyllodes tumours were identified retrospectively on the basis of the histopathological documentation from 1999 to 2018. The cases were evaluated, in particular, with a view to recurrences and the occurrence of multicentricity.A total of 66 patients were diagnosed with a PT. In 38 cases, the tumours were benign, in 15 borderline and in 13 malignant. Local recurrences were observed in one benign PT, 7 borderline and 5 malignant PTs. Two PTs that were initially classified as borderline tumours progressed to malignant PTs. Multicentricity occurred in about 20 % of borderline and malignant PTs but only in 5 % of benign PTs.The resection margins for phyllodes tumours should be chosen depending on dignity and recurrence. The key question to be challenged is whether or not there is a need to maintain a certain safety margin in benign PTs. In case of recurrence of borderline or malignant PTs, a mastectomy should be considered early.Phylloides-Tumore (PT) der Brust werden anhand der Konstellation definierter histologischer Parameter als benigne, borderline und maligne klassifiziert. Die chirurgische Exzision ist die primäre Therapie, aber die Notwendigkeit zur Einhaltung bestimmter Sicherheitsabstände wird für alle drei Kategorien kontrovers diskutiert. Ziel der Arbeit ist eine kritische Stellungnahme zur bestehenden Empfehlung zu Sicherheitsabständen der Resektion.In unserem Brustzentrum wurden retrospektiv anhand der histopathologischen Dokumentationen von 1999 bis 2018 alle Patientinnen mit Phylloides-Tumoren identifiziert und die Fälle insbesondere hinsichtlich des Auftretens von Rezidiven und Multizentrizität ausgewertet.Insgesamt wurde bei 66 Patientinnen die Diagnose eines PT gestellt. Dabei handelte es sich in 38 Fällen um benigne, in 15 um borderline und in 13 um maligne Tumore. Lokalrezidive traten bei einem benignen PT, 7 borderline und 5 malignen PT auf. Zwei initiale borderline PT zeigten dabei eine Progression zu malignen PT. Multizentrizität trat in etwa 20 % der borderline und malignen PT aber nur bei 5 % der benignen PT auf.Die Resektionsgrenzen bei Phylloides-Tumoren sollten abhängig von Dignität und Rezidivierung gewählt werden. In Frage zu stellen ist vor allem, ob ein Sicherheitsabstand bei benignen PT einzuhalten ist. Bei einem Auftreten von Rezidiven von borderline oder malignen PT sollte die Indikation zur Mastektomie eher großzügig gestellt werden.

The reconstruction of the nipple-areola complex (NAC) is an aesthetically and psychosocial important final step in breast reconstruction. While numerous publications examine the long-term results using various techniques to reconstruct the nipple, to our knowledge there have been few studies on the long-term results after areolar reconstruction. The study therefore examines the long-term results after areola reconstruction in women with autologous breast reconstruction. In the period 2014-2016 we performed NAC reconstructions in 126 patients in our clinic. The areola was reconstructed by full skin transplantation from the groin or upper eyelids. A total of 27 women with a median age of 52 ± 8.6 years after a median period of 1.7 ± 0.7 years were examined with regard to colour change, size change and satisfaction with the reconstruction result of the MAK. The results showed a noticeable colour fading with good satisfaction of the patients with the result. We observed an increase in the size of the neoareoles by an average of 13,9 percent with full skin from the groin and 34,6 percent with full skin from the upper eyelids. Patients should be informed preoperatively of colour fading and size changes of the neo-areola.Die Rekonstruktion des Mamillen-Areola-Komplexes (MAK) ist ein ästhetisch und psychosozial bedeutender letzter Schritt bei der Rekonstruktion der Brust. Während die Rekonstruktion der Mamille unter Anwendung verschiedener Techniken in zahlreichen Publikationen untersucht wurde, gibt es unseres Wissens nur wenige Studien zu den Langzeitergebnissen nach Rekonstruktion der Areola. Daher untersuchen wir in dieser Studie die Langzeitergebnisse nach Rekonstruktion der Areola bei Frauen mit autologer Brustrekonstruktion. Im Zeitraum von 2014 bis 2016 führten wir in unserer Klinik bei 126 Patientinnen eine Rekonstruktion des MAK durch. Die Areola wurde durch Vollhauttransplantation aus der Leiste oder den oberen Augenlidern rekonstruiert. Insgesamt wurden 27 Frauen mit einem medianen Alter von 52 ± 8,6 Jahren nach einem medianen Zeitraum von 1,7 ± 0,7 Jahren in Bezug auf Farbveränderungen, Größenveränderungen und Zufriedenheit mit dem Rekonstruktionsergebnis der MAK untersucht. Die Ergebnisse zeigen ein deutliches Ausbleichen bei guter Zufriedenheit der Patientinnen mit dem Gesamtergebnis. Wir beobachteten eine durchschnittliche Größenzunahme der neuen Areolen um 13,9 % bei Vollhauttransplantation aus der Leiste und 34,6 % bei Vollhauttransplantation aus den oberen Augenlidern. Die Patientinnen sollten präoperativ über Ausbleichen und Größenveränderungen der neuen Areola informiert werden.

In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities?A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling.A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Of those homepages, 20 % contain a direct link. 91 % of the homepages describe the possibility of breast reconstruction in general, 80 % of the websites the use of autologous tissue. In 51 % of the cases, a free tissue transfer is mentioned, whereas only 23 % describe the procedures like DIEP flap, TMG, or I-GAP in more detail. Only two centres use detailed illustrations. Six websites (17 %) describe reconstruction by pedicled TRAM flap only. Breast reconstruction with a silicone implant is mentioned on 71 % of the websites. The possibility of lipofilling is discussed in 31 %.About half of the websites of university breast centres do not show any cooperation with a plastic surgeon. There are significant gaps in the information on free tissue transfer for breast reconstruction.Das Internet hat sich in den letzten Jahrzehnten zu einer der wichtigsten Informationsquellen für Patienten entwickelt. Wie gut sind die Möglichkeiten, sich im Internet über eine Brustrekonstruktion zu informieren? Wie präsent ist die Plastische Chirurgie mit ihrem Spektrum an modernen rekonstruktiven Möglichkeiten in Deutschland?Insgesamt wurden 35 Homepages der universitären Brustzentren in Deutschland bezüglich Erwähnung einer Zusammenarbeit mit einem Plastischen Chirurgen bzw. einer Abteilung für Plastische Chirurgie und deren Verlinkung, Angaben bezüglich rekonstruktiver Möglichkeiten wie der Implantatrekonstruktion, Eigengeweberekonstruktion mit gestielten und freien Lappenplastiken sowie Lipofilling analysiert.Auf 49 % der Homepages wird ein Plastischer Chirurg bzw. eine kooperierende Abteilung erwähnt, 20 % beinhalten eine direkte Verlinkung. Auf 91 % der Seiten wird die Möglichkeit einer Brustrekonstruktion beschrieben, auf 80 % der Webseiten die Verwendung von Eigengewebe im Allgemeinen. In 51 % der Fälle wird ein freier Gewebetransfer erwähnt, wobei nur 23 % die Verfahren wie DIEP-Lappenplastik, TMG oder I-GAP genauer beschreiben. Nur zwei Zentren verwenden hierzu detaillierte Abbildungen. Bei sechs Internetauftritten (17 %) wird lediglich eine Rekonstruktion mit gestieltem TRAM Lappen beschrieben. Eine Rekonstruktion mit Silikonimplantat wird auf 71 % der Websites erwähnt. Die Möglichkeit eines Lipofillings wird in 31 % erörtert.In etwa der Hälfe der Webauftritte universitärer Brustzentren ist keine Zusammenarbeit mit einem Plastischen Chirurgen ersichtlich. Die Informationen über den freien Gewebetransfer zur Brustrekonstruktion weisen große Lücken auf.

Zusammenfassung Hintergrund Periprothetische Infektionen sind gefürchtete Komplikationen sowohl der ästhetischen, als auch der rekonstruktiven Brustchirurgie. Ziel dieser Arbeit ist die Aufarbeitung der in einem Referenzzentrum für primäre und sekundäre Brustchirurgie behandelten Implantatlagerinfektionen, um eine Empfehlung zur prophylaktischen, aber auch therapeutischen antibiotischen Therapie aussprechen zu können. Patienten und Methoden Für den Zeitraum vom 01.01.2012 bis 31.12.2015 wurden retrospektiv alle Patientinnen erfasst, bei denen ein Wechsel oder die Entfernung von Brustimplantaten erfolgt war. Anhand der Patientenakten wurden die OP-Indikationen herausgearbeitet und speziell auf Infektzeichen und Angaben zu Kapselfibrosen analysiert. Zudem wurden alle mikrobiologischen Untersuchungen dieser Eingriffe erfasst und ausgewertet. Ergebnisse In unserer Klinik wurden im betrachteten Zeitraum 468 Implantatwechsel bzw. -explantationen bei 360 Patientinnen durchgeführt. Bei insgesamt 169 Patientinnen wurden mikrobiologische Abstrichuntersuchungen aus 245 Implantatlagern durchgeführt. Aus 23 Implantatlagern (21 Patientinnen) erfolgte ein Erregernachweis. Bei 6 weiteren Implantaten (4 Patientinnen) lagen Zeichen eines periprothetischen Infektes vor, ohne dass jedoch ein Keimnachweis gelang. In den meisten Fällen ergab die fortgeschrittene Kapselfibrose die Indikation zum Implantatwechsel. In 17 Abstrichen erfolgte ein Keimnachweis trotz fehlendem klinischen Infektverdacht. Als Erreger wurden in 17 Fällen koagulasenegative Staphylokokken, in 4 Staphylococcus aureus, und jeweils in einem Fall E. coli, Morganella morganii und Proprionibacterium acnes nachgewiesen (eine Doppelinfektion). Alle Erreger waren gegenüber Piperacillin/Tazobactam und Vancomycin sensibel, gegenüber Cefuroxim und Amoxycillin/Clavulansäure lagen jeweils eine, gegenüber Gentamycin, Ciprofloxacin und Clindamycin je 2 Resistenzen vor. Schlussfolgerung In der Mehrzahl der Fälle ergab sich ein Keimnachweis als Zufallsbefund, während die Kapselfibrose klinisch führend war. Erreger und Resistenzlage unterschieden sich von der Mehrzahl internationaler Publikationen. Cefuroxim und Amoxycillin/Clavulansäure haben sich mit jeweils einer Resistenz als Antibiotika zur empirischen Infektprophylaxe und -therapie bewährt. Als Reserveantibiotikum, insbesondere bei fulminanten Infekten, bietet sich unter anderem Piperacillin/Tazobactam an.

Backround Tactile sensibility plays a critical role in medicine, especially in surgical practice. In order to prevent surgical site infections and protect the surgeon, the use of surgical gloves is standard practice. However, wearing these might affect the sensibility of the hand disadvantageously, especially in disciplines that require precision work. Methods We evaluated the influence of six different glove types, as well as gloves wearing habits (double gloving, over- and undersized gloves) on tactile sensibility using two-point-discrimination and Semmes-Weinstein monofilament testing in 27 non-surgeons. Results There were significant differences regarding tactile sensibility of gloved compared to bare hands and between different types of gloves. While undersized gloves and double gloving did not affect tactile sensibility, oversized gloves were associated with a significant deterioration of the sensibility of the hand in the Semmes-Weinstein monofilament test. Conclusion This study demonstrates that surgical gloves negatively affect the sensibility of the hand and show significant differences between different types of gloves., Highlights • There were significant differences regarding tactile sensibility of gloved compared to bare hands. • There were significant differences between different types of gloves. • Undersized gloves and double gloving did not affect tactile sensibility. • Oversized gloves were associated with a significant deterioration of the sensibility.

The diagnostic value of clinical tests and magnetic resonance (MR) imaging for the investigation of triangular fibrocartilaginous complex (TFCC) lesions is not clear due to a lack of clinical data.We retrospectively analyzed 908 patients who underwent clinical tests and arthroscopy for suspected TFCC lesions at our institution. Further, MR imaging findings concerning the TFCC were gathered. We correlated clinical tests and MR imaging findings with those obtained during arthroscopy, and we calculated sensitivity, specificity, as well as positive and negative predictive values.In the whole cohort, the positive predictive values of all clinical tests were low, ranging from 0.53 to 0.55. The ulna grinding test had the highest sensitivity, but lowest specificity. Sensitivity and specificity of the ulnar fovea sign and magnetic resonance imaging were similar, ranging from 0.73 to 0.76, and from 0.41 to 0.44, respectively. To some degree, the diagnostic value seemed to depend on the Palmer class of TFCC lesion.According to this study, clinical tests and MR imaging findings are of very limited diagnostic value for the diagnosis of TFCC lesions.

Summary Background Urogenital fistulas are devastating complications occurring after tumors or trauma. Surgical treatment is challenging. Thus, further surgical repair options are needed for treatment of complex fistulas within the pelvic region. Methods Twelve patients with urogenital fistulas were surgically treated in our department from 2004 to 2012. These selected cases fulfilled eligibility criteria for continence-preserving surgery – a history of fistula recurrences with ongoing incontinence after receiving at least two surgical attempts. Five VRAM and eight gracilis flaps were used to cover up given tissue defects and to perform functional continence-preserving reconstruction with mean follow-up of 6.3 years. Data were retrospectively reviewed, and standardized survey was performed to evaluate quality of life of all living patients ( n = 10). Results In all cases, final surgical treatment of the given fistulae by VRAM or gracilis flaps could be achieved, with mean operating time of 5:31 h (range: 4:50–6:48 h) for VRAM flap and 3:11 h (range: 2:04–4:42 h) for gracilis flap. Outcome measures were primarily to avoid fistula recurrence after plastic surgical treatment, and secondary quality of life and survival. All patients had their continence preserved, but two patients died during follow-up period. Postoperative assessment revealed the following: VRAM flap patients ( n = 3) showed slight incontinence during the follow-up period, whereas continence was restored in all patients with gracilis flap reconstruction ( n = 7). Quality-of-life assessment indicated restoration of quality of life in comparison to general population (women > men). Furthermore, key points of the two presented surgical techniques are demonstrated in detail. Conclusion With preformed VRAM or gracilis flaps, complex urogenital fistulas can be successfully eradicated and continence is restored. The main focus should be the recovery of quality of life, which could be successfully regained. Nevertheless, the continence success rate has to be defined on an individual, case-by-case basis. Level of evidence Original work, cohort study level III.

Summary Background In amniotic band syndrome (ABS) constriction rings affecting the limbs are regularly seen at birth. Circular resection and closure with multiple Z-plasties has been described as the treatment of choice. However, direct circular closure creating linear circumferential scars might replace multiple Z- or W-plasties to reduce scars and improve aesthetic outcome. Methods From 2000 to 2009 we treated 160 patients with ABS. In 43 cases release of isolated constriction rings was performed by circular excision and closure. Constriction rings were completely resected and skin closure could be performed without Z-plasty in all cases. Data from follow-up of all cases were reviewed and photographs and recordings reassessed. The median age at operation was 14.3 months (range 2–32). Constriction rings were localised on the upper arm in five patients, the lower arm in five, the wrist in two and at the metacarpal level in five. At the lower extremity the thigh was affected in three and the lower leg in 23 patients. Results In the 16 cases of the first treatment period from 2000 to 2004, average follow-up was 6.5 years (range 5.1–10.3). We observed two minor complications following 43 operations (wound dehiscence and secondary healing). No formation recurrence of banding was seen. Aesthetic outcome was overall good. Conclusions We found excellent aesthetical and functional results following change of treatment from multiple Z-plasties to linear circumferential closure. Scars were generally less noticeable and no recurrence or scar constriction could be detected with growth. However, radical excision of all constricting tissues prior to wound closure is mandatory.

Multiple operations have been proposed to slow the progression of osteonecrosis and secondary carpal damage in Kienböck’s disease. To assess the biomechanical changes after capitate shorting, we inserted pressure-testing devices into the carpal and radiocarpal joints in an anatomical study. Pressure sensors were placed into eight thawed non-fixated human cadaver arms to measure the forces transmitted in physiological loading. Longitudinal 9.8 N and 19.6 N forces were applied before and after capitate shortening. After capitate shortening, significant load reduction on the lunate was evident in all specimens. An average decrease of 49% was seen under a 9.8 N load and 56% under a 19.6 N load. The load was transferred to the radial and ulnar intercarpal joints. More relief of pressure on the lunate after isolated capitate shortening is achieved with a shallow angle between the scaphoid and capitate in the posteroanterior radiograph.

Tuberculous tenosynovitis is a rare manifestation of extrapulmonary tuberculosis (Tb), especially if solely the dorsal hand compartment is affected. In this report, we present the medical history of an immuno-competent 32-year-old man presented with a painful swelling of the right dorsal wrist. Initial inflammation onset had occurred 6 months before he consulted our service, resulting in consultation of several physicians and extensive diagnostic procedures without gaining a specific diagnosis. Finally, after extensive diagnostic tests, a tenosynovectomy was performed and tuberculosis-induced extensor tenosynovitis was detected. The diagnosis was established by positive histology, repeated specific PCR and T-SPOT.TB. Tuberculous tenosynovitis can easily be overlooked as a cause of chronic tenosynovitis particularly in immunocompetent young people lacking any risk factors.

With the development of cell-based gene transfer techniques, genetically modified human keratinocytes (Kc) and fibroblasts (Fb) have been proven to be a better choice in wound repair.This study was designed to construct in one step a gene-modified artificial skin by a genetically engineered Kc expressing PDGF-BB and Fb expressing VEGF(165) and bFGF. The wound healing effect in a full-thickness wound model was then observed. Unmodified artificial skin served as control. On the post-operative days 7, 14, and 21, residual wound area was calculated and skin wound tissues were subjected to biopsy for further investigation.Compared with unmodified artificial skin, gene-modified artificial skin resulted in a reduced wound contraction and a well-organized human epidermis and better formed dermis.The results suggest that our two-layer, gene-modified artificial skin improved both vascularization and epidermalization for skin regeneration. This technique could bring about a new approach in the treatment of burns and chronic wounds.

BackgroundIn the treatment of esophageal cancer neoadjuvant radiotherapy often leads to vascular damage of the usual recipient arteries for free jejunal transfer. End-to-side anastomosis to the carotid artery could be a potential alternative.Patients and methodsA total of 70 patients with locally advanced carcinoma of the esophagus underwent esophagectomy after neoadjuvant radiochemotherapy. In all patients reconstruction was carried out with a free jejunal transfer. Smaller vessels could be used for anastomoses in 54 of these patients and in 16 cases the jejunal flap artery was attached to the carotid artery.ResultsOut of 54 patients 9 (17%) with microvascular anastomoses to the smaller vessels needed surgical intervention for ischemia. In 16 patients with anastomosis to the carotid artery no significant failure of perfusion occurred.ConclusionThe carotid artery as recipient vessel in free jejunal transfer seems to be a safe therapeutic option for intestinal reconstruction of preradiated esophageal cancer with good functional results.

Schwere Schadel-Hirn-Traumata, Ruckenmarksverletzungen oder isolierte Gelenkverletzungen konnen mit heterotopen Ossifikationen einhergehen. Im Zusammenhang mit grosflachigen Brandverletzungen stellen periartikulare Knochenneubildungen eine seltene, schwerwiegende Komplikation dar, deren Pathogenese noch unklar ist. In einer retrospektiven Analyse der in den vergangenen 10 Jahren in unserem Zentrum fur Schwerbrandverletzte behandelten 672 Patienten haben wir in 5 Fallen (0,74%) die Problematik der heterotopen Ossifikationen festgestellt.

Hintergrund Zur Nachbehandlung kombinierter Verletzungen von Beugesehnen und Nerven der Hand finden sich keine einheitlichen Empfehlungen. Ziel dieser Studie ist ein Vergleich der individuellen Therapiestandards deutscher handchirurgischer Zentren zur Immobilisationsdauer bei isolierten und kombinierten Verletzungen.

Clinical success in tissue regeneration requires improvements in vascularization capacity of scaffolds. Several efforts have been made in this field including cellular and acellular technologies. In this work we combined the use of stem cells derived from pancreas or submandibular glands expressing green fluorescent protein (GFP(+)) with a commercially available scaffold for dermal regeneration. Cells were isolated, characterized and seeded in a scaffold for dermal regeneration. Scaffolds containing cells were used to induce dermal regeneration in a full skin defect model. After 3 weeks of in vivo regeneration, tissues were harvested and vascularization was analyzed. Results showed that gland-derived stem cells displayed stem cell features and presented multipotential differentiation capacity because they were able to differentiate in cell types representing the 3 different germ layers. After seeding, cells were homogeneously distributed and formed focal adhesions with the scaffold. Metabolic assays showed that cells can be cultured for at least 3 weeks in the scaffold. In vivo, the presence of pancreatic or submandibular stem cells significantly enhanced the vascularization compared to empty scaffolds. Presence of gland-derived stem cells in the regenerating tissue was confirmed by the detection of GFP expression in the wound area. In order to explore the possible mechanisms behind the improvement in vascular regeneration, in vitro experiments were performed, showing that gland-derived stem cells could contribute by angiogenic and vasculogenic mechanisms to this process. Our results suggest that the combined use of stem cells derived from glands and scaffold for dermal regeneration could be a rational alternative to improve vascularization in scaffold-mediated dermal regeneration.

Nerve injuries are common in trauma surgery. Today, even under excellent conditions nerve regeneration can never achieve complete histologic and clinical recovery. Regenerative medicine of peripheral nerves is dealing with the approaches to improve nerve regeneration and to overcome extended nerve l

Nerve injuries are common in trauma surgery and appear more frequently if the upper extremity is affected. The aim of this study is to estimate possible predictors of the outcome after nerve injury of the upper extremity and to demonstrate feasible tools to follow up postoperative nerve regeneration for the daily clinical practice. During January 2000 until December 2004, a total of 372 nerve lesions of the upper extremity have been treated in our clinic. Patient's age, site of nerve lesion, concomitant injuries, and the timing of surgical repair could be outlined to be significant predictors for clinical outcome. Digital nerve lesions showed the best regenerative capacity. Most predictors of clinical outcome such as patient's age, concomitant injuries, and site of lesion cannot be influenced. But knowing the predictors helps specify the prognosis of nerve regeneration. For the daily clinical practice, static two-point discrimination, location of Tinel's sign, and grip strength measurement seem to be fast and reproducible tools to follow up nerve regeneration at the upper extremity.

Tubulization as an alternative to autologous nerve grafting successfully bridges relatively short nerve gaps. Digital nerve lesions are ideal for clinical outcome studies, but only a few data have been published so far. We are presenting our clinical experiences based on a review of the outcome and techniques in the current literature. Fifteen digital nerve lesions in 14 patients have been overcome by interpositional grafting of a hollow collagen I conduit. A follow-up of 12 months could be guaranteed in 12 cases. The mean nerve gap was 12.5 +/- 3.7 mm. Four out of 12 patients, assessed 12 months postoperatively, showed excellent sensibility (S4). Five patients achieved good sensibility, one poor, and two no sensibility. Our results confirm tubulization as one possible technique in nerve reconstruction. However, the indication has to be set carefully, and the operation still requires solid microsurgical skills, especially for proper handling and debridement of the severed nerve endings.

Background Angiogenesis can be enhanced by several growth factors, like vascular endothelial growth factor-165 (VEGF(165)) and basic fibroblast growth factor (bFGF). Delayed release of such growth factors could be provided by incorporation of growth factors in fibrin matrices. In this study, we present a slow release system for VEGF(165) and bFGF in fibrin sealant.Materials and methods In vitro: Pieces of Integra (TM) matrix of 15 mm in diameter were prepared. Integra (TM) matrices were divided into four groups (A=control; B=fibrin sealant; C=fibrin sealant+growth factors; D=growth factors). In vivo: The bioartificial dermal templates were transplanted into a full-skin defect of the back of nu-nu mice. Four different groups included each six matrices at 2 and 4 weeks.Results In vitro: In groups C and D, continuous release of VEGF(165) and bFGF was eminent. The incorporation of growth factors into fibrin sealant evoked a prolonged growth factor release (p Conclusions A model of slow protein release by combining VEGF(165) and bFGF with fibrin sealant was produced. This model resulted in a prolonged bioavailability of growth factors in vivo for functional purposes. Fibrin and collagen can release growth factors in vivo and induce significant and faster neovascularisation in bioartificial dermal templates.

Der Goldstandard zur Uberbruckung von Defekten peripherer Nerven ist nach wie vor die autologe Nerventransplantation. In diesem Beitrag wird die alternative Verwendung von Nervenrohrchen zur Rekonstruktion kleinerer Nervendefekte beschrieben. Aktuelle Ergebnisse der Literatur werden ersten Ergebnissen aus unserer Klinik gegenubergestellt. Bei 11 Patienten fuhrten wir Nervenrekonstruktionen durch mikrochirurgische Implantation eines Nervenrohrchens durch. Wir beschrankten die Indikation zur Rekonstruktion durch Tubulisation auf Defekte sensibler Nerven von maximal 18 mm Lange. Die Bewertung der Fingersensibilitat erfolgte mittels statischer und dynamischer 2-Punkte-Diskrimination (s-, d2PD) und Monofilamenttest 3, 6 und 12 Monate postoperativ. Von 6 Patienten mit einem postoperativen Beobachtungszeitraum von mehr als 12 Monaten wiesen 4 gute Ergebnisse mit einer s2PD von ≤7 mm auf (Highet S4). Ein Patient erreicht keine (S0), ein weiterer lediglich Schutzsensibilitat (S3). Monofilamenttest und d2PD bestatigten diese Resultate. Ein vorubergehendes Fremdkorpergefuhl wurde bei 3 von 11 Patienten beschrieben und persistierte in 1 Fall. Wir beobachteten eine partielle Nervenregeneration uber die Nervenrohrchen bei 5 von 6 Patienten. Die Verwendung resorbierbarer Nervenrohrchen stellt bei gegebener Indikation insbesondere wegen der Vermeidung der Spendermorbiditat eine mogliche Alternative zur Nerventransplantation dar. Die Technik verlangt wie die autologe Nerventransplantation mikrochirurgische Kenntnisse des Operateurs.

Dysfunction of the lower limb's muscles can cause severe impairment and immobilisation of the patient. As one of the leg's major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase.

Various surgical techniques are described for separation of syndactylies leading to good results. However, the use of standard techniques is limited in complex syndactylies with extensive bony fusion and tight soft tissues. The aim of this study was to assess the outcomes of a two-stage procedure involving progressive soft tissue distraction prior to syndactyly release. Between 1996 and 2012 we treated 168 complex syndactylies with this technique. The main indications were syndactylies in Apert syndrome. The digits were distracted through an external fixator at 0.5 mm/day. Distraction of 15–25 mm was achieved. Soft tissue distraction provided additional skin, a wider nail matrix and more bone in the form of callus. Thus subsequent modelling of the fingertips was improved, especially if they were closely fused. This technique facilitates treatment of complex cases and improves aesthetic outcome. Level of evidence: Therapeutic IV

Summary Introduction One of the most common complications following breast augmentation is capsular contracture. The subclinical infection of the implant is often considered to be one of the main risk factors. It is believed that polyurethane (PU) implants, because of their larger foam-like surface, have lower capsular contracture rates due to better tissue integration. It remains unclear if bacterial contamination and biofilm formation result in higher capsular contracture rates under the condition of the increased surface of PU implants compared to textured silicone-gel implants. The effect of this bacterial contamination was examined in an animal-based study. Methods A total of 80 mini implants (40 textured silicone-gel implants and 40 PU implants) were implanted in the dorsum of female Wistar rats. In each group, 20 implants were inoculated before implantation with a standard amount of Staphylococcus epidermidis . Capsules and implants were explanted after 60 days, followed by double-blind histological, immunohistochemical, and microbiological examinations. Results Macroscopic separation of the total capsule in the textured implant group was possible whereas the growth of surrounding tissue into the foam structure of PU implants made separation in that group difficult. After contamination, a thicker capsule could be observed in both groups without significant differences. Histologically, capsules around PU implants showed significantly lower expression of parallel myofibrils. We were able to describe a significant higher infiltration with inflammatory cells in capsules around PU implants both with and without contamination. Microbiological investigations revealed positive growth of S. epidermidis around one PU implant without related signs of capsular contracture. Discussion This study demonstrates that aside from the surface of silicone implants, bacterial contamination has major impact on the architecture of capsule formation. In our study, we were able to demonstrate that bacterial contamination leads to a thicker capsule and an increased tissue reaction with a higher amount of inflammatory cells. However, a resulting bacterial infection was only demonstrated in one case and had an insignificant influence on capsule architecture. The observed inflammatory reaction around PU implants was observed as a nonbacterial, granulomatose foreign body reaction. EBM rating Level I: Evidence obtained from at least one properly designed randomized controlled trial.

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.

BACKGROUND: Shockwave (SW) application has been shown to limit flap necrosis. However, the underlying microhemodynamic mechanisms remain unclear. Therefore, the objective of this study was to analyze the effect of SW application on a microcirculatory level. METHODS: We treated 12 C57BL/6 mice with local SW application (500 shockwave impulses at 0.15 mJ/mm(2)) either 24 h before (preconditioning [PRE]) or 30 min after (postconditioning [POST]) flap elevation. Animals with an untreated flap (CON) or without a flap served as controls. We applied dorsal skinfold chambers to the animals and performed epifluorescence microscopy over a 10-d period to assess microcirculatory parameters (arteriolar diameter, red blood cell velocity, blood flow, functional capillary density, and intercapillary distance) as well as inflammation, apoptotic cell death, and necrosis. RESULTS: SW application significantly decreased tissue necrosis independently of the application time point (PRE: 29% ± 7%; POST: 25% ± 7% versus CON: 47% ± 2%; day 10, P < 0.05). Arteriolar diameter, red blood cell velocity, and blood flow were not statistically significantly different among the 3 flap groups. However, SW (PRE and POST) resulted in an early and persistent increase in functional capillary density and consequently decreased intercapillary distance compared with CON and the group without a flap (P < 0.05). Also, SW resulted in a significantly decreased inflammatory response (P < 0.05) and induced an angiogenic response, as indicated by new functional microvessel formation observed 5 d after therapy. CONCLUSIONS: Local SW application improved tissue survival by recruitment of sleeping capillaries within the non ischemic tissue and maintenance of capillary perfusion within the critically perfused tissue after induction of ischemia, which was independent of the application time point. Neoangiogenesis occurred beyond the ischemic tolerance of the tissue, and therefore does not seem to contribute to improved tissue survival.

Summary So far a few case reports about laptops causing burns have been published. Now for the first time, we report on a case, in which notebook-induced thermal injuries placed in a patient's lap resulted in severe second- and third-degree burns. As a consequence, a partial amputation of the left foot had to be performed. Furthermore, we measured maximum temperatures of 12 popular laptops, which were running full load for 3 h. For this experiment air circulation underneath the device was blocked in order to simulate surrounding conditions, which were present when the patient got injured. Although this setting may be the reason for most of all notebook burns, this kind of test has not been part of any scientific publication until now. Patients with lower extremity sensation, altered consciousness or decreased peripheral sensitivity have a higher risk for thermal injuries.

The clinical utilization of resorbable bone substitutes has been growing rapidly during the last decade, creating a rising demand for new resorbable biomaterials. An ideal resorbable bone substitute should not only function as a load-bearing material but also integrate into the local bone remodeling process. This means that these bone substitutes need to undergo controlled resorption and then be replaced by newly formed bone structures. Thus the assessment of resorbability is an important first step in predicting the in vivo clinical function of bone substitute biomaterials. Compared with in vivo assays, cell-based assays are relatively easy, reproducible, inexpensive and do not involve the suffering of animals. Moreover, the discovery of RANKL and M-CSF for osteoclastic differentiation has made the differentiation and cultivation of human osteoclasts possible and, as a result, human cell-based bone substitute resorption assays have been developed. In addition, the evolution of microscopy technology allows advanced analyses of the resorption pits on biomaterials. The aim of the current review is to give a concise update on in vitro cell-based resorption assays for analyzing bone substitute resorption. For this purpose models using different cells from different species are compared. Several popular two-dimensional and three-dimensional optical methods used for resorption assays are described. The limitations and advantages of the current ISO degradation assay in comparison with cell-based assays are discussed.

Introduction Nerve tubes seeded with cultured Schwann cells have become a promising alternative to nerve autografts. However, the functional results of these bioartificial cellular grafts remain to be improved. To imitate the three-dimensional structure of peripheral nerves, we designed a Schwann cell-seeded intrinsic framework within a semi-permeable biodegradable collagen nerve tube (Integra® ).

Background Induction of neovascularization by releasing therapeutic growth factors is a promising application of cell-based gene therapy to treat ischemia-related problems. In the present study, we have developed a new strategy based on nucleofection with alternative solution and cuvette to promote collateral growth and re-establishment of circulation in ischemic limbs using double transplantation of gene nucleofected primary cultures of fibroblasts, which were isolated from rat receiving such therapy. Methods and Results Rat dermal fibroblasts were nucleofected ex vivo to release bFGF or VEGF165 in a hindlimb ischemia model in vivo. After femoral artery ligation, gene-modified cells were injected intramuscularly. One week post injection, local confined plasmid expression and transient distributions of the plasmids in other organs were detected by quantitative PCR. Quantitative micro-CT analyses showed improvements of vascularization in the ischemic zone (No. of collateral vessels via micro CT: 6.8±2.3 vs. 10.1±2.6; p

Introduction: Even under perfect conditions nerve regeneration after reconstruction can never achieve complete histological and clinical recovery. Early and effective nutritive supply of the nerve graft could help to improve regeneration. In this study we are examining the influence of erythropoietin administration, which has well demonstrated angiogenetic effects and neuroprotective potencies, on the quality of nerve regeneration. Methods: 32 female Lewis rats were randomly divided into 4 groups with 8 animals each. Group A and B underwent autologous nerve grafting of the right sciatic nerve. In group C and D a 12 mm nerve defect was bridged by a 14 mm collagen nerve conduit. Group A and C received subcutaneous recombinant human erythropoietin (rhEpo) injections over two weeks on a daily basis (1,000 U/kg bw). The control groups (B and D) received normal saline injections. After 7 weeks nerve samples were harvested for histology and the weight of the gastrocnemius and tibial muscles was determined. Evaluation of axon count, diameter and degree of myelination was assessed applying a newly developed software. Results: We did not observe any wound infection, rejection or dehiscence. Muscle weight quotients (operated divided by non-operated side) of the tibial muscle gave evidence for a significant lower muscle atrophy (p = 0.026) in the erythropoietintreated group A (0.53 ± 0.05) compared to the control (group B, 0.43 ± 0.05). Equivalent values of the gastrocnemius muscle showed slightly higher muscle weights in group A (0.40 ± 0.06) than in group B (0.36 ± 0.07), but without being significant. In comparison of group C and D no differences could be observed after 7 weeks. Axon count, diameter and degree of myelination did not differ significantly between the control and rhEpo groups. Conclusion: Our findings gave evidence for a positive effect of erythropoietin on functional recovery after nerve grafting. Even without visible changes in neural morphology, muscle recovery benefited from rhEpo administration. Semiautomated axon detection facilitated accurate morphometrical assessment.

Neovascularization plays a pivotal role in tissue engineering and tissue regeneration. However, reliable technologies to visualize and quantify blood vessel networks in target tissue areas are still pending. In this work, we introduce a new method which allows comparing vascularization levels in normal and tissue-engineered skin. Normal skin was isolated, and vascular dermal regeneration was analyzed based on tissue transillumination and computerized digital segmentation. For tissue-engineered skin, a bilateral full skin defect was created in a nude mouse model and then covered with a commercially available scaffold for dermal regeneration. After 3 weeks, the whole skin (including scaffold for dermal regeneration) was harvested, and vascularization levels were analyzed. The blood vessel network in the skin was better visualized by transillumination than by radio-angiographic studies, the gold standard for angiographies. After visualization, the whole vascular network was digitally segmented showing an excellent overlapping with the original pictures. Quantification over the digitally segmented picture was performed, and an index of vascularization area (VAI) and length (VLI) of the vessel network was obtained in target tissues. VAI/VLI ratio was calculated to obtain the vessel size index. We present a new technique which has several advantages compared to others, as animals do not require intravascular perfusions, total areas of interest can be quantitatively analyzed at once, and the same target tissue can be processed for further experimental analysis.

A 24 mm long bioartificial nerve graft (BNG) was created to bridge extended peripheral nerve defects of the rat sciatic nerve. In our previous studies, an identical graft had demonstrated good results over nerve gaps of up to 15 mm. The BNG device comprised a collagen-I tube filled with ten Schwann-cell-seeded polyglactin filaments and 106 isogenic Schwann cells suspended in Matrigel which were implanted in 27 rats (group I). Schwann-cell-free grafts (27 rats) and nerve autografts (18 rats) served as controls. Functional recovery was followed over a period of six months using walking track analysis. Terminal analyses of graft efficacy included neurophysiology, muscle weight, and histological assessment of the implants and the distal nerve stumps. In 17/27 cases, axonal regeneration into the distal nerve stump could be detected across the BNG, but all animals in group I and II failed to regain motor function of the hindlimb upon completion of the experiment. Axon diameter and axonal density in the graft and distal nerve stump were greater in group I than in group II. Although Schwann cells had a significant positive effect on axonal regeneration, either granuloma formation or the amount of the inserted foreign material may have impaired nerve regeneration by acting as a physical impediment to nerve regeneration or negatively effecting cell function.

Summary Occurrence of clinically symptomatic benign neurofibromas of peripheral nerves after radiotherapy is a rarity. We saw a 55-year-old female who developed progressive failure of the ulnar nerve 55 years after 20Gy 226 Ra brachytherapy of a haemangioma of the left elbow at the age of 3 months. Nerve compression at the sulcus segment was caused by the intraneural growth of a neurofibroma and the formation of a nerve sheath ganglion. The rapidly progressive symptoms required operative treatment. Due to the infiltrating tumour growth we decided to resect this segment of the ulnar nerve and reconstruct it with an interfascicular nerve graft. This case demonstrates a rare possible consequence of radiotherapy in which the co-existence of two benign lesions required surgical intervention. Radiotherapy-induced malignant tumours and tissue scarring are well known as complications. The present case suggests further possible late effects of radiotherapy to consider.

Summary: Skin cancer formation is on the rise. Only a few case reports, which focus on skin cancer being caused by tattoos, have been published so far. Our aim is to determine whether skin cancer occurrence can be triggered by tattoos. In our presented case, a squamous-cell carcinoma developed inside of the red areas of a multicolored tattoo within months. Furthermore, surgical removal of the cancerously mutated skin area without mutilating the design of the tattoo was challenging. Due to widespread skin alterations in other red areas of the tattoo, those affected skin regions were surgically removed and split-skin grafting was performed. After 1-year follow-up period, the patient has been tumor free. Squamous-cell carcinoma is an unusual reaction that can occur in tattoos. Nevertheless, this skin cancer should be included in the list of cutaneous complications related to tattooing.