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„Wide awake local anesthesia no tourniquet“ (WALANT) bezeichnet ein blutungs- und komplikationsarmes Lokalanasthesieverfahren, das Handeingriffe am wachen Patienten ohne den Einsatz einer Blutsperre ermoglicht. Dies wird durch den Zusatz vasokonstriktiver Substanzen in der Infiltrationslosung moglich. Da die Motorik der Extremitat nicht beeinflusst wird, bietet es zusatzlich die Moglichkeit der intraoperativen aktiven Funktionsprufung. Die WALANT-Anasthesie ist ein etabliertes, effektives, leicht erlernbares und Ressourcen schonendes Verfahren. Das Spektrum der chirurgischen Moglichkeiten mit WALANT ist breit und deckt nahezu alle elektiven und viele notfallbedingten Eingriffe ab. Aufgrund mannigfaltiger Vorteile gegenuber allgemeinen Anasthesieverfahren findet WALANT in der Chirurgie immer neue Indikationen und Anwender. Es ist daher fur die handchirurgische Versorgung im klinischen wie im niedergelassenen Bereich gleichermasen interessant.

Introduction: Extracorporeal shock waves (ESWs) have been shown to have a positive effect on skin wound healing; however, little is known on the regeneration of the microcirculation and angiogenesis as well as the different application modes. Methods: A total of 40 BALB/c mice were provided with dorsal skin fold chambers and were divided into 3 therapy groups (n = 30) and one control group (n = 10). The 3 therapy groups were treated with shock waves at different pulse rates (500–1,000 pulses/min) and application frequencies (day 0 and day 6 or day 0 only). Photographic documentation and intravital microscopy were carried out on day 1, 2, 4, and 6 after wounding. Results: Using the newly developed Diver Box, shock waves could be applied in vivo without mechanical tissue damage. Shock wave therapy to skin wounds demonstrated to induce faster wound closure rates in the beginning than controls in groups with higher pulse rates and frequencies of the shock waves. Furthermore, the regeneration of microcirculation and perfusion in the healing skin was significantly improved after the application of, in particular, higher pulse rates as given by increased numbers of perfused capillaries and functional vessel density. The study of inflammation showed, especially in high-pulse ESW groups, higher leukocyte counts, and rolling leukocytes over time until day 6 as a response to the induction of inflammatory reaction after ESW application. Angiogenesis showed a marked increase in positive areas as given by sprouts, coils, and recruitments in all ESW groups, especially between days 4 and 6. Conclusion: The major findings of this trial demonstrate that ESW therapy to skin wounds is effective and safe. This is demonstrated by the initially faster wound closure rate, but later the same wound closure rate in the treatment groups than in controls. Furthermore, during the regeneration of microcirculation and perfusion in the healing skin, a significant improvement was observed after the application of, in particular, higher ESW pulse rates, suggesting an ESW-related increase in nutrient and oxygen supply in the wound tissue.

Defektdeckung von mittelgrosen Weichteildefekten der ulnaren Daumen- sowie der radialen Zeigefingerseite. Durch die Verwendung des Littler-Lappens konnen der defekte Weichteilmantel sowie die Sensibilitat, die fur den exakten Spitzgriff mit den Langfingern erforderlich ist, simultan wiederhergestellt werden. Mittelgrose ulnare Weichteildefekte der Daumenkuppe, frei liegende Knochen und Sehnenanteile, grosflachige Weichteilverluste mit sensorischem Defizit. Limitierende Begleitverletzungen der Hand. Allschichtiges Umschneiden des Lappens am ulnaren D(Digitus)III unter Darstellen des Nerven-Gefas-Bundels proximal. Verfolgen des Nerven-Gefas-Bundels bis zum Abgang aus dem Hohlhandbogen. Nach subkutaner Tunnelung Einschwenken des Lappens in den Defekt. Ruhigstellung des Daumens in Adduktion fur 7 Tage in dorsaler Gipsschiene, hiernach freie Beubung. Zuverlassige Defektdeckung mit geringer Hebedefektmorbiditat und sofortiger Wiederherstellung der Sensibilitat der ulnaren Daumenkuppe. Allerdings aufwendige mikrochirurgische Praparation insbesondere des Nerven.

Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers.We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal.The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group.The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.L’opération de remodelage corporel après une opération bariatrique fait partie des interventions à la croissance la plus rapide en chirurgie plastique. Le sérome en est l’une des principales complications. Il existe plusieurs méthodes pour réduire le drainage des plaies et la formation de sérome. Des méthodes efficaces pour réduire l’espace mort entre les couches de tissus sont une stratégie prometteuse.Les chercheurs ont réalisé une étude rétrospective pour comparer la colle Artiss à base de fibrine humaine aux sutures de tension progressive (STP) à l’aide du Stratafix, un fil de suture cranté bidirectionnel, pour les patients qui subissent un remodelage corporel après une opération bariatrique. Ils ont évalué 36 patients qui devaient subir une abdominoplastie ou un remodelage du bas du corps. Les patients traités se sont fait appliquer de la colle à base de fibrine humaine pour adapter les couches de tissus. Le groupe témoin a subi la même intervention, mais au moyen de STP. Les mesures de résultats primaires incluaient le drainage total des plaies et la période jusqu’au retrait du drain.En cas d’abdominoplastie, l’utilisation d’Artiss entraînait un volume de drainage moyen considérablement plus élevé et un plus grand nombre de jours avant de retirer tous les drains que la STP. En cas de remodelage corporel, le volume de drainage moyen et le nombre de jours nécessaire avant de retirer tous les drains tendaient à être plus élevés après l’utilisation d’Artiss que de STP.Par rapport aux STP, l’Artiss n’a pas réduit le taux de sérome ni la période d’utilisation des drains après des opérations de remodelage corporel suivant une chirurgie bariatrique.

Zusammenfassung Einleitung Die Bauchwand bildet eine feste anatomische Einheit und ist essentiell für die für Stabilisierung des Rumpfes. Erhöhter intraabdomineller Druck und Veränderungen der Gravitationskräfte können zu Dysbalancen und hierdurch Entwicklung von Rektusdiastasen und abdominellen Hernien führen. Material/Methode Die Betreuung und operative Behandlung postpartaler adipöser Patienten verlangt ein interdisziplinäres Konzept. In unserer Klinik wurde hierzu ein spezieller Behandlungsalgorithmus für adipöse Patienten mit postpartalen Bauchwandinsuffizienzen unter Berücksichtigung ihres BMI erstellt. Diskussion Der Verschluss von Rektusdiastasen ist eine zusätzliche Technik bei durchgeführter Abdominoplastik. Hierdurch kann eine verbesserte Stabilisierung der vorderen Bauchwand erzielt werden. Des Weiteren kann der Operateur die Kontur der Taille wiederherstellen und das äußere Erscheinungsbild optimieren. Je nach Ausmaß der Fettschürze und Größe der Hernien und Diastasen stehen unterschiedliche chirurgische Behandlungsalternativen zur Verfügung. Zusammenfassung Mit Hilfe der rekonstruktiven plastischen Chirurgie kann bei diesem Patientengut eine funktionelle Rekonstruktion der Bauchwand wiederhergestellt werden. Einen sekundären Therapiegewinn stellt die simultane Mitbehandlung der ästhetischen Problemzonen dar und hilft eine langfristige physische und psychosoziale Rehabilitation der Patientinnen zu ermöglichen.

Background Deep sternal wound infection remains a serious complication after cardiac surgery, leading to increased morbidity, mortality, and cost. The goal of our study was to develop a standardized, reproducible method to safely cover deep sternal wounds and ensure improved healing rates. Methods The study was developed as a retrospective cohort study. We included 58 patients who received standardized latissimus dorsi flap coverage of a sternum defect wound after poststernotomy mediastinitis at our institution between September 2015 and June 2017. Results The average age of the cohort was 66.75 years, and 51.72% of patients were men. The mean hospital stay was 26.83 days. Eight patients (14.75%) died during the hospital stay due to sepsis or heart failure. The average flap size was 137.13 cm2. The mean operative time was 155 minutes. Seventy-four percent of patients developed a seroma at the donor site, which was treated conservatively with compression garments and taps, and 7% of patients developed a wound dehiscence of the donor site, which was treated conservatively with dressings. The mean follow-up time was 15 weeks. All 50 surviving patients showed complete wound healing on follow-up. Conclusions The latissimus dorsi pedicled flap is a safe, reproducible technique for coverage of deep sternal wounds, with few relevant perioperative complications. By setting definite parameters for the flap dissection and by ensuring a reliable blood supply, our method enables the coverage of these complex wounds by an interdisciplinary team in any cardiovascular surgical setting.

Purpose Postoperative mediastinitis after cardiac surgery is still a devastating complication. Insufficient microbiological specimens obtained by superficial swabbing may only detect bacteria on the surface, but pathogens that are localized in the deep tissue may be missed. The aim of this study was to analyze deep sternal wound infection (DSWI) samples by conventional microbiological procedures and fluorescence in situ hybridization (FISH) in order to discuss a diagnostic benefit of the culture-independent methods and to map spatial organization of pathogens and microbial biofilms in the wounds. Methods Samples from 12 patients were collected and analyzed using classic microbiological culture and FISH in combination with molecular nucleic acid amplification techniques (FISHseq). Frequency of and the time to occurrence of a DSWI was recorded, previous operative interventions, complications, as well as individual risk factors and the microbiologic results were documented. Results Tissue samples were taken from 12 patients suffering from DSWI. Classical microbiological culture resulted in the growth of microorganisms in the specimens of five patients (42%), including bacteria and in one case Candida. FISHseq gave additional diagnostic information in five cases (41%) and confirmed culture results in seven cases (59%). Conclusion Microbial biofilms are not always present in DSWI wounds, but microorganisms are distributed in a “patchy” pattern in the tissue. Therefore, a deep excision of the wound has to be performed to control the infection. We recommend to analyze at least two wound samples from different locations by culture and in difficult to interpret cases, additional molecular biological analysis by FISHseq.

Wide awake local anesthesia no tourniquet (WALANT) refers to an anesthesia technique with low bleeding and complication rates, which enables interventions on the hand in an awake patient without the use of a tourniquet. Bleeding control is achieved through addition of vasoconstrictors to the infiltration solution. Since the motor function of the extremity is not affected, it offers the additional possibility of intraoperative active function testing. The WALANT procedure constitutes an established, effective, easily learnt and resource-sparing technique. The spectrum of surgical possibilities with WALANT is wide and covers nearly all elective and many emergency procedures. Due to multiple advantages in contrast to other regional and general anesthesia procedures, WALANT features an increasing spectrum of surgical applications and practitioners. It is therefore of interest for hand surgeons working both in hospitals and private practices.„Wide awake local anesthesia no tourniquet“ (WALANT) bezeichnet ein blutungs- und komplikationsarmes Lokalanästhesieverfahren, das Handeingriffe am wachen Patienten ohne den Einsatz einer Blutsperre ermöglicht. Dies wird durch den Zusatz vasokonstriktiver Substanzen in der Infiltrationslösung möglich. Da die Motorik der Extremität nicht beeinflusst wird, bietet es zusätzlich die Möglichkeit der intraoperativen aktiven Funktionsprüfung. Die WALANT-Anästhesie ist ein etabliertes, effektives, leicht erlernbares und Ressourcen schonendes Verfahren. Das Spektrum der chirurgischen Möglichkeiten mit WALANT ist breit und deckt nahezu alle elektiven und viele notfallbedingten Eingriffe ab. Aufgrund mannigfaltiger Vorteile gegenüber allgemeinen Anästhesieverfahren findet WALANT in der Chirurgie immer neue Indikationen und Anwender. Es ist daher für die handchirurgische Versorgung im klinischen wie im niedergelassenen Bereich gleichermaßen interessant.

Purpose Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR. Patients and Methods Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient’s charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL. Results SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care. Conclusion Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.

Purpose Demographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older patients. Therefore, this study evaluated free flap reconstruction of the extremities in older patients and compared the outcomes to those from younger patients who underwent similar procedures during the same period. Patients and Methods This single-center retrospective study used a case-control design to compare older and younger patients who underwent free flap reconstruction of soft tissue defects in the extremities. One-to-one matching was performed for older patients (≥65 years) and younger patients (≤64 years) according to indication, flap recipient site, and flap type. The parameters of interest were clinico-demographic characteristics, flap type, defect location, indication for free flap reconstruction, number of venous anastomoses, and postoperative complications (flap loss, infection, and wound healing disorders). Results The study included 48 older patients and 133 younger patients, with a mean follow-up of 12 months after discharge. The free flap reconstruction was performed at a mean interval of 19.8±22.8 days (range: 0–88 days). The 1:1 matching created 38 pairs of patients, which revealed no significant differences in the rates of flap necrosis and flap failure. Conclusion This study failed to detect a significant age-related difference in the flap necrosis rate after free flap reconstruction of extremity defects. Therefore, with careful perioperative management and patient selection, microsurgical free flap reconstruction is a feasible option for older patients.

The Diver Box is designed to prevent impedance differences, energy loss or damage to neighboring structures caused by the use of shock waves with application gels. The Diver Box is an acrylic glass container filled with tempered water and includes a coupling membrane to prevent the impedance jump from air to water and to avoid the continuous propagation of shock waves into the tissue, maintaining wave dynamics. Different modes of extracorporeal shock waves can be applied to a mouse skin wound without energy loss and protected from harmful phase-reversed waves. Macroscopic changes were seen in only 5% to 12% of tested specimens. Hazardous phase reversal, back reflection and mechanical tissue damage can be avoided by use of the Diver Box, ensuring standardized extracorporeal shock wave application.

Zusammenfassung Zielsetzung Defektdeckung einer persistierenden, sternalen Wundheilungsstörung, die nach frustranem Deckungsversuch mittels eines gestielten Latissimus-dorsi-Lappens durch eine Omentumplastik zur Ausheilung gebracht wurde. Indikation Tiefe sternale Wundheilungsstörungen sind seltene, aber schwerwiegende Komplikationen nach medianer Sternotomie. Wenn reguläre Deckungsverfahren fehlschlagen oder nicht zu entfernendes Fremdmaterial wie „Drivelines“ oder Gefäßprothesen mittels Muskellappen nicht zur Ausheilung gebracht werden können, bildet der Omentumlappen, aufgrund seiner immunologischen Kompetenz, eine sinnvolle Alternative. Methode Nach Exploration des persistierenden, sternalen Defekts schießt sich das radikale tangentiale Débridement und die Spülung der Wunde mittels einer Jet-Lavage an. Das Gewebe des Omentums wird nach Medianlaparotomie und Präparation des Lappens durch einen im vorderen Diaphragma angelegten Tunnel in den Defekt verlagert und kann hier spannungsfrei zur Ummantelung der Prothese verwendet werden. Der im Vorfeld verwendete Latissimuslappen wird in diesem Fall für den oberflächlichen Weichteilverschluss wiederverwendet. Schlussfolgerung Insbesondere bei infiziertem, nicht entfernbarem Restmaterial stellt der Omentumlappen aufgrund seiner immunologischen Kompetenz eine gute Behandlungsalternative zu Muskellappen dar.

Einleitung: Die wachsende Zahl an übergewichtigen Patienten sowie die Entwicklung der bariatrischen Chirurgie führte zu einer Zunahme der Hautstraffungsoperationen. Die Bauchdeckenstraffung ist eine der häufigsten durchgeführten postbariatrischen Operationen und ist oft von Wundkomplikationen[zum vollständigen Text gelangen Sie über die oben angegebene URL], 48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie, 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

Aim: Partial fasciectomy in cases of grade III-IV Dupuytren's contracture and coverage of the defect with local flaps. Indication: Dupuytren's contracture is a progressive disease of the hand associated with the formation of fascial cords, which may result in flexion and adduction contractures of the fingers leading up to complete dysfunction of the hands. Method: If several fingers are affected, partial fasciectomy is the gold standard in the treatment of Dupuytren's contracture. Ideally, the fingers reach the neutral position after the fibres causing the contracture are resected and arthrolysis is performed as needed. The skin deficits resulting from restored extension have to be covered by the use of Z-plasties, local or pedicled flaps of the hand. Conclusion: The resection of contracting cords in advanced cases of Dupuytren's contracture leads to large soft tissue defects. The microsurgical preparation of nerve and vascular structures is often difficult because of the fascial cords surrounding them. Exact preoperative planning of the extent of resection, as well as reconstruction options are essential and determine how incisions are made. To prevent a relapse, it is essential to reverse skin fibre direction using flaps and to insert intact skin with preserved subdermal adipose tissue.

Defect coverage of medium-sized soft tissue defects on the ulnar side of the thumb and radial side of the index finger. By using the Littler flap, both, the lost soft tissue coverage and sensitivity, which is necessary for an exact grip to the long fingers, can be simultaneously restored.Medium-sized soft tissue defect of the ulnar tip of the thumb, exposed bones and parts of the tendons, extensive soft tissue defects with sensory deficit.Limiting accompanying injuries of the hand.All-layer incision of the flap at ulnar 3rd digit with proximal exploration of the nerve and vascular bundle. Tracing the bundle to the exit from the palmar arch. After subcutaneous tunneling, shift of the flap into the defect.Immobilization of the thumb in adduction for 7 days in a dorsal plaster splint, followed by free exercise.Reliable defect coverage with low donor-site morbidity and immediate restoration of sensibility in the ulnar tip of the thump. However, microsurgical dissection, especially of the nerve, is challenging.

Recent studies indicate that adipose tissue in obesity promotes breast cancer progression by secreting protumorigenic chemokines, growth factors, and fatty acids. However, the detailed mechanisms by which hypertrophic adipose tissue influences breast cancer cells are still not well understood. Here we show that co-culture with adipose tissue from high-fat diet induced obese C57BL/6 mice alters transcriptome profiles in triple-negative breast cancer (TNBC) cells, leading to upregulation of genes involved in inflammation and lipid metabolism, such as IL1B, PLIN2, and ANGPTL4. Similar results were obtained by treating TNBC cells with adipose tissue conditioned media (ACM) generated from fat tissue of obese female patients. Many of the upregulated genes were activated by PPAR nuclear receptors, as shown by pathway analyses and gene expression experiments using PPAR agonists and antagonists. Metabolic analysis revealed that TNBC cells cultivated with ACM had significantly higher levels of β-oxidation. Furthermore, ACM-treated TNBC cells displayed a pronounced aggressive cell phenotype, with enhanced wound healing, proliferation, and invasion capabilities. ACM-induced invasion was dependent on the PPAR-target ANGPTL4 and activated FAK signaling, as shown by ANGPTL4 depletion and FAK inhibition. Together, our data suggest that factors released by adipose tissue change PPAR-regulated gene expression and lipid metabolism and induce a more aggressive TNBC cell phenotype. These effects are, at least in parts, mediated by fatty acids provided by the adipose tissue. Implications: Adipose tissue provides factors for increased progression of TNBC cells, identifying PPAR- and FAK-signaling as potential novel targets for treatment of TNBC, especially in obese women.

Background: Mediastinitis after cardiac surgery can lead to devastating consequences such as deep sternal wound infections (DSWI). Staphylococcus epidermidis and other coagulase-negative staphyloco...

Obesity is a known risk factor for breast cancer and a negative prognostic factor for cancer recurrence and survival. Several studies demonstrated that aggressive breast tumor cells contain higher numbers of intracellular lipid droplets (LDs). Here we applied simultaneous visualization, identification and quantification of the lipid accumulation in lipid droplets (LDs) of aggressive, human triple-negative MDA-MB-231 breast cancer cells treated with adipose tissue-conditioned medium (ACM) derived from overweight and obese patients. In addition to Oil Red O and AdipoRed fluorescent staining, label-free confocal Raman microspectroscopy (CRM) has been applied. CRM enables imaging of cell compartments as well as quantification and monitoring of specific biomolecules and metabolic processes on a single cell level. Interestingly, breast cancer cells incubated with ACM showed a significantly higher number of intracellular LDs. Cultivation of breast tumor cells with ACM of obese patients induced the formation of LDs with a 20-fold higher lipid concentration than cultivation with basal medium. This is in line with the significantly higher levels of NEFAs (non-esterified fatty acids) detected in the ACM obtained from obese patient compared to ACM obtained from overweight patients or basal medium. Further, by principal component analysis, we identified a significant increase in unsaturation, esterification and lipid to protein ratio in LDs in breast cancer cells incubated with ACM. CRM analyses might function as a valuable diagnostic tool to identify metabolic alterations in biological samples which in turn could provide more detailed insights in the pathogenesis of breast cancer in association with obesity.

Background At present, data describing patients’ long-term outcomes, quality of life, and survival after deep sternal wound infection are rarely available. The purpose of our study was to evaluate functional outcome and patient well-being after debridement and reconstruction of the sternal defect using a pedicled latissimus dorsi flap following deep sternal wound infection (DSWI). Methods This retrospective analysis reviewed 106 cases of DSWI after open-heart surgery treated between May 1, 2012, and May 31, 2015. The parameters of interest were demographic and medical data, including comorbidity and mortality. Follow-up consisted of physical examination of the patients using a specific shoulder assessment, including strength tests and measurements of pulmonary function. Results The population consisted of 69 (65%) male and 37 (35%) female patients. Their average age at the time of plastic surgery was 69 years (range: 35–85). The 30-day mortality was 20% (n = 21); after one-year, mortality was 47% (n = 50), and at follow-up, it was 54% (n = 58). Heart surgery was elective in 45 cases (42%), urgent in 31 cases (29%) and for emergency reasons in 30 cases (28%). The preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE) averaged 16.3 (range: 0.88–76.76). On the dynamometer assessment, a value of 181 Newton (N) (±97) could be achieved on the donor side, in contrast to 205 N (±91) on the contralateral side. The inspiratory vital capacity of the lung was reduced to an average of 70.58% (range: 26–118), and the forced expiratory volume in 1 s was decreased to an average of 69.85% (range: 38.2–118). Conclusions Given that only small adverse effects in shoulder function, strength, and pulmonary function were observed, the latissimus dorsi flap appears to be a safe and reliable option for the reconstruction of the sternal region after DSWI.

Symptome Eine Patientin stellt sich mit seit uber 20 Jahren bestehenden neuralgiformen Schmerzen im Bereich des medialen Fusrands vor.

Coverage of a deep sternal wound infection with a greater omentum flap. Due to a persistent infection caused by an infected aortic prosthesis, the primarily performed reconstruction with a latissimus dorsi flap had to be revised, and an alternative solution had to be found.A deep sternal wound infection is a rare but devastating complication following median sternotomy. If the commonly used muscle flap is not sufficient and artificial material is still present in the wound, for instant drivelines or a vascular prosthesis, the greater omentum flap is a useful option due to its immunologic capacity.After an exploration of the persisting infected deep sternal wound, a radical debridement is performed followed by a jet lavage. The soft tissue from the greater omentum is prepared via median laparotomy and transferred through a tunnel created in the diaphragm. Then it is pulled into the wound cavity and can be used for tension-free sheathing of the aortic prosthesis. The previously used muscle flap can additionally be used for superficial soft tissue coverage.Due to its immunologic competence, the greater omentum flap is a good treatment alternative to the commonly used muscle flaps in defects with infected artificial material.Defektdeckung einer persistierenden, sternalen Wundheilungsstörung, die nach frustranem Deckungsversuch mittels eines gestielten Latissimus-dorsi-Lappens durch eine Omentumplastik zur Ausheilung gebracht wurde.Tiefe sternale Wundheilungsstörungen sind seltene, aber schwerwiegende Komplikationen nach medianer Sternotomie. Wenn reguläre Deckungsverfahren fehlschlagen oder nicht zu entfernendes Fremdmaterial wie „Drivelines“ oder Gefäßprothesen mittels Muskellappen nicht zur Ausheilung gebracht werden können, bildet der Omentumlappen, aufgrund seiner immunologischen Kompetenz, eine sinnvolle Alternative.Nach Exploration des persistierenden, sternalen Defekts schießt sich das radikale tangentiale Débridement und die Spülung der Wunde mittels einer Jet-Lavage an. Das Gewebe des Omentums wird nach Medianlaparotomie und Präparation des Lappens durch einen im vorderen Diaphragma angelegten Tunnel in den Defekt verlagert und kann hier spannungsfrei zur Ummantelung der Prothese verwendet werden. Der im Vorfeld verwendete Latissimuslappen wird in diesem Fall für den oberflächlichen Weichteilverschluss wiederverwendet.Insbesondere bei infiziertem, nicht entfernbarem Restmaterial stellt der Omentumlappen aufgrund seiner immunologischen Kompetenz eine gute Behandlungsalternative zu Muskellappen dar.

Introduction Deep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures. Methods We treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs. Omentoplasty was performed in combination with a split skin graft and the wound was closed by a vacuum-assisted therapy for 7 days. The patients’ sex and comorbid risk factors supporting DSWIs as well as the postoperative complications were recorded. Results Retrospective analysis of 14 patients (10 males and four females) after a follow-up time of 24 months was performed. The average age was 75 years (range: 67–83). Heart surgery took place electively in eight cases, in three cases urgently and three for emergency reasons. The preoperative Euro Score was 16 (range 3.51–42.58). We had no flap loss in any patients. The skin graft showed a full take in all patients. Two patients needed revision of an abdominal wound dehiscence after laparotomy and one patient developed hernia in the late outcome. Discussion The greater omentum flap has, over many years, become an ideal partner in the coverage and treatment of DSWIs. Especially due to its immunologic capacity and amorphous structure, it has the ability to fill up cavities and cover infected artificial material so residual infections can be controlled.

C-type natriuretic peptide (CNP) is known to increase growth rate of endothelial cells in vitro. In addition, gene transfer of CNP into ischaemic muscle was shown to induce angiogenesis. So far, no study has addressed the effect of CNP on dermal wound healing. The ear wound model in mice was used in this study. The first group was treated with dsRed-CNP plasmid, whereas the second group was transfected with the empty dsRed-sine plasmid, lacking sequence coding for CNP. The third group was sham operated and treated with saline to serve as second control. Wound size was measured on days 0, 1, 3, 5, 7, 9, 11 and 14. On days 7 and 14 capillary density was analysed. Wound closure rate was significantly reduced in mice treated with CNP [dsRed-CNP 73·3 ± 3·2% versus dsRed-sine 94·5 ± 2·4% versus saline 92·1 ± 2·4%, n = 8 per group, analysis of variance (ANOVA) P < 0·001] at day 7 postop. Capillary density was found to be significantly higher in CNP-treated mice (dsRed-CNP 18·7 ± 3·9 versus dsRed-sine 12·3 ± 2·7 versus control 10·1 ± 4·7, CD31(+) capillaries per microscope field, ANOVA P = 0·018) at day 14 postoperative. CNP significantly reduces wound closure rate in hairless mice but promotes the development of new blood vessels. A possible explanation is the dual effect of CNP, inhibiting growth of fibromyoblasts but stimulating growth of endothelial cells. Thus, CNP may serve as a therapeutic approach to diseases caused by hyperfibrosis.

Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath. Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient’s desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility. The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.