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Microcirculation is a critical factor in burn wound healing. Remote ischemic conditioning (RIC) has been shown to improve microcirculation in healthy skin and demonstrated ischemic protective effects on heart, kidney, and liver cells. Therefore, we examined microcirculatory effects of RIC in partial thickness burn wounds. The hypothesis of this study is that RIC improves cutaneous microcirculation in partial thickness burn wounds. Twenty patients with partial thickness burn wounds within 48 hours after trauma were included in this study. RIC was performed with an upper arm blood pressure cuff on a healthy upper arm using three ischemia cycles (5 min inflation to 200 mm Hg) followed by 10-minute reperfusion phases. The third and final reperfusion phase lasted 20 minutes. Microcirculation of the remote (lower/upper extremities or torso) burn wound was continuously quantified, using a combined Laser Doppler and white light spectrometry. The capillary blood flow in the burn wounds increased by a maximum of 9.6% after RIC (percentage change from baseline; P < .01). Relative hemoglobin was increased by a maximum of 2.8% (vs. baseline; P < .01), while cutaneous tissue oxygen saturation remained constant (P > .05). RIC improves microcirculation in partial thickness burn wounds by improving blood flow and elevating relative hemoglobin.

Finger- und Mittelhandknochen (MHK)-Frakturen gehoren zu den haufigsten Frakturen des menschlichen Korpers. Die fruhzeitige Diagnose und Behandlung dieser Frakturen sind essenziell fur ein gutes funktionelles Ergebnis der verletzten Hand. Wir berichten uber die Symptomatik, Diagnostik, Klassifikation und uber die Behandlung dieser Frakturen je nach Lokalisation und Typ. Phalangeal and metacarpal fractures are among the most common fractures of the human body. The early diagnosis and treatment of these fractures are essential for a good functional result of the injured extremity. We report the symptoms, diagnosis, and classification and the treatment of these fractures depending on the type and location of the fracture.

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

Emergency capacities in the operating theatre are limited and often need to be split among surgical departments. Hand injuries often have to compete with other surgical disciplines for the availability of operating capacity. For this reason, an emergency classification was introduced to define a timespan in which the injury should be taken care of in the OR in order to enable the prioritizing of emergency cases in an interdisciplinary approach when capacities are scarce. However, neither valid data nor specific recommendations concerning the medical urgency of treatment or the forensic background of different hand injuries exist to this date.This work describes how emergency classifications in Germany are applied to hand surgical cases and how certain hand injuries are prioritized among different hand surgeons.An online survey was sent to all members of the German Society for Hand Surgery twice during a time span of several months. The survey featured questions on size and type of clinic or practice and requested an assessment of urgency levels for various hand injuries (immediately - within 2 h - within 6 h - within 12 h - within 24 h or elective care). The analysis of the questionnaire and graphic presentation was carried out using Excel.172 (25 %) out of 700 active members filled in the survey. Among the participants were members of university clinics, hospitals run by the German Statutory Accident Insurance, specialized clinics and primary care clinics. 15 % of participants work in a practice that offers hand-surgical treatment. First and foremost, maximum care hospitals with a hand surgical department participate in the treatment of hand injuries. 64 % of the hospitals use an emergency classification to enable the interdisciplinary prioritizing of surgical emergencies. The categorization of limb-threatening hand injuries appears to be very homogenous among participants whereas non-threatening injuries are assessed rather inconsistently.Emergency treatment of hand injuries primarily depends on available resources and surgical capacities. The assessment of urgency and severity of injuries additionally depends on experience and education. In order to maintain the ability to compete with other surgical disciplines for surgical capacities, a standard classification of hand surgical urgencies needs to be established. As valid data on the treatment of hand injuries are still missing, further studies need to evaluate possible outcomes in order to define the timespan in which surgery should take place.Die handchirurgische Notfallversorgung konkurriert in der Dienstzeit mit anderen chirurgischen Fächern um die zur Verfügung stehende OP-Kapazität. Fachübergreifend existiert in vielen Kliniken eine einheitliche Notfallkategorisierung, die festlegt, innerhalb welcher Zeitfenster eine chirurgische Versorgung von Notfällen erfolgen muss. Allerdings gibt es in der handchirurgischen Literatur keine einheitlichen Daten/Empfehlungen darüber, mit welcher zeitlichen Versorgungsdringlichkeit bestimmte Verletzungsmuster aus medizinischer und forensischer Sicht versorgt werden sollten. ZIEL: Die vorliegende Arbeit unternimmt den Versuch, die Versorgungssituation und den fachlichen Konsens bezüglich der Versorgungsdringlichkeiten in Deutschland mithilfe einer Online-Umfrage zu erfassen.Über den E-Mail-Verteiler der DGH wurde eine Online-Umfrage an alle Mitglieder zweimal im Abstand von mehreren Monaten versandt. Es erfolgte die standardisierte Abfrage von Art und Größe der Klinik bzw. Praxis sowie die Bitte um Einschätzung der zeitlichen Dringlichkeitsstufen für verschiedene handchirurgische Verletzungsmuster (sofort – innerhalb 2 h – innerhalb 6 h – innerhalb 12 h – innerhalb 24 h bzw. elektive Versorgung). Die anschließende Analyse und grafische Aufarbeitung erfolgten mittels Excel.Von rund 700 aktiven Mitgliedern beteiligten sich 172 (25 %) an der Umfrage. Vertreten sind Kollegen sowohl aus Universitätskliniken und BG-Kliniken als auch aus Schwerpunkthäusern und Kliniken der Grund- und Regelversorgung. 15 % sind in der Praxis tätig. An der Notfallversorgung partizipieren erwartungsgemäß hauptsächlich Häuser der Maximalversorgung, überwiegend mit eigener handchirurgischer Dienstbesetzung. 64 % der Häuser haben dabei eine fachübergreifende Notfallkategorisierung. Die Einschätzung der zeitlichen Versorgungsdringlichkeiten bei gefährdenden Verletzungen der Hand wie Amputationen und Kompartmentsyndrom ist insgesamt relativ einheitlich, bei nicht-gefährdenden Verletzungen wie Infekten oder Sehnendurchtrennungen hingegen sehr heterogen.Die Möglichkeit zur Versorgung handchirurgischer Notfälle hängt in erster Linie von den zur Verfügung stehenden Ressourcen und OP-Kapazitäten ab, die Einschätzung der Versorgungsdringlichkeit zusätzlich von Erfahrung und Schule. Um im Wettbewerb mit anderen chirurgischen Disziplinen um limitierte Ressourcen auf eine valide Argumentationsgrundlage zurückgreifen zu können, ist ein allgemeiner Konsens zu Versorgungsdringlichkeiten sinnvoll. Eine dazu valide Studiengrundlage fehlt allerdings bis heute.

Peripheral nerve injuries are often encountered in traumatological care. The aim of this manuscript is to provide initial data, experiences and performance reports from Germany in the implantation of acellular human nerve transplants in peripheral sensory nerve defects of the hand and to put these data in the context of a comprehensive review of the literature. Of the patients 4 (7 digital nerves) were examined 6 months postoperatively and 5 patients (6 digital nerves) were examined 1 year after the operation (3 were also at the 6‑month examination). All patients had a clinical improvement after nerve reconstruction (≥ S3 according to the classification of sensory recovery of the Medical Research Council modified by Mackinnon and Dellon). Disadvantages of our clinical study are the small number of patients, the inhomogeneity (primary and secondary nerve reconstruction) and the lack of comparison with other nerve reconstruction methods.Verletzungen peripherer Nerven werden regelmäßig in der traumatologischen Versorgung angetroffen. Ziel dieser Arbeit ist es, erste Daten, Erfahrungen und Anwendungsberichte aus Deutschland bei der Implantation von azellulären humanen Nerventransplantaten bei peripheren sensiblen Nervendefekten an der Hand anzubieten und diese Daten in den Kontext einer umfassenden Literaturübersicht zu stellen. Bei der 6-Monats-Untersuchung konnten 4 Patienten (7 Nervi digitalis propii) nachuntersucht werden. Ein Jahr postoperativ konnten 5 Patienten (6 Nervi digitalus propii) nachuntersucht werden (3 davon waren auch bei der 6-Monats-Untersuchung). Alle Patienten hatten eine klinische Verbesserung nach der Nervenrekonstruktion (≥ S3 nach der Klassifikation der sensiblen Regeneration nach dem Medical Research Council modifiziert durch Mackinnon und Dellon). Nachteile dieser klinischen Studie sind die kleine Anzahl von Patienten, die Inhomogenität (primäre und sekundäre Nervenrekonstruktion) sowie der fehlende Vergleich zu einer anderen Nervenrekonstruktionsmethode.

Despite the clinical importance of deep wrist injuries (DWIs), data comparing the outcome of suicide attempt survivors vs. accident survivors are lacking. Patients admitted to our Clinic for acute treatment of a DWI from 2008 to 2016 were contacted for a follow-up assessment of sensory, motor and functional outcomes. Patients also completed the Disability of the Arm, Shoulder and Hand Questionnaire, the Modified Mayo Wrist Score, the Boston Carpal Tunnel Questionnaire, and the WHOQOL-BREF questionnaires. 51 patients could be followed up, on average 4.3 ± 2.9 years after their injury. Suicide attempt survivors did not differ from accidents survivors concerning two-point discrimination, grip and pinch strength, but showed poorer outcomes in self-reported disability, symptom severity, and quality of life. Patients with DWIs from suicide attempts vs. accidents do not differ in sensorimotor outcomes but patient-reported outcome measures. Level of Evidence: II.

Zusammenfassung Hintergrund Die handchirurgische Notfallversorgung konkurriert in der Dienstzeit mit anderen chirurgischen Fächern um die zur Verfügung stehende OP-Kapazität. Fachübergreifend existiert in vielen Kliniken eine einheitliche Notfallkategorisierung, die festlegt, innerhalb welcher Zeitfenster eine chirurgische Versorgung von Notfällen erfolgen muss. Allerdings gibt es in der handchirurgischen Literatur keine einheitlichen Daten/Empfehlungen darüber, mit welcher zeitlichen Versorgungsdringlichkeit bestimmte Verletzungsmuster aus medizinischer und forensischer Sicht versorgt werden sollten. Ziel Die vorliegende Arbeit unternimmt den Versuch, die Versorgungssituation und den fachlichen Konsens bezüglich der Versorgungsdringlichkeiten in Deutschland mithilfe einer Online-Umfrage zu erfassen. Material und Methoden Über den E-Mail-Verteiler der DGH wurde eine Online-Umfrage an alle Mitglieder zweimal im Abstand von mehreren Monaten versandt. Es erfolgte die standardisierte Abfrage von Art und Größe der Klinik bzw. Praxis sowie die Bitte um Einschätzung der zeitlichen Dringlichkeitsstufen für verschiedene handchirurgische Verletzungsmuster (sofort – innerhalb 2 h – innerhalb 6 h – innerhalb 12 h – innerhalb 24 h bzw. elektive Versorgung). Die anschließende Analyse und grafische Aufarbeitung erfolgten mittels Excel. Ergebnisse Von rund 700 aktiven Mitgliedern beteiligten sich 172 (25 %) an der Umfrage. Vertreten sind Kollegen sowohl aus Universitätskliniken und BG-Kliniken als auch aus Schwerpunkthäusern und Kliniken der Grund- und Regelversorgung. 15 % sind in der Praxis tätig. An der Notfallversorgung partizipieren erwartungsgemäß hauptsächlich Häuser der Maximalversorgung, überwiegend mit eigener handchirurgischer Dienstbesetzung. 64 % der Häuser haben dabei eine fachübergreifende Notfallkategorisierung. Die Einschätzung der zeitlichen Versorgungsdringlichkeiten bei gefährdenden Verletzungen der Hand wie Amputationen und Kompartmentsyndrom ist insgesamt relativ einheitlich, bei nicht-gefährdenden Verletzungen wie Infekten oder Sehnendurchtrennungen hingegen sehr heterogen. Schlussfolgerung Die Möglichkeit zur Versorgung handchirurgischer Notfälle hängt in erster Linie von den zur Verfügung stehenden Ressourcen und OP-Kapazitäten ab, die Einschätzung der Versorgungsdringlichkeit zusätzlich von Erfahrung und Schule. Um im Wettbewerb mit anderen chirurgischen Disziplinen um limitierte Ressourcen auf eine valide Argumentationsgrundlage zurückgreifen zu können, ist ein allgemeiner Konsens zu Versorgungsdringlichkeiten sinnvoll. Eine dazu valide Studiengrundlage fehlt allerdings bis heute.

Despite the clinical importance of deep wrist injuries (DWIs), data on the timeframe of possible improvements in hand function are scarce. We tested the hypotheses that a) the length of follow-up is positively correlated with the outcome, and b) this correlation is tempered by nerve involvement. All patients admitted to the Clinic of Plastic Surgery with an acute DWI between 2008 and 2016 were contacted for a follow-up examination including two-point discrimination, range of motion, grip, and pinch strength, as well as DASH and MMWS questionnaires and employment status. Possible confounders such as age, handedness, and intentionality of the injury (accidental or suicidal) were assessed and controlled for statistically. Fifty-three patients were reviewed (74% male and 26% female, 86% right-handed, 70% accidental injuries, mean age at injury 42.0 ± 17.1 years), an average of 4.3 ± 2.9 years after their injury. In patients with a nerve injury, length of follow-up had significant effects on two-point discrimination, grip and pinch strength, self-reported symptom severity and impairment. Contrary to conventional knowledge, the clinical outcome of DWIs may improve beyond 3 years when there is nerve involvement. This important prognostic finding has far-reaching implications for both clinicians (e.g., asked to give their medical opinion) and patients (e.g., considering re-training after a DWI).

Objective As suicide attempts by definition entail at least some threat to physical integrity and life, they theoretically qualify as an A1 criterion for posttraumatic stress disorder (PTSD). This study uses the unique opportunity of deep wrist injuries to quantify the effect of intentionality on PTSD rates by comparing suicide attempt survivors with patients who sustained accidental injuries similar in mechanism, localization, and extent. Method Patients who had been admitted with an acute deep wrist injury from 2008 to 2016 filled out the revised Impact of Event Scale and reported other known PTSD risk factors. Mental morbidity and intentionality of the injury were determined by psychiatric consultation during the index hospitalization. Results Fifty-one patients were followed up (72.5% male, 92.2% Caucasian, mean age at injury 42.3 ± 17.5 years, 72.5% accidental injuries), on average 4.2 ± 2.9 years after their injury. The intentionality of the injury alone predicted the severity of intrusions, avoidance, hyperarousal, and probable PTSD (aOR = 14.0). Conclusions Traumatization in the context of a suicide attempt may be a hitherto unknown PTSD risk factor. Patients after suicide attempts, especially medically serious attempts, should be monitored for PTSD symptoms.

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

Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5 g, tid) was administered over 0.5 h. Blood samples were taken at 1, 4, and 7.5 h after the end of the infusion. Free piperacillin plasma concentrations were determined. Pharmacokinetic parameters and in silico analysis results were calculated using the freeware TDMx. The primary target was defined as percentage of the day (fT>1xMIC; fT>4xMIC) when piperacillin concentrations exceeded 1xMIC/4xMIC (minimum inhibitory concentration), considering a MIC breakpoint of 16 mg/L for Pseudomonas aeruginosa. In an off-label approach, two burn patients were treated with 8/1 g piperacillin/tazobactam, 3 h qid. fT>1xMIC (55 ± 22% vs. 77 ± 24%) and fT>4xMIC (17 ± 11% vs. 30 ± 11%) were lower in burn than in ICU patients after 4/0.5 g, 0.5 h, tid. In silico analyses indicated that fT>1xMIC (93 ± 12% burn, 97 ± 4% ICU) and fT>4xMIC (62 ± 23% burn, 84 ± 19% ICU) values increase by raising the piperacillin dosage to 8/1 g qid and prolonging the infusion time to 3 h. Off-label treatment results were similar to in silico data for burn patients (84%fT>1xMIC and 47%fT>4xMIC). Standard dosage regimens for piperacillin/tazobactam resulted in subtherapeutic piperacillin concentrations in burn and ICU patients. Dose adjustments via in silico analyses can help to optimize antibiotic therapy and to predict respective concentrations in vivo. Trial registration: NCT03335137, registered 07.11.2017, retrospectively.

In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRAC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.

Verbrennungen der Hand konnen bei inadaquater Therapie zu schweren Funktionseinschrankungen fuhren. Fur eine erfolgreiche Therapie sind genaue Kenntnisse der Schweregrade und der differenzierten operativen Therapie unabdingbar. Handverbrennungen stellen grundsatzlich eine Zentrumsindikation dar und sollten bei fehlender Behandlungsexpertise diesen auch zugefuhrt werden.

Background:. Despite the clinical importance of suicidal deep wrist injuries (DWIs), we currently do not know whether their injury patterns differ from accidental injuries. Methods:. This retrospective study included all patients admitted to the Clinic of Plastic Surgery for acute treatment of a DWI from 2008 to 2016, except for isolated injuries to the palmaris longus (PL) and amputations. Intentionality of the injury was determined using documentation of psychiatric evaluations; cases that could not be categorized regarding intentionality were excluded. Results:. About 20% of DWIs stemmed from suicide attempts, which involved the nondominant hand in 94.5%. Suicidal DWIs were more likely to involve the median nerve, radial artery, PL, and flexor carpi radialis (FCR), especially on the nondominant hand, but were less likely to involve the ulnar artery and nerve on the dominant hand. The effect of the protective structures PL/flexor carpi ulnaris on the median nerve/ulnar artery could be confirmed for suicidal DWIs, but intactness of the FCR was associated with increased radial artery injuries. Longitudinal cut orientation in suicidal DWIs was associated with more radial artery injuries, but fewer injuries to tendons and nerves. Frequencies of various other injury constellations are tabulated to aid in clinical assessment. Conclusions:. Suicidal and accidental DWIs differed in various aspects of injury pattern. Suicidal injuries were mostly localized to the nondominant radial side, and accidental injuries to the ulnar side. Also, the so-called protective structure FCR had the opposite effect in suicidal injuries. Thus, findings regarding injury patterns in accidental DWIs cannot be generalized to suicidal injuries.

Background Extracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable. Hypothesis High energy ESWT influences cutaneous microcirculation at body regions remote from application site. Methods Eighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10 J) or placebo shock wave treatment (Group B: 0 impulses, 0 J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry. Results In Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (p = 0.01). Postcapillary venous filling pressure remained statistically unchanged (p > 0.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (p = 0.220). Conclusion High energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation.

Die mikrochirurgische Versorgung von Nervenverletzungen an der Hand setzt nicht nur hohe apparative Ausstattung (Operationsmikroskop, Mikroinstrumentarium), sondern auch technische Fertigkeiten und Expertise voraus, da nicht nur die primare Nervennaht beherrscht werden muss, sondern auch rekonstruktive Eingriffe bei Nervendefekten. Dieser hohe Aufwand ist gerechtfertigt, um schmerzhafte Folgezustande zu vermeiden und regelhaft auch mindestens eine Schmerz-/Schutzsensibilitat wiederherzustellen und bei jungen Patienten auch eine (partielle) motorische Re-Innervation zu erreichen.

In diesem Artikel beschreiben wir unsere Erfahrungen bei der Versorgung von Veratzungen mit Diphoterine® und Suprathel®, eine Behandlung, die bei diesen Verletzungsmustern in der Vergangenheit eher im Hintergrund stand. Im untersuchten Zeitraum von Oktober 2012 bis Dezember 2013 behandelten wir 5 Patienten (4 m, 1 w, 2 Kinder und 3 Erwachsene) mit Veratzungen durch Diphoterine®-Spulung und Suprathel®-Auflage. Die Kontrollgruppe beinhaltete 5 Patienten mit ahnlichem Verletzungsmuster, die mit Diphoterine® und Okklusionsverbande behandelt wurden. Es traten keinerlei Wundinfektionen auf und eine Interaktion zwischen Suprathel® und der auslosenden Chemikalie war in keinem der Falle zu beobachten. In den 4 Fallen zeigte sich bei den IIa°-IIb°-Arealen eine gute Wundheilung mit diskreter Narbenbildung im Hautniveau in der Verlaufskontrolle nach 3 Monaten, einer der 5 Patienten musste im Verlauf chirurgisch behandelt werden. Der Verbrennungsmedizin steht mit Suprathel® ein temporarer Hautersatz zur Verfugung auch zur Behandlung von Veratzungen.

Interdisciplinary work including surgery and additive radiotherapy is often needed for the therapy of tumours. Beneath this, brachytherapy is an important part of the radiotherapy. It was first used over 100 years ago and is in regular use after the development of afterload technology in the early 1970s. Today it is often used in different tumour therapies, for example in soft tissue sarcoma or breast tumours, in order to decrease the risk of local recurrence. Concerning its benefits, higher doses could be used because of the localized effect with equivalent local control rate and less toxicity of treatment. Moreover, brachytherapy can also shorten the treatment time from 5-7 weeks to some days and is better reconcilable due to its localized effects, thus reducing side effects, as radiation-induced reactions, teleangiectasia and brosis. Precondition for application of brachytherapy is the need of a good soft tissue coverage and wound healing. Therefore, good interdisciplinary cooperation between plastic surgery and radiotherapy is important. After wide surgical resection reconstruction with different kind of flaps are often required, for achieving early wound healing and fast start of radiotherapy.Between 2011 and 2017 we applied brachytherapy to 13 patients with soft tissue sarcomas and other tumours like merkel-cell-carcinoma, schwannoma, and breast cancer. The treatment consisted of tumour resection, intraoperative insertion of brachytherapy catheters and after that brachytherapy alone or in combination with external beam radiotherapy. In half of the patients a reconstruction with different flaps was required, including pedicled trapezius flap, musculus latissimus dorsi flap and radial forearm flap; in some cases nerve and tendon reconstruction for better function and faster wound healing and so faster start of postoperative brachytherapy was also needed. The mean age of the patients was 55 years (±19) and we could start brachytherapy after 3-21 days after the operation, with a mean start on day 8±5 postoperatively. Three patients received additional percutaneous radiotherapy. The patients who received only brachytherapy got a dose of 2, 5 or 3Gy twice daily, with a mean total dose of 31±3Gy.Multidisciplinary work, including surgery as the main procedure and radiotherapy additionally, is needed for a successful treatment of soft tissue tumours. Depending on the type and the stadium of tumour plastic and reconstructive surgery provides soft tissue coverage, faster wound healing and the chance for limb salvage; on the other hand, additive brachytherapy contributes to a good tumour control. Therefore, a close collaboration between the two specialties is of particular importance, in order to improve the effectiveness of the therapy and the postoperative quality of life of the patient.

Systemic sclerosis (SSc) is a connective tissue disorder of unknown etiology, with heterogeneous clinical manifestations and chronic and often progressive course. The diffuse cutaneous form of SSc (dcSSc) is characterized by thickening of the skin (scleroderma) and distinctive involvement of multiple internal organs. Patients with limited cutaneous SSc (lcSSc) generally have long-standing Raynaud's phenomenon before other manifestations of SSc appear. Over the last decade the Interest of adipose-derived cell therapy in regenerative medicine has increased continuously. In compare to bone marrow-derived mesenchymal stem cells (MSCs) adipose tissue-derived stem cells (ADSCs) are considered to be ideal for application in regenerative medicine. Zuk et al., introduced a multipotent, undifferentiated, self-renewing progenitor cell population isolated from adipose tissue, called processed lipoaspirate (PLA). However, subcutaneous injections of autologous adipose tissue-derived stromal vascular fraction (ADSVF), which is known to contain mesenchymal stem cells, in hands of Patients with scleroderma for enhancing their impaired hand function is still in an experimental stage, although there are already promising results of the therapy. Commonly available therapeutic options for hands of Patients with systemic sclerosis, vasodilatator drugs and physiotherapy, have many restriction and limited effects.A 62 years old woman with scleroderma presented with progressive digital necrosis, ulceration, gangrene and impaired wound healing, despite of conventional therapy with vasodilatator drugs. Water-jet-Assisted Liposuction (Body-jet® evo, human med AG, Schwerin, Germany) of subcutaneous abdominal fat was carried out under general anesthesia by an experienced surgeon. Autologous adipose tissue-derived stromal vascular fraction (ADSVF) was harvested by in a single-use Q-graft® collector (human med AG, Schwerin, Germany). Cells were centrifuged in 400G for 5 minutes and cell pellets were aspirated carefully in a 20mL syringe filled with 0.9% NaCl. A total of ca. 2.72 million cells have been isolated. Meanwhile middle phalangeal amputation of digit 2, 3 and 4 of the left hand were performed, without closing the skin of the amputation stumps. The SVF cell suspension was injected subcutaneous into the area of metacarpophalangeal joints in both hands, as well as into the amputation stump of the left middle finger, and under a skin necrosis in the right hand.The therapy was good tolerated by the patient, with absence of adverse reactions. No infection was observed, despite open amputation. Three weeks after the stem cell therapy, no need to further amputation was demonstrated. The patient is still under regular clinical observation, in order to determine the long term effects of the therapy.Application of isolated adipose tissue-derived stem cells seems to be a very promising procedure in the treatment of the manifestation of systemic sclerosis. However, more clinical and experimental studies are required, in order to understand the exact mechanisms of action and standardize the therapy.

Summary:. An osteoid osteoma is a rare benign tumor of the carpal bones. It is extremely rarely found in the lunate bone in patients above 30 years of age. We present a case report of a 61-year-old man with an osteoid osteoma of the left wrist, which was masked by degenerative carpal bone disease and a comorbidity of an inflammatory bowel disease. The mainstay of imaging including plain radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy led to the clinical diagnosis of a lunatomalacia. The tumor was removed by coincidence during removal of the diseased lunate bone. Postoperatively, the patient was immediately free of pain and remained free at his 3 months postoperative follow-up.

Solitary primary non-Hodgkin bone lymphoma of the hand is a rare entity with only 3 cases reported in the literature. We report the case of a 77-year-old patient with isolated large B-cell bone lymphoma of the proximal phalanx of the little finger without rheumatoid arthritis or methotrexate treatment. The patient was treated with digital amputation and at 6 months' follow-up showed no relapse or dissemination of the disease.

Background Silicone implants have been used in breast augmentation for more than 45 years. Complications, in particular, capsular contracture, still occur with a high incidence. Titanium-coated polypropylene mesh (TCPM; TiLoop Bra®, pfm medical, Cologne, Germany) provides new opportunities for implant-based breast reconstruction. We investigated the influence of the surface of silicone implants on the formation of capsular contracture by comparing textured silicone with TCPM-covered smooth silicone implants.

Infektionen an der Hand stellen haufige Krankheitsbilder in handchirurgischen Abteilungen dar. Die richtige Diagnose und anschliesende Behandlung ist schwierig und wird oft unterschatzt. In der Literatur finden sich unterschiedliche, teils kontroverse Therapieempfehlungen. Die vorliegende Arbeit analysiert retrospektiv ein zweizeitiges Therapieregime. 60 Patienten (Durchschnitt: 51 Jahre, 38 mannlich, 22 weiblich) wurden retrospektiv anhand der Diagnose der Handinfektion (ICD L03.-) untersucht. Bei allen Patienten wurde ein zeitnahes radikales chirurgisches Debridement durchgefuhrt mit nachfolgender offener Wundbehandlung und antibiotischer Therapie. Untersucht wurde, inwieweit wahrend der Second-look-Operation, im Anschluss an eine Phase der offenen Wundbehandlung mit antiseptischen Verbanden, der sekundare Wundverschluss erfolgreich moglich war. Ein erfolgreicher sekundarer Wundverschluss konnte nach durchschnittlich 38,7 Stunden wahrend der Second-look OP bei 92% des Patientenkollektives erreicht werden. 8% der Patienten benotigten weitere Eingriffe. Bei diesen Patienten lag meist eine Grunderkrankungen oder eine verspatete Vorstellung mit initialer antibiotischer Vorbehandlung vor. Eine antibiotische Therapie wurde durchschnittlich fur 8,7 Tage durchgefuhrt. Die durchschnittliche sta­tionare Verweildauer lag bei 4,75 Tagen. Bei 85% der 58 nachuntersuchten Patienten konnte die ambulante Weiterbehandlung nach 3 Wochen, bei wiederhergestellter Funktion und Kraftmas der verletzten Hand, beendet werden. Eine Arbeitsunfahigkeit bestand im Durchschnitt fur 16 Tage. Die zweizeitige chirurgische Therapie stellte in unserem Kollektiv eine suffiziente Behandlung bei Handinfektionen dar. Sie ist ein sicheres Vorgehen, welches, kombiniert mit einer begleitenden antibiotischen Therapie, eine rasche Wiederherstellung der Funktionalitat der verletzten Hand ermoglicht.

Defektdeckung an der ulnaren Handkante, am ulnopalmaren Handgelenk und im Hypothenarbereich durch eine Abductor-digiti-minimi-Muskellappenplastik. Posttraumatische oder postinfektiose Weichteildefekte im Bereich der ulnaren Handkante, des ulnopalmaren Handgelenks und der Hypothenarregion. Osteitis des 5. Mittelhandknochens. Grose Defekte uber 3 × 5 cm, Verletzungen der A. ulnaris oder Verletzungen im Bereich des Gefasstiels. Zunachst Ausmessen des Rotationsradius des M. abductor digiti minimi ausgehend vom Os pisiforme, wobei das distale Lappenende auf Hohe des Grundgelenks lokalisiert ist. Anschliesend ulnare Inzision und Aufsuchen des distalen Muskelansatzes und Absetzen desselben. Praparation des gesamten Muskelbauchs bis zu seinem proximalen Gefasstiel knapp distal des Os pisiforme. Einschwenken und Fixieren des Muskels in den Defekt und abschliesende Defektdeckung durch ein Spalthauttransplantat. Primarer Wundverschluss der Hebestelle. Ruhigstellung mittels palmarer Handgelenkschiene in „Intrinsic-Plus“-Stellung fur 10 Tage und Physiotherapie aus der Schiene heraus. Fettsalbenpflege des Spalthauttransplantats und Kompressionshandschuh nach Mas fur ca. 3 Monate. Bei insgesamt 9 Patienten zuverlassige Defektdeckung bei relativ einfacher Praparation und konstanter Anatomie.

Nipple-areola complex (NAC) reconstruction tends to be the final phase of post-mastectomy reconstruction for many cancer patients, as it transforms the amorphous breast mound into a more aesthetically realistic breast. A variety of local-flap based techniques have been reported. In this paper we will describe a cantral-pedicled intracorial skin flap technique. Review of 12 patients showed aesthetic pleasing NAC and durable long-term results of nipple projection.

Background Electrosurgical instruments – one of the useful and most-used instruments within the surgeon's armamentarium – are potentially dangerous by causing unanticipated direct burns; fire occurring as a result of electrosurgical instruments and electromagnetic interference with a pacemaker, defibrillator, or cardiac monitoring device. Methods The Mega 2000 Patient Return Electrode System produced by Megadyne Medical Products is a noncontact electrode designed to provide adequate electrical return to facilitate function of electrocautery devices. We used this noncontact device in 67 patients (28 women, 39 men) with large burns during their stay in our burn unit and in 11 of these patients (4 women, 7 men) for escharotomies during admission in our burn care. Results The device functioned well in all cases, no additional cutaneous burns on the patients’ body were noticed. Conclusion This paper is a review of our experience with this noncontact electrosurgical grounding in burn surgery highlighting its advantages comparing with the conventional electrosurgical instruments.

Die lokale Therapie der Weichteilsarkome hat in den vergangenen Jahrzehnten umfassende Anderungen erfahren. Primare Amputationen sind funktionserhaltenden Therapiestrategien unter Anwendung plastisch-rekonstruktiver Masnahmen gewichen. Unterstutzt durch adjuvante Verfahren, wie z. B. der Bestrahlung, zeigte sich, dass bei vergleichbaren Uberlebensraten durch den Einsatz plastisch-chirurgischer Techniken ein deutlicher Zugewinn an Lebensqualitat bei den Betroffenen erzielt werden konnte.

Der Einfluss von Silikonimplantaten auf die Ausbildung einer periprothetischen Kapsel lasst sich gut in tierexperimentellen Studien untersuchen. Neue Oberflachen der Implantate wurden entwickelt, um die Inzidenz der Kapselfibrose zu reduzieren. Zur Begutachtung der Kapselbildung wurde von Wilflingseder et al. 1974 ein histologisches Beurteilungssystem entwickelt. Aufgrund von umfangreichen neuen Erkenntnissen uber die Kapselfibrose ist diese Klassifikation nicht mehr zeitgemas. Aktuelle Erkenntnisse werden nicht berucksichtigt, sodass eine Modifikation erforderlich ist. In einer randomisierten, tierexperimentellen Studie wurden insgesamt 31 Mini-Implantate [17 glatte, 10 mL kochsalzgefullte, Silikonimplantate (Gruppe A) und 14 titanisierte Silikonimplantate (Gruppe B)] in das Dorsum von weiblichen Wistar Ratten implantiert. Nach 12 (Gruppe A/B12) bzw. 36 (Gruppe A/B36) Wochen erfolgte die chirurgische Entfernung mit nachfolgender histomorphologischer und immunhistochemischer Untersuchung der periprothetischen Kapselformation durch 2 unabhangigen Untersucher doppelblind. Die Auswertung der Untersuchungen ergab, dass die innere synovia-like-metaplasia (SLM) sowie die Infiltration durch Entzundungszellen wie Lymphozyten, Histiozyten, Granulozyten und Plasmazellen, entscheidend mitverantwortlich fur die Entwicklung der fibrotischen Kapsel zu sehen sind. Ihr Auftreten korrelierte signifikant miteinander und beeinflusst die Kapselarchitektur masgeblich, wesentlich beeinflusst durch die Oberflache. Aus den gewonnenen Ergebnissen erfolgte eine Anpassung des bestehenden Wilflingseder Klassifikationssystems. Das aktuelle Bewertungsschema enthalt nun folgende Parameter: Kapseldicke, Zelllagen der Kapsel, Dicke der SLM, Kollagenstruktur, Vorkommen von Histiozyten sowie Auftreten von Entzundungszellen. Titanisierte Implantate zeigen nach diesem Klassifikationsschema einen Vorteil in Bezug auf die Ausbildung der Kapselfibrose. Das von Wilflingseder et al. 1974 entwickelte Klassifikationssystem uber die histologische Einteilung der Kapselfibrose ist nicht mehr zeitgemas, da es die aktuellen histologischen und immunhistochemischen Untersuchungsergebnisse nicht berucksichtigt. Der hier vorgestellte, weiterentwickelte Score schliest die neusten Erkenntnisse uber die Entstehung der Kapselfibrose ein und ermoglicht eine objektive histologische Klassifizierung der Veranderungen. Des Weiteren konnten wir zeigen, dass titanisierte Implantate einen vielversprechenden Ansatz in der Reduktion der Kapselfibrose darstellen.

Selbstverletzungen stellen eines der Hauptkriterien der Borderline-Personlichkeitsstorung dar. Dabei bedurfen thermische Verletzungen von Borderline-Patienten der Behandlung des plastischen Chirurgen, der sich aufgrund der komplexen psychiatrischen Storung der Patienten insbesondere bei repetitiven Verletzungen einer sein Fachgebiet uberschreitenden Herausforderung gegenuber sieht. Diese ist nur durch eine multidisziplinare Behandlungsstrategie zu bewaltigen. Anhand von 3 Fallbeispielen soll die Problematik der Behandlung im Spannungsfeld zwischen dem Bestreben nach einer optimalen plastisch-chirurgischen Behandlung der thermischen Verletzung einerseits und der Limitierung dieser Behandlung aufgrund der akuten psychischen Situation der Patienten andererseits dargestellt werden.

Borderline personality disorder (BPD) is a mental illness with a prevalence of 1.5% in Western countries. One of the major characteristics of patients with BPD is self-mutilation of any kind. These patients are especially often seen in our clinic since our institution is collaborating with the department of psychiatry that offers supra-regional specialist inpatient hospital treatment of BPD. Types of self-manipulation are various and include slashing and cutting, burning or freezing, bonebreaking, hitting or incorporation of foreign objects. Due to the difficult-to-treat primary disorder, more wound manipulation or self-injury may occur when tensions continue, even after adequate plastic reconstructive surgical treatment and during hospitalization, which represents a challenge for the plastic reconstructive strategy. We describe special problems associated with plasticreconstructive surgery in the light of BPD and self-mutilation and present our algorithm with a series of recommendations for the treatment of such patients as well as three illustrative case reports.

INTRODUCTION Toxic epidermal necrolysis (TEN) is associated with a high mortality. The need for mechanical ventilation is associated with an increased mortality in TEN patients. This study investigates the impact of the timing of initiation of the mechanical ventilation on the survival of TEN patients. PATIENTS, MATERIALS AND METHODS A retrospective study of 26 TEN patients was carried out. Primary (on admission (group A) and secondary ventilation (>1 day after admission (group B) were analysed for an association with mortality. RESULTS 8 patients did not require mechanical ventilation. 18 patients needed mechanical ventilation. In group A 8 patients with an epidermolytic body surface area (BSA) of 73 ± 16% and a mean SCORTEN of 3.2 ± 1.1 were analysed. In group B 10 patients with an epidermolytic BSA of 76 ± 19% and a mean SCORTEN of 3.8 ± 0.9 were evaluated. Statistical analysis showed an increased mortality in all mechanically ventilated compared with non-ventilated TEN patients (Odds ratio: 2.0; 95% CI: 1.26-3.17 p = 0.013). CONCLUSIONS Mechanical ventilation in TEN patients is associated with an increased mortality rate, but the timing of initiation of mechanical ventilation does not affect the patient survival rates.

Burn injury is a complex traumatic event with various local and systemic effects, affecting several organ systems beyond the skin. The pathophysiology of the burn patient shows the full spectrum of the complexity of inflammatory response reactions. In the acute phase, inflammation mechanism may have negative effects because of capillary leak, the propagation of inhalation injury and the development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later-stage processes of wound healing. In this review, we are attempting to present the current science of burn wound pathophysiology and wound healing. We also describe the evolution of innovative strategies for burn management.

Complete loss of free latissimus dorsi muscle flaps to the leg is frequently reported. The purpose of this study is to analyze the outcome of latissimus dorsi muscle flaps to the lower extremity in children. Patients and methods. This retrospective analysis includes 11 children treated with a free latissimus dorsi muscle flap after severe trauma to the lower leg and foot. Results. Fourteen free latissimus dorsi muscle flaps were performed in 11 children with a mean age of 13 ± 4 years. The injuries were caused by traffic accidents, lawnmower accidents, and a crush trauma. Thirteen (92.8%) flaps needed surgical revision. Three complete flap losses and 1 partial flap loss were registered. Conclusions. Free latissimus dorsi muscle flaps seem to be a useful technique for lower extremity salvage after severe injury, but there is a relevant flap failure risk in children. © 2010 Wiley-Liss, Inc. Microsurgery 30:537–540, 2010.

Acute intestinal ischemia represents a rare but often fatal disease. In retrospective analysis, up to 86% with this complication had a prior history of cardiovascular disease (Irvinen et al. Ann Chir Gynaecol 83:22-25, 1994). It is also a rare but well-known complication in severe thermally injured patients. Here, we describe our experience with this disease in our critically ill patients suffering from acute thermal injury. In a retrospective analysis of 634 patients who were treated at our burn care center, three patients were identified with intestinal ischemia. Two patients with non-occlusive disease during continuous veno-venous hemofiltration died, while one patient with arterial embolism in a superior mesenteric artery branch survived. Acute intestinal ischemia is a severe and life-threatening complication in thermally injured patients. It can occur even days after the acute trauma and diagnostic criteria are often insecure.

Background: Free tissue transfer in reconstruction of lower extremity wounds is well established. Controversy surrounds type and regimen of intravenous fluid application during microsurgery. Hemodilution is supposed to influence haemostatic process. Patients and Methods: We performed an analysis of 48 patients treated with a free latissimus dorsi muscle flap to the lower leg for posttraumatic soft-tissue coverage. Postoperative latissimus dorsi muscle flap perfusion was controlled by clinical monitoring. Intraoperative infusion management was evlatuated retrospectively. Results: In 4 of 48 included patients, a complete loss of free latissimus dorsi muscle flap was registered. Concomitant increased saline infusion was detected (4,534 ml versus. 6,125 ml; P = 0.048). Similar findings for relation of total infusion volume to body weight were seen (44 ml/kg versus 69 ml/kg; P = 0.01). No significant colloid infusion was detected. Conclusions: We demonstrate the clinical relevance of extensive intraoperative hyperhydration, which can provoke a complete free flap loss. © 2010 Wiley-Liss, Inc. Microsurgery, 2010.

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.

Adjuvant therapies may improve the outcome after nerve reconstruction. We analyzed the influence of recombinant human Erythropoietin (rHuEpo), which has proven angiogenic and neuroprotective effects, on the quality of peripheral nerve regeneration. Thirty two female Lewis rats underwent nerve reconstruction by means of tubulization (groups I and II) or autologous sciatic nerve grafting (groups III and IV). Groups I and III received daily subcutaneous rHuEpo injections over 2 weeks (1,000 U/kg bw) with normal saline injections as controls (groups II and IV). Data on histology and muscle weight were collected after 7 weeks. Axon count and diameter were assessed by a new method based on digital segmentation. Atrophy of the tibial muscle was less severe in the rHuEpo-treated group compared to controls resulting in significant higher muscle weight quotients (p = 0.006). The same trend was found in the gastrocnemius muscle, but without being statistically significant. No significant differences in axon count or axon diameter were detected in the presence of rHuEpo treatments. Our findings give evidence for a positive effect of Erythropoietin on functional recovery after nerve grafting. Muscle recovery benefited from rHuEpo administration despite absence of improved neural morphology. Semi-automated axon detection facilitated accurate morphometrical assessment.

Background In avulsion-type injuries of the fingers recovery of blood circulation is one of the major obstacles. The indication for finger reconstruction is discussed controversely, being influenced by the patient's needs, the degree of damage to the soft tissue and the prospects of success of the healing process. In this study we present our results after reconstruction of avulsion-type injuries of the fingers. Indications for finger reconstruction will be assessed in consideration of the expected outcome. Patients and methods From 1999 to 2006 we treated 18 patients with finger level avulsion injuries. 15 casualties were caused by rings and three by ropes looped around a digit. The median age at injury was 23 (12 - 66) years. All patients were examined by an independent observer, who did not participate in the operation. Criteria were functional outcome and patient's complaints and satisfaction. Sensibility was evaluated by 2-point discrimination applying the Greulich star. Finger mobility was assessed with the Buck-Gramcko goniometer. Results According to the classification of Urbaniak as modified by Kay, 2 patients ranked in class II, 3 in class III and 13 suffered from complete avulsion-amputations (class IV). Of the latter, 8 allowed primary reconstruction of the blood circulation. Two fingers required early or late secondary amputation. After finger reconstruction, patients spent a median time of 18 (12 - 32) days in hospital while primary amputation resulted in a shorter stay of 4 (2 - 5) days. Active motion after replantation in the proximal interphalangeal joint was reduced on average to 64 (25 - 100) degrees. The distal interphalangeal joint nearly ankylosed in all patients following replantation except for one case with an active motion of 40 degrees . Good sensibility could be achieved in one case, protective sensibility in three and none in two patients. All patients with preserved fingers would again decide in favour of finger replantation. Conclusion In specialised centres replantation of complete avulsion-type finger amputations can be achieved. The decision for or against replantation should only be made after microsurgical assessment of the severed soft tissue and in consideration of the patient's specific demands. With the right indication for reconstruction, the patient's satisfaction often outweighs even poor functional outcomes.

Heterotopic ossifications in periarticular tissue can appear after severe head injury, spine trauma or local joint trauma. Following extensive burns, heterotopic ossifications are a rare, severe complication with an unclear pathogenesis. We report one case with this kind of complication in a 50-year old male patient who sustained full and partial thickness burn injuries over 60 % of the body. The thermal injury was accompanied by a severe inhalation injury.

Gastrointestinal complications are a common problem in severe burned patients. Reported complications include paralytic ileus, gastrointestinal tract bleeding, gastric ulcers and acute necrotizing cholecystitis. Although there are no exact data concerning the frequency and outcome of acute intestinal necrotizing ischemia in severe burned patients, it is a well known complication in specialized burn centers. The most common reason for acute intestinal ischemia are arterial embolism, arterial thrombosis, venous thrombosis and non-occlusive disease. The overall survival differs between 81 % and 34 %. The therapy aims at arterial re-perfusion of life-threatening intestinal regions and resection of necrotic tissue. A 45-year-old male patient attempted suicide by inflaming himself with gasoline. He sustained partial and full thickness burn injury of the face and the throat. Additional burn injuries were found at the chest region, both arms and the abdominal wall. The total burn surface area (TBSA) was 42 % including an severe inhalation injury trauma. The ABSI-score (Abbreviated burn severity index) was 10. The combination of a thrombus at the aortic valve with an tachycardic dysrhythmia was the cause for an embolisation with acute intestinal ischemia. The necrotic part of the small intestine was resected, the further course was uncomplicated.