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Summary: Background: Despite the obvious advantages, face transplantation requires strict patient selection to guarantee optimal outcomes. Therefore, it is not suitable for all patients with severe facial disfigurements. Simultaneously, conventional plastic and reconstructive surgery techniques, as well as medical spa techniques, have evolved, offering minimally invasive treatment of complex deformities. Methods: The entire face of a young woman was severely disfigured because of a mistreated juvenile acne, with severe ectropions, oral incompetence and substantial midfacial tissue defect. We are describing the reconstruction with a combination of conventional reconstructive methods, such as scar release, skin transplantation, local flaps, medical needling and lipofilling. Results: Oral competence, unhindered breathing and adequate lid closure was achieved. Previously unable to participate in social life in any meaningful way, our patient was able to reintegrate fully and take a job. Conclusion: For selected patients, combined, invasive and non-invasive conventional techniques can provide satisfying outcomes in complex facial reconstruction. Modern regenerative approaches such as lipofilling and medical needling should be considered as integral parts of treatment strategies. Keywords: Face transplantation, Facial disfigurement, Vascularized composite allotransplantation

Zusammenfassung Problemstellung Die zunehmende Verwendung von autologen Fetttransplantationen veranlasste 2009 die American Society of Plastic Surgeons eine Fat Graft Task Force (AFGT) zu etablieren und in 2015 die Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) gemeinsam mit drei weiteren Fachgesellschaften (DDG, DGMKG, DGGG) an Hand der bislang publizierten Ergebnissen Behandlungsleitlinien zu erstellen. Die vorliegende Arbeit will die beiden Leitlinien hinsichtlich Ihres Anliegens, einer sicheren Durchführung von autologer Fetttransplantation, vergleichen. Methoden Die AFGT stützt ihre Empfehlungen ausschließlich auf Parameter der evidenzbasierten Medizin. Die DGPRÄC bewertet unter Berücksichtigung der aktuellen Literatur im Rahmen eines vierstufigen Expertenkonsenses das Vorgehen nach allgemeinen Anforderungen der Operativen Medizin und gesetzlichen Vorgaben. Ergebnisse Beide Gesellschaften stimmen in Indikation und technischen Vorgehen weitestgehend überein: Fetttransplantationen sind indiziert zum Brustaufbau, zur Rekonstruktion von Gewebsdefiziten oder Deformitäten. Beide weisen auf die Risikogruppe bestimmter Brusttumoren (BRCA-1, BRCA-2) bzw. familiäre Prädispositionen hin. In fast allen Anwendungsbereichen sind Ergebnisse abhängig von der verwendeten Applikationstechnik und den Erfahrungen eines Operateurs. Randomisierte, prospektive Studien für bestimmte Verfahren fehlen. Aufgrund der Einzelberichte und Expertenmeinungen liegt zwar nur eine Evidenz-Stufe von IV–V nach Einschätzung der AFGT vor. Demgegenüber vermittelt die DGPRÄC detailliertere Vorgehensverfahren und erreicht durch das Experten-Konsensusverfahren eine deutlich stärkere Aussagefähigkeit als die Leitlinie der AFGT. Zusammenfassung Beide Expertengremien empfehlen die Durchführung autologer Fetttransplantationen bei entsprechenden Indikationen und weisen darauf hin, dass es keine Standardverfahren für ein bestimmtes Vorgehen gibt. Die publizierten Leitlinien sollen Hinweise geben auf die richtige Patientenselektion, eine optimale Technik, mögliche Komplikationen und realistische Erfolgsaussichten. Die DGPRÄC empfiehlt die Einhaltung der von ihr gegebenen praktischen Einzelrichtlinien einschließlich der gesetzlichen Vorgaben, um die Patientensicherheit zu gewährleisten und ist damit in der Praxis richtungsweisender und verbindlicher. Die AFGT rät dringend zur erweiterten Grundlagenforschung und zur Durchführung randomisierter, prospektiver Studien.

The reconstruction of the body shape after post-bariatric surgery or high-grade gynecomastia involves, besides skin tightening, the repositioning of anatomical, apparent landmarks. The surgeon usually defines these during the preoperative planning. In particular, the positions of the nipple–areola complexes (NAC) should contribute to the gender-appropriate appearance. While in the female breast numerous methods have been developed to determine the optimal position of the NACs, there are only a few, metric and often impractical algorithms for positioning the nipples and areoles in the male. With this study, we show the accuracy of the intuitive positioning of the nipple–areola complex in men. From a pre-examined and measured quantity of 10 young and healthy men, six subjects were selected, which corresponded, on the basis of their chest and trunk dimensions, to the average of known data from the literature. The photographed frontal views were retouched in two steps. Initially, only the NACs were removed and the chest contours were left. In a second step, all contours and the navel were blurred. These pictures were submitted to resident and consultant plastic surgeons, who were asked to draw the missing NACs without any tools. The original positions of the nipples were compared with the inscriptions. Furthermore, the results were compared between the contoured and completely retouched pictures and between the residents and consultants. A total of 8 consultants and 7 residents were included. In the contoured and completely retouched images, a significant deviation of the marked positions of the missing features was found. The height of the NAC was determined somewhat more precisely than the vertical position. There was no significant difference between the contoured and completely retouched images, with a discretely more accurate tendency on the contoured images. In comparison with the professional experience, the consultants were tangentially more precise, but without a statistically significant impact. The intuitive determination of the NACs is a challenge for the plastic surgeon. In this study, a statistically significant deviation was seen in almost all dimensions, although the clinical relevance cannot be conclusively assessed. We found a positional relationship of the NAC to the infraclavicular groove (“Mohrenheim pit”) in the vertical and 4–4.5 cm above the submammary fold. The position of the NAC can be satisfactorily determined by a combination of plastic surgical intuition, patient wishes and practical metric methods using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Skin cancer and melanoma on the back part of the trunk are common, especially in men [1]. Melanoma is most common on the back in men and on legs in women, as these areas are prone to frequent sun exposure [2].

Objective In oral squamous cell carcinoma (OSCC), 20% of patients experience local recurrences. In this study, the addition of autofluorescence to a standard incandescent light examination was evaluated to enhance detection rates of recurrences in OSCC. Study Design Patients with OSCC who underwent follow-up examinations were included in this prospective cohort study. All patients (with or without recurrences) were examined clinically and with autofluorescence (using VELscope; Mectron, Cologne, Germany) and biopsy was used to examine suspect lesions for recurrences. Variables likely to influence results were analyzed. An analysis of dependencies, a general log-linear analysis, and a binary regression analysis were performed using SPSS version 26 (SPSS Inc., Chicago, IL). Results The study included 195 patients and in 39 cases a biopsy was performed. Results showed significantly more recurrences with the addition of autofluorescence to the usual clinical examination (P ≥ .5). Sensitivity was 95.2% and specificity was 100%. Conclusions This study showed the advantages of adding autofluorescence to routine clinical assessments in OSCC follow-up examinations. Clinical trial registration: German Clinical Trials Register DRKS-ID: DRKS00004836

In industry as well as in the private sector, cement is often used as building material. Although severe skin injuries are known to be caused due to improper handling of cement, the incidence and severity of these cutaneous injuries are often underestimated. Heavy cement burns are rare but in our centers the authors treat affected patients on a regular basis. The aim of this study is to analyze the given patient data in order to give treatment suggestions.During 2013 to 2017, a total of 7 patients (median age: 39 years), which had suffered chemical burns after concrete, cement or screed exposure, were treated in two German plastic-surgical clinics. The authors performed a retrospective data analysis by using the hospital information systems (HIS).All patients were treated with surgical interventions. Median inpatient treatment period was 9.8 days (n = 6). The average time for surgery was 1:04 hours (n = 5). During surgical treatment an average of 1.4 operations were performed (n = 7). In all cases a sustained wound healing could be achieved.If a patient suffers from a concrete burn, a fast and competent initial treatment is imperative in order to prevent worse. The presented patient cases prove the value of these rare but devastating medical conditions. Therefore, it is essential to implement the given treatment recommendations for a sustainable patient care.Im beruflichen und privaten Bereich ist Zement nach wie vor ein häufig verwendetes Baumaterial. In unseren Kliniken stellen sich immer wieder Patienten mit Verätzungen nach Betonexposition vor. Unser Ziel war es unsere gesammelten Fälle zu analysieren und Empfehlungen zur Behandlung bei Exposition und deren Folgen zu geben.Im Zeitraum von 2013–2017 wurden in zwei deutschen plastisch-chirurgischen Kliniken insgesamt 7 Patienten, welch nach Beton-, Zement- oder Estrich-Exposition Verätzungen in unterschiedlichen Körperregionen entwickelten, behandelt. Hierbei erfolgte im Verlauf eine systematische retrospektive Analyse der Patientendaten.Bei allen Fällen war eine chirurgische Behandlung erforderlich. Die mittlere stationäre Behandlungsdauer betrug 9,8 Tage (n = 6). Die durchschnittliche Operationsdauer für eine Spalthautdefektdeckung belief sich auf 1:04 Stunden (n = 5). Es wurden im Rahmen der chirurgischen Behandlung im Durchschnitt 1,4 Operationen durchgeführt (n = 7). In allen Fällen erfolgte eine nachhaltige Wundheilung.Bei Betonverätzungen ist eine schnelle und kompetente Erstbehandlung erforderlich, um einem Nachtiefen in den exponierten Arealen erfolgreich entgegenwirken zu können. Diese chirurgisch therapiebedürftigen seltenen Verätzungsverletzungen sollten demnach nur in speziellen Verbrennungskliniken therapiert werden.

BACKGROUND: Chronic pain is an important outcome variable after inguinal hernia repair that is generally not assessed by objective methods. The aim of this study was to objectively investigate chronic pain and hypoesthesia after inguinal hernia repair using three types of operation: open suture, open mesh, and laparoscopic. METHODS: A total of 96 patients were included in the study with a median follow-up of 4.7 years. Open suture repair was performed in 40 patients (group A), open mesh repair in 20 patients (group B), and laparoscopic repair in 36 patients (group C). Hypoesthesia and pain were assessed using von Frey monofilaments. Quality of life was investigated with Short Form 36. RESULTS: Pain occurring at least once a week was found in 7 (17.5%) patients of group A, in 5 (25%) patients of group B, and in 6 (16.6%) patients of group C. Area and intensity of hyposensibility were increased significantly after open nonmesh and mesh repair compared to those after laparoscopy (p = 0.01). Hyposensibility in patients who had laparoscopic hernia repair was significantly associated with postoperative pain (p = 0.03). Type of postoperative pain was somatic in 19 (61%), neuropathic in 9 (29%), and visceral in 3 (10%) patients without significant differences between the three groups. CONCLUSIONS: The incidence of hypoesthesia in patients who had laparoscopic hernia repair is significantly lower than in those who had open hernia repair. Hypoesthesia after laparoscopic but not after open repair is significantly associated with postoperative pain. Von Frey monofilaments are important tools for the assessment of inguinal hypoesthesia and pain in patients who had inguinal hernia repair allowing quantitative and qualitative comparison between various surgical techniques.

The renewed clinical interest in fat grafting for both reconstructive and aesthetic purposes prompted the American Society of Plastic Surgeons to establish a Fat Graft Task Force (AFGT) in 2009. Moreover, in 2015, the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), in cooperation with three relevant medical societies (DDG, DGMKG, DGGG), formulated statements on the provision of strategies for patient management and to guide physicians in clinical decision making, on the basis of the scientific literature, clinical experience and current laws. The aim of this paper is to compare both guidelines in regards to recommendations on fat grafting.Recommendations of the AFGT are based on evidence available in the published literature and graded within 5 (I-V) levels of appraisal. The available literature was reviewed by the aforementioned multidisciplinary consensus panel as well and graded according to a 4 level (I-IV) appraisal - focusing on general requirements for surgical procedures, quality of care, patient safety and legal provisions.For indications and practical surgical procedures, the two societies reached a unanimous consensus: Fat grafting is indicated for breast reconstruction, reconstruction of tissue deficits, and deformations caused by prior operations. Both emphasize risk groups with breast cancer (BRCA-1, BRCA-2 and family predispositions). However, in any clinical setting, results depend on the surgical procedure applied and the individual surgeon's experience. Since randomized, prospective studies are lacking and only individual case reports and clinical series or expert opinions have been published, the evidence grading does not exceed level IV to V. However, the DGPRÄC structured expert consensus panel conveys a more comprehensive and practical approach, and provides more reliable evidence to support their opinions.Both societies unanimously recommend fat grafting for appropriate indications and emphasize that there are no standard guidelines for any specific procedure. The published guidelines were developed to assist physicians in choosing optimal techniques, appropriate patient selection, and offer realistic advice on outcome and potential complications. The AFGT emphasizes the need for further research and randomized controlled studies. Overall, the DGPRÄC guidelines are more detailed, practically oriented and take into consideration current German and European Tissue Laws.Die zunehmende Verwendung von autologen Fetttransplantationen veranlasste 2009 die American Society of Plastic Surgeons eine Fat Graft Task Force (AFGT) zu etablieren und in 2015 die Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) gemeinsam mit drei weiteren Fachgesellschaften (DDG, DGMKG, DGGG) an Hand der bislang publizierten Ergebnissen Behandlungsleitlinien zu erstellen. Die vorliegende Arbeit will die beiden Leitlinien hinsichtlich Ihres Anliegens, einer sicheren Durchführung von autologer Fetttransplantation, vergleichen.Die AFGT stützt ihre Empfehlungen ausschließlich auf Parameter der evidenzbasierten Medizin. Die DGPRÄC bewertet unter Berücksichtigung der aktuellen Literatur im Rahmen eines vierstufigen Expertenkonsenses das Vorgehen nach allgemeinen Anforderungen der Operativen Medizin und gesetzlichen Vorgaben.Beide Gesellschaften stimmen in Indikation und technischen Vorgehen weitestgehend überein: Fetttransplantationen sind indiziert zum Brustaufbau, zur Rekonstruktion von Gewebsdefiziten oder Deformitäten. Beide weisen auf die Risikogruppe bestimmter Brusttumoren (BRCA-1, BRCA-2) bzw. familiäre Prädispositionen hin. In fast allen Anwendungsbereichen sind Ergebnisse abhängig von der verwendeten Applikationstechnik und den Erfahrungen eines Operateurs. Randomisierte, prospektive Studien für bestimmte Verfahren fehlen. Aufgrund der Einzelberichte und Expertenmeinungen liegt zwar nur eine Evidenz-Stufe von IV–V nach Einschätzung der AFGT vor. Demgegenüber vermittelt die DGPRÄC detailliertere Vorgehensverfahren und erreicht durch das Experten-Konsensusverfahren eine deutlich stärkere Aussagefähigkeit als die Leitlinie der AFGT.Beide Expertengremien empfehlen die Durchführung autologer Fetttransplantationen bei entsprechenden Indikationen und weisen darauf hin, dass es keine Standardverfahren für ein bestimmtes Vorgehen gibt. Die publizierten Leitlinien sollen Hinweise geben auf die richtige Patientenselektion, eine optimale Technik, mögliche Komplikationen und realistische Erfolgsaussichten. Die DGPRÄC empfiehlt die Einhaltung der von ihr gegebenen praktischen Einzelrichtlinien einschließlich der gesetzlichen Vorgaben, um die Patientensicherheit zu gewährleisten und ist damit in der Praxis richtungsweisender und verbindlicher. Die AFGT rät dringend zur erweiterten Grundlagenforschung und zur Durchführung randomisierter, prospektiver Studien.

The workload of university hospitals and hospitals with university association includes clinical patient care as well as teaching and research in particular. The current development with focus on financial issues leads to a reduction of teaching and research capacities. Economic focus in university medicine changes priorities of academic surgery.An online survey questioned medical students with regard to subjective assessment of quality of the academic body of university hospitals and current teaching quality. Students evaluated the current quality of teaching of postdoctoral lecturers in relation to their career stage and made suggestions for quality of teaching improvement.A total of 166 students participated in the survey. Of 123 students, about 78 % stated that the reputation of postdoctoral lecturers increases with the habilitation but about 85 % stated that professional expectations also rise. About 43 % of the students aim to achieve a postdoctoral lecture qualification.Among students academic career is still attractive, but restructuring and modernization of established working models is an essential prerequisite.Universitätskliniken und Kliniken mit universitärer Anbindung haben neben der klinischen Patientenversorgung vor allem den Auftrag der Lehre und Forschung. In der aktuellen Entwicklung zeigt sich verschärft eine finanzielle Orientierung der ärztlichen Tätigkeit mit einer Reduktion von Kapazitäten für Lehre und Forschung. Auf Basis einer betriebswirtschaftlichen Orientierung erfolgt eine Verlagerung von Prioritäten innerhalb chirurgischer Disziplinen.Im Rahmen einer Online-Umfrage wurden Medizinstudenten hinsichtlich ihrer subjektiven Einschätzung der akademischen Qualifikation von Habilitanden und über die Einschätzung der aktuellen Lehrqualität befragt. Hierbei evaluierten die Studenten sowohl die aktuelle Qualität der Lehre als auch die Perspektive einer akademischen Laufbahn und machten Vorschläge zur Verbesserung.An der Studentenumfrage nahmen insgesamt 166 Studenten teil. Von 123 Studenten gaben 78 % an, dass das Ansehen mit der Habilitation steige. 85 % der Studenten gaben an, dass sich mit der Habilitation aber auch die Erwartungshaltung im Hinblick auf die fachliche Qualifikation erhöht. 43 % der Studenten gaben an, sich in Zukunft habilitieren zu wollen.Unter den Studenten ist weiterhin die wissenschaftliche Karriere attraktiv, daher muss durch die Anpassung und Modernisierung bestehender Arbeitszeitmodelle eine Umstrukturierung zugunsten attraktiver Arbeitsplatzbedingungen stattfinden.

Extensive bone and soft tissue defects of the skull require unique plastic and reconstructive techniques to avoid and optimize aesthetic appearance following oncological resections. Procedures are ideally planned in an interdisciplinary board composed of neurosurgery, otorhinolaryngology, plastic and reconstructive surgery to facilitate reconstructive procedures of soft tissue and bone as early as possible in one approach. Large resections may require plastic surgery involvement from the beginning. Herein, we describe the function of a multidisciplinary approach to complex oncologic resections of the cranial base, scalp, and facial regions for neuro-oncologic patients.

Introduction:Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality.Materials and methods:We worked out the most common surgical approaches and treatment algorithm for a stepwise and effective approach. Part of this algorithm is a seven-step surgical approach.Results:This article provides modern plastic and reconstructive surgery concepts with an algorithm for scar management.Discussion:The treatment of scars follows an algorithm with the level of complexity of techniques adjusted to the individual case and the conditions. Disabilities induced by scarring can lead to further functional loss. In these cases, surgical strategies have to be considered.

Burn injuries can result in long-term mental and physical health problems. We investigated if patients at different time periods since the burn injury differed with regard to psychosocial impairment. Patients who were treated as inpatients because of burn injury between 2006 and 2012 were asked about quality of life (Burn Specific Health Scale - Brief; BSHS-B), anxiety and depression (Hospital Anxiety and Depression Scale - Deutsche Version; HADS-D), posttraumatic stress disorder (Impact of Event Scale - Revised; IES-R), stigmatization (Perceived Stigmatization Questionnaire; PSQ) and social support (Fragebogen zur sozialen Unterstützung; F-SozU-7). The sample (146 patients) was divided into 4 groups according to the time period elapsed since the burn injury. There were no significant differences in psychosocial distress between the 4 groups. The same applied to sociodemographic and burn specific variables. 18 (12.4%) patients had the cutoff of ≥11 for anxiety and 22 (15.2%) for depression on the HADS; 16 (11.1%) patients screened positive for posttraumatic stress disorder (PTSD). No differences were found for current psycho(pharmaco)therapy and the wish for psychotherapy. The results suggest persistence of psychosocial burden over time after burn injury. Psychosocial interventions might thus be indicated even many years after burn injuries.Brandverletzte leiden unter psychischen und sozialen Folgebeeinträchtigungen. In der vorliegenden Studie wurde geprüft, ob sich Patienten mit unterschiedlichen Zeitintervallen seit der Verbrennung im Hinblick auf psychosoziale Belastungen unterscheiden. Patienten, die in der Zeit zwischen 2006 und 2012 aufgrund einer Verbrennung stationär behandelt wurden, beantworteten Fragebögen zu Lebensqualität (Burn Specific Health Scale – Brief; BSHS-B), Angst und Depression (Hospital Anxiety and Depression Scale – Deutsche Version; HADS-D), posttraumatischer Belastungsstörung (PTBS, Impact of Event Scale – Revidierte Version; IES-R), Stigmatisierung (Perceived Stigmatization Questionnaire; PSQ) und sozialer Unterstützung (Fragebogen zur sozialen Unterstützung; F-SozU-7). Auf Basis der unterschiedlichen Zeiträume zwischen Unfall und Erhebungszeitpunkt der Daten fand eine Einteilung der Stichprobe (146 Patienten) in 4 Gruppen statt. Es zeigten sich keine signifikanten Unterschiede im Ausmaß der psychischen Belastung. Auch lagen keine Differenzen in soziodemografischen und verbrennungsspezifischen Merkmalen vor. Insgesamt lagen 18 (12,4%) Patienten im Bereich Angst und 22 (15,2%) Personen im Bereich Depression bei einem Cut-off von ≥11 im HADS. Ein Verdacht auf die Diagnose einer PTBS konnte bei 16 (11,1%) Patienten gestellt werden. Bezüglich laufender Psycho(pharmako)therapie und dem Wunsch nach Psychotherapie glichen sich die Gruppen. Die Ergebnisse deuten auf chronische psychische Beeinträchtigungen nach Verbrennungen hin. Psychosoziale Interventionen können daher auch noch mehrere Jahre nach der Brandverletzung indiziert sein.

Background Limited data is available for treatment of scald lesions in adults. The use of the biosynthetic matrix Biobrane ® has been suggested as treatment option with more benefits over topical dressings. Application of Biobrane ® in scalds in our center led to a perceived increase of infection, secondary deepening, surgery and length of stay. We therefore assessed the effect of different treatment options in adult scalds in our center. Methods We performed a retrospective cohort study of adult patients that have been admitted with scalds in our center between 2011 and 2014. We assessed two groups, group 1 with Biobrane ® as initial treatment and group 2 with topical treatment using polyhexanid hydrogel and fatty gauze. Primary outcome variables were rate of secondary deepening, surgery, infection (defined as positive microbiological swabs and antibiotic treatment) and length of stay. Total body surface area (TBSA) as well as diabetes mellitus (DM), hypertension, smoking and alcohol consumption as potential confounders were included. Results A total of 52 patients were included in this study. 36 patients received treatment with Biobrane ® and 16 with ointment and fatty gauze. No significant differences were found for age and TBSA whereas gender ratio was different (25/11 male/female in group 1 vs 4/12 in group 2, p = 0.003). Rate of secondary deepening, surgery, infection as well as days of hospital stay (DOHS) were comparable. Logistic and multilinear regression showed TBSA to be a predictive factor for infection ( p = 0.041), and TBSA and age for length of stay (age p = 0.036; TBSA p = 0.042) in group 1. Conclusion The use of Biobrane ® in adult scald lesions is safe and non-inferior to topical treatment options. In elder patients and larger TBSA Biobrane ® may increase the risk of infection or a prolonged stay in hospital. Level of evidence Level 3 – retrospective cohort study.

Summary Background and aim Large skull base defects are extremely difficult to treat and have a severe impact on patients' physical appearance and functional aspects. These extensive defect zones are mainly caused by trauma, surgical interventions, or wide tumor excision. High-level microsurgical techniques are necessary to provide sufficient treatment. The aim of this study is to describe successful reconstructive strategies for surgical treatment. Methods Nine patients with skull base defects were treated in our department from 2008 to 2014 (n = 9). Plastic surgical reconstruction was performed with latissimus dorsi (LD;) (n = 4), LD-scapula flaps (n = 2), vertical rectus abdominis myocutaneous (VRAM) flaps (n = 2), and a greater omentum flap (n = 1). The mean follow-up period was 2.3 ± 2.2 years (0.5–4.5 years). Oncologic diseases (8 patients) and iatrogenic damage (1 patient) caused the massive skull base defects. Results In all cases, we achieved the final surgical treatment of large skull base defects by free flaps with permanent wound closure. The mean operating time was 5:53 h (range 4:45–7:52 h). The primary outcome measures were survival and sufficient defect coverage. Flap survival rate was 100%, and none of the patients deceased during the follow-up period. Furthermore, we demonstrated the surgical key points of LD-scapula flap closure in detail. Conclusion Plastic surgical defect coverage by well-perfused tissue flaps of large skull base defects provides an efficient and effective treatment option. Complex skin, soft tissue, and dural defects can be successfully covered with these preformed free flaps. The choice of flap is based on the individual case.

OBJECTIVE: To investigate the factor structure, reliability, and validity of the German version of the Perceived Stigmatization Questionnaire/Social Comfort Questionnaire (PSQ/SCQ) in burn victims. METHODS: The PSQ/SCQ was answered by 139 adult burn survivors (age M=49.69, SD=15.16 years). Factor structure was examined using a confirmatory factor analysis (CFA). Validity was investigated through correlations between the PSQ/SCQ scales and questionnaires assessing perceived social support, burn-specific health-related quality of life, symptoms of anxiety/depression, and percent of total body surface area (TBSA) burned. Additionally, the link between perceived stigmatization/social comfort and current partnership status was investigated. RESULTS: The four-factor model showed the best fit to the data with three PSQ factors (Absence of Friendly Behavior, Confused/Staring Behavior, and Hostile Behavior) and one single SCQ factor. All PSQ/SCQ scales showed good internal consistency. Higher PSQ/lower SCQ means were related to less perceived social support, less burn-specific quality of life, and more symptoms of anxiety/depression. With the exception of a positive correlation with the PSQ subscale Confused Behavior and Staring, no other significant correlations were found between the PSQ/SCQ subscales and TBSA burned. While PSQ/SCQ scores were not linked to age or gender, less perceived social stigmatization/more social comfort was reported by participants who were currently living with a partner. CONCLUSIONS: The results indicate a four-factor structure and a good validity of the PSQ/SCQ which is in line with prior research. Further studies should investigate the application of the PSQ/SCQ in individuals with appearance distinctions that are not related to burns. publisher: Elsevier articletitle: Validation of the German version of the Perceived Stigmatization Questionnaire/Social Comfort Questionnaire in adult burn survivors journaltitle: Burns articlelink: http://dx.doi.org/10.1016/j.burns.2016.01.001 content_type: article copyright: © 2016 Elsevier Ltd and ISBI. All rights reserved. ispartof: Burns vol:42 issue:4 pages:790-796 ispartof: location:Netherlands status: published

Background: The Burn Specific Health Scale-Brief (BSHS-B) is recognized as a valid selfrating scale to evaluate quality of life after burn injury. Aim: To validate the translated German version of the BSHS-B. Method: 141 burn survivors (65.2% men) with a mean age of 49.62 years (SD=15.16) and a mean duration after burn injury of 45.01 months (SD=26.18) answered the BSHS-B. Factor structure was tested by using confirmatory factor analysis, reliability (internal consistency) of the scales was determined by means of Cronbach‟s α. Construct validity was explored through correlations between the BSHS-B and the Short-Form 8 Health Survey (SF-8), and the Hospital Anxiety and Depression Scale (HADS). In addition, the know-groups technique was used to determine to which degree the BSHS-B discriminates between patients with low and high burn severity based on the abbreviated burn severity index (ABSI). Results: The nine BSHS-B subscales showed good internal consistency. A second-order confirmatory factor analysis revealed the following main components: (1) Affect and Relationship, (2) Function and (3) Skin Involvement. The second-order factors were positively correlated with the SF-8 and negatively correlated with symptoms of anxiety and depression. Patients with low ABSI scored higher on all three BSHS-B domains than those with high ABSI. Conclusions: The results indicate good psychometric properties of the German BSHS-B. Further studies are needed to investigate the utility of the questionnaire in clinical routine practice, evaluation of burn management programs, and burn-specific research. publisher: Elsevier articletitle: Validation of the German version of the Burn Specific Health Scale-Brief (BSHS-B) journaltitle: Burns articlelink: http://dx.doi.org/10.1016/j.burns.2015.02.006 content_type: article copyright: Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved. ispartof: Burns vol:41 issue:6 pages:1333-1339 ispartof: location:Netherlands status: published

Background: Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation. Methods: Mesh fixation in 80 TAPP procedures was randomized to fixation with ST (n=40) or TA (n=40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity. Results: Median (range) follow-up was 38 (13-56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6weeks: 32 vs. 6%; 6months: 38 vs. 14%; 12months: 34 vs. 13%; 13-56months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6weeks (14 vs. 2%), 6months (15 vs. 5%), and 13-56months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time. Conclusions: Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling

BACKGROUND:: Although explosion injuries caused by terror attacks or in war are evaluated in many studies, limited information about civil explosion injuries can be found in the literature. METHODS:: In a retrospective study of 71 civil gas explosion injuries treated in a single burn center during a 16-year period, we evaluated trauma mechanisms, patterns of injury, and clinical outcome. RESULTS:: More than 50% of all gas explosions injuries occurred in private households. The mortality correlated significantly with higher burned total body surface area (TBSA), higher abbreviated burn severity index (ABSI) score, accompanying inhalation injuries, and lung contusions. Although mean ABSI score and burned TBSA were similar in men and women (6 vs. 7 and 22% vs. 21%), the female mortality from gas explosions was noticeably higher, albeit not statistically significant due to small patient numbers (32% vs. 17%). Although mean burned TBSA, ABSI scores, and intensive care unit lengths of stay in patients with burns from gas explosions were comparable and not significantly different compared with all burn patients treated in our burn center (TBSA: 22% vs. 17%; ABSI: 6 vs. 6; and intensive care unit lengths of stay: 12 vs. 11 days), the mortality from gas explosions was significantly higher (21% vs. 12%, P = 0.04). CONCLUSIONS:: The mortality from gas explosion-related burns correlated significantly with burned TBSA, ABSI score, accompanying inhalation injuries, and lung contusions. Despite comparable ABSI scores, the mortality from gas explosion-related burns was significantly higher than the mortality for all burn victims. Language: en

A number of liquid petroleum gas (LPG) burns have been reported in the last 3 years in line with the evolving widespread acceptance of LPG-powered cars in the public. LPG is a mixture of commercial butane and propane gas. Depending on the mixture of both, butane and propane, the boiling point of LPG lies in between 45 and 2 8C [1]. Refinements in the engineering process of LPG tanks using the Finite Element Method (FEM) lowered the wall sheet thickness from 3 to 2.8 mm without different bursting results [2]. To date some 25 cases are reported in the literature. In the largest case series with LPG-related burns among 18 patients (9 adults and 9 children), various injury mechanisms are described [1]. The weakening of the tank wall, crashes resulting in an impact to the tank and leakage from the tank was reported. Thus, technical errors or malfunctions were detected. All burned patients were inside the car when the explosion occurred with eleven cases of inhalation injury with seven of them requiring mechanical ventilation. Another case highlights a hand burn during refuelling a car with LPG [3]. He was struck by splashing LPG while he was disconnecting the LPG hose nozzle. The fact that LPG has such a low boiling point (between 45 and 2 8C) and its rapid vaporisation, frostbite injuries have been reported as the aforementioned case and another series on two patients [4]. Both cases were related to Article history: Accepted 22 July 2010

A 14-year-old BMX driver suffered a blunt trauma towards the lateral neck (Fig. 1). A computed tomography (CT) angiography revealed a dye stop in the left subclavian artery with collateral blood flow (Fig. 2). Interventional catheterisation revealed a rupture. However, no peripheral pulse deficit was evident, and, therefore, no immediate vascular surgery was performed. www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 37 (2010) 235

Objective This study aims to evaluate percutaneous collagen induction (PCI) in post-burn scarring. Background Patients with scarring after burn frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. Their scars are generally treated by tissue transfer, W- and Z-plasties, flaps, cortisone injections or ablative procedures that injure or destroy the epidermis and its basement membrane and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis. Patients A total of 16 consecutive patients (average age: 37 ± 15.5 years, average body mass index (BMI): 25.7) in Germany with post-burn scarring. Intervention PCI using the Medical Roll-CIT (Vivida, Cape Town, South Africa). This device was designed to multiply-puncture the skin to the level of the dermal scar to institute remodelling. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively to maximise collagen stimulation. Outcome measures The outcome was measured rating (visual analogue scale (VAS) and Vancouver Scar Scale (VSS)), histological specimen 12 months after intervention. Results On average, patients rated their improvement as a mean of 80% better (±15.5) than before treatment. Histologic examination revealed considerable increase in collagen and elastin deposition 12 months postoperatively. The epidermis demonstrated 45% thickening of stratum spinosum and normal rete ridges as well as the normalisation of the collagen/elastin matrix in the reticular dermis at 1 year postoperatively. Conclusions This pilot study shows that PCI appears to be a safe method for treating post-burn scarring without destroying the epidermis. The procedure can be repeated safely and is also applicable in regions where laser treatments and deep peels are of limited use. However, it is necessary to initiate an efficacy trial to prove the data of this pilot study.

BACKGROUND: Ventral hernia repair is increasingly performed by laparoscopic means since the introduction of dual-layer meshes. This study aimed to compare the early complications and cost effectiveness of open hernia repair with those associated with laparoscopic repair. METHODS: Open ventral hernia repair was performed for 92 consecutive patients using a Vypro mesh, followed by laparoscopic repair for 49 consecutive patients using a Parietene composite mesh. RESULTS: The rate of surgical-site infections was significantly higher with open ventral hernia repair (13 vs 1; p = 0.03). The median length of hospital stay was significantly shorter with laparoscopic surgery (7 vs 6 days; p = 0.02). For laparoscopic repair, the direct operative costs were higher (2,314 vs 2,853 euros; p = 0.03), and the overall hospital costs were lower (9,787 vs 7,654 euros; p = 0.02). CONCLUSIONS: Laparoscopic ventral hernia repair leads to fewer surgical-site infections and a shorter hospital stay than open repair. Despite increased operative costs, overall hospital costs are lowered by laparoscopic ventral hernia repair.

Background Complications arising from accidental intraarterial drug injections have been described in the past. However, given the multitude of injected substances and complex pathophysiology, guidelines regarding diagnosis and management of patients with intraarterial injections remain vague. As such it remains unclear, when to expect limb ischemia and whether and for how long to monitor patients after intraarterial injections. Case report We present the case of a "near miss event" in an i.v. drug abuser presenting to the emergency department 3 hours after injection of water dissolved zolpidem (Ambien™) tablets into the right ulnar artery. Chief complaint was forearm pain. Clinical examination at the time revealed no concern for limb ischemia and patient was discharged. The patient returned unplanned 18 hours after injection with an ischemic right hand. Angiography revealed no flow in the distal ulnar artery and minimal flow in the palmar arch. Emergent intraarterial thrombolysis with Urokinase was performed and restored hand perfusion. Clinical follow-up 3 months after injury showed full recovery with regular recapillarisation and normal Allen test. Conclusion This case report highlights the need to rigorously monitor patients with suspected intraarterial injections for potential delayed onset of limb ischemia. This is to our knowledge the first described case report of a successful revascularization after prolonged ischemia with delayed onset after zolpidem injection. We recommend close monitoring of these patients for at least 24 hours in addition to starting prophylactic anticoagulation.

Scarring at the level of the fingertip can cause major problems and discomfort. We report a case of a professional bass player who suffered impaired functionality of his middle finger after surgical treatment of a felon. We performed a collagen induction therapy after plastic reconstruction of the middle finger’s fingertip with an adipofascial turnover flap and two lateral VY flaps. This resulted in a long-term improvement of the previous symptoms and full functional rehabilitation as musician with an esthetically pleasing result.