[Lipedema - basics and current hypothesis of pathomechanism].
Dec,
2018
Lipoedema is a painful, chronic progressive disorder of adipose tissue, characterised by symmetrical swelling of the lower and/or upper limbs. Due to a lack of awareness, lipoedema is frequently misdiagnosed. However, accurate diagnosis and treatment are essential since they determine the patient's prognosis. There is no known causal therapy because the exact aetiology of the disease is not fully understood at this time. Familial aggregation is common, which suggests a genetic disorder. Since lipoedema is almost exclusively found in women and manifests around hormonal changes (puberty, pregnancy, menopause), oestrogen is believed to play a decisive role in its pathogenesis. This review aims to summarise the symptoms and clinical features of lipoedema, its differential diagnosis, treatment options, and current theories on the pathogenesis of lipoedema. leer más
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...
Aesthetic Refinements in Patients with Prominent Eyes.
Dec,
2015
The treatment of prominent eyes is still a challenging task. As well as the surgery, proper preoperative diagnosis differentiating between patients with and without Graves ophthalmopathy plays an important role. In functionally asymptomatic patients with Graves disease suffering from the aesthetic impairment of prominent eyes, the transpalpebral decompression by intraorbital fat removal technique has been proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon. This technique provides long-lasting results, leading to improvement not only in visual function but also in personal well-being and in the patient's social life, with a high benefit-to-risk ratio. The most powerful tool to treat the lower lid deformity and malar bags in patients without Graves disease is the subperiosteal midface lift. It shortens the lid-cheek junction and blends the retaining periorbital ligaments. Furthermore, it adds volume to the lower lid and gives a stable support. By the nature of the procedure, it also turns a negative into a positive vector. In experienced hands, Olivari's orbital decompression and Hester's midface lift are ideal options for the treatment of prominent eyes. leer más
Facial plastic surgery : FPS
Skin graft fixation in severe burns: use of topical negative pressure.
Sep,
2014
Over the last 50 years, the evolution of burn care has led to a significant decrease in mortality. The biggest impact on survival has been the change in the approach to burn surgery. Early excision and grafting has become a standard of care for the majority of patients with deep burns; the survival of a given patient suffering from major burns is invariably linked to the take rate and survival of skin grafts. The application of topical negative pressure (TNP) therapy devices has demonstrated improved graft take in comparison to conventional dressing methods alone. The aim of this study was to analyze the impact of TNP therapy on skin graft fixation in large burns. In all patients, we applied TNP dressings covering a %TBSA of >25. The following parameters were recorded and documented using BurnCase 3D: age, gender, %TBSA, burn depth, hospital length-of-stay, Baux score, survival, as well as duration and incidence of TNP dressings. After a burn depth adapted wound debridement, coverage was simultaneously performed using split-thickness skin grafts, which were fixed with staples and covered with fatty gauzes and TNP foam. The TNP foam was again fixed with staples to prevent displacement and finally covered with the supplied transparent adhesive film. A continuous subatmospheric pressure between 75-120 mm Hg was applied (VAC®, KCI, Vienna, Austria). The first dressing change was performed on day 4. Thirty-six out of 37 patients, suffering from full thickness burns, were discharged with complete wound closure; only one patient succumbed to their injuries. The overall skin graft take rate was over 95%. In conclusion, we consider that split thickness skin graft fixation by TNP is an efficient method in major burns, notably in areas with irregular wound surfaces or subject to movement (e.g. joint proximity), and is worth considering for the treatment of aged patients. leer más
Annals of burns and fire disasters
The properties of the "ideal" donor site dressing: results of a worldwide online survey.
Sep,
2013
Split skin grafting is a widely used technique for reconstructing skin defects. Although a vast number of different coverage options for donor sites have become available in daily clinical practice, no optimum dressing material has been found to date. For this reason, we conducted a globally-distributed online survey to poll for the properties of such an "ideal" donor site dressing, possibly leading to an improved clinically-driven direction of future wound dressing developments. A total of 69 respondents from 34 countries took part in the questionnaire, resulting in a response rate of 13.8% (69/500) over a 1-month period. The majority of respondents rated the characteristics of an "ideal" donor site dressing to be either "essential" or "desirable" as follows: lack of adhesion to the wound bed ("essential": 31/69, 44.9%; "desirable": 30/69, 43.5%); pain-free dressing changes ("essential": 38/69, 55.1%; "desirable": 30/69, 43.5%); absorbency ("essential": 27/69, 39.1%; "desirable": 33/69, 47.8%); ease of removal ("essential": 37/69, 53.6%; "desirable": 27/69, 39.13%). With regard to the desired frequency of dressing changes, respondents preferred "no dressing change until the donor site has healed" (51/69, 73.9%) in the majority of cases, followed by "twice weekly" (10/69, 14.5%), "alternate days" (5/69, 7.2%) and "daily" (3/69, 4.3%). With regard to the design of the dressing material, the majority of participants preferred a one-piece (composite) dressing product (44/69, 63.8%). The majority of respondents also denied the current availability of an "ideal" donor site dressing (49/69, 71%). The strength of this study was the remarkable geographic distribution of responses; all parts of the world were included and participated. We believe that this globally conducted online survey has polled for the properties of the "ideal" donor site dressing and possibly will lead to an improved clinically-driven direction of future wound dressing development. leer más
Annals of burns and fire disasters
No adverse affect after harvesting of free fibula osteoseptocutaneous flaps on gait function.
Jul,
2012
The aim of this study was to analyze gait function and muscular strength on donor site after harvesting of a vascularized fibula osteoseptocutaneous flap. Nine patients with a mean follow-up of 33 months (range, 7-59) and a mean resection length of the middle portion of the fibula of 18.0 cm (range, 14.0-23.0) underwent an instrumented three-dimensional gait analysis to evaluate gait function. Furthermore, CYBEX II extremity system was used for muscular strength measurements. Subjective muscle strength measurements were performed according to Kendall et al. and were classified according to the British Medical Research Council. Intraindividual comparison between the operated and the nonoperated leg revealed no significant differences for gait function parameters (cadence, velocity, and stride length, P > 1.00) and for muscular strength measurements for flexion (knee: P = 0.93, ankle: P = 0.54) and extension (knee: P = 0.97, ankle: P= 0.21), respectively. In conclusion, intraindividual comparison of the operated and nonoperated sides after harvesting of the middle portion of the fibula for gaining a free fibula osteoseptocutaneous flap has no adverse affect on gait function or muscular flexion and extension strength on donor site at a mean follow-up of 33 months. leer más
Microsurgery
The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature.
Apr,
2011
Soft-tissue reconstruction in the knee area needs thin, pliable, and tough skin. The availability of local soft tissue, which would meet the requirements best, is limited. This study is a retrospective analysis of our clinical experience with the superior lateral genicular artery (SLGA) flap for soft-tissue reconstruction around the knee, and a review of the relevant literature. Between 2000 and 2002, 6 SLGA flaps were elevated for reconstruction of defects around the knee in our institution. Indications for the SLGA flap were chronic ulcers after bursectomy of the prepatellar bursa, a pressure ulcer over the patella, and a defect after resection of a malignant fibrous histiocytoma on the anterolateral aspect of the distal thigh. There was no flap loss in any of our 6 patients. Three patients had partial tissue loss at the distal tip of the flap. Two of the 3 resulting wounds were effectively covered with split skin graft, the third one eventually healed with wound care. Primary donor site closure was possible in all cases. There were no late complications, either in the flap area or in the donor site region. We conclude that the SLGA flap is a good option for defect coverage around the knee, because of its fast and easy harvest and the very good aesthetic results. leer más
Annals of plastic surgery
[Clinical experiences using the Versajet system in burns: indications and applications].
Oct,
2007
Early debridement and early skin grafting are the "Gold standard" in the surgical treatment of burns. There are different debridement methods available. Concerning the treatment of burns, surgical-sharp debridement, laser ablation and hydrosurgery system are used. While in full thickness burns the sharp debridement is advisable, the Versajet shows its benefits in the treatment of partial thickness burns. Especially for debridement of difficult to treat areas - face, neck, lips, fingers, interdigital spaces, convex and concave areas the Versajet System shows its benefits. With the Versajet System, tissue excision is precise; moreover it helps to avoid the damage of viable tissue and its vascular supply. leer más
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...
Simultaneous dermal matrix and autologous split-thickness skin graft transplantation in a porcine wound model: a three-dimensional histological analysis of revascularization.
2014
Despite the popularity of a simultaneous application of dermal matrices and split-thickness skin grafts, scarce evidence exists about the process of revascularization involved. In this study, we aimed at analyzing the progression of revascularization by high-resolution episcopic microscopy (HREM) in a porcine excisional wound model. Following the surgical procedure creating 5 × 5 cm(2) full-thickness defects on the back, one area was covered with an autologous split-thickness skin graft alone (control group), the other with a collagen-elastin dermal matrix plus split-thickness skin graft (dermal matrix group). Two skin biopsies per each group and location were performed on day 5, 10, 15, and 28 postoperatively and separately processed for H&E as well as HREM. The dermal layer was thicker in the dermal matrix group vs. control on day 5 and 28. No differences were found for revascularization by conventional histology. In HREM, the dermal matrix did not appear to decelerate the revascularization process. The presence of the dermal matrix could be distinguished until day 15. By day 28, the structure of the dermal matrix could no longer be delineated and was replaced by autologous tissue. As assessed by conventional histology and confirmed by HREM, the revascularization process was comparable in both groups, notably with regard to the vertical ingrowth of sprouting vessels. The presented technique of HREM is a valuable addition for analyzing small vessel sprouting in dermal matrices in the future. leer más
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society
