Stefan Nitsch

University Medical Center Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

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Publications (15)16.22 Total impact

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    ABSTRACT: Background: Silicone gel is one therapeutic approach in the treatment and prevention of excessive scarring. The likely mechanism of action is the hydration of the tissue. This should lead to reduced angiogenesis and capillary blood flow. The efficacy is still controversial and the evidence base, insufficient. The aim of this prospective and standardized study is to investigate silicone gel in the preventive treatment of scars. Patients and Methods: Included in the study were 20 patients with costal cartilage harvest. Half of a standard chest scar was treated for three months with a silicone gel. The other half served as an internal control. After three months both scar sides were compared subjectively by visual analog scale and objectively by elasticity, moisture and color measurements. Results: Of 19 patients 8 had a better subjective result in the treated half. In one subject, no difference was seen. A worse subjective result in the treated half was seen in 10 out of 19. The objective measurements showed no significant difference. A correlation between the different results was not seen. Conclusions: The use of silicone gel caused subjective differences within the same scar (worsening as well as improvement of the appearance). Positive effects were not detectable in the investigated parameters.
    Journal der Deutschen Dermatologischen Gesellschaft 02/2013; · 1.40 Impact Factor
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    ABSTRACT: In head and neck squamous cell carcinoma (HNSCC) aerobic glycolysis is the key feature for energy supply of the tumor. Quantitative microdialysis (μD) offers an online method to measure parameters of the carbohydrate metabolism in vivo. The aim was to standardize a quantitative μD-study in patients with HNSCC and to prove if a ketogenic diet would differently influence the carbohydrate metabolism of the tumor tissue. Commercially available 100 kDa-CMA71-μD- catheters were implanted in tumor-free and in tumor tissue in patients with HNSCC for simultaneous measurements up to 5 days. The metabolic pattern and circadian rhythm of urea, glucose, lactate, and pyruvate was monitored during 24 h of western diet and subsequent up to 4 days of ketogenic diet. After 3 days of ketogenic diet the mean lactate concentration declines to a greater extent in the tumor tissue than in the tumor-free mucosa, whereas the mean glucose and pyruvate concentrations rise. The in vivo glucose metabolism of the tumor tissue is clearly influenced by nutrition. The decline of mean lactate concentration in the tumor tissue after ketogenic diet supports the hypothesis that HNSCC tumor cells might use lactate as fuel for oxidative glucose metabolism.
    Nutrition and Cancer 01/2013; 65(6):843-9. · 2.70 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 01/2013; 11(5). · 1.40 Impact Factor
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    ABSTRACT: During the first stage of total auricular reconstruction with autologous rib cartilage, according to Nagata, the cartilage framework is placed in a subcutaneous pocket. Its posterior skin flap is relatively large and can be prepared with or without a subcutaneous pedicle. This represents the crucial part of the procedure, as impaired healing and infection can occur due to low perfusion. Nothing was known about the blood supply of ear remnants or flap perfusion during reconstruction. It was not clear whether the preservation of the additional subcutaneous pedicle secures high blood supply. We used laser fluorescence angiography with indocyanine green dye for anatomical and functional perfusion studies in eight normal ears. Subsequently the anatomical and functional vessel architecture of 18 dysplastic ears was investigated. Finally, five patients each were operated on with or without subcutaneous pedicle during auricular reconstruction and intraoperatively monitored with laser fluorescence angiography. We showed that the vessel structure of normal ears detected by fluorescence angiography is equivalent to anatomical preparations. The surrounding skin in high grade microtia remnants is biphasically perfused by deep perforators and by the cutaneous vessel network. The preservation of the subcutaneous pedicle during auricular reconstruction leads to significantly better perfusion of the posterior skin flap. No signs of critical perfusion or complications were observed in these patients. We present the feasibility of laser fluorescence angiography to simultaneously gain anatomical and functional data about skin blood supply. The first anatomical and functional description of blood supply of ear remnants in third grade microtia is given. Functional data of skin flap perfusion during and after complete ear reconstruction were evaluated. The present study shows that the subcutaneous pedicle of Nagata's procedure is of great importance for success of the first stage operation as it prevents impaired wound healing. In contrast, patients without a subcutaneous pedicle had a broad spectrum of reduced perfusion and therefore some had complications.
    Journal of Plastic Reconstructive & Aesthetic Surgery 05/2008; 61 Suppl 1:S21-8. · 1.44 Impact Factor
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    ABSTRACT: Despite significant advances in the use of diagnosis and therapy to treat head and neck squamous cell carcinoma (HNSCC), the prognosis has improved only marginally in the last decades. Thus, there is an enormous need for better understanding of tumor biology and reversely novel immunotherapeutic approaches. It is becoming increasingly obvious that stem cells play an important role in tumor development and progression. The identity of these cells and the underlying cellular and molecular mechanisms are mostly unknown in HNSCC to date. Solid HNSCC tumors, as well as permanent HNSCC cell lines, were analyzed by flow cytometry concerning the expression of different putative stem cell marker proteins. Distinct populations of CD44 expressing potential stem cells could be identified in solid tumors of HNSCC patients with strong individual deviations. Surprisingly, the potential stem cell marker CD44 was found to be constitutively expressed on the surface of all the permanent HNSCC cell lines analyzed. CD44+ 'tumor stem cells' may play a key role in the establishment of permanent HNSCC cell lines, selecting especially robust cell entities that might drive the progression and metastasis of HNSCC. Individual analysis of 'tumor stem cell' markers will be an important tool for innovative therapies and for determining the prognosis of patients with HNSCC.
    In vivo (Athens, Greece) 01/2008; 22(1):89-92. · 1.15 Impact Factor
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    ABSTRACT: There are few data focusing on the improvement of psychosocial functioning and self-esteem in patients with congenital or acquired severe auricular defects. We investigated the satisfaction of patients following auricular reconstruction with rib cartilage. One hundred patients treated for reconstruction with rib cartilage for congenital or traumatic auricular defects have been evaluated retrospectively for changes in self-esteem, performance ability, and psychosocial attitude using a clinically established questionnaire, Frankfurter Selbstkonzeptskalen (FSKN). In addition, patients were asked to judge the new auricle and the thoracic scar using a new questionnaire. Of 68 patients who took part in this study, almost 90% could integrate the new ear into their body concept. If faced with the same decision for surgery again, 75% would again choose a reconstruction with rib cartilage. More than three-quarters rated the thoracic scar as acceptable in relation to the benefits of the new ear, although one-third felt uncomfortable with the pain and cosmetic appearance of the thoracic scar. According to the results of the FSKN questionnaire, values in psychosocial abilities improved postoperatively. There was no clear change in either self-esteem or performance ability. Ear reconstruction with rib cartilage remains, under most circumstances, the procedure of choice for repairing auricular defects. There is a high acceptance of this method among patients, although the impact of the thoracic scar needs to be discussed extensively before surgery. The importance of the surgeon's experience cannot be underestimated, because it determines the aesthetic results and the patient's satisfaction in this challenging area of plastic surgery.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 01/2008; 28(4):404-11.
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    ABSTRACT: Patients with high-grade microtia and atresia require a sophisticated and specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air-bone gap, and new techniques in hearing rehabilitation are needed for these patients. We present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window. The air-bone gap was reduced to 17 dB, 14 dB and 0.25 dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found. The integration of active middle ear implants in auricular reconstruction opens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.
    HNO 06/2007; 55(5):349-56. · 0.42 Impact Factor
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    ABSTRACT: Auricular trauma is rare but can seriously reduce self-acceptance and function. Epidemiologic data on the causes of trauma causes and patient characteristics are limited. The case notes of 141 from 197 patients with ear injuries have been reviewed retrospectively according to trauma cause and to the distribution of age and gender. Two thirds of the documented cases occurred between the age of 11 and 40 years. Men outnumbered women at a ratio of 2 to 1. The most frequent causes for ear trauma were traffic accidents (43 %), accidents at home (33 %), and fights (14 %). Mainly younger and active groups of the population are affected by ear trauma. Therefore, it is of particular concern in the acute setting to select those therapeutic options that have turned out good aesthetic and functional results in the long-term perspective.
    Handchirurgie · Mikrochirurgie · Plastische Chirurgie 05/2007; 39(2):98-102. · 0.86 Impact Factor
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    ABSTRACT: HintergrundPatienten mit hochgradiger Mikrotie und Atresie bedrfen einer anspruchsvollen und speziellen Therapie. Neben der plastischen Rekonstruktion der Ohrmuschel besteht teilweise die medizinische Notwendigkeit oder zumindest der Patientenwunsch nach einer hrverbessernden Manahme. Die Langzeitergebnisse der simultanen chirurgischen Rekonstruktion des Schallleitungsapparates sind aufgrund der persistierenden Schallleitungskomponente ber die Jahre oft ungengend und es bedarf daher neuer Techniken der Hrverbesserung fr diese Patienten.Material und MethodenAnhand von 3Fallbeispielen mit einseitiger Atresie zeigen wir die Integration des aktiven Mittelohrimplantates Vibrant Soundbridge (VSB) in die plastische Ohrmuschelrekonstruktion. Die Ankopplung der VSB erfolgte in 2Fllen ber den Clip auf die dysplastische Ossikelkette, einmal ber einen subfazialen Zugang direkt auf die Rundfenstermembran.ErgebnisseDie Schallleitungskomponente konnte auf durchschnittlich 17dB, 14dB bzw. 0,25dB HL gesenkt werden. Im Sprachverstndlichkeitstest erreichten die Patienten mit aktiviertem Implantat bei 65dB SPL 100%, 90% bzw. 100% Verstndlichkeit. Es traten keine Komplikationen wie Fazialisparese, Schwindel oder Innenohrschaden auf.SchlussfolgerungDie Integration von aktiven Mittelohrimplantaten in die plastische Ohrmuschelrekonstruktion erffnet eine neue Mglichkeit, diese Patienten vollstndig zu rehabilitieren. Die Implantation der VSB verlief ohne Nachteil fr die plastische Rekonstruktion.BackgroundPatients with high-grade microtia and atresia require a sophisticated annd specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air–bone gap, and new techniques in hearing rehabilitation are needed for these patients.MethodsWe present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window.ResultsThe air–bone gap was reduced to 17dB, 14dB and 0.25dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found.ConclusionsThe integration of active middle ear implants in auricular reconstruction iopens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.
    HNO 04/2007; 55(5):349-356. · 0.42 Impact Factor
  • Handchirurgie Mikrochirurgie Plastische Chirurgie - HANDCHIR MIKROCHIR PLAST CHIR. 01/2007; 39(2):98-102.
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    Stefan M Nitsch, Ralph Pries, Barbara Wollenberg
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    ABSTRACT: Head and neck squamous cell carcinoma (HNSCC) are infiltrated by various kinds of immune cells, which show massively impaired immune functions. The influence of HNSCC on CD34 + progenitor cells from human cord blood was analyzed. CD34+ cells were isolated from human cord blood by 'magnetic bead separation' using magnetically labelled antibodies. Immunofluorescent staining of CD34+ cells in solid HNSCC was carried out. Cytokine levels of IL-6, IL-8, and IL-10 were analyzed with flow cytometry using the BD CBA Human Soluble Protein Flex Set system (Becton Dickinson). We demonstrated that HNSCC triggered CD34+ cells to produce increased levels of the tumor-promoting cytokine IL-6 and thus they participate in the development of the microenvironment of head and neck cancer. HNSCC modulates the cytokine secretion profile of tumor infiltrating cells to escape from efficient immune responses und to trigger its own malignant progression.
    In vivo (Athens, Greece) 01/2007; 21(3):493-8. · 1.15 Impact Factor
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    ABSTRACT: While the indication for an ear reconstruction with rib cartilage is clear in pediatric patients and patients without previous surgery, there are borderline cases in which neither a reconstruction nor a prosthesis seems to be first choice. Within the last 6 years, approximately 120 patients were treated with a reconstruction with rib cartilage and 20 with a prosthesis at our hospital. Patients without extensively scarred periauricular tissue clearly benefit by a reconstruction with cartilage. The classic indication for an ear prosthesis is status post-malignant tumor resection. In borderline cases presenting with heavy scars, the most favorable repair method has to be decided upon individually. Under these circumstances, one of the main criteria for a reconstruction with rib cartilage is a viable temporoparietal fascia flap. A consideration that is important to note is that an unfavorable ear reconstruction can be converted almost always into a prosthesis repair but very rarely vice versa.
    Annals of Plastic Surgery 01/2007; 57(6):626-30. · 1.38 Impact Factor
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    ABSTRACT: Head and neck squamous cell carcinoma is one of the most frequent cancers and standard treatment has only marginally improved the 5-year survival rate of patients with this disease in the last few decades. It is supposed that cytokine alterations in immune, inflammatory and angiogenetic regulatory routes within the head and neck squamous cell carcinoma microenvironment play a critical role in tumor aggressiveness, its response to chemo- and radiation therapies, as well as the development of immune escape mechanisms.
    Expert Review of Anti-infective Therapy 10/2006; 6(9):1195-203. · 3.06 Impact Factor
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    ABSTRACT: The incidence of microtia in Germany is 100-150 per year. These cases require a specific and challenging therapy. All patients need audiologic consultation. If desired plastic reconstruction is performed, which is aiming at achieving a lifelike as possible appearance corresponding to the shape of the opposite ear including an excellent skin color. The present paper describes background information, the interdisciplinary schedule of treatment, and the results of our operative strategy in two to three steps using autologous rib cartilage. Furthermore we expand on anomalous cases of microtia which require a modified procedure. In dystopic microtia, repositioning of the rudiment is necessary before reconstruction. In cases of excessive scar tissue due to injuries or previous operations, a one-step reconstruction using an axial fascia flap can be useful.
    HNO 07/2006; 54(6):493-511; quiz 512-3. · 0.42 Impact Factor
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    ABSTRACT: Zusammenfassung Es gibt jährlich in Deutschland 100–150 neu aufgetretene hochgradige Fehlbildungen der Ohrmuschel, die einer speziellen und anspruchsvollen Therapie bedürfen. Alle Patienten benötigen eine intensive audiologische Betreuung, auf Wunsch wird darüber hinaus eine plastische Korrektur durchgeführt. Ziel dieser Therapie ist eine möglichst naturgetreue, der Gegenseite entsprechende Ohrmuschelform mit ausgezeichnetem Hautkolorit. In der vorliegenden Arbeit präsentieren wir neben den Grundlagen und dem interdisziplinären Behandlungsplan die Ergebnisse der bei uns durchgeführten Operationstechnik mit autologem Rippenknorpel in 2–3 Schritten. Des Weiteren wird auch auf die Sonderformen der Mikrotie eingegangen, die eines modifizierten Vorgehens bedürfen. Bei dystopen Rudimenten ist vor der Rekonstruktion eine Rudimentverlagerung notwendig. Sind die lokalen Hautverhältnisse durch Verletzungen oder Vernarbungen ungünstig, bietet sich eine 1-Schritt-Rekonstruktion mit einem axialen Faszienlappen an.
    HNO 01/2006; 54(6):493-514. · 0.42 Impact Factor

Publication Stats

139 Citations
16.22 Total Impact Points

Institutions

  • 2008–2013
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2006–2008
    • Universität zu Lübeck
      • Department of Otorhinolaryngology
      Lübeck, Schleswig-Holstein, Germany
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany