Hans-Martin Häfner

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (28)58.13 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: It is widely accepted that local anesthetics with epinephrine should not be used in areas served by terminal vessels. There is no evidence in studies for this in penile surgery, and given the anatomy of the penis, perfusion complications are highly unlikely. The goal of this study was to show that a penile block using a local anesthetic with epinephrine is safe. In a follow-up study between 2005 and 2010, we analyzed 95 patients who got a penile ring block with subcutaneous infusion anesthesia (SIA). The SIA solution consisted of ropivacaine and lidocaine (0.11% and 0.21%) plus epinephrine. There were no anesthetic complications. Short-term negative postoperative occurrences (<72 hrs.) were swelling (42%), problems with suture material (22%), pain (19%), hematoma and paresthesia (each 13%), erectile dysfunction (12%), small-area skin necrosis after wound healing without requiring further surgery (13%), micturition disorders (7%), and wound infection (6%). Two patients on anticoagulation therapy had postoperative bleeding requiring revision surgery. 5% of the patients were given further analgesic sedation. 19% complained about postoperative pain. Persistent complaints (maximum 6 months) were disturbances of skin sensation (7%), swelling (4%), and redness and micturition disorders (3% each). Supplementing a local anesthetic with epinephrine in penis operations has many advantages, including high patient satisfaction, relatively painless infiltration, low complication rates, improved view of the operating field, and an extended effect of anesthetics with a prolonged reduction in pain. Because of the anatomy of the organ, there is no risk of necrosis related to using a subcutaneous penile ring block. Thus the view that epinephrine should not be used in penis procedures is obsolete.
    Journal der Deutschen Dermatologischen Gesellschaft 03/2014; · 1.40 Impact Factor
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    ABSTRACT: Abstract Parents experience anxiety and concern about their children' anesthesia and surgeries, which can adversely affect the children's outcomes. Therefore, it is important to identify the factors that influence parental fear. Because dermatological surgery is often performed in young children, we examined how a child's age and the size of the dermatological surgical area affected the levels of parental anxiety and concern. The parents' levels of anxiety and concern were accessed by parental self-reports in a prospective observational study of 106 children undergoing dermatological surgery. Correlation analysis showed that the level of parental anxiety decreased with the chil's age. In contrast, level of parental anxiety increased with the size of the surgical area. Our findings thus indicate that parents whose children undergo large-sized surgeries at a young age are at high risk. This result should be considered when performing dermatological surgery in children.
    Journal of Dermatological Treatment 06/2013; · 1.50 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 06/2013; 11(6):558-60. · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 04/2013; · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 08/2012; 10(8):579-86. · 1.40 Impact Factor
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    ABSTRACT: Recently the "Union for International Cancer Control" (UICC) and the "American Joint Committee on Cancer" (AJCC) changed their TNM (tumor, node, metastasis) classification of cutaneous carcinomas. We compared these classifications, tested their practicability with 615 prospectively collected, unselected, primary cutaneous squamous cell carcinomas, and introduced additional classification criteria. Neither classification contains information about prognosis. Non-metastasizing types of cutaneous carcinoma should be excluded. The vermilion border of the lower lip and the eyelids should be included. Both systems have been improved, but in part they are irreproducible. The AJCC has introduced six "high-risk features" to differentiate between T1 and T2. However, this does not seem reasonable. Only rare cases are classified as T4. Both systems have different N classifications. A clinical cT classification based on tumor size 2 cm seems reasonable but not sufficient. It should be complemented by a postoperative p (pathologic) T classification based on tumor thickness: "no risk"≤ 2 mm thickness (0% risk of metastasis), "low risk" > 2 mm to 6 mm thickness (4% risk of metastasis), and "high risk" > 6 mm thickness (16% risk of metastasis). Immune suppression, poor differentiation/desmoplasia, and the ear as tumor site are additional risk factors for metastasis, currently not evaluable. The classifications are unsuitable for a realistic estimate of the risk of metastasis which is possible using a combination of tumor size and thickness. The N staging system should consider histopathologic findings.
    Journal der Deutschen Dermatologischen Gesellschaft 03/2012; 10(8):579-86. · 1.40 Impact Factor
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    ABSTRACT: To describe the long-term effects of infertility on life and partnership satisfaction. Longitudinal cohort study. A university outpatient andrology and gynecology infertility clinic. 275 men and 272 women treated for infertility between August 2000 and December 2001. None. The Life Satisfaction Questionnaire (FLZ), the Partnership Questionnaire (PFB), and sociodemographic items at baseline (T1) and 5 years later (T2). Compared with a representative sample, our male and female participants had higher Finance and Partnership scores and lower Health scores on the FLZ at T1. They also had markedly higher PFB scores, with the exception of Conflict Behavior. After 5 years (T2), 101 men and 113 women rated the Partnership and Sexuality FLZ subscales as well as all the PFB subscales statistically significantly lower than at baseline. Only the women rated the Self-esteem FLZ subscale lower than at baseline (T1). Participants who became parents had lower Leisure and Partnership FLZ subscale scores, and fathers had lower Finance FLZ subscale scores. Satisfaction declined over 5 years for both men and women, but only in the partnership-related domains. Women were more affected than men. The success of infertility treatment had only a minor influence on a couple's future satisfaction.
    Fertility and sterility 08/2011; 96(2):416-21. · 3.97 Impact Factor
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    ABSTRACT: In current dermatological practice lymphatic mapping and sentinel lymph node biopsy (SLNB) are frequently used in patients with cutaneous cancers, like malignant melanoma, squamous cell carcinoma and Merkel cell carcinoma. However, those tumors are often located on the head and neck, regions with notoriously variable lymphatic drainage patterns. Consequently, the incidence of successful SLNB in the head and neck is considerably lower compared to the SLNB on the trunk and extremities. Thus, there is a need to improve the hit rate of SLNB in this special area. Therefore, in the current study we analyzed SLNB of 149 patients treated for cutaneous tumors at the Department of Dermatology, University of Tuebingen, Germany. By mapping SLN (sentinel lymph node) locations to their specific tumor sites on the head and neck, we were able to calculate the frequency of SLN distribution to defined tumor locations. Furthermore, our analysis revealed that approximately 7% of tumors on the head and neck drain to contralateral SLN, which is of relevance for the classification in the current cancer TNM system. Thus, our mapping can predict SLN location in patients with cutaneous head and neck tumors and might help to further increase the rate of successful SLNB.
    European journal of dermatology: EJD 06/2011; 21(3):354-8. · 1.95 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 05/2011; 9(5):418-9. · 1.40 Impact Factor
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    ABSTRACT: Primary closure in dermatologic surgery is state of the art in small lesions at the head, but also in larger lesions at the trunk or the extremities. Microcirculatory effects on the skin blood flow near to the wound edges affected by primary closure. Forty three patients were investigated. Before and after surgery, skin blood flow was measured using Laser Doppler Fluxmetry (LDF). During primary closure, tension in the suture was measured and the tension on the wound edges was calculated. Times series were analyzed using continuous wavelet analyses, before, after 2 h and 24 h after surgery. After three months, the cosmetic results were requested. Median horizontal diameter was 22 mm (quartiles 20/48 mm), median vertical diameter was 44 mm (quartiles 26/60 mm). Mean string force was 12.0 SD 10.2 N. During the whole course of investigation, we found no change of microcirculatory parameters such as mean LDF or any scaling level following wavelet analysis caused by primary closure. Average of the cosmetic result was 1.8. It is a relative small number of patients and the defects are located in different areas. Skin blood flow and the microcirculatory pattern is not affected in the area by the tension on wound edges and provides therefore a fast healing process without any vegetatively induced complications even if the string force is high. In dermatosurgery, wounds can be closed directly without changing the microcirculatory pattern in the direct area of the wound margins.
    Clinical hemorheology and microcirculation 01/2011; 47(2):99-109. · 3.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 01/2011; 9(5). · 1.40 Impact Factor
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    ABSTRACT: To confirm a local R0 resection of tumors with infiltrative growth at problem sites and for sparing of tissue, microscopically controlled surgery represents a safe and proven method, particularly when there are no gaps between the tissue taken at the incision margins.
    Journal der Deutschen Dermatologischen Gesellschaft 03/2010; 8(11):920-5. · 1.40 Impact Factor
  • Dermatologic Surgery 03/2010; 36(3):428-30. · 1.87 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 01/2010; 8(3). · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 08/2009; 7(7):641-2. · 1.40 Impact Factor
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    ABSTRACT: Does controlled vascular training influence plasmaviscosity and the pain free walking distance in patients with peripheral arterial occlusive disease (paod) Fontaine stage II?37 patients, 24 men and 13 women with a mean age of 64.5 years SD 8.5 took part in ambulant vascular training over a period of 12 months.Before, after 6 months and after 12 months, pain free (pfwd) and maximum walking distance (mwd) was measured using a standardized treadmill program. Also ankle-brachials systolic pressure index (a-bspi), transcutaneous oxygen tension (tcPO2) and plasmaviscosity (pv) were measured.Pfwd increased from 212 SD 143 m to 371 SD 249 m (p<0.02). TcPO2 increased during training, but without statistically significance. A-bspi increased between the first 6 months of training statistically significant. Before training pv was 1.31 mPa s SD 0.10, after training period of 6 months it was 1.27 mPa s SD 0.11 (p=0.06) and 12 months later it was 1.28 SD 0.11 mPa s (p=0.35). The improvement of pfwd and the decrease of pv correlates (r=-0.39, p=0.05).In most patients, arterial vascular training improves pfwd and mwd. Simultaneously to the increase of the walking distances plasmaviscosity decreases and crurobrachial indexes increases. We found a coupling between improvement of pfwd and pv. Pv seems to participate in improvement of leg hemodynamics in patients with paod.
    Clinical hemorheology and microcirculation 02/2009; 41(1):73-80. · 3.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 02/2009; 7(1):66-7. · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 01/2009; 7(1):66-67. · 1.40 Impact Factor
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    ABSTRACT: We use continuous wavelet analysis (WA) of Laser Doppler Flux (LDF) time series measured in basal cell carcinomas (BCC) and plaque psoriasis (PP) in order to investigate the rhythmical behavior of blood flow in tumor or inflammatory associated neoangiogenesis.A total of 68 patients with primary BCCs and 40 patients with PP were included in the study. LDF time series were separated in four scaling levels corresponding to the influences of sympathetic activity (SL1), myogenic activity in the vessel wall (SL2), respiration (SL3) and heart beat (SL4).In BCC, SL1 decreased compared to healthy skin. In all other scaling levels, we found a statistically significant increase of the SLs compared to healthy skin. These increases were not found in PP.Rhythmical behavior of blood flow in malignant tumors is totally different from that in regions with inflammation. In BCCs, thermoregulatory processes, ascribed to sympathetic activity, decrease statistically significant. In contrast, inflammatory processes in PP do not substantially change sympathetic activity. WA of tumor perfusion could open a new noninvasive monitor system for controlling tumor therapy.
    Clinical hemorheology and microcirculation 01/2009; 43(3):191-201. · 3.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 12/2008; 7(1):29 - 33. · 1.40 Impact Factor

Publication Stats

62 Citations
58.13 Total Impact Points

Institutions

  • 2007–2014
    • University of Tuebingen
      • Department of Dermatology
      Tübingen, Baden-Württemberg, Germany
  • 2005–2012
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
    • University of Greifswald
      • Department of Dermatology
      Greifswald, Mecklenburg-Vorpommern, Germany