[Show abstract][Hide abstract] ABSTRACT: Objective: Toxic epidermal necrolysis and Stevens-Johnson syndrome have related high morbidity and mortality. We predict that preexisting multimorbidity is a major prognostic factor of both these diseases. Methods: A retrospective analysis in toxic epidermal necrolysis and Stevens-Johnson syndrome patients over the past 10 years. Three severity categories (minor, moderate, and severe multimorbidity) were defined according to a point-rating system. Results: Twenty-seven inpatients, with a median age of 63 years, diagnosed with toxic epidermal necrolysis (n = 13) or Stevens-Johnson syndrome/toxic epidermal necrolysis (n = 14) were assessed in this study. Of these, 14 patients died during the course of the study. Nonsurvivors showed significantly higher multimorbidity (P = .038), with higher scoring on the points system for disease severity (P = .003), than survivors and CART (Classification and Regression Trees) cross-validation (P < .05). Limitations: Restricted number of patients due to low prevalence rate. Conclusion: The complexity of associated multimorbidity appears to have a large influence on toxic epidermal necrolysis and Stevens-Johnson syndrome prognosis, which has not been considered in any of the established scoring systems.
[Show abstract][Hide abstract] ABSTRACT: 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.
European Journal of Plastic Surgery 03/2012; 35(3). DOI:10.1007/s00238-011-0548-3
[Show abstract][Hide abstract] ABSTRACT: Silicone implants have been used for breast augmentation for more than 45 years. Complications, in particular capsular contracture, occur with an incidence of <10% and up to 60%. We investigated the influence of the surface of breast implants on the formation of capsular contracture by comparing silicone with titanium-coated silicone. Seventeen smooth saline-filled silicone (group A) and 14 saline-filled titanium-coated silicone (group B) implants were implanted in female Wistar rats. After 12 and 36 weeks, the implants and capsules were extracted; histological and immunohistochemical staining was performed. The evaluation of the capsules was performed by two examiners in a double-blinded manner. Histologically, no significant difference in total capsule thickness was found. There was a significant difference in synovial-like metaplasia layer (SLM) thickness between groups A and B ( p = 0.041). Regarding implantation time (12 vs. 36 weeks), a significant difference was found in SLM thickness ( p = 0.021). Immunohistochemical staining indicated a significantly lower infiltration with inflammatory cells in group B. A significant correlation ( p = 0.019) between a thick SLM layer and inflammatory cell infiltration was detected. Titanium-coated silicone implants reduce SLM thickness and capsular inflammatory cell infiltration. These findings postulate that titanium-coated silicone implants might point out a new chance in the prevention of capsular contracture.
European Journal of Plastic Surgery 01/2012; 35(1):19-24. DOI:10.1007/s00238-011-0579-9
[Show abstract][Hide abstract] ABSTRACT: Self-mutilations are one of the major characteristics of patients with borderline personality disorder (BPD). Thermal injuries of BPD should be treated by a plastic surgeon who is faced to a challenge in the plastic-reconstructive strategy because of the most complex psychiatric disease. This means the need of a multidisciplinary strategy. Based on 3 case reports such conflict between best plastic reconstructive treatment of the burns wound and the psychiatric limit with the appropriate therapy options are presented.
[Show abstract][Hide abstract] ABSTRACT: Constriction ring syndrome is an uncommon deformity with unknown etiology and multiple manifestations. The most common change occurs at the lower extremities. A complete circular amniotic band syndrome of the trunk is an extremely rare condition. There are less than ten other reported cases in the literature. We present a new case of this congenital abnormality, the operation procedure and the results.
German medical science : GMS e-journal 07/2011; 9:Doc17. DOI:10.3205/000140
[Show abstract][Hide abstract] ABSTRACT: Extensive burn injury has systemic consequences due to capillary leak. After restoration of cellular integrity, infused fluid volume has to be removed partially. This can provoke electrolyte disorders.
We investigated the effect of progressive fluid removal on serum sodium level.
Retrospective study. Patients admitted to a burn unit were analyzed and separated in two groups without (Group A) or with (Group B) prolonged hypernatremia. Daily infusion-diuresis-ratio (IDR) was analyzed.
Fourty (12 female; 28 male) patients with a mean age of 47±19 years, a total burn surface area (TBSA) of 26±12%, and a mean abbreviated burned severity index (ABSI) score of 7.3±2 were included. In Group A 25 patients with a mean age of 47±18 years, a mean TBSA of 23±11%, and a mean ABSI score of 6.9±2.1 were summarized. In Group B 15 patients with a mean age of 47±22 years, a mean TBSA of 30±13%, and a mean ABSI score of 8.1±1.7 were included. Hypernatremia occurred on day 5±1.4. There was no significant difference between both groups for fluid resuscitation amount within the first 24 hours. Statistical analysis of the first 7 days after burn injury showed a significantly higher percentage of removed fluid in Group B for day 3, day 4, day 5, day 6 and day 7.
Amount and velocity of fluid removal regimen after burn injury can provoke electrolyte disorders. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy.
German medical science : GMS e-journal 06/2011; 9:Doc13. DOI:10.3205/000136
[Show abstract][Hide abstract] ABSTRACT: One symptom of Borderline personality disorder is self inflicting behavior, especially cuts and thermal injuries in the upper extremity. Due to the complex underlying psychiatric disease, surgical treatment of these injuries can be tedious and frustrating; therefore it is sometimes necessary to differ from classical plastic surgery principals and to favorite a more conservative approach. In every case, close cooperation with psychiatrist is inalienable.
Der Chirurg 05/2011; 82(5):433-41. · 0.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung
Hintergrund Symptome der Borderline-Persönlichkeitsstörungen (BPS) sind unter anderen selbstverletzende Verhaltensweisen im Bereich der
Hand und des Unterarms, die oft eine chirurgische Konsultation erfordern.
Material/Methoden In den Jahren 2007 bis 2010 wurden insgesamt 61 BPS-Patienten mit Selbstverletzungen behandelt und retrospektiv analysiert.
Ergebnisse Insgesamt 23 Patienten mussten zum Teil mehrfach operativ versorgt werden. 39 Patienten befanden sich zum Zeitpunkt der Vorstellung
in stationärer psychiatrischer Therapie. 38 Patienten konnten konservativ behandelt werden. Führend waren Schnittverletzungen
und thermische Schädigungen. In 6 Fällen waren bei Schnittverletzungen funktionelle Strukturen am Unterarm/Hand betroffen.
Schlussfolgerung Das Vorliegen einer BPS macht es häufig erforderlich, von klassischen chirurgischen Behandlungsalgorithmen abzuweichen und
einen interdisziplinären konservativen Therapieversuch vorzunehmen. Komplizierte Verläufe sind bei ausgeprägter BPS und laufender
stationärer Therapie zu beobachten. Eine begleitende psychiatrische Betreuung ist unumgänglich.
Der Chirurg 05/2011; 82(5):433-441. DOI:10.1007/s00104-010-1970-y · 0.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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).
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.
[Show abstract][Hide abstract] ABSTRACT: Severely burned patients need extensive initial fluid resuscitation. Formulas to calculate fluid needs during burn shock are well established. However, protocols for normalizing circulating fluid volume after cellular integrity has recovered do not exist. Resultant electrolyte shifts can cause hypernatremia, a possible sign of hypovolemia, which may in turn result in decreased tissue perfusion, subsequently affecting burn wound healing. The purpose of this retrospective chart review was to explore the hypothesis that hypernatremia in burn patients is a possible sign of systemic dehydration and that dehydration may affect burn wound skin graft take. Medical chart data from otherwise healthy burn victims with deep partial-thickness burns (total burn surface area [TBSA] >10%) who underwent skin grafting 7 days post injury were reviewed. Thirty (11 female; 19 male) patients with an average TBSA of 30% (± 11%) and an Abbreviated Burn Severity Index (ABSI) score of 7.9 (± 1.8) were included. Of those, 17 had normal average serum levels between day 2 and 6 following injury and 13 developed hypernatremia (serum sodium ≥146 mmol/L) an average of 5.5 days (± 1.5) after injury. Patients in this group underwent an average of 1.3 (± 0.8) re-grafting procedures compared to 0.35 (± 0.5) for patients without hypernatremia (P = 0.001). There was good correlation (r = 0.525) between daily infusion-diuresis ratios (IDR) and serum sodium levels, as well as between serum sodium levels and re-skin grafting occurrences (r = 0.62). The results indicate that research to confirm that hypernatremia is an indicator of dehydration and affects skin graft take is warranted and that protocols to optimize fluid volume following burn shock treatment are needed.
[Show abstract][Hide abstract] ABSTRACT: Desmoid tumors are non-metastatic mesenchymal tumors with an aggressive local growth. Depending on the anatomic location, morbidity varies. We report of a patient with a desmoid tumor of the right shoulder which was treated in our department by surgical excision, plastic-surgical wound closure and postoperative adjuvant radiation.
German medical science : GMS e-journal 02/2011; 9:Doc04. DOI:10.3205/000127
[Show abstract][Hide abstract] ABSTRACT: In-hospital hypernatremia is associated with increased mortality rates. We want to elucidate the impact of in-hospital acquired hypernatremia in mortality of Toxic Epidermal Necrolysis (TEN).
Is there an association between hypernatremia and mortality in patients with TEN?Method: Retrospective study of 25 patients with TEN. Laboratory electrolyte results, diuresis and survival were analyzed. Patients were separated in two groups without (Group A) or with (Group B) hypernatremia.
In Group A 10 patients with a TBSA of 74 ± 25% (mean ± standard deviation), and a SCORTEN-Score of 2.7 ± 0.9 were summarized. Diuresis within the first 10 days after admission was 1 ± 0.3 ml/kg/hour. In Group B 15 patients with a TBSA of 76 ± 19%, and a SCORTEN-Score of 3.5 ± 1 were included. Diuresis within the first 10 days after admission was 1.4 ± 0.4 ml/kg/hour. Hypernatremia occurred on day 3.3 ± 2.4 after admission and persisted for 5.3 ± 2.9 days. Statistical analysis showed a significantly higher diuresis (p=0.007) and SCORTEN-Score (p=0.04) in the hypernatremic patients. One normonatremic and 8 hypernatremic patients died during ICU-stay (overall mortality rate 36%). A significantly higher mortality rate was found in Group B (odds ratio: 13,5; 95% confidence interval: 1.34-135.98; p=0.01) during ICU-stay.
TEN patients with an in-hospital acquired hypernatremia have an increased mortality risk. Close electrolyte monitoring is advisable in these patients.
German medical science : GMS e-journal 11/2010; 8:Doc30. DOI:10.3205/000119
[Show abstract][Hide abstract] ABSTRACT: The skin protects against fluid and electrolyte loss. Burn injury does affect skin integrity and protection against fluid loss is lost. Thus, a systemic dehydration can be provoked by underestimation of fluid loss through burn wounds.
We wanted to quantify transdermal fluid loss in burn wounds.
Retrospective study. 40 patients admitted to a specialized burn unit were analyzed and separated in two groups without (Group A) or with (Group B) hypernatremia. Means of daily infusion-diuresis-ratio (IDR) and the relationship to totally burned surface area (TBSA) were analyzed.
In Group A 25 patients with a mean age of 47 ± 18 years, a mean TBSA of 23 ± 11%, and a mean abbreviated burned severity index (ABSI) score of 6.9 ± 2.1 were summarized. In Group B 15 patients with a mean age of 47 ± 22 years, a mean TBSA of 30 ± 13%, and a mean ABSI score of 8.1 ± 1.7 were included. Statistical analysis of the period from day 3 to day 6 showed a significant higher daily IDR-amount in Group A (Group A vs. Group B: 786 ± 1029 ml vs. -181 ± 1021 ml; p<0.001) and for daily IDR-TBSA-ratio (Group A vs. Group B: 40 ± 41 ml/% vs. -4 ± 36 ml/%; p<0.001).
There is a systemic relevant transdermal fluid loss in burn wounds after severe burn injury. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy to avoid water and electrolyte imbalances.
German medical science : GMS e-journal 10/2010; 8:Doc28. DOI:10.3205/000117
[Show abstract][Hide abstract] ABSTRACT: Rhabdomyolysis (RML) is a precarious complication in severely burned patients and the principal treatment goal is prevention of acute renal failure (ARF). This 10-year retrospective study analyses the causes for RML in severely burned patients and evaluates treatment algorithms. Eight of 714 patients (1%) were diagnosed with RML. Percentage TBSA burn was 25 ± 13%. The mean abbreviated burn severity index score (ABSI) was 9 ± 2. ARF was found in 75% (6/8) of the patients. Serum myoglobin (MB) was reduced by 41 ± 16% after 24-h treatment by solitary volume repletion (VR) and by 44 ± 20% through VR+continuous veno-venous hemodiafiltration (CVVHDF). Mortality was 50% (4/8). Peak mean CPK-levels were more than two and MB-levels more than four times higher in non-survivors than in survivors. Burns associated with RML result in poor survival. VR and CVVHDF are effective measures in treating RML. CVVHDF is effective in removing MB when using high flux filter membranes. Early CVVHDF (within 24h of diagnosis) with high-cut off membranes could reduce the risk of ARF and mortality.
Burns: journal of the International Society for Burn Injuries 10/2010; 37(2):240-8. DOI:10.1016/j.burns.2010.09.009 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
This retrospective analysis includes 11 children treated with a free latissimus dorsi muscle flap after severe trauma to the lower leg and foot.
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.
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.
[Show abstract][Hide abstract] ABSTRACT: Malignant tumors of pediatric hand are very rare. This case report describes an epithelioid sarcoma at the finger of an 11 year old girl and discusses general treatment options in this rare patient population.
German medical science : GMS e-journal 09/2010; 8. DOI:10.3205/000110