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ABSTRACT: : Although a multitude of proposed forehead rejuvenation procedures have been described, long-term and systematic morphometric evaluation is rare. There are no studies comparing endoscopic forehead lifts and transpalpebral browpexy techniques according to their efficacy in raising and reshaping the brow.
: In a retrospective study, standardized photographic documentations of patients undergoing an endoscopic forehead lift or a transpalpebral browpexy were morphometrically analyzed. Five measurements were taken to evaluate brow height, and two measurements were taken to describe the change in brow shape.
: Fifty-six and 29 patients, respectively, in the two groups were analyzed up to 5 years postoperatively. Morphometric evaluation proved a significant elevation of the total brow and an improvement in brow shape for the endoforehead group, whereas the brow position after the transpalpebral browpexy significantly descends, despite an improvement in subjective aesthetic outcome. An additional blepharoplasty after the endoscopic forehead lift does not lower the brow significantly.
: The efficacy of the endoforehead lift is supported by extensive, systematic, and long-term data, and its superiority over transpalpebral approaches has been proven. The descent of the brow after transpalpebral browpexy is most likely caused by a decrease of frontalis hyperactivity after the simultaneously performed blepharoplasty. Further studies need to evaluate its effect compared with blepharoplasty alone.
: Therapeutic, III.
Plastic and reconstructive surgery 12/2012; 130(6):830e-40e. · 2.74 Impact Factor
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ABSTRACT: Resection of intraorbital fat compartments in lower-lid blepharoplasty has been widely replaced by their realignment over
the orbital rim. For older patients this usually includes an open subciliary approach with skin resection and orbicularis
muscle modification. In younger patients this may be done transconjunctivally. Fixation of the adipose tissue is controversial.
Whereas reliance of realignment on spontaneous prolapse may be unpredictable, suture fixations may be tedious and even cause
scleral show or ectropion. A monofilament, double-armed, polypropylene suture on bent straight needles can be used safely
to transfix the three compartments across maxilla and zygoma. These transcutaneous pullout sutures are simply fixed with steri-strips.
After only 2days the orbital fat will be sufficiently adherent to its new bed.
Aesthetic Plastic Surgery 04/2012; 32(5):785-789. · 1.41 Impact Factor
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Plastic and reconstructive surgery 06/2011; 127(6):2507. · 2.74 Impact Factor
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ABSTRACT: Radical surgical resection remains the single-most important treatment in the curative multimodal therapy of soft tissue sarcomas. Refinements in surgical techniques have resulted in the development of function preserving approaches increasingly avoiding limb amputation.
The records of all patients (n = 34) who underwent microsurgical soft tissue coverage subsequent to primary resection of soft tissue sarcoma of the upper or lower limb from 1999 to 2009 are reviewed regarding postoperative complications, time until start of adjuvant radiation and functional outcome (Toronto Extremity Salvage Score, TESS). Results: Thirty-four patients (range: 21-86 years) received a total of 35 free flaps. Complete tumor resection was obtained in 33 patients, one patient required re-excision ultimately resulting in tumor-free margin status (R0 resection). Major complications were encountered in four cases including one patient with complete flap loss requiring an additional free flap and three patients with partial flap loss requiring split-thickness skin graft procedures. Minor complications were observed in three patients (9%). Extremity salvage could be achieved in 33 patients with adequate postoperative ambulation (TESS 84 ± 18) and adequate use of the upper extremity (TESS 80 ± 22). One patient underwent amputation. Mean time until start of adjuvant radiotherapy was 37 days (range 24-56 days).
A synergetic center-based interdisciplinary approach is crucial in therapeutical management of soft tissue sarcomas with the aim of R0 resection status and limb preservation. Plastic surgery contributes by offering microsurgical reconstruction using free tissue transfer, thus broadening surgical possibilities. This increases the chance of both adequate oncosurgical resection and limb preservation.
Microsurgery 05/2011; 31(6):434-40. · 1.61 Impact Factor
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ABSTRACT: Our current knowledge of the pathophysiological sequelae of ischemia or reperfusion (I/R) injury in free tissue transfer in reconstructive surgery is based on data obtained in animal experiments. In this study, we investigated the histologic and molecular changes after 11 free microsurgical muscle transfers in human muscle tissue.
Biopsies of free muscle flap tissue were taken immediately before clipping of the pedicle and 5 days after ischemia and successful microanastomosis and restoration of the blood flow. Samples were analyzed histologically for edema formation and by immunohistochemistry for infiltration of inflammatory cells and angiogenesis. Expression levels of the inflammatory marker proteins interleukin-1β and tumor necrosis factor α and of complement component 3 as a major mediator of I/R injury were analyzed by real-time polymerase chain reaction. A TUNEL (terminal desoxynucleotidyl transferase-mediated-dUTP-nick-end-labeling) assay was used to assess apoptosis levels within the human muscle tissue.
I/R injury leads to a significant up-regulation of inflammatory parameters, infiltration of inflammatory cells, and angiogenesis. Increased complement component 3 deposition and apoptosis of cells were accompanied by interstitial edema as indication for a pronounced postischemic inflammatory reaction within the muscle tissue after free tissue transfer.
Our findings of molecular changes induced by I/R injury in human striated muscle tissue validate data obtained in animal models of I/R injury. The parameters and inflammatory patterns defined in this study will allow for the monitoring of the success of novel pharmaceutical strategies in the future and will help to transfer data obtained in animal work to the in vivo setting in human beings.
Annals of plastic surgery 04/2011; 68(2):202-8. · 1.29 Impact Factor
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ABSTRACT: A 75-year-old woman presented with progressing pain, cyanosis, and hypaesthesia in her left hand after an intra-articular injection with diazepam into the wrist for osteoarthritis-related pain. Due to an iatrogenic intra-arterial injection, malperfusion of the ulnar digits developed. Angiography revealed blockage of perfusion of the 4th and 5th digits. Despite intra-arterial lysis, heparinisation, and vasodilatation, perfusion could not be reinstalled. Necrosis of the distal phalanges of the 4th and 5th digits developed, which had to be treated with amputation. The pathomechanism of tissue damage and the treatment options after intra-arterial injections are reviewed and discussed.
Case reports in surgery. 01/2011; 2011:347523.
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ABSTRACT: Introduction of vacuum-assisted closure (VAC) system into clinical practice has revolutionized wound care. Despite its multiple advantages, however, the VAC is only rarely used in the setting of microsurgical reconstruction. Concerns have been the inability to clinically monitor the flap as well the possibility of flap compression by the device. The authors put their postoperative treatment concept of applying the VAC to free flaps to the test by reviewing their experience with this concept in patients undergoing microsurgical reconstruction of posttraumatic lower-extremity soft tissue defects. Twenty-six patients (22 male, 4 female) were included in this study. Use of the implantable Doppler probe allowed for postoperative flap monitoring. Two flap failures were observed, both in patients with peripheral vascular disease. In conclusion, using the VAC device in the setting of microsurgical reconstruction is safe and allows for increased patient comfort.
Journal of Reconstructive Microsurgery 10/2010; 26(9):615-22. · 1.43 Impact Factor
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Plastic and reconstructive surgery 08/2010; 126(2):83e-4e. · 2.74 Impact Factor
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ABSTRACT: Modern reconstructive surgery allows for radical resection and reconstruction of any scalp tumor. However, a significant number of patients are still not treated optimally because of incomplete reconstructive guidelines.
The treatment of scalp tumors was documented in 60 patients over a 10-year period. Data regarding tumor type, size, and localization; reconstructive procedure; oncologic, functional, and aesthetic outcome; and complications were collected and analyzed retrospectively. These data were correlated to recurrence and survival rates. The findings extracted from the data were amalgamated to produce the proposed reconstructive algorithm.
Five reconstructive categories were defined and their application could be described in an algorithmic approach. Indications, limitations, and adequate reconstructive procedures for each category were identified. The most important decisions are when to use local flaps versus primary closure and when to use free tissue transfer.
Radical surgical resection and reconstruction presents the best available method to cure scalp tumors or to establish local disease control in palliative settings. The authors present an algorithm to assist in the planning process of oncologic scalp reconstruction. If this algorithm is applied, the occurrence of inadequate resections and the need for repeated procedures can be minimized.
Plastic and reconstructive surgery 08/2010; 126(2):450-9. · 2.74 Impact Factor
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ABSTRACT: : Stable internal screw/plating systems for hand fractures have evolved during the last 20 years. The improved versatility leads to the increased use of these materials in open fractures, with the benefit of early mobilization. The aim of this retrospective study is to discern whether the broadening of the indications for these implants is accompanied by increased complication rates.
: Data from 365 patients treated during the last 10 years at our department for metacarpal or phalangeal fractures with stable internal fixation by screw or plate were gathered and analyzed.
: Uneventful bony consolidation was observed in 91.2% (n = 333). The functional results were excellent to acceptable in 85.2%, whereas in 14.8% (n = 54), the result was unsatisfactory, the latter group presenting with concominant soft tissue injury. There was no statistically significant difference in infection and nonunion rates when comparing open and closed fractures.
: These results confirm that most patients with open metacarpal and phalangeal fractures can be treated by stable internal fixation.
The Journal of trauma 03/2010; 68(3):624-8. · 2.48 Impact Factor
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ABSTRACT: Evaluation parameters for free flap monitoring devices are used inconsistently, leading to considerable confusion about the quality and applicability of these devices. A comparison of different systems and different clinical series is almost impossible. The ultimate questions that need to be answered are those regarding the efficiency and the effectiveness of the system. A new tool consisting of two simple parameters that sufficiently and comparably describe the quality of monitoring devices is developed. The flap failure reduction rate describes the percentage of saved flaps (effectiveness). The revision success rate describes the efficiency. Literature reevaluation shows inconsistent results, although all authors describe a positive experience. This shows the limited value of the classical parameters. Larger studies have flap failure reduction rates of 5 to 12% (5 to 12% of monitored flaps are saved). Revision success rates of 75 to 90% prove that the system is efficient enough in daily use. Reevaluation of the smaller reported series result in lower parameters, which shows that there is a significant learning curve for this device. The new parameters alleviate the confusion surrounding evaluation of monitoring systems by giving specific information about effectiveness and efficiency. The benefits of the implanted Doppler probe can now be clearly described. However, in several studies the benefit of the system is overrated.
Journal of Reconstructive Microsurgery 02/2010; 26(4):265-70. · 1.43 Impact Factor
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ABSTRACT: Upper lip rejuvenation is achieved by a large variety of different treatment approaches that clearly lack a unified theoretical background of the aging processes of the upper lip complex. In this study, the histological changes that occur in the aging upper lip were systematically evaluated for the first time.
Histological cross-cuts of the upper lip complex of 20 individuals in two age groups, young (<40 years, n = 10) and old (>80 years, n = 10), were analyzed. The specimens were collected during the autopsies of individuals with no facial injuries. Hematoxylin-eosin and elastica van Gieson staining was performed, and the relevant anatomical structures were measured and compared using Student's t test.
Histomorphometric analysis revealed statistically significant thinning of the cutis, thinning of the orbicularis oris muscle, and an increase of the orbicularis oris muscle angle defining the vermilion border in the old lip group. Elastic and collagen fibers in the cutis undergo degeneration processes during aging. The orbicularis oris muscle is not subject to fatty or fibroblastic degeneration, but shows signs of atrophy.
The histomorphometric and histomorphological analyses shed light on the, so far, only unsystematically and episodically described process of upper lip aging on a histological level. The distinct changes add further evidence to the theory that the aged look is due to a loss of elasticity and resultant ptosis of the upper lip rather than to often-postulated but unproven total volume loss.
Plastic and reconstructive surgery 08/2009; 124(2):624-8. · 2.74 Impact Factor
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The Journal of thoracic and cardiovascular surgery 10/2008; 136(3):790-1, 791.e1-13. · 3.41 Impact Factor
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ABSTRACT: A lack of scientific data about the complex three dimensional changes in relation to the rest of the face is the reason for the multitude of rejuvenation approaches to the aging upper lip. In this study the underlying anatomic changes and facial proportions of the senile upper lip are scientifically evaluated for the first time.
(1) In 182 standardized subject photographs proportions of the upper lip were measured, compared to facial dimensions and correlated to age. (2) In cranial MRI scans of 30 women aged 20-35 and 30 women aged 65-80 relevant anatomical dimensions were measured.
Both studies showed a statistically significant lengthening of the aging upper lip. The photomorphometric study further shows an increase of prolabium skin at the cost of a decreasing visible upper lip vermilion. The MRI scans showed a decrease in thickness. A loss of volume could not be shown.
Isolated volume augmentation is not a causal method of upper lip rejuvenation and it may therefore rather lead to an unnatural 'blown up' look.
Journal of Plastic Reconstructive & Aesthetic Surgery 10/2008; 61(10):1170-6. · 1.49 Impact Factor
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ABSTRACT: The pectoralis myocutaneous island flap is a well established technique for tissue reconstruction. In female patients with concomitant breast hypertrophy there may be a simultaneous indication for breast reduction mammoplasty. The inferior pole of the breast and the inframammary fold coincide with the skin island territory of myocutaneous flaps supplied by the thoracoacromial artery.
A technique is described where this tissue is preserved as the flap skin island in combination with a superior pedicle reduction mammoplasty. The technique is illustrated with two exemplary cases.
The technique is suitable in women with relative unilateral or absolute bilateral large breasts with a combined sternal defect and should be taken into consideration for respective cases.
Journal of Plastic Reconstructive & Aesthetic Surgery 07/2008; 62(8):1076-80. · 1.49 Impact Factor
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ABSTRACT: Although many technical descriptions of nipple reconstruction exist in the medical literature, insufficient evidence-based data are present about the outcome. This study aimed to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) in the plastic surgical literature addressing nipple reconstruction, and to elucidate whether a hand search was superior to an extensive database search in retrieving all pertinent studies. The hand search included analysis of all "original articles" published in four of the leading plastic surgery journals from January 1990 to December 2005, with subsequent identification of RCTs and CCTs. Additionally, a computerized search was conducted including the following databases: PubMed, Web of Science, and Evidence-Based Medicine Reviews. From a total of 10,476 published original articles in four plastic surgery journals over a 16-year period, only one RCT was identified that addressed nipple reconstruction. The database search, however, retrieved two trials: the RCT identified by hand search and one CCT. The impact of nipple reconstruction is well described in the literature. However, it is astonishing that the plastic surgical literature lacks evidence-based trials addressing this issue. Clearly, more evidence-based trials are necessary to ensure that recommendations for a particular technique are based on solid scientific data.
Aesthetic Plastic Surgery 02/2008; 32(1):18-20. · 1.41 Impact Factor
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ABSTRACT: Liposuction or its modifications have become accepted therapy for hyperhidrosis. During the nearly 20 years since its introduction, the actual anatomic removal of sweat glands has not been investigated. In this study, three patients underwent axillary liposuction and histologic examination of the aspirates. Apocrine sweat glands embedded in adipose tissue were found throughout the crosscuts. These results prove that the therapeutic effects are at least partially attributable to removal of glandular tissue.
Aesthetic Plastic Surgery 31(1):16-8. · 1.41 Impact Factor
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ABSTRACT: A recent clinical case at the Freiburg University Hospital, Germany, involving burn injuries sustained by cupping treatments is reviewed. The history of the cupping method, indications and contemporary use of this treatment, and the risks from the standpoint of the plastic surgeon are discussed.
Journal of burn care & research: official publication of the American Burn Association 28(2):355-8. · 1.37 Impact Factor
