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ABSTRACT: To treat the ever growing number of obese patients, reduction of adipocyte number by apoptosis may complement other therapeutic options. On the other hand in free fat grafts, apoptosis along with necrosis is responsible for long term volume reduction. To ensure successful soft tissue reconstruction it is mandatory to keep apoptosis on a low level in adipocytes, adipose-derived stromal cells and others cells of the fat graft. Apoptotic pathways have been sufficiently studied in various tissues, but the knowledge about apoptotic pathways in adipocytes is surprisingly scarce. Current knowledge about apoptotic pathways in adipose tissue is elaborately reflected in this review as well as the association of cancer with obesity. Possibilities to induce and reduce adipose tissue apoptosis in animal models are discussed as well as clinical implications of fat cell apoptosis. Mechanisms of apoptosis induction have been studied in animal models and suggest that a tight control of apoptosis induction is necessary because otherwise detrimental metabolic effects of fat mass loss will occur that may mimic lipodystrophic diseases. At present, targeted induction of adipocyte apoptosis appears to be of some concern related to increased blood lipid concentrations, ectopic lipid storage and other detrimental metabolic effects. Treatment of autologous adipocytes used for lipofilling procedures with appropriate substances may result in more satisfactory long-term outcomes as well as stimulation of stem cell differentiation in a strictly local manner.
Apoptosis 04/2013; · 4.07 Impact Factor
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[show abstract]
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ABSTRACT: Autologous fat transplantation has gained great recognition in aesthetic and reconstructive surgery. Two main aspects are of predominant importance for progress control after autologous fat transplantation to the breast: quantitative information about the rate of fat survival in terms of effective volume persistence and qualitative information about the breast tissue to exclude potential complications of autologous fat transplantation. There are several tools available for use in evaluating the rate of volume survival. They are extensively compared in this review. The anthropometric method, thermoplastic casts, and Archimedes' principle of water displacement are not up to date anymore because of major drawbacks, first and foremost being reduced reproducibility and exactness. They have been replaced by more exact and reproducible tools such as MRI volumetry or 3D body surface scans. For qualitative and quantitative progress control, MRI volumetry offers all the necessary information: evaluation of fat survival and diagnostically valuable imaging to exclude possible complications of autologous fat transplantation. For frequent follow-up, e.g., monthly volume analysis, repeated MRI exams would not be good for the patient and are not cost effective. In these cases, 3D surface imaging is a good tool and especially helpful in a private practice setting where fast data acquisition is needed. This tool also offers the possibility of simulating the results of autologous fat transplantation. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Aesthetic Plastic Surgery 01/2013; · 1.41 Impact Factor
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Plastic and reconstructive surgery 09/2012; 130(3):479e-80e. · 2.74 Impact Factor
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[show abstract]
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ABSTRACT: In spite of potential implications for anti-aging therapy regarding the selection of the most suitable therapeutical method and potential perinterventional complications, cutaneous microcirculation of the aging hand in healthy individuals as well as in those with diabetes mellitus or peripheral arterial occlusive disease (PAOD) has never been evaluated.
Functional microcirculation of the dorsal hand differs between healthy individuals and individuals with diabetes or PAOD at the same age.
Prospective controlled cohort study. One hundred ten individuals were allocated to group A (healthy individuals, n = 37), group B (diabetes mellitus, n = 36), and group C (PAOD, n = 37). Microcirculatory data were obtained using combined laser-Doppler and photospectrometry.
Cutaneous oxygen saturation at the dorsal hand of healthy individuals was 11.1% higher than of those with diabetes mellitus (p = .04) and 18.8% higher than of those with PAOD (p = .001). Cutaneous capillary blood flow in participants with PAOD was 20% higher than in healthy individuals (p = .047).
This is the first study demonstrating that capillary microcirculation of the dorsal hand differs between healthy individuals and those with diabetes or PAOD of the same age. Further studies should explore whether ameliorating cutaneous tissue oxygen saturation could emerge as a viable antiaging strategy for elderly hands.
Dermatologic Surgery 07/2012; 38(7 Pt 2):1136-42. · 1.80 Impact Factor
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[show abstract]
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ABSTRACT: Operationsziel
Defektdeckung des beuge- und streckseitigen Hand- und
Unterarmbereichs bis zu einer maximalen Defektgröße
von 10 × 25 cm.
Indikationen
Weichteildefekte des beuge- und streckseitigen Hand-
und Unterarmbereichs bis zu einer maximalen Defektgröße
von 10 × 25 cm.
Kontraindikationen
Polytraumatisierte Patienten mit lebensbedrohlichen Begleitverletzungen.
In diesen Fällen sollte die definitive
Weichteildeckung spätprimär oder sekundär nach Kreislaufstabilisierung
erfolgen.
Schlecht vaskularisiertes Empfängergebiet (z.B. nach
Radiatio).
Floride Infekte im Empfänger- und/oder Spendergebiet
sowie Nekrosen.
Voroperationen der Leistenregion mit Kompromittierung
der Gefäße.
Nicht kooperativer Patient.
Operationstechnik
Orientierungspunkte zur Lappenumschneidung sind der
tastbare Puls der Arteria femoralis, das Leistenband, die
Spina iliaca anterior superior und der Musculus sartorius.
Einzeichnung des Lappenober- und -unterrandes parallel
zum Leistenband, wobei die Längsachse des Lappens dem
Verlauf der Arteria circumflexa ilium superficialis entspricht,
die anteilig oberhalb des Leistenbandes verläuft.
Ein Drittel des Lappens sollte oberhalb und zwei Drittel
sollten unterhalb des Leistenbandes zu liegen kommen.
Die Lappenpräparation beginnt im lateralen Abschnitt ohne
Einschluss der Faszie. Um eine Verletzung des Gefäßstiels zu
vermeiden, erfolgt die vorsichtige Identifikation des lateralen
Sartoriusrandes, dessen Faszie eingeschnitten und in den
Lappen miteinbezogen wird. Ein langer Rundstiel erfordert
unter Umständen, die Präparation der A. circumflexa ilium
superficialis bis zu ihrem Ursprung fortzusetzen. Nach
Hebung des Lappens Einschwenken des Lappens in den
Defektbereich und Einnaht mit Rundstielbildung. Der Rundstiel
schützt die Lappengefäße und erleichtert die ischämische
Konditionierung des Lappens in der postoperativen
Phase. Je nach Lappengröße spannungsfreier Primärverschluss
des Hebedefekts oder Spalthautdeckung.
Die durchschnittliche Operationszeit in einer Ausbildungsklinik
beträgt 120 min (Daten aus dem eigenen Pa-tientengut).
Weiterbehandlung
3-wöchige Stielung des Lappentransplantats und sofortige
Mobilisierung des Patienten. Vermeidung von Abknickungen
des Lappenstiels; hierzu ggf. Unterpolsterung des
Arms und Lagerung in angepasster Schulterabduktion.
Tägliche Verbandswechsel und Lappenmonitoring zur Vitalitätsprüfung.
Ab dem 10.–14. postoperativen Tag Lappentraining
mit Abklemmen des Lappenstiels mit einer
Darmklemme. Steigerung der Abklemmzeit um täglich
5–10 min von initial 3 × 5 min/d auf 3 × 1 h/d. Lappenstieldurchtrennung
nach Erreichen der maximalen Abklemmzeit
nach 3 Wochen unter Belassung eines ausreichend
langen Lappenstiels im Empfängergebiet und Sekundärverschluss
der Leiste. Nach Demarkierung des Lappenstielendes
endgültige Einpassung des Leistenlappens.
Ergebnisse
In einem 3-Jahres-Zeitraum wurde bei insgesamt 14 Patienten
eine Defektdeckung mit dem gestielten Leistenlappen
durchgeführt. Indikationen für das Verfahren waren
die Daumenrekonstruktion nach Avulsionsamputation
zum Längenerhalt und zur Defektdeckung, die spätsekundäre
Wiederherstellung der Daumenlänge durch eine Beckenkammspaninterposition,
die Rekonstruktion der Daumenweichteile
nach radikalem Débridement einer tiefen
zweitgradigen Verbrennung, Hautweichteildefekte im Bereich
des Handrückens nach traumatischer Kontusion und
Infekt, ausgedehnte Hautweichteildefekte nach Kombinationsverletzung
des distalen Unterarms, Handgelenks und
der Hohlhand sowie ein plastisch-rekonstruktiver Langfingererhalt
mit nachfolgender Phalangealisierung bzw. Syndaktylietrennung.
Die Anwendung des Leistenlappens führte in allen Fällen
zur vollständigen Defektdeckung. In keinem der Fälle kam
es zu einem Lappenverlust, und bei sämtlichen Patienten
konnte ein zufriedenstellendes funktionelles und ästhetisches
Ergebnis erzielt werden.
Objective
Soft-tissue defect closure of the volar and dorsal aspect of
the hand and lower arm with a maximum defect size of
10 × 25 cm.
Indications
Soft-tissue defects of the entire palm and dorsum of the
hand and lower arm with a maximum defect size of
10 × 25 cm.
Contraindications
Polytraumatized patients presenting with concomitant
life-threatening injuries. In these cases one should perform
the definite defect closure secondary after cardiovascular
stabilization. Scars and vascular injury at the donor site.
Lack of vascularity and necrosis of implantation site.
Poorly vascularized recipient site (e.g. after radiation)
Infection and necrosis at the donor and/or recipient site.
Prior operations of the groin with impairment of the vasculature.
Noncompliant patient.
Surgical Technique
Landmarks are the femoral artery, inguinal ligament, anterior
superior iliac spine, and sartorius muscle.
The superior and inferior border of the flap should be orientated
parallel to the inguinal ligament. The longitudinal
axis of the flap is parallel to the superficial circumflex iliac
artery, which is partially located superior to the inguinal
ligament. One third of the flap is located superior, and two
thirds inferior, to the inguinal ligament.
Flap dissection starts at the lateral border without including
the fascia. Identification of the lateral border of the sartorius
muscle, incision of its fascia and inclusion of the fascia
into flap dissection in order to preserve the vessel.
If a long flap pedicle is favored, flap dissection is continued
to the source of the superficial circumflex iliac artery.
Primary closure of the donor site and, finally, inset of the
flap. A tubed pedicle protects the vessels and simplifies the
ischemic preconditioning during the postoperative phase.
According to the flap size, the donor site closure is either
primary or split-thickness skin grafting is necessary at the
lateral aspect of the donor site.
The mean duration of the procedure is 120 min in a teaching
hospital (own data).
Postoperative Management
The patient should be mobilized as early as possible. Dressings
and flap monitoring should be performed daily. Ischemic
preconditioning by applying a tourniquet starts after
10–14 days. The ischemic period is increased continuously
from 3 × 5 min/d in the beginning to 3 × 1 h/d before flap
dissection. Flap dissection of the pedicle is performed after
3 weeks. The residual donor site is closed, while the distal
pedicle is left untrimmed and closed secondarily a few days
later to allow for sufficient venous drainage. Finally, defect
closure can be completed after demarcation of the pedicle.
Results
In a 3-year period, defect closure with a pedicled groin flap
was performed in 14 patients. Indications for this procedure
were the following: thumb reconstruction for lengthening
and defect closure after amputation and burn injury,
soft-tissue reconstruction of the dorsum of the hand after
decollement and infection, soft-tissue reconstruction of the
distal part of the lower arm, wrist and palm after complex
and combined trauma, and plastic reconstructive preservation
of multiple fingers with subsequent phalangealization
and syndactyly release, respectively.
In all patients, complete soft-tissue coverage and flap survival
could be achieved. The functional and aesthetic result
was satisfactory in all cases.
Schlüsselwörter
Leistenlappen-Defektdeckung-Daumenrekonstruktion
Key Words
Groin flap-Defect closure-Thumb reconstruction
Operative Orthopädie und Traumatologie 04/2012; 22(4):440-451. · 0.46 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Fat cells are fragile cells with a short life span outside the body. Ways to reduce cell death in a biochemical way are almost unknown due to scarce information on the type of cellular death that is induced in fat tissue. This study was designed to investigate the apoptotic pathways of fat tissue in a permanent perfusion bioreactor system with the Hannover preservation solution and the Eurocollins solution in fat flaps of rats. In Lewis rats, the inguinal adipofascial flaps were elevated bilaterally and placed in a bioreactor at 37°C. To detect caspases 3, 8, 9 and 12, immunofluorescence stains of fat tissue specimen were analysed at several time points after preservation of flaps were placed in Hannover solution and Eurocollins solution for 10 days. An additional visual assessment of viability by a calcein based life/dead test was performed. It revealed a superior viability of the adipose tissue preserved in Hannover solution. Immunofluorescence staining demonstrated that apoptotic pathways via mitochondria, endoplasmatic reticulum and death receptors were activated, as Caspases 8, 9 and 12 were detected. Caspase 3 as an effector in the common apoptotic pathway was detected as well. Adipose tissue preserved at 37°C ex vivo in a bioreactor system undergoes apoptosis. Immunofluorescence examination of the fat tissue preserved ex vivo revealed that apoptotic pathways via mitochondria, endoplasmatic reticulum and death receptors are being activated. Significantly less activation of Caspase 3, 8, 9 and 12 in flaps preserved in Hannover solution in comparison to Eurocollins was found, supporting the anti apoptotic characteristics of Hannover solution. Based on these findings, further research to modify the apoptotic pathways to ameliorate viability of fat tissue can be performed.
Apoptosis 01/2012; 17(4):400-9. · 4.07 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Advanced strategies in reconstructive microsurgery and especially free tissue transfer with advanced microvascular techniques have been routinely applied and continuously refined for more than three decades in day-to-day clinical work. Bearing in mind the success rates of more than 95%, the value of these techniques in patient care and comfort (one-step reconstruction of even the most complex tissue defects) cannot be underestimated. However, anticoagulative protocols and practices are far from general acceptance and - most importantly - lack the benchmark of evidence basis while the reconstructive and microsurgical methods are mostly standardized. Therefore, the aim of our work was to review the actual literature and synoptically lay out the mechanisms of action of the plethora of anticoagulative substances. The pharmacologic prevention and the surgical intervention of thrombembolic events represent an established and essential part of microsurgery. The high success rates of microvascular free tissue transfer as of today are due to treatment of patients in reconstructive centers where proper patient selection, excellent microsurgical technique, tissue transfer to adequate recipient vessels, and early anastomotic revision in case of thrombosis is provided. Whether the choice of antithrombotic agents is a factor of success remains still unclear. Undoubtedly however the lack of microsurgical experience and bad technique can never be compensated by any regimen of antithrombotic therapy. All the more, the development of consistent standards and algorithms in reconstructive microsurgery is absolutely essential to optimize clinical outcomes and increase multicentric and international comparability of postoperative results and complications.
German medical science : GMS e-journal 01/2012; 10:Doc01.
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ABSTRACT: Therapeutic strategies aiming to reduce ischemia/reperfusion injury by conditioning tissue tolerance against ischemia appear attractive not only from a scientific perspective, but also in clinics. Although previous studies indicate that remote ischemic intermittent preconditioning (RIPC) is a systemic phenomenon, only a few studies have focused on the elucidation of its mechanisms of action especially in the clinical setting. Therefore, the aim of this study is to evaluate the acute microcirculatory effects of remote ischemic preconditioning on a distinct cutaneous location at the lower extremity which is typically used as a harvesting site for free flap reconstructive surgery in a human in-vivo setting.
Microcirculatory data of 27 healthy subjects (25 males, age 24 ± 4 years, BMI 23.3) were evaluated continuously at the anterolateral aspect of the left thigh during RIPC using combined Laser-Doppler and photospectrometry (Oxygen-to-see, Lea Medizintechnik, Germany). After baseline microcirculatory measurement, remote ischemia was induced using a tourniquet on the contralateral upper arm for three cycles of 5 min.
After RIPC, tissue oxygen saturation and capillary blood flow increased up to 29% and 35% during the third reperfusion phase versus baseline measurement, respectively (both p = 0.001). Postcapillary venous filling pressure decreased statistically significant by 16% during second reperfusion phase (p = 0.028).
Remote intermittent ischemic preconditioning affects cutaneous tissue oxygen saturation, arterial capillary blood flow and postcapillary venous filling pressure at a remote cutaneous location of the lower extremity. To what extent remote preconditioning might ameliorate reperfusion injury in soft tissue trauma or free flap transplantation further clinical trials have to evaluate.
ClinicalTrials.gov: NCT01235286.
BMC Surgery 11/2011; 11:32. · 1.33 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Heparin-induced thrombocytopenia (HIT) is a life-threatening complication in intensive care settings. The timely diagnosis and management of HIT are challenging, and the incidences of HIT and deep venous thrombosis (DVT) may be related to prophylactic anticoagulation standards in burn units. We therefore evaluated, using a questionnaire, prophylactic anticoagulation, HIT management, and incidences of DVT and HIT in burn centers located in the German-speaking part of Europe. In the 21 responding burn centers, 1611 patients were treated and the overall incidences for clinically overt DVT and HIT in 2008 were 1.1% and 1.4%, respectively. Burn centers using low molecular weight heparin (LMWH) subcutaneous for all patients had a low rate of DVT (0.9%) and significantly lower rates of HIT (0.2%) relative to all other centers (P < 0.05). The highest rates of HIT (2.7%) and DVT (3.8%) were found in burn centers administering unfractionated heparin intravenous. While current HIT guidelines do not specify the administration of unfractionated heparin or LMWH for burn patients, these data warrant controlled prospective studies to confirm the advantage of LMWH administration in burn patients.
Annals of plastic surgery 07/2011; 67(1):17-24. · 1.29 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: A postoperative defect of the surrounding soft tissue is one main risk factor for implant exposure and infection following total knee arthroplasty (TKR). The main factors that promote infection, tissue ischemia, and hypoxia are strongly associated with arterial insufficiency and the prevalence of impaired peripheral perfusion. We hypothesized that vascular malperfusion is the predisposing reason for soft tissue complications following TKR necessitating plastic reconstructive surgery.
A retrospective chart review was made among patients (n = 12) with soft tissue defects due to wound infection following a total knee arthroplasty referred to plastic reconstructive surgery. All patients presented with an exposed implant, and angiographic imaging was performed prior to reconstructive procedures.
Eight out of twelve patients (67%) had a pathological vascular status. In three of these patients, interventional procedures were performed to ameliorate perfusion. In ten patients (83%), the defect was covered with a plastic reconstructive regional or free tissue transfer. Four patients received a free latissimus dorsi flap and six patients a pedicled a gastrocnemius muscle flap. In one patient, a secondary wound closure was needed after knee arthrodesis and an amputation was performed in another patient due to a multiresistant staphylococcus aureus infection and massive tissue destruction at the time of admission.
We suggest to rule out peripheral occlusive disease among patients undergoing TKR at best prior to orthopedic surgery using pulses and, if in doubt ankle-brachial index and doppler sonography Consequently, if vascular occlusions are then confirmed by angiography, dilatation and stenting or revascularization should be performed, to ameliorate perfusion.
Knee Surgery Sports Traumatology Arthroscopy 05/2011; 19(12):2045-9. · 2.21 Impact Factor
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Journal of Reconstructive Microsurgery 05/2011; 27(5):327-8; authors reply 329-30. · 1.43 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Traditionally, carbon monoxide poisoning and/or burn are considered contraindications to organ procurement. Previously reported cases have shown mixed results and many have been redundantly reported in the literature.
We performed a systematic review of all reported cases of organ transplantation procured from donors with carbon monoxide poisoning and/or burn to investigate whether these patients are suitable donors for solid organ transplantations.
Organ survival rates of reported organs were high (86%). All organs procured from donors with carbon monoxide poisoning and burn survived during follow-up. Mean donors' peak carbon monoxide levels were comparable for organs surviving or failing during follow-up (31 ± 2.7 vs. 29 ± 26.8; p=0.95). Eighty-seven per cent of organs procured from donors supported with inotropes or vasopressors prior to organ procurement and 91% of organs procured from donors who were cardiopulmonary resuscitated prior to organ procurement survived during follow-up.
Burn, carbon monoxide poisoning, high peak carbon monoxide-levels, use of inotropes or vasopressors or cardiopulmonary resuscitation prior to procurement are not contraindications for organ procurement and transplantation. New guidelines for burn units defining the special requirements for organ procurement from donors with carbon monoxide poisoning and/or burn are needed to raise the awareness for potential organ donors and to ultimately increase the donor pool and save patients' lives.
Burns: journal of the International Society for Burn Injuries 03/2011; 37(5):814-22. · 1.95 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients.
Journal of Reconstructive Microsurgery 02/2011; 27(2):127-32. · 1.43 Impact Factor
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Plastic and reconstructive surgery 11/2010; 126(5):260e-261e. · 2.74 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Soft-tissue defect closure of the volar and dorsal aspect of the hand and lower arm with a maximum defect size of 10 × 25 cm.
Soft-tissue defects of the entire palm and dorsum of the hand and lower arm with a maximum defect size of 10 × 25 cm.
Polytraumatized patients presenting with concomitant life-threatening injuries. In these cases one should perform the definite defect closure secondary after cardiovascular stabilization. Scars and vascular injury at the donor site. Lack of vascularity and necrosis of implantation site. Poorly vascularized recipient site (e.g. after radiation) Infection and necrosis at the donor and/or recipient site. Prior operations of the groin with impairment of the vasculature. Noncompliant patient.
Landmarks are the femoral artery, inguinal ligament, anterior superior iliac spine, and sartorius muscle. The superior and inferior border of the flap should be orientated parallel to the inguinal ligament. The longitudinal axis of the flap is parallel to the superficial circumflex iliac artery, which is partially located superior to the inguinal ligament. One third of the flap is located superior, and two thirds inferior, to the inguinal ligament. Flap dissection starts at the lateral border without including the fascia. Identification of the lateral border of the sartorius muscle, incision of its fascia and inclusion of the fascia into flap dissection in order to preserve the vessel. If a long flap pedicle is favored, flap dissection is continued to the source of the superficial circumflex iliac artery. Primary closure of the donor site and, finally, inset of the flap. A tubed pedicle protects the vessels and simplifies the ischemic preconditioning during the postoperative phase. According to the flap size, the donor site closure is either primary or split-thickness skin grafting is necessary at the lateral aspect of the donor site. The mean duration of the procedure is 120 min in a teaching hospital (own data).
The patient should be mobilized as early as possible. Dressings and flap monitoring should be performed daily. Ischemic preconditioning by applying a tourniquet starts after 10-14 days. The ischemic period is increased continuously from 3 × 5 min/d in the beginning to 3 × 1 h/d before flap dissection. Flap dissection of the pedicle is performed after 3 weeks. The residual donor site is closed, while the distal pedicle is left untrimmed and closed secondarily a few days later to allow for sufficient venous drainage. Finally, defect closure can be completed after demarcation of the pedicle.
In a 3-year period, defect closure with a pedicled groin flap was performed in 14 patients. Indications for this procedure were the following: thumb reconstruction for lengthening and defect closure after amputation and burn injury, soft-tissue reconstruction of the dorsum of the hand after decollement and infection, soft-tissue reconstruction of the distal part of the lower arm, wrist and palm after complex and combined trauma, and plastic reconstructive preservation of multiple fingers with subsequent phalangealization and syndactyly release, respectively. In all patients, complete soft-tissue coverage and flap survival could be achieved. The functional and aesthetic result was satisfactory in all cases.
Operative Orthopädie und Traumatologie 10/2010; 22(4):440-51. · 0.46 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: As lipofilling of the female breast is becoming more popular in plastic surgery, the use of MRI to assess breast volume has been employed to control postoperative results. Therefore, we sought to evaluate the accuracy of magnetic resonance imaging (MRI)-based breast volumetry software tools by comparing the measurements of silicone implant augmented breasts with the actual implant volume specified by the manufacturer. MRI-based volume analysis was performed in eight bilaterally augmented patients (46 ± 9 years) with three different software programs (Brainlab© I plan 2.6 neuronavigation software; mass analysis, version 5.3, Medis©; and OsiriX© v.3.0.2. 32-bit). The implant volumes analysed by the BrainLab© software had a mean deviation of 2.2 ± 1.7% (r = 0.99) relative to the implanted prosthesis. OsiriX© software analysis resulted in a mean deviation of 2.8 ± 3.0% (r = 0.99) and the Medis© software had a mean deviation of 3.1 ± 3.0% (r = 0.99). Overall, the volumes of all analysed breast implants correlated very well with the real implant volumes. Processing time was 10 min per breast with each system and 30 s (OsiriX©) to 5 min (BrainLab© and Medis©) per silicone implant. MRI-based volumetry is a powerful tool to calculate both native breast and silicone implant volume in situ. All software solutions performed well and the measurements were close to the actual implant sizes. The use of MRI breast volumetry may be helpful in: (1) planning reconstructive and aesthetic surgery of asymmetric breasts, (2) calculating implant size in patients with missing documentation of a previously implanted device and (3) assessing post-operative results objectively.
Journal of Digital Imaging 10/2010; 23(5):603-10. · 1.25 Impact Factor
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Plastic and reconstructive surgery 08/2010; 126(2):675; author reply 675-6. · 2.74 Impact Factor
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[hide abstract]
ABSTRACT: Although explosion injuries caused by terror attacks or in war are evaluated in many studies, limited information about civil explosion injuries can be found in the literature.
In a retrospective study of 71 civil gas explosion injuries treated in a single burn center during a 16-year period, we evaluated trauma mechanisms, patterns of injury, and clinical outcome.
More than 50% of all gas explosions injuries occurred in private households. The mortality correlated significantly with higher burned total body surface area (TBSA), higher abbreviated burn severity index (ABSI) score, accompanying inhalation injuries, and lung contusions. Although mean ABSI score and burned TBSA were similar in men and women (6 vs. 7 and 22% vs. 21%), the female mortality from gas explosions was noticeably higher, albeit not statistically significant due to small patient numbers (32% vs. 17%). Although mean burned TBSA, ABSI scores, and intensive care unit lengths of stay in patients with burns from gas explosions were comparable and not significantly different compared with all burn patients treated in our burn center (TBSA: 22% vs. 17%; ABSI: 6 vs. 6; and intensive care unit lengths of stay: 12 vs. 11 days), the mortality from gas explosions was significantly higher (21% vs. 12%, p = 0.04).
The mortality from gas explosion-related burns correlated significantly with burned TBSA, ABSI score, accompanying inhalation injuries, and lung contusions. Despite comparable ABSI scores, the mortality from gas explosion-related burns was significantly higher than the mortality for all burn victims.
The Journal of trauma 03/2010; 69(4):928-33. · 2.48 Impact Factor
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Plastic and reconstructive surgery 01/2010; 125(1):17e-19e. · 2.74 Impact Factor
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Takahiko Naka,
Carsten Boltze,
Amir Samii,
Madjid Samii, Christian Herold,
Helmut Ostertag,
Yukihide Iwamoto,
Yoshinao Oda,
Masazumi Tsuneyoshi,
Doerthe Kuester,
Albert Roessner
[show abstract]
[hide abstract]
ABSTRACT: In skull base chordoma, c-MET expression has been reported to correlate with younger patient age and favourable prognosis; however, it also contributes to tumour invasiveness, especially in recurrent lesions, suggesting variable roles for c-MET according to clinical status. The aim of this study was to investigate the significance of c-MET expression in spinal chordoma, which affects patients who are 10-20 years older than those with skull base chordoma.
Using immunohistochemical techniques, the expression of c-MET and its ligand, hepatocyte growth factor (HGF) was investigated in 34 primary spinal chordomas and compared with other clinicopathological parameters. Expression of c-MET and HGF was observed in 85.3 and 21.7% of lesions, respectively. c-MET expression correlated with the expression of an epithelial marker, low-molecular-weight cytokeratin (CAM5.2). Lesions with higher c-MET expression showed significantly stronger expression of proteinases, including matrix metalloproteinase (MMP)-1 and MMP-2. However, c-MET expression was not associated with patient age, proliferative ability estimated by MIB-1 labelling index, or prognosis.
c-MET expression was observed in most spinal chordomas and correlated with the expression of CAM5.2, suggesting a relationship to an epithelial phenotype.
Histopathology 04/2009; 54(5):607-13. · 3.08 Impact Factor
