GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

Objective: As the number of elective hand surgeries has increased across the board, this systematic review aims to elucidate the effectiveness of extracorporeal shockwave therapy (ESWT) in hand surgery. Of interest are Dupuytren's disease (DD), trigger finger (TF), De Quervain's tenosynovitis, osteonecrosis of the lunate (ONL), and carpal tunnel syndrome (CTS).

Methods: Qualitative analysis of the current evidence according to the Cochrane Handbook for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using electronic databases, and quality assessment of the included studies using the Cochrane risk of bias in non-randomized Studies - of Interventions assessment tool, the Cochrane risk-of-bias tool for randomized trials and the measurement tool to assess systematic reviews 2 were performed.

Results: ESWT with ≥5 sessions in DD improved functional status and symptom severity significantly and consistently, especially pain, in the short- and mid-term. In TF ESWT alleviated pain in the short-, mid- and long-term. Also, functional status and severity of triggering improved consistently in the mid- and long-term. Three sessions of ESWT are the optimal number in TF patients. In DQT ESWT improved pain and functional status in the short- and mid-term. One study showed LCI and ESWT to be equally effective in DQT patients. Another study showed ESWT as an effective treatment of the pain and progression of ONL. ESWT improved pain and functional status in CTS in the short- and mid-term, especially if ≥4 sessions of ESWT are performed. The long-term effectiveness of ESWT has been suggested but not sufficiently proven.

Conclusions: ESWT is an effective and recommended treatment in DD, TF, and CTS to improve pain and functional status, especially, rESWT regarding CTS and likely also TF. It represents an equally effective option as local corticosteroid injections in TF, DD and CTS with fewer and less severe adverse effects. In the treatment of DQT, ESWT should be considered an option in the clinical setting. Further research is necessary to develop normed protocols and expand its scope of application.

Trial registration: The review and search protocol were registered at PROSPERO (National Institute for Health and Care Research) - CRD42024598627.

Background: The authors report a case of a 42-year-old male patient who presented with a relapse of penile acne inversa five years after a split-thickness skin graft without use of collagen-elastin-matrix (CEM). After unsatisfactory pharmacological treatment, resection of the affected skin, negative pressure wound therapy (NPWT), CEM application, and split-thickness skin graft (STSG) were performed in several steps.

Methods: We performed initial debridement and consecutive NPWT. After achieving a clean wound bed, a CEM (1 mm MatriDerm^®; MedSkin Solutions Dr. Suwelack AG, Germany) was applied, followed by split-thickness skin grafting.

Results: During a 19-month follow-up, the patient presented with a very good functional and cosmetic outcome. Under intravenous antibiotic therapy and intensive wound care, we achieved complete recurrence-free status in the genital area at the 19-month follow-up. The subjective quality of life almost tripled from 3.2 to 9.3 on the numeric analog scale (NAS).

Conclusion: Complex reconstruction procedures of penile defects in acne inversa can be avoided if there is a well-perfused wound bed. Coverage of the defect with MatriDerm^® and split-thickness skin grafting may lead to long-term aesthetically satisfactory results with high patient satisfaction. We have monitored one patient over 19 months, who presented with stable penile soft tissue coverage and no signs of relapse. We anticipate that coverage of penile defects using MatriDerm^® and split-thickness skin grafts may prevent or at least delay the need for complex reconstruction in cases of recurrence.

Arthroplasty in managing tumors of the extremities is a challenging surgery. Careful planning and the expertise of the surgical team are of utmost importance, especially when managing unpredictable intraoperative complications. In this study, we report on the surgical management of a pathological femoral neck fracture with multiple metastases with carcinoma of an unknown primary origin. Primary total hip replacement was planned. However, due to the presence of multiple metastases in the lower limb with intraoperative fracture of the distal femur, a total femoral replacement with a push-through endoprosthesis was carried out primarily. The duration for the surgical intervention was three hours and 56 minutes. Following surgery, initial intensive care was necessary due to the multimorbidity of the patient. Two days after surgery, the patient could be mobilized with full weight bearing and no restriction of range of motion of the entire left lower limb supervised by physiotherapists at ward level, which she tolerated well. The pain was significantly relieved during hospital stay. Mega-endoprostheses with push-through stems are a reliable option in cases with multiple metastases.

Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumors worldwide with an increasing incidence. The surgical treatment is challenging and often requires the entire repertoire of plastic surgery. Diagnostically only a few crucial parameters are in use and even less for an individual and specific drug targeting. An individualised prognostic calculation is unavoidable to be able to adapt very complex surgical processes to an acceptable level. Unfortunately, the classic TNM system and grading are no longer sufficient, especially for individualized prognosis. Moreover, despite advances in treatment, studies have shown that the prognosis of patients with OSCC in terms of survival rate has not improved significantly, which is mainly due to the presence of treatment-resistant OSCC. Therefore, the identification of new, reliable biomarkers for early diagnosis and drug targets of OSCC is urgently needed. Meanwhile, the abundance of potential biomarkers for OSCC is difficult to keep track of. Therefore, the aim of the article was to provide an overview of articles listed in Pubmed^® that deal with the topic of biomarkers in oral squamous cell carcinoma, focusing in particular on the topic metabolism. Another question of this study was to set the focus on essential additive metabolic biomarkers, which can also be easily used in clinical routine.

Background: Significant osseous defects or osteonecrosis, precipitated by open fractures, infections, or neoplastic conditions, represent infrequent yet critical medical conditions. The free vascularized fibular graft (FVFG) is a challenging but straightforward, reliable surgical intervention for the reconstruction of defects across various anatomical regions. This study aims to compare, quantify, and demonstrate the FVFG's versatility. The utilization of a single- or double-barrel approach, contingent on the defect's characteristics, optimizes length conservation or enhances the stability of extensive defects.

Methods: We retrospectively evaluated patients who underwent the FVFG procedure, employing either a single- or double-barrel technique, at our medical center during the period from August 2017 to May 2023. The inclusion criterion was the presence of substantial osseous defects (bone loss in straight bone over 8-10 cm or multi-level spine resection), precipitated by trauma, neoplasms, non-union fractures or infections.

Results: Our study encompassed eight male patients, with an average age of 31 years, ranging from 10 to 56. Each patient underwent osseous resection due to osteomyelitis (n=2), tumor excision (n=4), or pseudarthrosis (n=2) resulting from previous trauma, followed by a free fibula flap as part of the FVFG procedure. When fibula was simultaneously prepared already during tumor resection (n=2), there was a significant reduction in the overall operation time. Postoperative assessment revealed that full osseous integrity without any graft failure was restored in all patients, and the same number of patients regained independent ambulatory ability. Surgical complications were observed in one patient, who exhibited wound healing post-reconstruction, all of which were rectified through subsequent surgical intervention.

Conclusion: Diverse osseous defects in complex cases can be reconstructed by using the FVFG, thereby restoring maximal reconstructive capacity, expedited union compared to non-vascularized bone, and acceptable donor site morbidity. FVFG remain a reliable solution for diverse defects. Moreover, in cases requiring complex tumor defects, careful preoperative planning and an interdisciplinary treatment are essential for successful treatment.

Hyperhidrosis, with a prevalence of 1 to 2% of the population, primarily affects young people under 40 years of age. The individually perceived burden of odor and amount of sweat leads to a reduced quality of life. In recent years, conservative and surgical measures have been used to treat hyperhidrosis. The miraDry^® method based on microwave technology is a non-invasive treatment that enables comparable results in terms of effectiveness while at the same time reducing the burden. In the Park-Klinik Birkenwerder, 282 hyperhidrosis patients were treated with the miraDry^® method between 2017 and 2024. An online survey was conducted in May and June 2024. 220 patients were contacted, the results of 80 patients are available (response rate: 36.4%). Changes in the restrictions caused by increased sweating in various areas of life were asked before and after the treatment. In addition, the assessment of general quality of life before and after the treatment was compared. There is a significant reduction in restrictions and a corresponding increase in quality of life after treatment with miraDry^®. Satisfaction with the method is high, which is reflected in a high recommendation rate of over 80%.

Introduction: Scalp defect reconstruction requires interdisciplinary cooperation to restore soft tissue and osseous defects. While wound closure and form restoration, often a short-term treatment goal, ensures patient survival, the long-term preservation of the head and neck's integrity and aesthetics is crucial for maintaining quality of life. This study aims to compare, quantify, and establish a safe and reproducible approach to various reconstruction options and the postoperative complication profile for individual scalp defect areas.

Materials and methods: We retrospectively evaluated patients who underwent scalp reconstruction at our institution between March 2017 and April 2022. The inclusion criterion was the presence of a soft tissue defect at the cranium level.

Results: We included 31 patients in the study (17 males, 14 females), with an average age of 61 years (range 17-92 years). Eight patients had received radiotherapy in the affected region. The mean defect size was 72.5±116 cm² (range 20-441 cm²), and an average of 3±2 surgeries had been performed before the plastic surgical treatment was initiated. Eleven patients had only a soft tissue defect, while 20 patients had an associated bone defect. Fifteen of these patients received a cranioplasty. The rotation flap was the most frequently used (n=23), with or without split-thickness skin grafting, followed by the free latissimus dorsi muscle flap with split-thickness skin grafting (n=5), and the free lateral arm flap (n=2). Revision surgeries were necessary in 38.7% of cases due to wound healing disorders (n=9), bleeding (n=2), and cerebrospinal fluid leaks (n=1). Eventually, all wounds were successfully closed.

Conclusion: Complex scalp defects can be closed using local flaps, thereby restoring aesthetics and tissue integrity. Free flaps remain a reliable solution for extensive defects. Moreover, in cases requiring cranioplasty, careful preoperative planning and an uncontaminated wound are essential for successful treatment.

The use of silicone breast implants has a history of over 60 years. In recent years, specific health issues among implant wearers have repeatedly come into focus. The term "breast implant illness" has been circulating in scientific literature and on social media for several years. It describes a cluster of up to 60 different symptoms. The present results of an online survey conducted within a clinic's patient population of the last 8 years show, among other things, the evolution of 8 reported symptoms before and after breast implant removal. In the comparison before and after, there is a significant reduction in the intensity of symptoms after implant removal. A causal relationship with the removal of the implants is to be presumed.

Background: The clinical appearance of acral melanoma is diverse and can cause diagnostic difficulties in individual cases.

Case description: We present a clinical case of an 83-year-old patient with a melanoma in the heel area that was initially interpreted as a pressure ulcer, resulting in delayed and more complicated treatment.

Conclusions: Melanomas should be included in the differential diagnosis even in "typical" pressure ulcer areas. Against the background of increasingly poor healthcare in rural areas, an increase in such cases can be expected.

Arthrodesis of the knee joint has proven effective in the treatment of chronic periprosthetic infections as well as in cases of previous multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In this case report, we report on the use of a custom-made intramedullary arthrodesis nail of the knee joint following multiple revisions due to aseptic loosening after total knee replacement. Surgery was performed according to preoperative computerized planning. Microbiological and histological samples obtained intraoperatively showed no evidence of infection. Yet, the patient presented postoperatively with complete loss of active dorsiflexion of the ipsilateral foot. On one-year follow-up, the patient did not complain of any pain. The radiological findings one year after surgery showed no sign of loosening or any other pathological findings. The neurological lesion has completely recovered. The Harris Hip Score HHS improved from 24 (prior to implantation of the arthrodesis) to 75 on one-year follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index WOMAC improved from 86 to 20. The particularity of this case lies in the fact that an additional femoral neck screw was brought in to prevent periprosthetic fracture of the proximal femur. Careful preoperative planning as well as surgical performance were necessary to adjust the rotation of the femoral nail to allow adequate positioning of the femoral neck screw. Intramedullary arthrodesis of the knee is a suitable management option following multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In many cases, an individual therapeutic plan is necessary ranging up to the use of custom-made implants.