GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

Introduction: During the past decades, free flaps have been given a central role in the reconstructive surgery. Especially in the extremities, where there is a scarcity of available tissues for local flaps, free flaps play a central part. The aim of this study was to evaluate the risk factors contributing to partial and total flap failure. Patients and methods: In a retrospective cohort study, all data concerning patients who underwent free flap reconstruction of the extremities during the first five years since the founding of the department of plastic surgery were gathered. Patient- and surgery-related risk factors were analyzed in correlation to the postoperative complications. Results: In total, 182 free flaps were included in this study. Partial and total flap failure were noted in 21.42% and 17.03%, respectively. A correlation was seen between the time lapsed from debridement until flap coverage, with flaps performed between day 4 and 14 having the least quote of flap failure (p=0.022). Gender, age, arterial hypertension, nicotine abuse, diabetes mellitus, peripheral arterial disease and the number of anastomosed veins were not significantly associated with free flap failure. Conclusion: Our study showed that free flaps can be safely performed in healthy patients as well as in patients with risk factors, with an acceptable flap loss rate. Randomized controlled studies are needed to clarify the exact role of each risk factor in free flap surgery.

Objective: Objective analysis of the effects of a series of skin care products by application of modern imaging technology.

Method: A study was conducted in 25 volunteers who attended a plastic surgical clinic. The cosmeceuticals chosen for investigation were from the IMAGE MD^® series provided by the company IMAGE Skincare. Facial images were taken with the Visia^® camera system by the company Canfield Scientific. The volunteers stopped their own skin care regimen after the initial facial captures and applied a series of the products for three months. 19 volunteers returned and underwent again facial capture. Eight different skin aspects - spots, wrinkles, skin texture, pores, UV spots, brown spots, red marks and porphyrins - as well as the skin age were determined and analysed.

Results: Overall, the volunteers turned out to appear younger by 1.4 years, however not at a significant level. There was a spread in the results and a tendency for a stronger reduction of the measured skin age in women under 55 years old by 3.2 years. Best effects of the studied product line were obtained for the skin aspects red areas and brown spots. For the criteria spots, texture, pores and UV spots at least two thirds of the comparisons between the two time points, before and after treatment, were positive. In wrinkles and porphyrins, results did not improve. Altogether the majority of the examined skin criteria improved.

Conclusion: The IMAGE MD^® product series caused the volunteer testers overall to appear slightly younger. An objective measurement of skin changes over time by application of the Visia^® imaging technology was found to be possible.

Background: The aim of this study was to independently investigate the precision of the high resolution Visia^® camera, from Canfield Scientific, to capture several skin surface features.

Method: Facial images of eight volunteers were taken with closed eyes and a relaxed face. The capture was conducted in a resting position within a positioning rig. Frontal view images were taken. In the first capture session, the images were captured three times in a row with the head steadily resting in the capture rig. Each volunteer then left the capture rig and returned to it one week later repositioning the face, and the capture was repeated three times. On the basis of this study, it was additionally investigated which number of study participants would be required in order to make a claim as to the reproducibility of the captures. As a possible approach to making this determination, a power analysis was considered. In order to conduct this analysis, it was necessary to determine which differences between individual image captures would be clinically acceptable. To answer this question, a subjective assessment of the repeated image captures for all study participants and for all skin surface features was conducted in order to identify any differences that were visible with the human eye.

Results: Differences in skin criteria of the eight volunteers in terms of means and standard deviations were collected for weeks one and two. For the criteria skin texture, UV spots, brown spots and porphyrins, these differences were less than 2% and for pores and red areas they were between 2% and 4%. The results for spots and wrinkles were around 6%. Looking at the differences between the data from week one and two as well as the standard deviations, these differences turned out to be relatively small. This finding also pointed to a quite good precision of the measurement technique. The subjective assessment of the images of the eight participants on each of the eight skin criteria revealed that no differences were detectable in the recaptured versions of the images of the participants' faces in their native digital forms solely with the human eye. There was an exception for only one participant, in whom a distinction between two image captures appeared to be subjectively visible with the human eye, but only for the criterion of red areas. As the subjective assessment revealed that no clinically relevant differences could be identified, a power analysis involving a test for significant differences between the recaptured images was discarded. As a consequence, the number of participants recruited for the study on the reproducibility of the system presented herein was deemed to be sufficient.

Conclusion: The precision of the Visia^® camera system was found to be satisfactory in this study. The Visia^® camera helped to visualise skin features beyond what is

Objective: Lipedema is a relatively common yet debilitating and often misdiagnosed lipodystrophy that mainly affects females. Very little is known about the etiology and pathophysiology of the disease. However, due to its high preference for female patients, hormonal factors may contribute to the pathogenesis. Case: A 62-year-old male patient presented to the authors with painful swelling of the thighs. The patient had been treated elsewhere for lymphedema with subsequent disease progression. Lipedema stage IV was confirmed by clinical examination and ultrasound. The patient underwent three sessions of tumescence liposuction which was well tolerated. Later on, the patient reported great improvement in terms of complaints as well as disfigurement. Conclusion: The etiology and pathophysiology of lipedema remain unclear. However, the case at hand shows that lipedema may, albeit rare, also present in male patients. Moreover, we show that liposuction is efficient and safe in treating lipedema even in atypical cases.

The coronavirus disease 2019 (COVID-19) is a novel, rapidly changing pandemic. It has affected specialized medical services in unprecedented ways. Surgical decision making, always the most important aspect of care has taken on an added layer of complexity in the face of the COVID-19 pandemic. Therefore, recommendations for breast reconstruction during COVID-19 remain challenging and unclear. This article reviews the impact of the COVID-19 pandemic and suggests potential approaches that could be considered in the absence of validated strategies in breast reconstruction.

Miescher's cheilitis, also known as cheilitis granulomatosa, is an infrequent disease characterized by chronic recurrent swelling of one lip or both lips. It is considered as one of the three main symptoms of the triad of the Melkersson-Rosenthal syndrome, although in many cases it may develop monosymptomatically. The initial management is based on the administration of corticoids, followed in many cases by the use of other systemic treatments. Nevertheless, because recurrence is quite frequent, surgery remains in many cases as the only definitive treatment. In this report we present the case of a Caucasian woman with Miescher's cheilitis who was successfully surgically managed.

Introduction: Pulsatile tinnitus (PT) can be very distressing for the patient. An identifiable abnormality is rarely detected. Dural AV malformation is responsible for arterial PT. Venous PT has rarely been attributed to an obvious abnormality on venogram. Dehiscent high jugular bulb or sigmoid sinus have been thought to be potential cause for venous PT. Ligation of internal jugular vein (IJV) has been advocated as a definitive surgical treatment. To our knowledge the use of acellular dermal matrix for treatment of venous PT has not been reported previously. Objectives: To share our experience of a successful treatment of PT using acellular dermis. Methodology: Case report and literature review. Case description: A 23-year-old Caucasian female presented with right-sided PT of 9 months duration. All clinical and audiological investigations were normal. MRI brain and internal auditory canals was normal but the CT scan showed a high right jugular bulb. It also showed dehiscence of the right sigmoid plate with herniation of sigmoid sinus into the mastoid. She underwent transmastoid correction of dehiscent sigmoid sinus and jugular bulb. Acellular dermis was used for extra luminal packing of mastoid cavity and hypotympanum. The patient made a good post-operative recovery and reported resolution of tinnitus on recovering from anaesthesia. The patient was discharged home the following day. There were no sequelae from surgery. The patient has remained symptom-free 11 years following her treatment. Conclusion: The surgical goal of dehiscent sigmoid sinus correction can be accomplished with acellular dermis packing. Traditionally ligation of the IJV or rigid correction of herniated sinus has been recommended; however, we have demonstrated that a relatively thick pliable acellular dermis is more than adequate to correct herniation of the sigmoid venous sinus.

Background: Abdominal wall hernias are frequent in patients with peritoneal dialysis. Guidelines recommend an open hernia repair with extraperitoneal mesh placement to avoid access to the abdominal cavity. Method: We performed a lateral docking robotically assisted enhanced-view totally extraperitoneal repair (eTEP) of a recurrent umbilical hernia with diastasis recti in a patient with peritoneal dialysis due to polycystic kidney disease. After suturing of the midline a 20 x 28 cm mesh was placed in the retrorectus space, covering the whole area of preparation while also overlapping all trocar sites. A drainage was left in the retrorectus space until the first session of PD did not sample any form of leakage. Result: Robotically assisted totally extraperitoneal hernia repair was feasible. The patient was able to continue peritoneal dialysis without intermittent hemodialysis. There was no leakage of the dialysate to the retrorectus space. Postoperative recovery was uneventful. 6 months after surgery the patient was free from pain and showed no signs of recurrence. Conclusion: Robotically assisted totally extraperitoneal hernia repair in patients with umbilical hernia and peritoneal dialysis could be a promising surgical technique to combine the advantages of minimally-invasive surgery with totally extraperitoneal mesh placement without access to the abdominal cavity.