GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

Introduction: Autologous fat transplantation for breast augmentation has become increasingly interesting for patients and surgeons but only a few standardized procedures are available. BEAULI™ (Berlin Autologous Lipotransfer) protocol provides a suitable method with a standardized protocol. The aim of the study was to trace the 5-year long-term results after breast enlargement using the BEAULI™ protocol and the determination of changes in quality of life in relation to the intervention. Patients and methods: The study included non-smoking, currently non-pregnant women from the first BEAULI™ study (2007-2010), who were operated only for aesthetic reasons. BMI values, the jugulum nipple distance (JND), the breast base, and the maximum breast circumference were determined. The patients answered also a questionnaire with 30 questions on the postoperative quality of life. Results: The results measured after 6 months remained constant over 5 years. There was an average increase of the JND by 1.8 cm or 9.5%, and a widening of the base by 1.2 cm or 8.8%, and of breast circumference by 4.4 cm or 24%. The patients' quality of life, especially self-confidence and acceptance of their own body, has improved significantly after the operation. Discussion: The satisfying 5-year long-term results and low complication rate are two big advantages of the BEAULI™ method. The option to use autologous fat transplantation for another purpose like for reconstruction of breasts after a mastectomy increases the attractiveness of this method. Conclusions: Fat transplantation for breast enlargement using BEAULI™ is a high-quality method with good results, and it is an alternative to silicone implants or other autologous tissue transplantations. Patients are satisfied with the BEAULI™ protocol, the complication rate is small, and natural results are achieved with moderate scars.

Background: Migration of mesh after ventral and incisional hernia repair is a rare but well described complication. The aim of our work is to present two cases of mesh migration after incisional hernia repair and to review the current literature. Methods: We describe the two cases of mesh migration that occurred at our department. Additionally, we performed a systematic literature search. Results: In both cases we observed a mesh migration with formation of an entero-cutaneous fistula that required surgical therapy. In the literature search we found a total of 16 publications dealing with mesh migration after incisional (n=14) and ventral hernia (n=2) repair in adult patients (15 case reports and one retrospective study). In 9 out of 15 patients (54%) who presented with mesh migration or erosion, a polypropylene mesh was responsible for this complication. Conclusions: Mesh migration after abdominal hernia repair is rare, the only available retrospective study reports a rate of 2.7%. The ability of polypropylene mesh to migrate into hollow viscera is well known and confirmed both by our data and the results of the literature review. As the incidence of mesh erosion/migration is significantly lower than the recurrence rate after hernia repair without mesh, up to now, no better alternative exists for the treatment of abdominal wall hernia than mesh augmentation.

Aim: To present a rare case of giant congenital nevocellular nevus in a 7-year-old girl's scalp and to highlight our management steps and outcomes. Case description: An otherwise healthy 7-year-old girl presented to plastic surgery clinic with a giant congenital nevus (GCN) that covered almost her entire scalp that was treated successfully with tissue expander three times over a period of 14 months. A total of 34 cm width of skin, which comprised 78% of the patient's scalp, was removed. The patient was reassessed five years later with a great cosmetic outcome represented by a remarkable hair growth and near normal scalp appearance. Conclusion: Giant scalp nevocellular nevi in pediatric age group can be treated completely with tissue expanders more than twice to achieve near normal outcomes.

Thoracic injuries are the most lethal penetrating injuries. After attempting suicide, two patients with a penetrating thoracic wound were admitted to our emergency department. During CT scan they became hemodynamically unstable, which is why we had to perform an emergency thoracotomy. In both cases, a perforation in the left ventricle as well as multiple lesions of the lung parenchyma and vessel injuries were found. After the treatment of the different injuries, a massive edema of the heart and lung prevented a primary closure of the thorax. Due to massive diffuse bleeding, a "packing" of the pleural cavity became necessary. To prevent a thoracic compartment syndrome, the thoracic wall was left open and the skin was closed with a plastic sheet. Due to the "open chest" procedure combined with "packing" of the thoracic cavity, the majority of patients with an edema of the heart and lung after a penetrating chest injury can be saved. Pitfalls of preclinical and clinical treatment, aspects of diagnostics and surgery are discussed.

Introduction: Osteogenesis imperfecta (OI) is a genetic disease that primarily affects bone formation and metabolism. Craniofacial malformations belong to the broad spectrum of the OI phenotype. The introduction of bisphosphonate medications was intended to counteract the significant brittleness of the bones of OI patients. In connection with the application of bisphosphonates, drug-associated osteonecrosis of the jaw has become known as an undesirable effect of the therapeutically intended reduction of osteoclast activity. Originally, the pharmacological inhibition of bone loss was mainly used in oncological therapy. For some time now, osteoporosis has also been treated with substances that inhibit bone resorption. In OI, malposition of the jaws is relatively common, in particular retrognathia of the maxilla and progeny of the mandible. The literature discloses complications of orthognathic surgery in OI patients. Previous literature reviews suggest that bisphosphonate medication has no significant impact on the performance of and healing after oral surgery in OI patients. Material and methods: An essential prerequisite of a therapy adapted to the patient's condition is the knowledge of the patient's medical history. This case report describes the orthodontic-surgical treatment of an OI patient and the treatment experience derived in dealing with the condition. The unusual circumstance of this case is that the patient had concealed both his underlying disease and his medication during the current treatment period. In addition, the relevant literature is evaluated for combining the keywords OI, orthodontic therapy, bisphosphonates, and orthognathic surgery. Results: Based on the literature and our own experience, it is concluded that orthodontic treatment with bisphosphonate medication can also be carried out in OI patients. However, considerably greater forces and longer time intervals should be scheduled for each treatment. Orthognathic surgery with bisphosphonate medication turned out to be uncomplicated in our own case, considering the underlying disease in the planning of surgical procedures. However, there have been very few reports of OI patients in whom orthodontic-surgical treatment of jaw malformation has been performed with bisphosphonate medication. Conclusion: Taking into account the reported experience of severe complications of orthognathic surgery, the multiple documented adjustments to the treatment strategy of OI patients should be taken seriously. The basic condition of therapy adapted to the disease is that the patient informs the practitioner in an appropriate manner about his or her state of health.

Hamate fractures are commonly divided into hook fractures and body fractures. The coronal fractures as a special form of hamate's body fracture are very rare injuries. Because of unspecific clinical findings and the mostly inconclusive x-ray imaging, these fractures are frequently overseen or misdiagnosed. This leads to further complications like secondary arthritis, persisting pain, and functional deficits in patient's wrist mobility. In our study, a collocation of coronal hamate fractures is analyzed and evaluated with respect to functional outcome after operative treatment and compared to the literature. Furthermore, we compare the strategies for diagnosis and treatment in our clinical center with those presented in the literature. Our standard in the initial diagnostic process is to obtain radiographs in an anterior-posterior, lateral, and 30° oblique view of the wrist. For further diagnosis and preoperative planning, a CT scan of the wrist is obligatory. Due to the high occurrence of comorbidities (especially CMC dislocations) all patients in our cohort obtained operative treatment. In long-term post-operative evaluation, we present the following results: The Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M² DASH) imposed with an average of 26.22 points (MD=22/ SD=11.31/MIN=18/MAX=52). None of the re-evaluated patients sorrowed for severe pain in rest. Four patients stated pain (ranging from 3 to 5 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting). In exploring the range of motion of the operated hand the following results are obtained: dorsal extension: average 83.33° (MD=85°/SD=3.54°/MIN=75°/MAX=85°), flexion: average 77.78° (MD=80°/SD=4.41°/MIN=70°/MAX=80°). Additionally, a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 77.78%, opposition digitus manus I-V complete in 66.67%. The conservative treatment is not recommended (especially shown in the here presented "add" case with a misdiagnosed fracture). The open approach has its advantages compared to a closed operative procedure and should always be intraoperatively considered as an operative expansion.

We report the case of a 65-year-old male patient with massive epigastric pain of sudden onset and vomiting due to an organoaxial volvulus of the stomach. We comment on the surgical management in our case and discuss etiology and therapeutic options of this rare entity.

Vater-Pacini neuromas are rare causes of severe pain in the phalanges. The cause of this change in the tactile corpuscles is unknown. A traumatic cause has been plausibly demonstrated, at least in some cases. Here, the rare occurrence of a Vater-Pacini neuroma in a patient with neurofibromatosis type 1 is reported. The discussion addresses the difficulties of terminology and current diagnostic procedures for differentiating small nodular masses of the palm and digits. The surgical treatment leads to rapid relief of the symptoms.

Aim: To share our experience with the management of Fournier gangrene (FG) using the bagging technique of the testes, and to highlight the importance of implementing a multidisciplinary approach in managing FG. Case presentation: A 58-year-old male with type 2 diabetes mellitus (DM) was brought to the emergency department (ED) with necrotizing fasciitis involving the genitalia; he was managed in the ED with Intravenous (IV) fluid resuscitation and IV antibiotics. The surgical team was consulted and multiple debridement procedures were done. Healthy granulation tissue was formed within one month of the serial debridement. A split-thickness skin graft using bagging technique of the testes and vacuum-assisted closure (VAC) were applied. The patient was reassessed one year following presentation, and a result with a near normal appearance was achieved with complete preservation of functional outcome. Conclusion: FG is a type of necrotizing fasciitis that could be managed either conservatively with IV antibiotics and/or hyperbaric oxygen, or surgically by debridement and applying VAC. In our case, the testes were debrided and bagging technique of the testes was used. It's believed that with this technique, the overall cosmetic and functional results are superior.

Nasofrontal fistulas correspond to the persistence of an abnormal communication of embryological origin between the deep layer of the skin and the central nervous system (CNS). They can rarely be associated with a dermoid cyst and be revealed by a locoregional infection, and especially neuromeningeal infections can be serious. The treatment is mainly surgical by performing a total excision of the cyst and the repair of defects. The authors report the case of an 18-month-old infant operated for a dermoid cyst revealed by a nasofrontal fistula. They insist on the characteristics of this pathology in order to establish a diagnosis and an early treatment to avoid the complications that can be heavy in certain cases. They describe the steps of nasofrontal reconstruction by a small flap taken from the outer table of the frontal bone with better esthetic results.