Publications by authors named "Georg M Huemer"

122 Publications

Tips to Prevent Posterior Wound Dehiscence After Lower Body Lift Procedure.

Aesthetic Plast Surg 2022 Apr 21. Epub 2022 Apr 21.

Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.

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http://dx.doi.org/10.1007/s00266-022-02882-yDOI Listing
April 2022

The Versatility of the Fasciocutaneous Infragluteal (FCI) Flaps for locoregional or free flap reconstruction.

J Plast Reconstr Aesthet Surg 2022 Mar 8. Epub 2022 Mar 8.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Altenbergerstr. 69, 4040 Linz, Austria. Electronic address:

Background: The wide range of reconstructive purposes requires specific demands and considerations for appropriate flap selection. One versatile and reliable option, which is rarely reported in current literature, is the fasciocutaneous infragluteal (FCI) flap. In this study, we present our results of performing the FCI flap for different clinical indications.

Patients And Methods: This retrospectively study was conducted between September 2011 and September 2019. We included 30 patients (21 females and 9 males) who underwent reconstruction with either pedicled or free FCI flap. Indications for performing FCI flap were uni- or bilateral autologous breast reconstruction, perineal reconstruction, congenital thoracic deformity, lower extremity coverage, and vulva reconstruction.

Results: Forty-one FCI flaps were performed (34 free and 7 pedicled flaps). The average flap dimension was 7  ×  20 cm (range, 7-8  ×  19-21) and the mean length of the pedicle was 13.4 cm (range, 10.5-15.5). The mean diameter of the artery was 2.5 mm (range, 2.2-3.2), the mean diameter of the accompanying vein was 3 mm (range, 2.4-3.3). The flap survival rate was 97.6% (one flap loss). The most common minor complications were infragluteal wound healing disorders and hematoma.

Conclusion: The FCI flap provides constant and reliable anatomy with a long vascular pedicle as well as enough soft tissue bulk and a well-hidden scar. In our clinical practice, this flap has emerged as a first choice in perineal/vulvar reconstruction and a reliable alternative in breast reconstruction if the gold standard procedure cannot be performed.

Level Of Evidence: IV (Therapeutic).
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http://dx.doi.org/10.1016/j.bjps.2022.02.077DOI Listing
March 2022

Auto-Augmentation Mastopexy: Inferiorly Based Parenchymal Flap Technique and Evaluation of Outcomes Using BREAST-Q After 151 Consecutive Patients.

Aesthetic Plast Surg 2022 Apr 5. Epub 2022 Apr 5.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020, Linz, Austria.

Background: Mastopexy is one of the most performed annual plastic surgery procedures; hence, various techniques are described over the last decades. It varies from simple skin incisions to internally shaped pedicle designs. In this study, the authors present their modified auto-augmentation mastopexy technique and the resulting patient satisfaction.

Patients And Methods: For this retrospectively conducted study, 151 female patients were included. The average age was 40.6 years (range, 27-72 years). All patients underwent auto-augmentation mastopexy which is a combination of a superior pedicle for the nipple-areola complex and an inferiorly based soft-tissue flap which is shaped like an implant. Additionally, the BREAST-Q for Reduction/Mastopexy was used to analyze patient-reported satisfaction and quality of life after mastopexy.

Results: All breast corrections were successfully performed. General complication rate was 9%, and no major complication was observed. In two patients, local surgical revision due to hypertrophic scarring and nipple asymmetry was necessary. Analysed surveys of the BREAST-Q showed statistically significantly improved results.

Conclusion: Depending on the breast-shape and the grade of ptosis, the selection of mastopexy technique is crucial. Our described mastopexy procedure is a safe and easily reproducible technique for almost all shapes of ptotic breasts which fulfill patient desires as well as aesthetic satisfaction and quality of life.

Level Of Evidence Iv: 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.
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http://dx.doi.org/10.1007/s00266-022-02868-wDOI Listing
April 2022

Letter-to-the-Editor: The Three-Hour Lower Body Lift: Evolution of a Technique and Personal Experience after 155 Consecutive Cases.

Aesthetic Plast Surg 2022 Apr 14;46(Suppl 1):118-119. Epub 2022 Mar 14.

Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.

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http://dx.doi.org/10.1007/s00266-022-02825-7DOI Listing
April 2022

De-epithelialized Dermal Flap to Reduce Sacral Wound Healing Complications After Lower Body Lift Procedure.

Aesthet Surg J 2022 06;42(7):NP451-NP460

Johannes Kepler University Linz Medical Faculty, Linz, Austria.

Background: Lower or circumferential body lift procedures in the massive-weight-loss population have been associated with significant complication rates. Particularly, the sacral area is at risk of wound-healing problems due to high wound tension or shear forces.

Objectives: The authors introduced a de-epithelialized dermal flap to reinforce the sacral area.

Methods: Within this retrospective study, outcomes of 40 consecutive patients who underwent lower body lift between 2017 and 2021 were analyzed. The patient population was divided into 2 study groups (sacral flap vs no flap) including 20 patients each. Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed.

Results: Thirty-seven female and 3 male patients with a median age of 36.5 years (range, 23-54 years) and a mean weight loss of 46.3 ± 12 kg participated in the study. The most common complication was sacral wound dehiscence (n = 7, 17.5%), and its occurrence was statistically significantly lower in the sacral flap group (P = 0.037). The odd ratios for complications when executing the sacral flap procedure were reduced to 0.306 (95% confidence interval = 0.075 to 1.246) and 0.261 (95% confidence interval = 0.055 to 1.250) for the uncorrected and corrected logistic regressions, respectively. In addition, findings showed a significantly shorter hospital stay as well as statistical trends towards a lower occurrence of overall complications in the sacral flap group. Concerning the remaining data, no statistically significant differences between study groups were detected.

Conclusions: The presented de-epithelialized dermal flap leads to a significant reduction of sacral wound-healing complications and a shorter hospital stay for patients. This surgical technique is easily reproduceable, rapid, and effective; therefore, we would recommend it for each circumferential or lower body lift procedure.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjac012DOI Listing
June 2022

The Three-Hour Lower Body Lift: Evolution of a Technique and Personal Experience after 155 Consecutive Cases.

Aesthetic Plast Surg 2021 Nov 10. Epub 2021 Nov 10.

Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.

Background: Body-contouring is a surgical field in growing demand, as the number of massive weight loss patients following bariatric surgery is increasing. The purpose of this study was to provide a straightforward and time-efficient circumferential body lift technique to achieve optimal lower truncal contouring.

Patients And Methods: A total of 155 massive weight loss patients (133 women and 22 men) underwent lower body lift surgery between 2006 and 2018. The mean preoperative weight reduction and body mass indices were 56.5 ± 16.6 kg and 26.7 ± 4.7 kg/m, respectively. The preoperative markings focused on the back and gluteal region, and the modified surgical technique are described. Additionally, improvements of intra-operative repositioning of the patient and how to deal with sterilization and dressings are elucidated.

Results: The average intra-operative time was 178 ± 54.6 minutes. The mean follow-up of all patients was 8.2 ± 2.4 years. The most common complications were related to wound dehiscence (n = 38) and seroma (n = 18). The mean weight of the resected tissue was 3 056 ± 1 816.5 g.

Conclusion: The lower body lift represents an effective and safe body contouring procedure to treat massive weight loss patients with multiple regions of concern. The current study describes a modified surgical technique that reduces operating time and complications, notably.

Level Of Evidence Iv: 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 http://www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-021-02651-3DOI Listing
November 2021

[An innovative concept for microsurgical training: a feedback analysis].

Handchir Mikrochir Plast Chir 2021 Apr 15;53(2):119-124. Epub 2021 Apr 15.

Kepler Universitätsklinikum GmbH, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie.

Background: There has been a shift in microsurgical education towards simulation training. Hence a number of training programs are being proposed to educate aspiring microsurgeons. However, it is challenging to master the skill of microsurgery and no program has proposed a fully satisfactory training model to date. Therefore, we present an innovative course concept and assess the participants' feedback.

Methods: Being offered a four-step modular curriculum, participants can tailor their program to their individual needs and reinforce specific aspects of their training. The program is characterised by exercises ranging from basic techniques performed on avital biologic models to specific surgical techniques performed on human anatomic specimens. In our feedback questionnaire we ask participants to evaluate the parameters "course design", "expectations" and "overall satisfaction" based on a Likert scale with 5 items (100 %, 75 %, 50 %, 25 % and 0 %).

Results: From 2015 to 2017, 274 students completed and evaluated individual courses. The average values exceeded 90 % for all three parameters.

Discussion: In conclusion, we have developed and evaluated an innovative training program with a constantly high satisfaction rate and a rising number of participants, thus contributing to the advancement of microsurgical skills in Central Europe.
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http://dx.doi.org/10.1055/a-1291-7725DOI Listing
April 2021

Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity.

Clin Hemorheol Microcirc 2021 ;78(3):283-290

Kepler University Hospital, Linz, Austria.

Background: The length of the amputation stump is crucial for optimal prosthetic fitting and rehabilitation. Especially in traumatic amputation, direct closure of the stump may be challenging, and bone shortening is frequently needed. To avoid excessive bone shortening, coverage of exposed bone with free flaps is a versatile option.

Objective: Here we present our experience with the utilization of free flaps from the lower abdomen for the coverage of amputations stumps of the lower extremity.

Methods: Between March 2008 and October 2010, five patients (three female, two male) with complex wounds on amputation stumps of the lower extremity were treated with a mean age of 50 years (range: 15-72 years). Six abdominal free flaps were performed in five patients (one bilateral case), including four deep inferior epigastric artery (DIEP-) and two muscle-sparing transverse rectus abdominis muscle (ms-TRAM-) flaps. Patient's and operative data were collected retrospectively.

Results: One complete flap failure occurred (overall success rate: 83.3%). Three of five patients gained full ambulatory status.

Conclusions: Due to the low donor site morbidity a long vascular pedicle and the large amount of available tissue, abdominal based free flaps represent our first choice for microsurgical reconstruction of lower extremity stumps.
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http://dx.doi.org/10.3233/CH-211112DOI Listing
October 2021

A modified microvascular "Tube-in-Tube" concept for penile construction in female-to-male transsexuals: Combined radial forearm free flap with anterolateral thigh flap.

J Plast Reconstr Aesthet Surg 2021 Sep 5;74(9):2364-2371. Epub 2021 Feb 5.

Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040 Linz, Austria. Electronic address:

Introduction: Phalloplasty is a complex surgical task and remains a significant challenge in plastic surgery. To date, there are various techniques; however, complication rates are still not satisfactory. Here, we present our surgical approach of a modified tube-in-tube concept combining a radial forearm free flap and an anterolateral thigh flap and assess its outcome in a series of female-to-male transsexuals.

Patients And Methods: In this report, 21 female-to-male transsexual patients were included. The first surgical step includes colpectomy and elongation of the fixed part of the urethra with a full-thickness skin graft. Subsequently, a radial forearm free flap was adapted to build the inner tube which represents the neourethra. For the last step, a free anterolateral thigh flap is utilized as the outer tube of the neophallus. All patients were evaluated regarding aesthetic and functional outcomes as well as postoperative complications and revision surgeries.

Results: Our results showed a 100% flap survival rate with a mean follow-up of 4.4 years (range, 2.7-6). Three radial forearm free flaps and one free anterolateral thigh flap presented with partial flap necrosis. Generally, complications occurred in 11 patients (52.4%). The most common complications were related to urethral reconstruction including fistula formation (n = 8) and stenosis (n = 5). All except one patient obtained the ability to void while standing.

Conclusion: Despite the complexity, the initial results are very promising for a single-stage phalloplasty with complete functional creation of a neophallus. Further improvements have to be implemented for reduction of postoperative complications particularly regarding urethral reconstruction.

Level Of Evidence: IV (Therapeutic).
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http://dx.doi.org/10.1016/j.bjps.2021.01.016DOI Listing
September 2021

Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP.

J Clin Med 2020 Dec 31;10(1). Epub 2020 Dec 31.

Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria.

Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton-Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months ( < 0.0001) and 2 (IQR 5) after two years ( < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months ( = 0.004) and to 35 (IQR 34) after two years ( < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.
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http://dx.doi.org/10.3390/jcm10010113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795524PMC
December 2020

Pectoralis Major Median Myotomy: The Median Cut.

Plast Reconstr Surg 2021 03;147(3):561e-562e

Section of Plastic and Reconstructive Surgery, Department of General Surgert, Kepler Uniklinikum Linz, Linz, Austria.

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http://dx.doi.org/10.1097/PRS.0000000000007652DOI Listing
March 2021

Occult Pathologic Findings in Reduction Mammaplasty in 5781 Patients-An International Multicenter Study.

J Clin Med 2020 Jul 13;9(7). Epub 2020 Jul 13.

Unit of Plastic Surgery, SABES, South Tyrol, 39042 Brixen, Italy.

Breast cancer is among the most commonly diagnosed cancers in the world, affecting one in eight women in their lifetimes. The disease places a substantial burden on healthcare systems in developed countries and often requires surgical correction. In spite of this, much of the breast cancer pathophysiology remains unknown, allowing for the cancer to develop to later stages prior to detection. Many women undergo reduction mammaplasties (RM) to adjust breast size, with over 500,000 operations being performed annually. Tissue samples from such procedures have drawn interest recently, with studies attempting to garner a better understanding of breast cancer's development. A number of samples have revealed nascent cancer developments that were previously undetected and unexpected. Investigating these so-called "occult" findings of cancer in otherwise healthy patients may provide further insight regarding risk factors and countermeasures. Here, we detail occult findings of cancer in reduction mammaplasty samples provided from a cohort of over 5000 patients from 16 different institutions in Europe. Although the majority of our resected breast tissue specimens were benign, our findings indicate that there is a continued need for histopathological examination. As a result, our study suggests that preoperative imaging should be routinely performed in patients scheduled for RM, especially those with risk factors of breast cancer, to identify and enable a primary oncologic approach.
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http://dx.doi.org/10.3390/jcm9072223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408965PMC
July 2020

Preauricular pull through flap for reconstruction of the auricle.

J Plast Reconstr Aesthet Surg 2021 01 26;74(1):130-134. Epub 2020 May 26.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital - Medcampus 3, Krankenhausstrasse 9, 4020 Linz, Austria; Medical Faculty, Johannes Kepler University, Altenberger Straße 69, 4040 Linz, Austria.

Introduction: Reconstruction of the crus of the antihelix after tumor resection is a significant surgical challenge and to date no ideal method has been described. The authors present a novel approach using a pedicled flap from preauricular excess skin, which is tunneled through the helix to the anterior auricular surface.

Material And Methods: The presented technique was successfully applied in a series of three patients requiring reconstruction of the superior and inferior crus of the antihelix after resection of skin malignancies. Technique and outcomes are described in detail.

Results: Postoperative course was uneventful in all patients and all flaps healed with excellent esthetic results. Initial flap edema was observed in two cases that resolved spontaneously.

Conclusion: The preauricular pull-through flap is a versatile, straightforward, and reliable method for reconstruction of auricular defects located at the superior and inferior crus of the antihelix, including the triangular fossa, using the natural preauricular skin excess.
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http://dx.doi.org/10.1016/j.bjps.2020.05.078DOI Listing
January 2021

Giant basal cell carcinoma including focal squamous cell carcinoma of the buttock: A rare case.

Dermatol Ther 2020 07 22;33(4):e13674. Epub 2020 Jun 22.

Medical Faculty, Johannes Kepler University Linz, Linz, Austria.

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http://dx.doi.org/10.1111/dth.13674DOI Listing
July 2020

3D Printing for scaphoid-reconstruction with medial femoral condyle flap.

Injury 2020 Dec 22;51(12):2900-2903. Epub 2020 Feb 22.

Johannes Kepler University Linz, Medical Faculty, Department of Traumasurgery and Sports Traumatology, Kepler University Hospital, Altenbergerstrasse 69, 4040 Linz, Austria; maz - Microsurgical Training and Research Center, Industriezeile 36/7, 4020 Linz, Austria.

Three-dimensional (3D) printing has emerged as an innovative technology to derive a maximum benefit from high-resolution tomography images and virtual 3D reconstructions. The present study describes a novel technique using a 3D printed model for harvesting osteochondral medial femur condyle (MFC) flap to replace the proximal pole of the scaphoid in case of proximal avascular pole. MFC bone grafting has already proved to be reasonable surgical method for this indication. To refine this technique, we introduce a 3D model of the proximal scaphoid pole on a handlebar with anatomic orientation marks on its surface, which was virtually planned via 3D imaging and finally 3D printed. This 3D model was sterilized and facilitated several intraoperative steps, such as resecting the proximal pole, simulating the alignment of the future MFC flap, detecting the most feasible harvest site, reducing the donor site morbidity and precisely modeling the graft. In summary, 3D printing is an innovative, feasible technology to aid in various surgical steps while performing a MFC flap for posttraumatic avascular proximal scaphoid pole. It enhances the surgeon's perception of complex patient-specific pathologies and intraoperative accuracy. Especially, we emphasize the benefit of a handlebar on the 3D model, because it enormously improves its maneuverability and usability.
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http://dx.doi.org/10.1016/j.injury.2020.02.102DOI Listing
December 2020

Reply: Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years.

Plast Reconstr Surg 2019 04;143(4):891e-892e

Section of Plastic, Aesthetic, and Reconstructive Surgery, Medcampus III, Kepler University Hospital, Johannes Kepler University, Linz, Austria, Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

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http://dx.doi.org/10.1097/PRS.0000000000005462DOI Listing
April 2019

A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps: An Anatomical Study.

Plast Reconstr Surg 2019 02;143(2):381-390

From the Division of Anatomy and Cell Biology, Medical University of Vienna; the Department of Radiology, Kaiser-Franz-Josef Hospital; Plastic and Reconstructive Surgery, University of St. Pölten; the Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital; and maz, Microsurgical Training and Research Center.

Background: Perforator flaps of the upper thigh or buttock provide a valuable secondary choice in autologous breast reconstruction. The purpose of this study was to compare the vascular territories and supplying vessels of the transverse myocutaneous gracilis flap, the profunda artery perforator flap, and the fasciocutaneous infragluteal flap.

Methods: In total, 26 lower limbs from 13 fresh specimens were investigated. All flap pedicles were selectively injected with methylene blue, eosin red, or green ink. The pedicle external diameters, lengths, and locations were measured. The dimensions of angiosomes, their intraindividual and interindividual correlations, and their relations to anatomical landmarks were analyzed.

Results: The profunda artery perforator pedicle had the greatest mean external diameter with 3.6 ± 0.7 mm, followed by the transverse myocutaneous gracilis and fasciocutaneous infragluteal pedicles with 2.9 ± 0.6 mm and 2.9 ± 0.7 mm, respectively. The fasciocutaneous infragluteal pedicle was longest with a mean length of 12.5 ± 1.5 cm, whereas the profunda artery perforator and transverse myocutaneous gracilis pedicles had lengths of 8.8 ± 1.0 cm and 6.7 ± 1 cm on average. The profunda artery perforator angiosome provided the largest size, with a mean area of 98.5 ± 26.7 cm(2), followed by the fasciocutaneous infragluteal angiosome (77.2 ± 9.0 cm(2)) and the transverse myocutaneous gracilis angiosome (74.1 ± 32.1 cm(2)).

Conclusions: The authors' anatomical findings about the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal territories provide clinically valuable data for flap selection in breast reconstruction if an abdominal flap is not feasible.
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http://dx.doi.org/10.1097/PRS.0000000000005276DOI Listing
February 2019

Posterior intercostal artery perforator flap for posterior trunk reconstruction: Perforator mapping with high-resolution ultrasound and clinical application.

J Plast Reconstr Aesthet Surg 2019 May 13;72(5):737-743. Epub 2018 Dec 13.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital - Medcampus 3, Krankenhausstrasse 9, A-4020 Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Department of General Surgery, Altenberger Strasse 69, 4040 Linz, Austria.

Background: Pedicled perforator flaps have progressively been used for reconstructive purposes of the anterior trunk. However, reports regarding perforator flaps for local reconstruction of the posterior trunk are sparse. The aim of this study was to investigate the vascular basis of perforator flaps based on the posterior intercostal arteries and to highlight the clinical versatility of these flaps for local posterior trunk reconstruction.

Methods: The posterior intercostal artery perforators (PICAP) between the 4th and 12th intercostal space were investigated using high resolution ultrasound in ten healthy volunteers. The location, diameter, suprafascial length and course of the individual perforators was measured. PICAP flaps were used in a series of ten cases for defect reconstruction of the posterior trunk to demonstrate their clinical versatility.

Results: A total number of 100 perforators was investigated. The mean diameter was 0,7 ± 0,24 mm with an average length until arborisation of 0,8 ± 0,8 cm. Perforators were located at 2,4 ± 1,8 cm from the midline on average. Only 16% of all measured perforators were identified as major perforators (diameter ≥ 1 mm). In ten patients (mean age at surgery 61,7 years, f:m = 3:7) a PICAP flap was used for defect reconstruction at the back with a mean follow-up of 2,9 years. Flap dimensions ranged from 7 × 3 to 16 × 7 cm. In three cases, a complication was observed (one seroma, one hematoma, one marginal tip necrosis).

Conclusion: In the present study, a reliable vascular basis of the posterior intercostal artery perforator flap could be demonstrated. Clinically these flaps replace "like with like" and may be transposed in a propeller - or V to Y - fashion. The donor site can be closed primarily in most cases, thus resulting in a favorable donor side morbidity.
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http://dx.doi.org/10.1016/j.bjps.2018.12.005DOI Listing
May 2019

Reply: Motiva Ergonomix Round SilkSurface Silicone Breast Implants: The Tale of Goldilocks: Never Be Afraid of Exploring Unknown Territory.

Plast Reconstr Surg 2019 01;143(1):240e-241e

Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Linz, Private practice, Wels, Austria, and, Department of Plastic and Hand Surgery, Technical University Munich, Munich, Germany.

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http://dx.doi.org/10.1097/PRS.0000000000005147DOI Listing
January 2019

Giant extraskeletal chondroma of the hand: A rare case.

Arch Plast Surg 2018 Jul 15;45(4):388-389. Epub 2018 Jul 15.

Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Linz, Austria.

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http://dx.doi.org/10.5999/aps.2017.01053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062709PMC
July 2018

Comparison of Energy-Based Tissue Dissection Techniques in Abdominoplasty: A Randomized, Open-Label Study Including Economic Aspects.

Aesthet Surg J 2019 04;39(5):536-543

Kepler University Hospital Linz, Linz, Austria.

Background: Abdominoplasty is one of the most common procedures in plastic surgery, and energy-based tissue dissection techniques have become the gold standard. Despite its frequency, abdominoplasty is still associated with high complication rates.

Objectives: The authors compared clinical and economic data of 4 methods of energy-based tissue dissection in a randomized, open-label study.

Methods: A total of 57 patients were preoperatively randomized into 4 groups: electrocautery, Ultracision Harmonic Scalpel, argon plasma coagulation, and PEAK-Plasmablade. Demographic and operational data as well as information on the postoperative course and complications were collected. For economic analysis, quotes were obtained from the device companies or official suppliers.

Results: Duration of surgery, drainage quantity, and wound healing complications did not differ significantly between groups. The Ultracision method caused significantly greater blood loss compared with all other techniques (P < 0.01). PEAK and Ultracision devices entailed greater surgical costs compared with APC and electrocautery.

Conclusions: All methods evaluated can be applied safely and effectively in abdominoplasty procedures. However, these data demonstrate a significantly higher blood loss for the Ultracision Harmonic Scalpel. Considering the clinical data, the higher costs of PEAK and Ultracision methods appear unjustified.

Level Of Evidence: 2:
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http://dx.doi.org/10.1093/asj/sjy177DOI Listing
April 2019

Breast cancer recurrence after reconstruction: know thine enemy.

Oncotarget 2018 Jun 12;9(45):27895-27906. Epub 2018 Jun 12.

Department of Plastic and Hand Surgery, Technical University of Munich, Munich 81675, Germany.

Breast reconstruction proceeding cancer treatment carries risk, regardless of the type of surgery. From fat grafting, to flap placement, to implants, there is no guarantee that reconstruction will not stimulate breast cancer recurrence. Research in this field is clearly divided into two parts: scientific interventional studies and clinical retrospective evidence. The reconstructive procedure offers hypoxia, a wound microenvironment, bacterial load, adipose derived stem cells; agents shown experimentally to cause increased cancer cell activity. This is compelling scientific evidence which serves to bring uncertainty and fear to the reconstructive procedure. In the absence of clinical evidence, this laboratory literature landscape is now informing surgical choices. Curiously, clinical studies have not shown a clear link between breast cancer recurrence and reconstructive surgery. Where does that leave us? This review aims to analyze the science and the surgery, thereby understanding the oncological fear which accompanies breast cancer reconstruction.
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http://dx.doi.org/10.18632/oncotarget.25602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021250PMC
June 2018

Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years.

Plast Reconstr Surg 2018 09;142(3):653-660

From the Section of Plastic and Reconstructive Surgery and the Department of Surgery, Kepler University Hospital Linz; Upper Austrian State Medical Insurance; private practice; the Department of Plastic and Reconstructive Surgery, University Clinic St. Pölten; and the Department of Plastic and Hand Surgery, Technical University Munich.

Background: Postoperative surgical-site infections are severe complications following body contouring surgery. Here, the authors evaluate whether surgical-site infection rates are influenced by higher temperatures during the summer season.

Methods: We enrolled 602 patients who underwent body contouring surgery between 2009 and 2015 in a retrospective cohort study. Data collected included demographics, surgical data, and postoperative outcome. Body contouring surgery procedures included lower and upper body lift, abdominoplasty, breast reduction, mastopexy, brachioplasty, and thigh lift. Infection rates were calculated on a seasonal basis and compared using Fisher's exact test and logistic regression analysis.

Results: There were 136 patients (125 women and 11 men) in the warm season [June to August; with an average temperature of 67.622°F (19.79°C)] and 466 patients (438 women and 28 men) in the cold seasons group [September to May, with an average temperature of 45.45 °F (7.47°C)]. The composition of the study cohorts was comparable. The average age was 40 years and the average body mass index was 27 kg/m. From a total of 602 patients, the authors observed 33 surgical-site infections, representing a rate of 5.48 percent. A statistically significant increase of postoperative surgical-site infections could be detected during summer (10.29 percent versus 4.08 percent; p = 0.0071), representing an increase of 150 percent. In addition, a logistic regression analysis determined "season" as the strongest predictor for surgical-site infections, with a risk increase of 2.693 times in the warm season.

Conclusions: Body contouring operations are elective procedures, making careful risk consideration an absolute prerequisite. The authors demonstrate a significantly increased infection risk during summer and establish a causal link between the warm season and surgical-site infection accumulation. Consequently, preoperative patient information and operative planning should be adjusted accordingly.

Clinical Question/level Of Evidence: Risk, II.
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http://dx.doi.org/10.1097/PRS.0000000000004677DOI Listing
September 2018

Motiva Ergonomix Round SilkSurface Silicone Breast Implants: Outcome Analysis of 100 Primary Breast Augmentations over 3 Years and Technical Considerations.

Plast Reconstr Surg 2018 06;141(6):831e-842e

Linz and Wels, Austria; and Munich, Germany.

Background: Macrotextured anatomical implants are frequently used in aesthetic breast surgery; however, several safety concerns linked to this implant type have been raised recently. In an attempt to address these shortcomings, Motiva Ergonomix implants have been introduced. Here, the authors describe the current world's largest experience with these novel devices in aesthetic breast surgery and evaluate the postoperative outcome of 100 primary breast augmentations.

Methods: A retrospective assessment of 100 consecutive primary breast augmentation patients over a period of 3 years was conducted. Patients were followed for a minimum of 6 months postoperatively. Demographics, surgical data, and complications were recorded. In addition, a survey regarding the breast augmentation outcome was performed.

Results: The reasons for surgery were mainly hypoplasia (52 percent) and ptosis (28 percent). All implants were placed by means of an inframammary approach in a submuscular pocket, and the average implant volume was 370 cc (range, 150 to 700 cc) with mostly full projection (65 percent). The revision rate was 7 percent. The authors observed four cases of implant malpositioning, one implant rupture, one implant exchange for aesthetic reasons, and one hematoma evacuation. Nevertheless, the authors achieved a 100 percent satisfaction rate with the postsurgical outcome among both patients and surgeons.

Conclusions: Motiva Ergonomix implants provide reliable and satisfying results for both patients and surgeons. They can be used safely and effectively for aesthetic breast surgery. However, like all breast prostheses, Motiva Ergonomix implants are not completely free of complications and should be used only with advanced technique to achieve optimal results.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000004367DOI Listing
June 2018

Skin Rejuvenation through HIF-1α Modulation.

Plast Reconstr Surg 2018 04;141(4):600e-607e

Munich, Germany; Stanford, Calif.; Gainesville, Fla.; and Vienna and Linz, Austria.

The constant intrinsic and extrinsic stress the skin is exposed to leads to significant impairments of the regenerative capacity of aging skin. Current skin rejuvenation approaches lack the ability to holistically support the biological processes that exhaust during aging skin degeneration, such as collagen production, cell migration and proliferation, and new vessel formation. Similar to chronic wounds, aged skin is characterized by dysfunction of key cellular regulatory pathways impairing regeneration. Recent evidence suggests that the same mechanisms hindering a physiologic healing response in chronic wounds are the basis of impaired tissue homeostasis in aged skin. Dysfunction of a main response-to-injury pathway, the hypoxia-inducible factor (HIF)-1α regulatory pathway, has been identified as pivotal both in chronic wounds and in aging skin degeneration. HIF-1α signaling is significantly involved in tissue homeostasis and neovascularization, resulting in the production of new collagen, elastin, and nourishing blood vessels. Modulating the functionality of this pathway has been demonstrated to significantly enhance tissue regeneration. In this review, we present an overview of the regenerative effects linked to the up-regulation of HIF-1α functionality, potentially resulting in skin rejuvenation on both the cellular level and the tissue level.
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http://dx.doi.org/10.1097/PRS.0000000000004256DOI Listing
April 2018

[Soft tissue fillers: state of the art and future perspectives].

Handchir Mikrochir Plast Chir 2017 12 4;49(6):423-431. Epub 2017 Aug 4.

Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität.

In addition to cosmetic use, filler materials are frequently employed for reconstruction of contour defects. Scars and tissue defects after accidents, surgery and irradiation are also ideal indications for injectables. The ideal filler should be easy to inject, easy to form, and should remain in the body as long as possible. It should neither be allergenic or carcinogenic nor susceptible to infections or biofilms, but still potentially reversible, temperature-stable, and cheap. There is still no augmentation material that fulfils all of these criteria. A wide range of materials with widely varying characteristics is available on the market. Hyaluronic acid, collagen (human or bovine), polylactic acid (PLLA), calcium hydroxyapatite (CaHA), polymethylmethacrylate (PMMA), silicone and natural fat are all used in clinical practice for various indications. The current research efforts carried out at industrial institutions and universities are directed towards the development of augmentation materials with higher biocompatibility on the one hand and better durability on the other. In this review we provide an overview on filler materials currently used with their pros and cons. We further give an outlook on promising new approaches in the development pipeline.
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http://dx.doi.org/10.1055/s-0043-112498DOI Listing
December 2017

A Novel Method for Intraoperative Breast Implant Pocket Assessment: Air Augmentation.

Arch Plast Surg 2017 Jul 15;44(4):354-355. Epub 2017 Jul 15.

Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Linz, Austria.

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http://dx.doi.org/10.5999/aps.2017.44.4.354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533052PMC
July 2017

Reply: Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients.

Plast Reconstr Surg 2017 03;139(3):803e-804e

Section of Plastic, Aesthetic, and Reconstructive Surgery Department of General Surgery Kepler University Hospital Linz, Austria.

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http://dx.doi.org/10.1097/PRS.0000000000003098DOI Listing
March 2017

Correction of Polymastia Vera Class I with Skin-sparing Mastectomy and Immediate Rib-sparing DIEP-Flap Reconstruction.

Plast Reconstr Surg Glob Open 2017 Jan 18;5(1):e1192. Epub 2017 Jan 18.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital - Med Campus III, Krankenhausstrasse 9, 4020 Linz, Austria; and maz - Microsurgical Training and Research Center, Industriezeile 36/7, 4020 Linz, Austria.

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http://dx.doi.org/10.1097/GOX.0000000000001192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293293PMC
January 2017
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