Publications by authors named "Julian Ramin Andresen"

8 Publications

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Complex nasal reconstruction for skin cancer and posttraumatic deformity using a modified frontonasal flap - Case report.

Int J Surg Case Rep 2021 Apr 30;83:105944. Epub 2021 Apr 30.

Plastic and Aesthetic Surgery, AARE KLINIK, Bern, Switzerland. Electronic address:

Introduction And Importance: Reconstruction of the nasal tip is challenging, especially when large defects are associated with compromised nasal soft tissues and framework. The frontonasal flap is an axial-pattern myocutaneous flap from the glabella and nasal dorsum that allows for various modifications in flap design to cover medium sized defects of the nasal tip.

Case Presentation: A 66-year-old male patient presented with a large and ulcerated squamous cell carcinoma of the nasal tip that was associated with substantial posttraumatic damage of the nasal soft tissue envelope and cartilaginous vault of the dorsum. Considering patient comorbidity, risk factors, and specific nasal condition, a single-stage tumor resection and reconstruction using a modified frontonasal flap was intended. While tumor excision resulting in a tip defect of 1.5 × 1.5 cm and flap coverage were initially achieved in a single stage, histologically incomplete tumor resection and individual patient requests mandated further surgery, including re-excision, cartilage grafting, and soft tissue contouring.

Clinical Discussion: The frontonasal flap allows for single-stage reconstruction of moderate size tip defects. Even in the case of prior soft tissue damage and scarring, the flap may be used safely pending individual adjustments in flap design. However, additional measures may be employed as needed to optimize the functional and aesthetic outcome in cases of complex nasal pathology.

Conclusion: In a case with a combined tumor and posttraumatic nasal deformity, an individualized surgical concept incorporating a modified frontonasal flap with adjunct cartilage grafting and soft tissue contouring achieved an excellent functional and cosmetic outcome.
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http://dx.doi.org/10.1016/j.ijscr.2021.105944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129936PMC
April 2021

CT-guided thoracic sympathicolysis versus VATS sympathectomy in the therapeutic concept for severe primary palmar Hyperhidrosis.

Thorac Cardiovasc Surg 2021 Apr 15. Epub 2021 Apr 15.

Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany.

Background:  The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome.

Materials And Methods:  In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred.

Results:  Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients.

Conclusion:  For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.
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http://dx.doi.org/10.1055/s-0041-1725205DOI Listing
April 2021

CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects.

Rofo 2021 May 21;193(5):574-581. Epub 2020 Dec 21.

Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany.

Purpose:  The objective of the present study was to evaluate the benefit of a thoracic, computed tomography-guided sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis of the hands. In addition, the influence of the amount and distribution of the administered sympathicolytic agent was to be assessed.

Patients And Methods:  Retrospectively, 78 patients [13 (16.7 %) men, mean age 31.2 ± 9 years and 65 (83.3 %) women, mean age 34.2 ± 12 years], who had been treated using CTSy, were included in the study. The indication for treatment was primary focal palmar hyperhidrosis grade II and grade III after exhaustion of all conservative treatment options and a continued high level of suffering. CTSy was performed after establishing the entry plane at the level of the intervertebral space T2 / T3 via a dorsolateral approach using a 22-G coaxial needle. On average 5 (2-10) ml of a sympathicolytic mixture (10 ml consisting of 8 ml 96 % alcohol, 1.6 ml 0.5 % Carbostesin and 0.4 ml 0.9 % NaCl solution, with added amounts of contrast medium) were instilled. The volume of distribution of the sympathicolytic agent was determined in craniocaudal direction using CT images. The patients evaluated their sense of discomfort preinterventionally, 2 days postinterventionally, and 6 and 12 months after the intervention, on the basis of a Dermatology life Quality Index (DLQI) as well as the side effects that occurred.

Results:  The technical success rate of CTSy was 100 %. No major complications occurred. The interventions performed led to a significant reduction (p < 0.001) in the preinterventional sense of discomfort 2 days, 6 and 12 months after CTSy. As the most common side effect, compensatory sweating was reported by 16/78 (20.5 %) of the patients over the further course. In all of these patients, the volume of sympathicolytic agent administered was below 5 ml. In no case did the sympathicolytic agent extend caudally beyond the base plate of Th 3. No compensatory sweating of the back was observed in 5/78 (6.4 %) patients; here the sympathicolytic volume was above 5 ml and extended significantly caudally below the baseplate of T3.Transient miosis and ptosis was found in 8/78 (10.3 %) patients. In all of these patients, the volume of sympathicolytic agent administered was above 5 ml and it extended markedly cranially beyond the upper plate of T2. A mild to moderate recurrent sweating developed in 35/78 (44.9 %) patients, which was more marked if the volume of sympathicolytic administered was below 5 ml and slightly more pronounced on the left than on the right. Given a high level of satisfaction overall, 71/78 (91.0 %) patients said that they would undergo the intervention again.

Conclusion:  For patients with primary, focal palmar hyperhidrosis CTSy represents a therapeutic option that offers good benefit and has few side effects. The amount and spatial distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects.

Key Points: · CT-assisted thoracic sympathicolysis is a minimally invasive, low-complication therapy for treatment of severe forms of primary hyperhidrosis palmaris.. · CT-assisted thoracic sympathicolysis can usually be performed on an outpatient basis.. · The quantity and local distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects..

Citation Format: · Andresen J, Scheer F, Schlöricke E et al. CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects. Fortschr Röntgenstr 2021; 193: 574 - 581.
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http://dx.doi.org/10.1055/a-1299-2098DOI Listing
May 2021

[Clinical outcome and revenue situation after conservative, interventional and surgical/osteosynthetic treatment of sacral insufficiency fractures].

Unfallchirurg 2020 Dec 10. Epub 2020 Dec 10.

Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide, Deutschland.

Background: Insufficiency fractures of the sacrum are being detected increasingly more frequently, whereby their incidence will no doubt increase further as a result of the rise in life expectancy.

Objective: The clinical appearance of sacral insufficiency fractures, the treatment approach taking into account the clinical outcomes and the DRG proceeds are discussed on the basis of clinical examples.

Patients And Methods: Three female patients (average age 78.3 years) with sacral insufficiency fractures were admitted for inpatient treatment due to increasing disabling pain. Taking into account the clinical symptoms and the recommendation of an interdisciplinary case conference, one patient was treated conservatively with short-term bed rest, accompanying analgesic medication and pain-adapted exercise measures. The second patient underwent computed tomography (CT)-guided balloon sacroplasty. Transsacroiliac screw fixation was performed on the third patient. Pain was documented over the course on a visual analogue scale (VAS) and the degree of independence on the Barthel scale. The fractures were classified according to Denis et al. and the classification of the FFP according to Rommens and Hofmann. The DRG revenue for the 2020 accounting period was then presented for each case.

Results: Patient No. 1: conservative therapy, unilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 4 score points, the Barthel scale increased from 55 to 75 points. After 6 days hospitalization, transferred to rehab. The DRG proceeds were € 3817.95. Patient No. 2: balloon sacroplasty, bilateral Denis 1-2 fracture zone, corresponding to an FFP type IIa, baseline pain 9 score points, at discharge 2 score points, the Barthel scale increased from 35 to 95 points. After 4 days hospitalization, discharged to outpatient follow-up treatment. The DRG proceeds were € 7409.44. Patient No. 3: osteosynthesis, bilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 2 score points, the Barthel scale increased from 40 to 90 points. After 5 days hospitalization, transferred to rehab. The DRG proceeds were € 6714.30.

Conclusion: The sacral insufficiency fracture is a strong indicator for the presence of manifest osteoporosis. Fracture risk factors are the female sex, advanced age, the presence of osteoporosis and vitamin D deficiency. Conservative therapy is the first step of the treatment cascade; however, in patients with persistent, disabling pain and no potential for mobilization, sacroplasty or osteosynthesis should be performed at an early stage. In patients treated with coordinated therapy processes and without clinical complications, all three treatment options are economically sufficient.
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http://dx.doi.org/10.1007/s00113-020-00932-1DOI Listing
December 2020

Surgical treatment of abdominal wall weakness and lumbar hernias in Ehlers-Danlos syndrome - Case report.

Int J Surg Case Rep 2020 26;76:14-18. Epub 2020 Sep 26.

Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany.

Introduction: Ehlers-Danlos syndrome (EDS) is a rare and diverse group of heritable connective tissue disorders. Gastrointestinal manifestations and abdominal pain are frequent in most subtypes of EDS. Conservative treatment is the standard of care.

Presentation Of The Case: A 43-year-old female patient with genetically confirmed EDS classic subtype presented with diffuse gastrointestinal symptoms (bloating, belching and pain) that were controlled by the patient through inclined posture and external abdominal compression. A standard abdominoplasty with rectus muscle plication and mesh implantation lead immediately to complete relief of symptoms, which allowed the patient to assume an upright posture and resume all daily activities again. After 7 years, the patient was again seen with severe, persistent abdominal pain and inclined posture related to right lumbar herniations, as confirmed by MRI. However, there was no recurrence of the previous abdominal midline weakness and related gastrointestinal symptoms. Following lumbar hernia repair and mesh implantation, the patient was free of abdominal pain and resumed an upright posture again.

Discussion: Although conservative treatment of EDS is primarily recommended and most surgeons are reluctant to operate on these patients except in life threatening situations, we present the successful surgical relief of disabling abdominal symptoms.

Conclusion: Regarding the variability and complexity of symptoms in different subtypes of EDS, a personalized multimodal treatment including surgical approaches should be considered and achieved a significant and long-lasting improvement in quality of life in our patient.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530213PMC
September 2020

Clinical Improvement and Cost-effectiveness of CT-guided Radiofrequency Sacroplasty (RFS) and Cement Sacroplasty (CSP) - a Prospective Randomised Comparison of Methods.

Z Orthop Unfall 2019 Oct 8;157(5):524-533. Epub 2019 Feb 8.

Klinik für Innere Medizin I, Klinikum Südstadt Rostock, Akademisches Lehrkrankenhaus der Universität Rostock.

Introduction: The objective of this study was a comparative analysis of cement augmentation by means of RFS and CSP with regard to outcome and cost-effectiveness.

Patients And Methods: CT-guided cement augmentation was performed on 100 patients with a total of 168 non-dislocated insufficiency fractures, 50 patients being treated with RFS and 50 patients with CSP. Leakages were detected by CT. Pain intensity was determined on a VAS before and after the intervention. The patients' self-sufficiency was assessed using the Barthel index. Patients were asked about any complications and their level of satisfaction. Costs incurred for carrying out the procedure were compared with the respective reimbursements received.

Results: Both procedures were technically fully feasible. No leakages were found in the RFS group, as opposed to 8.1% asymptomatic leakages in the CSP group. The mean value for pain before intervention was 8.8 in the RFS group and 8.7 in the CSP group. On the second postoperative day, there was a significant pain reduction with a value of 2.4 for both groups, which remained more or less constant over the follow-up period. The Barthel index increased significantly from an average of 30 before the intervention to 80 on the fourth postoperative day and 70 after 24 months. No differences were found between the two procedures with regard to pain, improvement in functional status and satisfaction. Taking into account the state-wide base rate used for calculating reimbursement, 3,834.75 € remained for RFS and 5,084.32 € for CSP.

Conclusion: RFS and CSP are minimally invasive procedures that achieve equally good and sustained pain reduction, leading to markedly improved self-sufficiency of the patients. With regard to possible cement leakages, RFS is the safer method. A profit can be generated with both techniques.
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http://dx.doi.org/10.1055/a-0815-5073DOI Listing
October 2019

CT-guided cement sacroplasty (CSP) as pain therapy in non-dislocated insufficiency fractures.

Eur J Orthop Surg Traumatol 2017 Dec 26;27(8):1045-1050. Epub 2017 Jun 26.

Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany.

Introduction: In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically associated with severe disabling pain. The objective of the present study was to examine the feasibility of cement augmentation by CSP, to determine post-interventional leakages and other complications, and to present the outcome of pain over the course of 18 months.

Materials And Methods: In 23 patients (20 women and 3 men) with an average age of 81.3 (71-92) years, a total of 41 sacral fractures were detected by MRI, 5 of them unilateral and 18 bilateral. Conservative treatment initially performed over a period of 3 weeks did not bring any satisfactory reduction in the severe disabling pain. The indication for intervention was established after an interdisciplinary case conference. The intervention was performed under intubation anaesthesia. Single-shot antibiotic prophylaxis was given routinely immediately prior to the intervention. Under sterile conditions, a Jamshidi needle was then advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis). After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. High-viscosity PMMA cement was then inserted discontinuously with the aid of a pressure gauge under low-dose CT control. Cement leakages were determined in the CT image on the day after the intervention, all cement outside of the cortical boundary being rated as a leakage. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and 6, 12, and 18 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to rate their satisfaction after 6 and 18 months.

Results: CSP was technically feasible in all patients. In the control CT scan, sufficient cement distribution and interlocking with vital bone were found along the course of the fracture in the sacrum. An average of 6.0 ± 0.83 ml of cement was inserted per fracture. Leakage was found in 5 of 41 (12.2%) of the fractures treated, although none were symptomatic. The mean pain score on the VAS was 8.8 ± 0.59 before the intervention, a significant pain reduction (p < 0.0005) was seen on the second post-operative day, with an average value of 2.1 ± 0.36, and this was stable at 2.2 ± 0.28 after 6, 2.3 ± 0.31 after 12, and 2.2 ± 0.41 after 18 months. Now that they no longer experienced disabling pain, all of the patients were fully remobilised and discharged back home. A high level of patient satisfaction was found after 6 and 18 months.

Conclusion: As a minimally invasive procedure, CSP is an effective treatment method for rapid, significant, and sustained pain reduction.
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http://dx.doi.org/10.1007/s00590-017-2001-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686249PMC
December 2017

Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study.

Eur Spine J 2017 12 9;26(12):3235-3240. Epub 2017 Jan 9.

Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany.

Purpose: The objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty.

Methods: In 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann-Whitney U tests.

Results: BSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p < 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results.

Conclusions: BSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term.
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http://dx.doi.org/10.1007/s00586-016-4935-0DOI Listing
December 2017