Publications by authors named "Karl Schwaiger"

25 Publications

  • Page 1 of 1

Anterograde Injection of Alteplase Salvages Deep Inferior Epigastric Perforator Flap in Reconstructive Breast Surgery.

Plast Reconstr Surg Glob Open 2022 Jun 20;10(6):e4415. Epub 2022 Jun 20.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.

The DIEP flap is currently considered the gold standard for autologous reconstructive breast surgery. Postoperative flap failure due to microvascular postanastomotic thrombotic occlusion is a rare but severe complication. Alteplase, a thrombolytic agent typically used in the setting of an ischemic stroke, myocardial infarction, or pulmonary embolism, has also been injected into the microcirculation of flaps as a rescue procedure due to imminent flap loss. The purpose of this article is to provide an overview and detailed guidance for such a thrombolytic procedure due to suspected thrombotic microsurgical failure in free flap surgery. We report the case of a 43-year-old woman who underwent unilateral breast reconstruction with a DIEP flap at our department. Approximately 12 hours postoperatively, an arterial inflow problem was suspected and revision surgery was performed. Peripheral flap perfusion remained absent without an obvious cause and distal thrombosis was assumed to be present. Therefore, alteplase was gradually injected into the arterial pedicle in the anterograde direction just distal to the anastomosis while clamping the artery proximally. About 3 hours after selective flap thrombolysis, microcirculation of the flap was successfully restored without complications. Anterograde injection of alteplase can successfully salvage a free flap. To our knowledge, evidence for optimal dosing and delivery of alteplase for the treatment of thrombosed DIEP flaps has not been published to date. Our approach presents a therapeutic option that both maximizes alteplase concentration in the flap and minimizes the dosage required for flap salvage to significantly reduce systemic adverse effects.
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http://dx.doi.org/10.1097/GOX.0000000000004415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208890PMC
June 2022

"Pyoderma gangrenosum - a lifelong chronic disease. A 10 year clinical follow up of a pyoderma patient".

J Plast Reconstr Aesthet Surg 2022 07 10;75(7):2387-2440. Epub 2022 May 10.

Department of Dermatology and Allergology, University Hospital Salzburg, Paracelsus Medical University, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria.

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http://dx.doi.org/10.1016/j.bjps.2022.04.103DOI Listing
July 2022

Microsurgical Scalp Replantation: Lessons Learned and Technical Considerations.

Plast Reconstr Surg Glob Open 2022 Mar 30;10(3):e4155. Epub 2022 Mar 30.

Department Plastic, Aesthetic and Reconstructive Surgery, Hospital of the Brothers of St. John of Gods, Salzburg, Austria.

Total scalp avulsion is defined as a severe soft-tissue injury which involves the hairy scalp and commonly occurs in women as a result of the entrapment of long hair in high-speed rotating industrial machinery. The first microvascular replantation of an avulsed scalp was described by Miller et al in 1976 when both superficial temporal arteries along with five veins were successfully reanastomosed. Our patient was managed with a vein graft measuring 8 cm in length for reanastomosis of the superficial temporal artery. Furthermore, after successful replantation, we used an expander for aesthetic refinement and achieved an excellent outcome. A scalp replantation should be performed in every possible case. Despite partial skin necrosis, hair growth in the remaining areas is possible. In cases of partial skin necrosis, it is possible to eliminate the hairless areas by implanting an expander and excising the hairless area. A pressure-related ulcer at the occiput is likely due to immobility of the head postoperatively and may be avoided by using a halo fixation device.
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http://dx.doi.org/10.1097/GOX.0000000000004155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966971PMC
March 2022

Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and Its Passage beneath the Inguinal Ligament.

Plast Reconstr Surg 2022 05 11;149(5):1147-1151. Epub 2022 Mar 11.

From the Department of Plastic, Aesthetic, and Reconstructive Surgery, Hospital of St. John of God Salzburg, Paracelsus Medical University Salzburg; Department for Plastic, Reconstructive, and Hand Surgery, Nuremberg Hospital, Paracelsus Medical University; and Gottfried Schatz Research Center, Macroscopic and Clinical Anatomy, Medical University Graz.

Background: Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve. According to the literature, the nerve travels beneath the inguinal ligament 1.3 to 5.1 cm medial to the anterior superior iliac spine. Compression at this site may cause pain and paresthesia. The aim of this study was to provide more accurate measurements to improve the diagnostic and surgical management of meralgia paraesthetica.

Methods: The lateral femoral cutaneous nerve was dissected bilaterally in 50 Thiel-embalmed human cadavers. Measurements were performed with a standard caliper at the superior and inferior margins of the inguinal ligament. The distance from the inner lamina of the anterior superior iliac spine to the medial margin of the lateral femoral cutaneous nerve was measured. Data were collected and statistical analysis was performed with R.

Results: Ninety-three lateral femoral cutaneous nerves of 50 cadavers were dissected. In 6 percent of cadavers, the lateral femoral cutaneous nerve could not be found. The mean distance from the inner lamina of the anterior superior iliac spine to the lateral femoral cutaneous nerve's medial border was 2.1 ± 1.3 cm (range, 0.2 to 6.4 cm; 95 percent CI, 1.8 to 2.4 cm) at the superior margin of the inguinal ligament and 1.9 ± 1.4 cm (range, 0.2 to 3.0 cm; 95 percent CI, 1.6 to 2.2 cm) at the inferior border of the inguinal ligament.

Conclusion: This anatomical study shows that the majority of the lateral femoral cutaneous nerve passes beneath the inguinal ligament in a very narrow area of 0.6 cm.
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http://dx.doi.org/10.1097/PRS.0000000000009034DOI Listing
May 2022

[Decompression of the lateral femoral cutaneous nerve of the thigh : Treatment of meralgia paresthetica].

Oper Orthop Traumatol 2022 Apr 5;34(2):90-97. Epub 2021 Nov 5.

Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Privatuniversität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich.

Objective: Treatment of non-responding pain to conservative treatment located at the anterolateral thigh with surgical decompression of the lateral femoral cutaneous nerve of the thigh (LFCN).

Indications: Compression syndrome of the LFCN; patients suffering from the following symptoms: pain (dysesthesia), numbness (paresthesia), hypersensibility to temperature (or temperature changes) along the course of the LFCN located at the anterolateral thigh.

Contraindications: A new or recrudescent hernia with additional pain or recent laparoscopic hernia repair as a supposed iatrogenically induced compression of the LFCN.

Surgical Technique: Dissection and release of the LFCN of connective tissue, scar tissue, bone rims, and retraction located along the passage underneath the inguinal ligament and distally.

Postoperative Management: Suture removal after 10-14 days, no sports for 2 weeks. Physiotherapy if necessary. Neurography 4 months after surgery (obligatory if symptoms are persistent). The patient should be followed up for about 24 months.

Results: Of the patients, 69% had a history of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses and 22% had previous falls. Postoperatively, a significant reduction of pain of 6.6 points on the numeric rating scale was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.
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http://dx.doi.org/10.1007/s00064-021-00747-2DOI Listing
April 2022

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases.

J Clin Med 2021 Aug 17;10(16). Epub 2021 Aug 17.

Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 72074 Tübingen, Germany.

Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction.

Patients And Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings.

Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site.

Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.
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http://dx.doi.org/10.3390/jcm10163629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396873PMC
August 2021

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap-A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients.

J Clin Med 2021 Mar 1;10(5). Epub 2021 Mar 1.

Department of Plastic, Reconstructive and Aesthetic Surgery Hospital of the Brothers of St. John of God (Barmherzige Brüder), Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria.

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals.

Patients And Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson's chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome.

Results: No significant differences in patients' age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight.

Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.
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http://dx.doi.org/10.3390/jcm10050926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957526PMC
March 2021

Correspondence to the article: "Hyperbaric oxygen therapy for large composite grafts: An alternative in Pediatric Facial Reconstruction" by Camison et al., Published in JPRAS (J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2178-2184).

J Plast Reconstr Aesthet Surg 2021 09 13;74(9):2392-2442. Epub 2021 Mar 13.

Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Reconstructive and Aesthetic Surgery, Paracelsus Medical University, Kajetanerplatz 1, Salzburg, Austria.

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http://dx.doi.org/10.1016/j.bjps.2021.02.003DOI Listing
September 2021

Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis.

J Clin Med 2020 Nov 26;9(12). Epub 2020 Nov 26.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria.

Background: Proximal radial nerve lesions located between the brachial plexus and its division into the superficial and deep branches are rare but severe injuries. The majority of these lesions occur in association with humerus fractures, directly during trauma or later during osteosynthesis for fracture treatment. Diagnostics and surgical interventions are often delayed. The best type of surgical treatment and the outcome to be expected often is uncertain.

Methods: Twelve patients with proximal radial nerve lesions due to trauma or prior surgery were included in this study and underwent neurolysis ( = 6) and sural nerve graft interposition ( = 6). Retrospective analysis of the collected patient data was performed and the postoperative course was systematically evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) and the LSUHS (Louisiana State University Health Sciences) scores were used to determine regeneration after surgery. Comparison between the patients' and calculated normative DASH scores was performed.

Results: All patients had a traumatically or iatrogenically induced proximal radial nerve lesion and underwent secondary treatments. The average time from radial nerve lesion occurrence to surgical intervention was approximately four months (1.5-10 months). Eight patients (66.67%) had a humeral fracture. During follow up, no statistically significant difference between the calculated normative and the patients' DASH scores was observed. The LSUHS scores were at least satisfactory.

Conclusions: Neurolysis or sural nerve graft interposition performed within a specific period of time are the primary treatment options for radial nerve lesions. They should be performed depending on the lesion type. Regeneration to a satisfactory degree was observed in all patients, and the majority achieved full recovery of sensory and motor functions. This was the first study to highlight the efficiency of neurolysis and sural nerve graft interposition as secondary treatment interventions, especially for radial nerve lesions.
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http://dx.doi.org/10.3390/jcm9123823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760920PMC
November 2020

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis.

J Clin Med 2020 Jun 28;9(7). Epub 2020 Jun 28.

Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Germany; Boeheimstr 37, 70199 Stuttgart, Germany.

Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome.

Patients And Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps ( = 152) in group 1, or double TMG flaps ( = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated.

Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% ( = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded ( = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, = 0.0047, RR 1.71).

Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.
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http://dx.doi.org/10.3390/jcm9072031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409039PMC
June 2020

Occult papillary thyroid cancer presenting as cystic metastasis of the lateral neck: A case report.

Medicine (Baltimore) 2019 Jul;98(30):e16659

Hospital of the Barmherzige Brüder Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University Salzburg (PMU), Salzburg, Austria.

Rationale: Papillary thyroid cancer accounts for up to 85% of all cases of thyroid carcinoma. This disease entity is notorious for metastatic invasion of adjacent lymph nodes, including the cervical lymph nodes, potentially presenting as a growing lateral neck mass. However, these lesions tend to be recognized and diagnosed soon due to the palpable mass.

Patient Concerns: This report describes a very rare case of a huge slow-growing neck metastasis based on a 6 mm papillary thyroid microcarcinoma. This patient presented with a painless, but continuously growing right lateral neck mass. Aside from that, no specific complaints were mentioned.

Diagnosis: The underlying cause of this patient's neck mass turned out to be an occult papillary thyroid microcarcinoma (Ø 6 mm) with metastatic invasion and subsequent cystic degeneration of cervical lymph nodes. Accurate diagnosis was made after surgical intervention through histopathological analysis.

Interventions: The patient underwent complete resection of the cervical mass in conjunction with total thyroidectomy and right cervical neck dissection, followed by adjuvant iodine- and chemotherapy.

Outcome: Margin free surgical resection without any postoperative complications could be achieved. The patient received iodine supplementation and remained free of recurrence during regular clinical follow-ups for 2 years. The therapy was curative.

Lessons: This case report emphasizes the importance of a thorough diagnostic work-up including preoperative tissue sampling of any cervical neck mass, since a benign appearance on imaging does not exclude a malignant process.
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http://dx.doi.org/10.1097/MD.0000000000016659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708659PMC
July 2019

Effects of Preoperative Extracorporeal Shockwave Therapy on Scar Formation-A Pilot Study on 24 Subjects Undergoing Abdominoplasty Surgery.

Lasers Surg Med 2020 02 29;52(2):159-165. Epub 2019 Apr 29.

Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5020, Salzburg, Austria.

Objectives: Extracorporeal shockwave therapy (ESWT) has been demonstrated as a feasible noninvasive method to improve wound healing. This effect was demonstrated to result from increased perfusion and angiogenesis due to systemic growth factor expression. We, therefore, hypothesized that preoperative ESWT reduces scar formation after surgery.

Methods: A prospective, controlled pilot study on 24 patients undergoing abdominoplasty was conducted and the efficacy of preoperative unfocused, low energy EWST was evaluated. The right and left half of the operative area were randomly allocated to ESWT or placebo treatment in intrapatient control design. At 6 and 12 weeks after surgery, scar formation was evaluated by 19 different scar parameters included in the patient, observer scar assessment, and the Vancouver scar scale.

Results: The overall rating of the Vancouver and POSAS scale with Mann-Whitney (MW) analysis revealed a clear trend favoring ESWT. At week 6, 7 of 19 parameters clearly favored ESWT (MW > 0.53). At week 12, 8 of 19 parameters clearly favored ESWT. The largest differences were observed in thickness and overall impression (Vancouver scar scale).

Conclusions: ESWT presumably reduces scar formation and postoperative symptoms after abdominoplasty surgery. Further studies are required to confirm ESWT efficacy with statistical significance. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23089DOI Listing
February 2020

Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis.

Medicine (Baltimore) 2018 Aug;97(33):e11914

Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Meralgia paresthetica (MP) is a rare lateral femoral cutaneous nerve-(LFCN)-mononeuropathy. Treatment for this disorder includes conservative and operative approaches; the latter is considered if conservative therapy fails. The most commonly used surgical approaches are decompression/neurolysis and avulsion/neurectomy. However, there are no definitive guidelines on the optimal surgical approach to be used. The purpose of this study was to evaluate the outcome of surgical decompression of the LFCN for the treatment of persistent MP with preservation of sensation along the distribution of the LFCN.We evaluated the outcomes of LFCN procedures performed between 2015 and 2016. A total of 16 surgical decompressions could be identified. Retrospective analysis of prospectively collected patient data was performed, as well as systematic evaluation of the postoperative course, with regular follow-up examinations based on a standardized protocol. Pain was analyzed using an NRS (numeric rating scale). Several postsurgical parameters, including temperature hypersensitivity and numbness in the LFCN region, were compared with the presurgical data.Sixty-nine percent of patients had histories of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses, 2 had previous falls. Postoperatively, a significant reduction of 6.6 points in the mean NRS pain value was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.Previous studies favor either avulsion/neurectomy as the preferred procedure for MP treatment, or provide no recommendation. Our findings instead confirm the decompression/neurolysis approach as the primary surgical procedure of choice for the treatment of MP, if conservative treatment fails.
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http://dx.doi.org/10.1097/MD.0000000000011914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113044PMC
August 2018

Minimizing the Short-term Reoperation Rate in Abdominoplasty Procedures by Prolonged Postoperative Immobilization.

Obes Surg 2018 10;28(10):3253-3258

Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Kajetanerplatz 1, 5020, Salzburg, Austria.

Background: Abdominoplasty is a common procedure in postbariatric surgery. Over the years, a high number of technical refinements of the procedure have been established to improve safety and reduce associated complications. Nevertheless, the complication rate is high. The purpose of this study was to examine the incidence of postoperative complications in patients undergoing abdominoplasty in association with prolonged postoperative immobilization.

Methods: Retrospective analysis of 82 patients who underwent abdominoplasty was performed. Patients were divided in two study groups regarding their immobilization period. Group 1 included patients with an immobilization period defined as strict bed rest for at least 45 h after surgery. Group 2 included all patients with shorter immobilization time, but earliest mobilization in the evening on the day of surgery.

Results: Overall, complication rate was 27%. Major complications were observed in 15% in group 1 and in 23% in group 2. Hematoma requiring surgical revision was observed in 5% in group 1 and in 14% in group 2. Surgical revisions within the first 60 days were necessary in 5% in group 1 and in 20% in group 2.

Conclusion: Prolonged immobilization after abdominoplasty does not crucially lower the overall complication rate, but influences the severity of complications in a positive way. Increasing the duration of postoperative immobilization up to 45 h after abdominoplasty significantly decreases the reoperation rate in our practice. The risk for a surgical revision is nearly four times higher if the patient leaves bed earlier. Surgeons should consider this option especially in patients with a high risk for complication development.
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http://dx.doi.org/10.1007/s11695-018-3337-2DOI Listing
October 2018

Spalthauttransplantation zur Defektdeckung am Ohr: eine statistische Analyse.

J Dtsch Dermatol Ges 2018 Feb;16(2):163-173

Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien.

Hintergrund Und Ziele: Die Rekonstruktion nach Entfernung ausgedehnter maligner Hauttumoren am Ohr ist eine Herausforderung. Verschiedene Methoden der Defektdeckung wurden beschrieben. Lappenplastiken, längere Anästhesiezeiten, geringe Compliance und Antikoagulation stellen bei den oft älteren Patienten zusätzliche Risiken dar. Eine rasch, effizient und unkompliziert durchführbare Methode der Defektdeckung ist daher wünschenswert. Ziel der Studie war die Beurteilung des ästhetischen Resultats, des Heilungsprozesses, der Komplikations- und Rezidivrate nach Transplantation ungenetzter Spalthaut (SPHT) zur Defektdeckung nach knorpelerhaltender Resektion maligner Tumoren am Ohr.

Patienten Und Methodik: 32 Patienten wurden nach Entfernung von Hauttumoren am Ohr einer Defektdeckung mittels SPHT unterzogen.

Ergebnisse: Die durchschnittliche Defektgröße betrug 8,0 cm . Eine vollständige Einheilung des Transplantates erfolgte in allen Fällen innerhalb von zwei Wochen. Wesentliche Komplikationen traten nicht auf. Das ästhetische Resultat wurde sowohl von den Patienten als auch von einem Dermatochirurgen und zwei plastischen Chirurgen als gut bewertet.

Schlussfolgerungen: Die SPHT am Ohr ist eine zuverlässige Methode zur Deckung ausgedehnter Hautdefekte. Selbst bei großen Tumoren des äußeren Ohres ist der Ohrknorpel nicht immer infiltriert. Eine knorpelschonende Tumorresektion mit anschließender Defektdeckung mittels SPHT ist eine ausgezeichnete und rasch durchführbare Technik mit hoher Patientenzufriedenheit.
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http://dx.doi.org/10.1111/ddg.13415_gDOI Listing
February 2018

Split-thickness skin grafting for reconstruction of auricular skin defects: a statistical analysis.

J Dtsch Dermatol Ges 2018 Feb 12;16(2):163-173. Epub 2018 Jan 12.

Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy.

Background And Objectives: Surgical reconstruction following the removal of large malignant auricular lesions is challenging. While many options for defect closure have been described, in the elderly population usually affected flap surgery, long anesthesia times, patient compliance, and anticoagulant therapy pose additional risks. An alternative quick, simple, and effective method of defect closure is therefore highly desirable. The objective of the present study was to assess the aesthetic outcome, healing process, complications, and recurrence rates associated with unmeshed split-thickness skin grafts (STSGs) used for covering large auricular skin defects following cartilage-sparing skin cancer removal.

Patients And Methods: Under local tumescent anesthesia, 32 patients received STSGs for defect closure following the removal of malignant cutaneous neoplasms of the ear.

Results: The average defect size was 8.0 cm². In all cases, complete healing of the recipient site occurred within two weeks. There were no major complications. The aesthetic outcome was rated highly by patients as well as by the dermatosurgeon involved and two independent plastic surgeons.

Conclusions: STSGs are a valid option for closing large auricular skin defects. Even large cutaneous tumors of the external ear do not necessarily infiltrate the cartilage. Thus, cartilage-sparing tumor resection with subsequent defect closure using a STSG is an excellent and quick method associated with high patient satisfaction.
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http://dx.doi.org/10.1111/ddg.13415DOI Listing
February 2018

Thighplasty: improving aesthetics through revival of the medial, horizontal procedure: A safe and scar-saving option.

J Plast Reconstr Aesthet Surg 2018 04 25;71(4):585-589. Epub 2017 Oct 25.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Barmherzige Brüder Salzburg, Paracelsus Medical University, Kajetanerplatz 1, Salzburg 5020, Austria.

Introduction: Thighplasty is a common bodycontouring procedure, but also associated with a high complication rate. The purpose of this study was to access the outcome of the medial horizontal thigh lift as it is a common surgical technique regarding thigh deformity correction performed at the authors' department. Surgical keysteps, clinical applications, advantages and disadvantages of the procedure are shown. Postoperative evaluation took place with special focus on individual patient satisfaction.

Methods: Retrospective analysis of 25 bilateral thigh lifts with single medial horizontal incision line was performed. Evaluated data include patient age, sex, body mass index, combined procedures, additional liposuction, weight loss, former bariatric surgery, comorbidities, smoking status and surgical complications. Follow-up was performed with a standardized protocol and the scar was accessed according to the Vancouver-Scare-Scale. Additionally the patients were asked to complete a questionnaire divided into the sections 'scars', 'postoperative result' and 'sexuality'.

Results: Average patient-age was 43 years. Average follow-up was 2 years and 8 months. Average weight loss before surgery was 57 kg. 36% of all patients additionally received a liposuction of the medial thigh. In six cases (24%), we observed complications, which were designated as 'minor complications' in five times (conservative management without problems) and 'major complication' in one time (surgical revision). Postoperative patient-satisfaction was high.

Discussion And Conclusion: Compared to the horizontal and vertical combined thigh lift with the classic T-shaped incision lines we observed fewer complications and a reduction of postoperative morbidity. Additionally patient satisfaction was very high. We estimate that the main reason therefore is the avoidance of the vertical scar and its associated short- and longterm problems. The evaluated data confirm the medial horizontal thighplasty as a good and valuablesurgical option for the management of thigh deformities with moderate skin and tissue excess, localized in the upper part of the thigh.
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http://dx.doi.org/10.1016/j.bjps.2017.10.002DOI Listing
April 2018

Reconstructive microsurgical approach for the treatment of pyoderma gangrenosum.

J Plast Reconstr Aesthet Surg 2018 Jan 16;71(1):44-52. Epub 2017 Aug 16.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Barmherzige Brüder Salzburg, Paracelsus Medical University (PMU), Kajetanerplatz 1, 5020, Salzburg, Austria.

Introduction: Pyoderma gangrenosum (PG) is a rare type of autoimmune disease that results in progressive ulcers with or without previous trauma. However, PG is not well understood to date, and its treatment therefore remains a challenge. Because of the disease's systemic characteristic and the unpredictability of the clinical course, no gold standard treatment is available, especially concerning the surgical procedures to treat pyodermic lesions. Often, PG is not recognized during routine clinical practice, and standard ulcer treatment (conservative wound care, debridement, skin grafting, and local flap coverage) is initiated; this induces an autoinflammatory response, resulting in disastrous ulcers, thereby making free flap coverage necessary. The purpose of this study was to assess the outcome of microvascular free-tissue transfer as a treatment option for extended soft-tissue defects resulting from PG.

Materials And Methods: We retrospectively evaluated 8 cases in 5 patients suffering from PG of the lower extremity who received defect closure with a microvascular free-tissue transfer under immunosuppressive and corticosteroid therapy.

Results: The average patient age was 60 years; three were male, and two were female. Seven defects were covered with free gracilis muscle flap. One patient received an anterolateral thigh flap. The average defect size was 93 cm. No flap loss was observed during follow-up. All patients received broad-spectrum antibiotic treatment and corticosteroids. Two patients also received infliximab.

Discussion And Conclusion: PG once diagnosed is not a contraindication for microvascular free-tissue transfer. Multidisciplinary evaluation of each case is fundamental. All surgical treatments should be performed only with sufficient protective immunosuppression therapy. If the defect requires free flap coverage, it should be considered as a surgical option despite the potential risk of a pathergic response in PG and was a safe treatment option in all our cases. In conclusion, we share our experience regarding preoperative, intraoperative, and postoperative care of patients with PG receiving free flap surgery.
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http://dx.doi.org/10.1016/j.bjps.2017.08.013DOI Listing
January 2018

Hailey-Hailey Disease and Reduction Mammoplasty: Surgical Treatment of a Gene Mutation.

Aesthetic Plast Surg 2018 Feb 15;42(1):331-332. Epub 2017 Sep 15.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), Paracelsus Medical University (PMU) Salzburg, Kajetanerplatz 2, 5020, Salzburg, Austria.

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http://dx.doi.org/10.1007/s00266-017-0963-3DOI Listing
February 2018

Simply Do Not Go Snowboarding 2 Weeks after Augmentation.

Plast Reconstr Surg Glob Open 2017 Jun 13;5(6):e1354. Epub 2017 Jun 13.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of the Barmherzige Brüder Salzburg, Paracelsus Medical University Salzburg (PMU), Salzburg, Austria.

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http://dx.doi.org/10.1097/GOX.0000000000001354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505830PMC
June 2017

Trigger Finger Caused by Extraskeletal Chondroma.

J Hand Surg Am 2017 Jan 3;42(1):e51-e55. Epub 2016 Nov 3.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.

Chondroma is a relatively rare, but well-reported benign neoplasm. This lesion normally occurs attached to bone; however, they may be rarely found without association to bone and embedded in soft tissue. The authors describe the case of a 76-year-old man in whom flexor tendon triggering was associated with an extraskeletal chondroma between the annular ligament and the flexor tendon.
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http://dx.doi.org/10.1016/j.jhsa.2016.10.003DOI Listing
January 2017

Aesthetic Breast Augmentation Mastopexy Followed by Post-surgical Pyoderma Gangrenosum (PSPG): Clinic, Treatment, and Review of the Literature.

Aesthetic Plast Surg 2015 Aug 28;39(4):506-13. Epub 2015 May 28.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University (PMU) Salzburg, Kajetanerplatz 1, 5010, Salzburg, Austria,

Introduction: Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic ulcerative skin disease, often developing after a trauma or surgical wounds. In the literature there are several reports of post-surgical PG (PSPG) of the breast. The authors of this article experienced an impressive case of PSPG after an aesthetic breast augmentation mastopexy. PSPG is a rare but severe complication in this elective aesthetic surgical procedure.

Method: A systematic review of the literature was performed, focusing on PSPG after aesthetic breast surgery (augmentation mammoplasty/mastopexy). The online databases Pubmed, Medline, and Cochrane were used and additionally a Google© search was conducted. We compared the data obtained from a systematic literature review to an index case of PSPG after esthetic augmentation mammoplasty.

Results: The literature search identified seven articles describing eight cases of PSPG after aesthetic breast surgery. In four of these cases augmentation mammoplasty had been carried out, in two cases mastopexy and in two cases augmentation mammoplasty and mastopexy (augmentation mastopexy). The patient we treated and describe in this paper underwent an augmentation mastopexy outside our clinic. Eight patients suffered from local disease, at the site of surgical wounds, one patient had disseminated disease. Leukocytosis was present in five cases (out of nine). Eight patients had received corticosteroid treatment, one patient refused such treatment. The duration of corticosteroid treatment was on average for 41 days (range 21-60 days). In all cases, the areola had been spared. Complete healing of PSPG was observed on average after 5 months (range 1.5 months-1 year).

Discussion: PSPG of the breast after aesthetic breast surgery is rare, but every plastic surgeon should consider this possibility, especially if skin disease develops post-surgery, mimicking wound infection that does not respond to broad-spectrum antibiotic treatment.

Conclusion: Although the literature does not recommend this step, implant removal is recommended by the authors because bacterial wound infection normally cannot be ruled out definitely in the early stages of disease. Additional surgical intervention should be limited to the absolute necessary and performed only under adequate systemic immunosuppressive therapy.
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http://dx.doi.org/10.1007/s00266-015-0499-3DOI Listing
August 2015

Localized hypertrichosis after index finger revascularization and complex regional pain syndrome.

Arch Plast Surg 2014 Sep 15;41(5):603-4. Epub 2014 Sep 15.

Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital of Innsbruck, Innsbruck, Austria.

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http://dx.doi.org/10.5999/aps.2014.41.5.603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179371PMC
September 2014

An easy and novel method of preoperative laser-assisted marking for body lift procedures.

Plast Reconstr Surg 2013 Oct;132(4):693e-694e

Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), Department of Plastic, Aesthetic, and Reconstructive Surgery, Academic Teaching Hospital, Paracelsus Medical University Salzburg Paracelsus Medical University Salzburg Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), Department of Plastic, Aesthetic, and Reconstructive Surgery, Academic Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria.

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http://dx.doi.org/10.1097/PRS.0b013e31829fe3beDOI Listing
October 2013
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