Publications by authors named "Stefan Langer"

79 Publications

Hyperspectral Imaging (HSI) as a new diagnostic tool in free flap monitoring for soft tissue reconstruction: a proof of concept study.

BMC Surg 2021 Apr 30;21(1):222. Epub 2021 Apr 30.

Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany.

Objectives: Free flap surgery is an essential procedure in soft tissue reconstruction. Complications due to vascular compromise often require revision surgery or flap removal. We present hyperspectral imaging (HSI) as a new tool in flap monitoring to improve sensitivity compared to established monitoring tools.

Methods: We performed a prospective observational cohort study including 22 patients. Flap perfusion was assessed by standard clinical parameters, Doppler ultrasound, and HSI on t0 (0 h), t1 (16-28 h postoperatively), and t2 (39-77 h postoperatively). HSI records light spectra from 500 to 1000 nm and provides information on tissue morphology, composition, and physiology. These parameters contain tissue oxygenation (StO2), near-infrared perfusion- (NIR PI), tissue hemoglobin- (THI), and tissue water index (TWI).

Results: Total flap loss was seen in n = 4 and partial loss in n = 2 cases. Every patient with StO2 or NIR PI below 40 at t1 had to be revised. No single patient with StO2 or NIR PI above 40 at t1 had to be revised. Significant differences between feasable (StO2 = 49; NIR PI = 45; THI = 16; TWI = 56) and flaps with revision surgery [StO2 = 28 (p < 0.001); NIR PI = 26 (p = 0.002); THI = 56 (p = 0.002); TWI = 47 (p = 0.045)] were present in all HSI parameters at t1 and even more significant at t2 (p < 0.0001).

Conclusion: HSI provides valuable data in free flap monitoring. The technique seems to be superior to the gold standard of flap monitoring. StO2 and NIR PI deliver the most valuable data and 40 could be used as a future threshold in surgical decision making. Clinical Trial Register This study is registered at the German Clinical Trials Register (DRKS) under the registration number DRKS00020926.
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http://dx.doi.org/10.1186/s12893-021-01232-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086299PMC
April 2021

Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants.

Patient Prefer Adherence 2021 13;15:741-750. Epub 2021 Apr 13.

Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.

Purpose: Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR.

Patients And Methods: Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient's charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL.

Results: SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care.

Conclusion: Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.
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http://dx.doi.org/10.2147/PPA.S303208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053496PMC
April 2021

[Implementation of the wide awake local anesthesia no tourniquet (WALANT) type of anesthesia in hand surgery].

Orthopade 2021 May 13;50(5):415-424. Epub 2021 Apr 13.

Bereich für Plastische, Ästhetische und Spezielle Handchirurgie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland.

Wide awake local anesthesia no tourniquet (WALANT) refers to an anesthesia technique with low bleeding and complication rates, which enables interventions on the hand in an awake patient without the use of a tourniquet. Bleeding control is achieved through addition of vasoconstrictors to the infiltration solution. Since the motor function of the extremity is not affected, it offers the additional possibility of intraoperative active function testing. The WALANT procedure constitutes an established, effective, easily learnt and resource-sparing technique. The spectrum of surgical possibilities with WALANT is wide and covers nearly all elective and many emergency procedures. Due to multiple advantages in contrast to other regional and general anesthesia procedures, WALANT features an increasing spectrum of surgical applications and practitioners. It is therefore of interest for hand surgeons working both in hospitals and private practices.
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http://dx.doi.org/10.1007/s00132-021-04098-5DOI Listing
May 2021

Free Flap Reconstruction of the Extremities in Patients Who are ≥65 Years Old: A Single-Center Retrospective 1-to-1 Matched Analysis.

Clin Interv Aging 2021 18;16:497-503. Epub 2021 Mar 18.

Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.

Purpose: Demographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older patients. Therefore, this study evaluated free flap reconstruction of the extremities in older patients and compared the outcomes to those from younger patients who underwent similar procedures during the same period.

Patients And Methods: This single-center retrospective study used a case-control design to compare older and younger patients who underwent free flap reconstruction of soft tissue defects in the extremities. One-to-one matching was performed for older patients (≥65 years) and younger patients (≤64 years) according to indication, flap recipient site, and flap type. The parameters of interest were clinico-demographic characteristics, flap type, defect location, indication for free flap reconstruction, number of venous anastomoses, and postoperative complications (flap loss, infection, and wound healing disorders).

Results: The study included 48 older patients and 133 younger patients, with a mean follow-up of 12 months after discharge. The free flap reconstruction was performed at a mean interval of 19.8±22.8 days (range: 0-88 days). The 1:1 matching created 38 pairs of patients, which revealed no significant differences in the rates of flap necrosis and flap failure.

Conclusion: This study failed to detect a significant age-related difference in the flap necrosis rate after free flap reconstruction of extremity defects. Therefore, with careful perioperative management and patient selection, microsurgical free flap reconstruction is a feasible option for older patients.
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http://dx.doi.org/10.2147/CIA.S300558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987263PMC
March 2021

New model in diabetic mice to evaluate the effects of insulin therapy on biofilm development in wounds.

GMS Interdiscip Plast Reconstr Surg DGPW 2020 23;9:Doc06. Epub 2020 Dec 23.

Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Germany.

Diabetic patients suffer more frequently from biofilm-associated infections than normoglycemic patients. Well described in the literature is a relationship between elevated blood glucose levels in patients and the occurrence of biofilm-associated wound infections. Nevertheless, the underlying pathophysiological pathways leading to this increased infection vulnerability and its effects on biofilm development still need to be elucidated. We developed in our laboratory a model to allow the investigation of a biofilm-associated wound infection in diabetic mice under controlled insulin treatment. A dorsal skinfold chamber was used on 16 weeks old BKS.Cg-Dock7 +/+ Lepr/J mice and a wound within the observation field of the dorsal skinfold chamber was created. These wounds were infected with ATCC 49230 (10 cells/mL). Simultaneously, we implanted implants for sustained insulin release into the ventral subcutaneous tissue (N=5 mice). Mice of the control group (N=5) were treated with sham implants. Serum glucose levels were registered before intervention and daily after the operation. Densitometrical analysis of the wound size was performed at day 0, 3, and 6 after intervention. Mice were sacrificed on day 6 and wound tissue was submitted to fluorescence hybridization (FISH) and colony forming unit (CFU) analysis in addition to immunohistochemical staining to observe wound healing. Experiments were carried out in accordance with the National Institute of Health Guidelines for the Care and Use of Laboratory Animals (protocol number 05/19). The insulin implants were able to reduce blood glucose levels in the mice. Hence, the diabetic mice in the intervention group were normoglycemic after the implantation. The combination with the dorsal skinfold chamber allowed for continuous, in vivo measurements of the infection development. Implantation of the insulin implant and the dorsal skinfold chamber was a tolerable condition for the diabetic mice. We succeeded to realize reproducible biofilm infections in the animals. We developed a novel model to assess interactions between blood glucose level and -induced biofilm-associated wound infections. The combination of the dorsal skinfold chamber model with a sustained insulin treatment has not been described so far. It allows a broad field of glucose and insulin dependent studies of infection.
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http://dx.doi.org/10.3205/iprs000150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818390PMC
December 2020

Leptin promotes adipocytes survival in non-vascularized fat grafting via perfusion increase.

Microvasc Res 2021 05 7;135:104131. Epub 2021 Jan 7.

Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Germany.

Background: Though autologous fat transplantation is regularly and successfully performed in plastic surgery, little is known about the factors that contribute to the rise of preadipocytes and how the viability of adipocytes is regulated. As sufficient blood supply is a key parameter for the transplant's survival, we opted to analyse the development of preadipocytes within the fat transplant via stimulation of tissue perfusion with the angiogenesis enhancing hormone leptin.

Methods: In a murine (C57BL/6N) model inguinal fat was autologously transplanted into a dorsal skinfold chamber. In the intervention group the fat transplant was treated with local administration of leptin (3 μg/ml) at days 3, 7 and 10 after transplantation. Saline solution was administered respectively in the control group. On the postoperative days 3, 7, 10, and 15 intra vital microscopy was done to assess the functional vessel density, vessel diameter, adipocyte survival and preadipocyte development. The study was completed by histological tissue analysis on days 15 after transplantation.

Results: Leptin administration leads to an increase of angiogenesis, which starts from day 7 after implantation and elevates perfusion as well as functional vessel density FVD at days 10 and 15 after transplantation. Perfusion develops first from the border zones of the transplant. Histological evaluation showed that the percentage of perilipin positive adipocytes increased markedly in the study group of mice. Moreover, fat transplants of mice of the leptin group disclosed significantly higher Pref-1 positive cells than fat transplants of the control group. The findings reported in this study indicate that the leptin can enhance the survival and the quality of grafted fat tissue, which may be due to induction of angiogenesis.

Conclusion: Leptin administration to fat transplants induced an increase in angiogenesis in the transplanted tissue and may play a role in reducing the resorption rate of lipoaspirates.
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http://dx.doi.org/10.1016/j.mvr.2021.104131DOI Listing
May 2021

Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study.

BMC Musculoskelet Disord 2020 Dec 1;21(1):799. Epub 2020 Dec 1.

Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.

Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.

Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.

Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year.

Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.
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http://dx.doi.org/10.1186/s12891-020-03827-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709287PMC
December 2020

[Surgical flap according to Littler (neurovascular island flap)].

Oper Orthop Traumatol 2020 Dec 6;32(6):486-493. Epub 2020 Nov 6.

Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für Plastische, Ästhetische und Spezielle Handchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.

Objective: Defect coverage of medium-sized soft tissue defects on the ulnar side of the thumb and radial side of the index finger. By using the Littler flap, both, the lost soft tissue coverage and sensitivity, which is necessary for an exact grip to the long fingers, can be simultaneously restored.

Indications: Medium-sized soft tissue defect of the ulnar tip of the thumb, exposed bones and parts of the tendons, extensive soft tissue defects with sensory deficit.

Contraindications: Limiting accompanying injuries of the hand.

Surgical Technique: All-layer incision of the flap at ulnar 3rd digit with proximal exploration of the nerve and vascular bundle. Tracing the bundle to the exit from the palmar arch. After subcutaneous tunneling, shift of the flap into the defect.

Postoperative Management: Immobilization of the thumb in adduction for 7 days in a dorsal plaster splint, followed by free exercise.

Results: Reliable defect coverage with low donor-site morbidity and immediate restoration of sensibility in the ulnar tip of the thump. However, microsurgical dissection, especially of the nerve, is challenging.
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http://dx.doi.org/10.1007/s00064-020-00683-7DOI Listing
December 2020

Scar quality examination comparing titanium-coated suture material and non-coated suture material on flap donor sites in reconstructive surgery.

BMC Surg 2020 Nov 3;20(1):268. Epub 2020 Nov 3.

Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany.

Background: Wound healing and scar quality after trauma are subject to impairment through excessive wound healing, chronic wound or even surgical site infections. Optimizing the process of scar formation and skin healing is crucial in virtually all fields of medicine. In this regard, we tested the possible usage and advantages of titanium coated suture material.

Methods: We performed a prospective observational cohort study including 30 patients who underwent soft tissue reconstruction. One half of the donor flap site was sutured with titanium coated suture material, while the other half was closed with non-coated sutures. Scar quality of the donor flap site was assessed by photographs and POSAS scores on days 2-5, 14, 42, 72 and 180 postoperatively.

Results: No difference between the titanium coated sutures and non-coated sutures was seen in the POSAS assessment, neither for the patient scale at 14, 42, 72 and 180 days, nor for the observer scale on the same dates. Comorbidities like diabetes, chronic renal failure and smoking as well as the BMI of each patient affected the wound healing process to an equal degree on both sides of the suture.

Conclusions: No difference between the titanium coated and non-titanium-coated suture material was seen in the POSAS assessment in regard to scar quality and wound healing. The titanium-coated suture material can be considered to be equally as effective and safe in all qualities as the non-titanium-coated suture material, even in patients with comorbidities. Clinical trial register This study is registered at the German Clinical Trials Register (DRKS) under the registration number DRKS00021767. ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021767 ).
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http://dx.doi.org/10.1186/s12893-020-00932-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640681PMC
November 2020

Examination of ex-vivo viability of human adipose tissue slice culture.

PLoS One 2020 26;15(5):e0233152. Epub 2020 May 26.

Institute of Anatomy, University Leipzig, Leipzig, Germany.

Obesity is associated with significantly higher mortality rates, and excess adipose tissue is involved in respective pathologies. Here we established a human adipose tissue slice cultures (HATSC) model ex vivo. HATSC match the in vivo cell composition of human adipose tissue with, among others, mature adipocytes, mesenchymal stem cells as well as stroma tissue and immune cells. This is a new method, optimized for live imaging, to study adipose tissue and cell-based mechanisms of obesity in particular. HATSC survival was tested by means of conventional and immunofluorescence histological techniques, functional analyses and live imaging. Surgery-derived tissue was cut with a tissue chopper in 500 μm sections and transferred onto membranes building an air-liquid interface. HATSC were cultured in six-well plates filled with Dulbecco's Modified Eagle's Medium (DMEM), insulin, transferrin, and selenium, both with and without serum. After 0, 1, 7 and 14 days in vitro, slices were fixated and analyzed by morphology and Perilipin A for tissue viability. Immunofluorescent staining against IBA1, CD68 and Ki67 was performed to determine macrophage survival and proliferation. These experiments showed preservation of adipose tissue as well as survival and proliferation of monocytes and stroma tissue for at least 14 days in vitro even in the absence of serum. The physiological capabilities of adipocytes were functionally tested by insulin stimulation and measurement of Phospho-Akt on day 7 and 14 in vitro. Viability was further confirmed by live imaging using Calcein-AM (viable cells) and propidium iodide (apoptosis/necrosis). In conclusion, HATSC have been successfully established by preserving the monovacuolar form of adipocytes and surrounding macrophages and connective tissue. This model allows further analysis of mature human adipose tissue biology ex vivo.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233152PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250419PMC
August 2020

[Necrotizing fasciitis].

Chirurg 2020 Jan 9. Epub 2020 Jan 9.

Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.

Necrotizing fasciitis is a rare but always life-threatening disease, which necessitates a rapid diagnosis and immediate treatment. It can occur on the extremities as well as on the trunk and the perineum. It spreads rapidly along the fascia leading to septic shock. The mortality rate under intensive care treatment is approximately 20%. The pathogen spectrum ranges from mixed bacterial infections to group A streptococci, clostridia and fungi. Clinically, the discrepancy between skin affection and systemic disease symptoms is remarkable. The diagnosis is primarily clinical and the key to successful treatment is rapid and radical surgical debridement combined with broad-spectrum antibiotic therapy under intensive patient monitoring.
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http://dx.doi.org/10.1007/s00104-019-01108-3DOI Listing
January 2020

Mycoplasma nasistruthionis sp. nov. and Mycoplasma struthionis sp. nov. isolated from ostriches with respiratory disease.

Syst Appl Microbiol 2020 Jan 9;43(1):126047. Epub 2019 Dec 9.

Institute of Microbiology, University of Veterinary Medicine, Vienna, Austria.

Twelve Mycoplasma (M.) strains isolated from the nose, the trachea, and the lung of ostriches (Struthio camelus) displaying respiratory disease were investigated. Analysis of 16S rRNA gene sequences placed five of these strains within the M. synoviae cluster, and seven strains within the M. hominis cluster of genus Mycoplasma, which was further confirmed by analyses of the 16S-23S rRNA intergenic spacer region, and partial rpoB gene and amino acid sequences. Genomic information as well as phenotypic features obtained by matrix-assisted laser desorption ionization time of flight (MALDI-ToF) mass spectrometry analysis and serological reactions indicated that the strains examined are representatives of two hitherto unclassified species of genus Mycoplasma, for which the names Mycoplasma nasistruthionis sp. nov., with type strain 2F1A (= ATCC BAA-1893 = DSM 22456), and Mycoplasma struthionis sp. nov., with type strain 237IA (= ATCC BAA-1890 = DSM 22453), are proposed.
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http://dx.doi.org/10.1016/j.syapm.2019.126047DOI Listing
January 2020

Clinical and Microbiological Analysis of Deep Sternal Wound Infections in Fifty-Two Consecutive Patients.

Surg Infect (Larchmt) 2020 May 6;21(4):370-377. Epub 2019 Dec 6.

Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany.

Mediastinitis after cardiac surgery can lead to devastating consequences such as deep sternal wound infections (DSWI). and other coagulase-negative staphylococci belong to the physiological skin flora and therefore generally are not considered pathogenic agents. Thus, local resistance patterns of these bacterial species often recovered from wound specimens generally are ignored while choosing antibiotics for peri-operative prophylaxis in cardiac surgery as well as in the selection of empiric antibiotic therapy of DSWI. During the period May 2012-May 2013, 52 patients suffering from DSWI were treated at our institution. For every patient, deep tissue samples were obtained during surgical debridement procedures and submitted to microbiologic analysis. The frequency of and the time to occurrence of a DSWI was recorded, and baseline data, previous operative interventions, complications, and the technique used for soft tissue reconstruction, as well as the microbiologic results and individual risk factors, were documented. There were 32 male patients (62%) and 20 female. The patients' age at the time of revision was a mean of 67 ± 11.5 years (range 35-83 years). There was bacterial growth in 31 cases (60%), the predominant species being (20 patients; 65%). Extended antibiotic therapy was indispensable to controlling the infection. The local resistance patterns of antibiotics should have a greater influence on the standardized prophylaxis or empirical therapy of DSWI and need to be discussed specifically for this high-risk population. Because of its multi-resistance spectrum, must be classified as a potential pathogen. In the cases reported here, extended antibiotic therapy was necessary to support wound healing and thus good patient outcomes.
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http://dx.doi.org/10.1089/sur.2018.300DOI Listing
May 2020

Deep sternal wound infection - latissimus dorsi flap is a reliable option for reconstruction of the thoracic wall.

BMC Surg 2019 Nov 21;19(1):173. Epub 2019 Nov 21.

Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.

Background: At present, data describing patients' long-term outcomes, quality of life, and survival after deep sternal wound infection are rarely available. The purpose of our study was to evaluate functional outcome and patient well-being after debridement and reconstruction of the sternal defect using a pedicled latissimus dorsi flap following deep sternal wound infection (DSWI).

Methods: This retrospective analysis reviewed 106 cases of DSWI after open-heart surgery treated between May 1, 2012, and May 31, 2015. The parameters of interest were demographic and medical data, including comorbidity and mortality. Follow-up consisted of physical examination of the patients using a specific shoulder assessment, including strength tests and measurements of pulmonary function.

Results: The population consisted of 69 (65%) male and 37 (35%) female patients. Their average age at the time of plastic surgery was 69 years (range: 35-85). The 30-day mortality was 20% (n = 21); after one-year, mortality was 47% (n = 50), and at follow-up, it was 54% (n = 58). Heart surgery was elective in 45 cases (42%), urgent in 31 cases (29%) and for emergency reasons in 30 cases (28%). The preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE) averaged 16.3 (range: 0.88-76.76). On the dynamometer assessment, a value of 181 Newton (N) (±97) could be achieved on the donor side, in contrast to 205 N (±91) on the contralateral side. The inspiratory vital capacity of the lung was reduced to an average of 70.58% (range: 26-118), and the forced expiratory volume in 1 s was decreased to an average of 69.85% (range: 38.2-118).

Conclusions: Given that only small adverse effects in shoulder function, strength, and pulmonary function were observed, the latissimus dorsi flap appears to be a safe and reliable option for the reconstruction of the sternal region after DSWI.
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http://dx.doi.org/10.1186/s12893-019-0631-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868737PMC
November 2019

Standardized Musculocutaneous Flap for the Coverage of Deep Sternal Wounds After Cardiac Surgery.

Ann Thorac Surg 2019 03 26;107(3):802-808. Epub 2018 Oct 26.

Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.

Background: Deep sternal wound infection remains a serious complication after cardiac surgery, leading to increased morbidity, mortality, and cost. The goal of our study was to develop a standardized, reproducible method to safely cover deep sternal wounds and ensure improved healing rates.

Methods: The study was developed as a retrospective cohort study. We included 58 patients who received standardized latissimus dorsi flap coverage of a sternum defect wound after poststernotomy mediastinitis at our institution between September 2015 and June 2017.

Results: The average age of the cohort was 66.75 years, and 51.72% of patients were men. The mean hospital stay was 26.83 days. Eight patients (14.75%) died during the hospital stay due to sepsis or heart failure. The average flap size was 137.13 cm. The mean operative time was 155 minutes. Seventy-four percent of patients developed a seroma at the donor site, which was treated conservatively with compression garments and taps, and 7% of patients developed a wound dehiscence of the donor site, which was treated conservatively with dressings. The mean follow-up time was 15 weeks. All 50 surviving patients showed complete wound healing on follow-up.

Conclusions: The latissimus dorsi pedicled flap is a safe, reproducible technique for coverage of deep sternal wounds, with few relevant perioperative complications. By setting definite parameters for the flap dissection and by ensuring a reliable blood supply, our method enables the coverage of these complex wounds by an interdisciplinary team in any cardiovascular surgical setting.
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http://dx.doi.org/10.1016/j.athoracsur.2018.09.017DOI Listing
March 2019

A Novel Technique for the Standardized Application of Shock Waves in Experimental Research: The Diver Box.

Ultrasound Med Biol 2018 07 23;44(7):1563-1568. Epub 2018 Apr 23.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, St. Rochus Hospital Castrop-Rauxel, Katholische St. Lukas Gesellschaft, Castrop-Rauxel, Germany. Electronic address:

The Diver Box is designed to prevent impedance differences, energy loss or damage to neighboring structures caused by the use of shock waves with application gels. The Diver Box is an acrylic glass container filled with tempered water and includes a coupling membrane to prevent the impedance jump from air to water and to avoid the continuous propagation of shock waves into the tissue, maintaining wave dynamics. Different modes of extracorporeal shock waves can be applied to a mouse skin wound without energy loss and protected from harmful phase-reversed waves. Macroscopic changes were seen in only 5% to 12% of tested specimens. Hazardous phase reversal, back reflection and mechanical tissue damage can be avoided by use of the Diver Box, ensuring standardized extracorporeal shock wave application.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2018.03.006DOI Listing
July 2018

[Conjunction of Orthopaedic and Trauma Surgery - the Leipzig Model - Three Years Experiences of O & U + P at the University Hospital Leipzig].

Z Orthop Unfall 2018 06 12;156(3):266-271. Epub 2017 Dec 12.

Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig, Medizinische Fakultät.

The establishment and implementation of the combined specialisation of orthopaedic and trauma surgery in daily routine was and still is a huge challenge for all stakeholders. In recent years, major efforts have been made by the professional associations, the specialty societies and all parties involved in the implementation of this project. Basically, there is no general recipe for the implementation of such a concept. For each centre or clinic, the local structural, professional and historical circumstances must be meticulously taken into account when considering implementation of this concept. Therefore, the authors would like to report on the strategy of Leipzig University Hospital in combining to the clinics for orthopaedics, traumatology and plastic surgery into a single and interdisciplinary department and the first three years of experience and further development since its implementation.
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http://dx.doi.org/10.1055/s-0043-122606DOI Listing
June 2018

[Pedicled Omentum Flaps in the Management of Deep Sternal Wound Infections].

Zentralbl Chir 2018 Apr 6;143(2):138-141. Epub 2017 Nov 6.

Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Deutschland.

Aim: Coverage of a deep sternal wound infection with a greater omentum flap. Due to a persistent infection caused by an infected aortic prosthesis, the primarily performed reconstruction with a latissimus dorsi flap had to be revised, and an alternative solution had to be found.

Indication: A deep sternal wound infection is a rare but devastating complication following median sternotomy. If the commonly used muscle flap is not sufficient and artificial material is still present in the wound, for instant drivelines or a vascular prosthesis, the greater omentum flap is a useful option due to its immunologic capacity.

Method: After an exploration of the persisting infected deep sternal wound, a radical debridement is performed followed by a jet lavage. The soft tissue from the greater omentum is prepared via median laparotomy and transferred through a tunnel created in the diaphragm. Then it is pulled into the wound cavity and can be used for tension-free sheathing of the aortic prosthesis. The previously used muscle flap can additionally be used for superficial soft tissue coverage.

Conclusion: Due to its immunologic competence, the greater omentum flap is a good treatment alternative to the commonly used muscle flaps in defects with infected artificial material.
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http://dx.doi.org/10.1055/s-0043-111724DOI Listing
April 2018

Double-Pedicled Free Deep Inferior Epigastric Perforator Flap for the Coverage of Thigh Soft-Tissue Defect.

Plast Reconstr Surg Glob Open 2017 Aug 28;5(8):e1372. Epub 2017 Aug 28.

Department for Plastic, Aesthetic and special Handsurgery, University Clinic Leipzig, Germany.

Soft-tissue defects caused by radiation injury are a challenging task for the reconstructive surgeon, due to the extent of the soft-tissue damage and the associated injuries of the local blood vessels and bone tissue. We present the application of the versatile deep inferior epigastric perforator (DIEP) flap for the coverage of an extended lateral thigh soft-tissue defect after the surgical resection of an undifferentiated pleomorphic high-grade sarcoma, neoadjuvant chemotherapy, and adjuvant chemo- and radiotherapy. A double-pedicled free DIEP flap (756 cm) was harvested and anastomosed to the transverse branch of the lateral femoral circumflex artery and a lateral branch of the popliteal artery (P1). The flap survived completely without serious complications, and the patient was able to walk with crutches 3 months postoperatively. This is the first case report of a free bipedicled DIEP flap for the coverage of a thigh defect in a male patient.
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http://dx.doi.org/10.1097/GOX.0000000000001372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585425PMC
August 2017

Omentum flap as a salvage procedure in deep sternal wound infection.

Ther Clin Risk Manag 2017 23;13:1077-1083. Epub 2017 Aug 23.

Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig.

Introduction: Deep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures.

Methods: We treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs. Omentoplasty was performed in combination with a split skin graft and the wound was closed by a vacuum-assisted therapy for 7 days. The patients' sex and comorbid risk factors supporting DSWIs as well as the postoperative complications were recorded.

Results: Retrospective analysis of 14 patients (10 males and four females) after a follow-up time of 24 months was performed. The average age was 75 years (range: 67-83). Heart surgery took place electively in eight cases, in three cases urgently and three for emergency reasons. The preoperative Euro Score was 16 (range 3.51-42.58). We had no flap loss in any patients. The skin graft showed a full take in all patients. Two patients needed revision of an abdominal wound dehiscence after laparotomy and one patient developed hernia in the late outcome.

Discussion: The greater omentum flap has, over many years, become an ideal partner in the coverage and treatment of DSWIs. Especially due to its immunologic capacity and amorphous structure, it has the ability to fill up cavities and cover infected artificial material so residual infections can be controlled.
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http://dx.doi.org/10.2147/TCRM.S134869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574694PMC
August 2017

An Asian Perspective on Povidone Iodine in Wound Healing.

Dermatology 2017 29;233(2-3):223-233. Epub 2017 Aug 29.

Clinical Research Unit for Skin, Allergy and Regeneration (CRUSAR), Institute of Medical Biology, Agency for Science, Technology and Research, Singapore, Singapore.

Antiseptics, with a broader spectrum of antimicrobial efficacy, lower risk of antibiotic resistance development, and minimal collateral damage to host tissues, are important alternatives to control the bioburden in wounds. Povidone iodine (PVP-I), in use for several decades, has the broadest spectrum of activity, a persistent antimicrobial effect, an ability to penetrate biofilms, and a lack of acquired or cross-resistance. It demonstrates good skin tolerance and low cytotoxicity. However, some reports on PVP-I have raised concerns over allergy, ineffective penetration, and toxic effects on host cells. The majority of these concerns are based on in vitro or rodent wound studies with diverse study designs and outcomes; these results may not be directly applicable in the clinical reality in humans. In this paper, we discuss the efficacy and safety of PVP-I and outline its place in wound healing in Asia, based on an appraisal of recent literature and clinical practice across the region.
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http://dx.doi.org/10.1159/000479150DOI Listing
July 2018

Dorsal skinfold chamber models in mice.

GMS Interdiscip Plast Reconstr Surg DGPW 2017 10;6:Doc10. Epub 2017 Jul 10.

Department of Plastic, Aesthetic and Special Hand Surgery, Clinic and Polyclinic for Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Germany.

: The use of dorsal skinfold chamber models has substantially improved the understanding of micro-vascularisation in pathophysiology over the last eight decades. It allows pathophysiological studies of vascularisation over a continuous period of time. The dorsal skinfold chamber is an attractive technique for monitoring the vascularisation of autologous or allogenic transplants, wound healing, tumorigenesis and compatibility of biomaterial implants. To further reduce the animals' discomfort while carrying the dorsal skinfold chamber, we developed a smaller chamber (the Leipzig Dorsal Skinfold Chamber) and summarized the commercial available chamber models. In addition we compared our model to the common chamber. The Leipzig Dorsal Skinfold Chamber was applied to 66 C57Bl/6 female mice with a mean weight of 22 g. Angiogenesis within the dorsal skinfold chamber was evaluated after injection of fluorescein isothiocyanate dextran with an Axio Scope microscope. The mean vessel density within the dorsal skinfold chamber was assessed over a period of 21 days at five different time points. The gained data were compared to previous results using a bigger and heavier dorsal skinfold model in mice. A PubMed and a patent search were performed and all papers related to "dorsal skinfold chamber" from 1 of January 2006 to 31 of December 2015 were evaluated regarding the dorsal skinfold chamber models and their technical improvements. The main models are described and compared to our titanium Leipzig Dorsal Skinfold Chamber model. The Leipzig Dorsal Skinfold Chamber fulfils all requirements of continuous models known from previous chamber models while reducing irritation to the mice. Five different chamber models have been identified showing substantial regional diversity. The newly elaborated titanium dorsal skinfold chamber may replace the pre-existing titanium chamber model used in Germany so far, as it is smaller and lighter than the former ones. However, the new chamber does not reach the advantages of already existing chamber models used in Asia and the US, which are smaller and lighter. Elaborating a smaller and lighter dorsal skinfold chamber allows research studies on smaller animals and reduces the animals' discomfort while carrying the chamber. Greater research exchange should be done to spread the use of smaller and lighter chamber models.
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http://dx.doi.org/10.3205/iprs000112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506728PMC
July 2017

Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection.

GMS Interdiscip Plast Reconstr Surg DGPW 2017 6;6:Doc09. Epub 2017 Jun 6.

Institute of Anatomy, University of Leipzig, Leipzig, Germany.

Deep sternal wound infections (DSWI) are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel. This anatomic study was carried out on the anterior chest wall of 7 specimens. The thorax plates of 7 specimens were analyzed macroscopically after microsurgical preparation. Different anatomic preparations were produced using different contrast or form-giving substances. Radiological analysis and three-dimensional reconstructions were performed to show alternative, collateral sternal vessel perfusion under estimation of the loss of the internal thoracic artery due to a bypass. The length of the ITA (internal thoracic artery), measured from the beginning of the first rib to the division into the superior epigastric artery and musculophrenic artery, was an average of 16.3 cm. On average, 18.5 branches were delivered from each artery, 10 medially to the sternum supply, and 8 to the intercostal muscle. Our analysis gives an overview of the macroanatomic vessel system supplying the sternal bone, describing especially a common trunk deriving from the ITA and supplying multiple branches and playing an important role in building a collateral circulation of the sternum. For better evaluation, in vivo CT analysis with contrast media should be performed in patients prior to the operation and directly after the use of the double ITA to demonstrate the change in perfusion of the sternum. In the future, preconditioning of the sternum by coiling the deriving branches could become an option, although patient selection has to be improved and further analysis of the topic performed.
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http://dx.doi.org/10.3205/iprs000111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461580PMC
June 2017

A new in vivo model using a dorsal skinfold chamber to investigate microcirculation and angiogenesis in diabetic wounds.

GMS Interdiscip Plast Reconstr Surg DGPW 2016 18;5:Doc09. Epub 2016 Feb 18.

Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany.

Introduction: Diabetes mellitus describes a dysregulation of glucose metabolism due to improper insulin secretion, reduced insulin efficacy or both. It is a well-known fact that diabetic patients are likely to suffer from impaired wound healing, as diabetes strongly affects tissue angiogenesis. Until now, no satisfying in vivo murine model has been established to analyze the dynamics of angiogenesis during diabetic wound healing. To help understand the pathophysiology of diabetes and its effect on angiogenesis, a novel in vivo murine model was established using the skinfold chamber in mice.

Materials And Methods: Mutant diabetic mice (db; BKS.Cg-m+/+Lepr (db) /J), wildtype mice (dock7Lepr (db) +/+m) and laboratory BALB/c mice were examined. They were kept in single cages with access to laboratory chow with an 12/12 hour day/night circle. Lesions of the panniculus muscle (Ø 2 mm) were created in the center of the transparent window chamber and the subsequent muscular wound healing was then observed for a period of 22 days. Important analytic parameters included vessel diameter, red blood cell velocity, vascular permeability, and leakage of muscle capillaries and post capillary venules. The key parameters were functional capillary density (FCD) and angiogenesis positive area (APA).

Results: We established a model which allows high resolution in vivo imaging of functional angiogenesis in diabetic wounds. As expected, db mice showed impaired wound closure (day 22) compared to wounds of BALB/c or WT mice (day 15). FCD was lower in diabetic mice compared to WT and BALB/c during the entire observation period. The dynamics of angiogenesis also decreased in db mice, as reflected by the lowest APA levels. Significant variations in the skin buildup were observed, with the greatest skin depth in db mice. Furthermore, in db mice, the dermis:subcutaneous ratio was highly shifted towards the subcutaneous layers as opposed to WT or BALB/c mice.

Conclusion: Using this new in vivo model of the skinfold chamber, it was possible to analyze and quantify microangiopathical changes which are essential for a better understanding of the pathophysiology of disturbed wound healing. Research in microcirculation is important to display perfusion in wounds versus healthy tissue. Using our model, we were able to compare wound healing in diabetic and healthy mice. We were also able to objectively analyze perfusion in wound edges and compare microcirculatory parameters. This model may be well suited to augment different therapeutic options.
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http://dx.doi.org/10.3205/iprs000088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764794PMC
March 2016

Fibrin glue as a protective tool for microanastomoses in limb reconstructive surgery.

GMS Interdiscip Plast Reconstr Surg DGPW 2015 15;4:Doc14. Epub 2015 Dec 15.

Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany.

Aim: Fibrin glue becomes a more and more routinely used tool for stabilization of microanastomoses and nerve repair. This paper summarizes the technical properties and advantages of its use in a wide variety of microsurgical contexts, and includes an exemplary limb reconstructive case.

Patients And Methods: A total of 131 patients who had undergone elective and emergency microsurgery mainly of the limbs were retrospectively analyzed, as was the use of free flaps.

Results: The use of fibrin glue allows for proper positioning of anastomoses and repaired nerves. No torsion of the pedicle could be seen. The flap survival rated >94%. The fibrin glue could stay in place in >99%. In the rare case of revision, the fibrin glue could easily be removed without damaging the region of the microanastomosis.

Conclusion: Fibrin glue should not be used to repair insufficient, i.e., leaking anastomoses, but it does protect the site of anastomosis from tissue and fluid pressure. It prevents the pedickle from torsion and its use facilitates relocation of the microanastomoses in cases of revision surgery.
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http://dx.doi.org/10.3205/iprs000073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709928PMC
January 2016

A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report.

Arch Orthop Trauma Surg 2016 Jan 27;136(1):47-53. Epub 2015 Oct 27.

Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.

Background: Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath.

Case Presentation: Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient's desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility.

Conclusion: The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.
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http://dx.doi.org/10.1007/s00402-015-2355-yDOI Listing
January 2016

Free anterolateral thigh flaps for upper extremity soft tissue reconstruction.

GMS Interdiscip Plast Reconstr Surg DGPW 2015 5;4:Doc05. Epub 2015 Feb 5.

Abteilung für Plastische, Ästhetische und Spezielle Handchirurgie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Deutschland.

Introduction: Limb-threatening wounds of the upper extremity pose a challenge to the micro vascular surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction.

Methods: A retrospective review of patients undergoing this procedure from 2005 to 2012 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes.

Results: Thirty-two patients with a mean age of 53 years (9-84 yrs) underwent upper extremity reconstruction with an anterolateral thigh (ALT) flap. There were 24 (75%) males and 8 (25%) females. The etiology of the soft tissue defects was: infection (44.6%); post-tumor ablation (40%); and trauma (15.6%). The defect site was most commonly in the forearm (53.1%), followed by the elbow (12.5 %), arm (12.5%) and hand (21.9%). The mean timing of free flap transfer was 6.8 days after admission to our institution (minimum 1 days, maximum 9 days). Mean operative time of surgery was 4 h 39 min (minimum 3 h 2 min, maximum 6 h 20 min). The mean hospitalization was 24.8 days (minimum 5, maximum 85). The ALT success rate was at 92.3%. Partial flap necrosis was documented in five cases (15.6%). Complete flap loss occurred in two post-traumatic cases who both lost their limbs.

Discussion: This flap, in the hands of experienced surgeons, provides reliable coverage of upper extremity defects.
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http://dx.doi.org/10.3205/iprs000064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604768PMC
October 2015

New model for long-term investigations of cutaneous microcirculatory and inflammatory changes following irradiation.

J Radiat Res 2015 May 16;56(3):456-61. Epub 2015 Feb 16.

Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

Radiotherapy is used for curative and palliative treatment. However, its negative effect on normal tissue is a limiting factor for the deliverable dose. Microcirculatory breakdown and prolonged inflammation in particular are major features of late side effects. The purpose of this study was to develop a reliable animal model that will allow a long-term in vivo analysis of microcirculation and inflammation following irradiation. A single dose of 90 Gy was delivered to the ears of hairless mice (n = 15). Intravital fluorescent microscopy was used to assess microcirculatory parameters and leukocyte behaviour. Values for the identical (control) areas were obtained before as well as during the following days, weeks and months following irradiation. The arteriolar and venular diameter increased up to Day 14, decreased during the following months, and increased again after one year. The red blood cell velocity increased up to 145% on Day 3, decreased on Day 7 to 115%, and stayed above baseline value the whole year. The integrity loss of the endothelium increased up to Day 7 and continued up to Day 75 after radiation. After one year, the oedema was at the baseline level. Leukocytes showed their maximal activity at one year after trauma. An increase was measured up to Day 25; the lowest values were measured at Day 40 post-irradiation, followed by a repeated increase. The present model allows a certain visualization of microcirculatory disturbances and inflammation over a period of months. This permits the possibility of long-term investigations of the underlying pathophysiology following irradiation, including possible drug interactions.
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http://dx.doi.org/10.1093/jrr/rru124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426918PMC
May 2015

Telomere length differences between subcutaneous and visceral adipose tissue in humans.

Biochem Biophys Res Commun 2015 Feb 13;457(3):426-32. Epub 2015 Jan 13.

IFB AdiposityDiseases, Junior Research Group 2 "Animal Models of Obesity", University of Leipzig, Leipzig, Germany. Electronic address:

Adipocyte hypertrophy and hyperplasia have been shown to be associated with shorter telomere length, which may reflect aging, altered cell proliferation and adipose tissue (AT) dysfunction. In individuals with obesity, differences in fat distribution and AT cellular composition may contribute to obesity related metabolic diseases. Here, we tested the hypotheses that telomere lengths (TL) are different between: (1) abdominal subcutaneous and omental fat depots, (2) superficial and deep abdominal subcutaneous AT (SAT), and (3) adipocytes and cells of the stromal vascular fraction (SVF). We further asked whether AT TL is related to age, anthropometric and metabolic traits. TL was analyzed by quantitative PCR in total human genomic DNA isolated from paired subcutaneous and visceral AT of 47 lean and 50 obese individuals. In subgroups, we analyzed TL in isolated small and large adipocytes and SVF cells. We find significantly shorter TL in subcutaneous compared to visceral AT (P < 0.001) which is consistent in men and subgroups of lean and obese, and individuals with or without type 2 diabetes (T2D). Shorter TL in SAT is entirely due to shorter TL in the SVF compared to visceral AT (P < 0.01). SAT TL is most strongly correlated with age (r = -0.205, P < 0.05) and independently of age with HbA1c (r = -0.5, P < 0.05). We found significant TL differences between superficial SAT of lean and obese as well as between individuals with our without T2D, but not between the two layers of SAT. Our data indicate that fat depot differences in TL mainly reflect shorter TL of SVF cells. In addition, we found an age and BMI-independent relationship between shorter TL and HbA1c suggesting that chronic hyperglycemia may impair the regenerative capacity of AT more strongly than obesity alone.
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http://dx.doi.org/10.1016/j.bbrc.2014.12.122DOI Listing
February 2015

Diagnosis, treatment and survival of 65 patients with malignant peripheral nerve sheath tumors.

Anticancer Res 2014 Feb;34(2):777-83

Department of Plastic Surgery Sarcoma Reference Center, BG University Hospital Bergmannsheil Buerkle de la Camp Platz 1, 44789 Bochum, Germany.

Background: Malignant peripheral nerve sheath tumors (MPNST) account for up to 10% of all malignant soft tissue tumors in adults. Insufficient data are available on diagnosis, differential diagnosis and treatment modalities as well as prognosis.

Patients And Methods: Examining our sarcoma database from 1991 to 2004, we evaluated 65 patients with histologically-proven MPNST in terms of clinical, histopathological as well as prognostic factors.

Results: The median age was 54 years, the gender ratio was equal, the follow-up 36 months. Extremities were involved in 75% of cases, the trunk in 15% and the head in 9% respectively. A total of 9% of our patients presented with disease-positive lymph nodes, in 28%, distant metastases (primarily lung) occurred. A primary closure was performed in 60%; in 22%, a tendon transfer and flap coverage was necessary. In 11% of cases, the final treatment was amputation. The initial diagnoses which had to be revised during re-evaluation was 32.3%. The 5-year disease-free survival rate was 49%. Overall, 27% of patients first operated on at our Institution experienced local recurrence. The only significant negative prognostic factor for survival was occurrence of metastases.

Conclusion: Our data indicate, that MPNST are tumor entities with a high rate of initial diagnoses that subsequently need to be adjusted (32%). Therefore, reference pathology should be requested. Tumor localization close to major nerves often results in functional restrictions after tumor resection. Because of the low mean life expectancy, early functional reconstructions by tendon transfer should be performed instead of nerve repair. Despite less radical tumor excision with often marginal resections, the survival rate is comparable to that of the literature where patients were treated with more radical procedures.
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February 2014