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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Huynh J, Ghoreschi FC, Häfner HM, Scheu A. Tumeszenz-Lokalanästhesie bei geriatrischen Patienten mit Hauttumoren im Kopf-Hals-Bereich - Eine retrospektive Studie an 782 Patienten: Tumescent local anesthesia in geriatric patients with head and neck skin cancer - a retrospective study of 782 patients. J Dtsch Dermatol Ges 2024; 22:210-222. [PMID: 38361199 DOI: 10.1111/ddg.15287_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/28/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungAufgrund ihrer Morbidität werden dermatochirurgische Eingriffe bei älteren Patienten vorzugsweise in Tumeszenz‐Lokalanästhesie durchgeführt. Allerdings ist die Datenlage hierzu begrenzt. Ziel der Arbeit war es, die Tumeszenz‐Lokalanästhesie für Hautkrebsoperationen bei älteren Patienten mit dem Fokus auf klinische Vorteile (Behandlungsprozesse, Schmerzmanagement) und dem lokalen postoperativen Komplikationsrisiko zu evaluieren.Patienten und MethodikUntersuchung von Patienten ≥75 Jahren mit stationär durchgeführten Hautkrebsoperationen im Kopf‐Hals‐Bereich unter Tumeszenz‐Lokalanästhesie.Ergebnisse2940 Eingriffe bei 782 Patienten (Durchschnittsalter 83,3 Jahre) mit dem Ziel einer vollständigen Tumorresektion während des stationären Aufenthaltes wurden durchgeführt. 3,8 (Bereich: 1–20) Eingriffe erfolgten über einen Zeitraum von durchschnittlich 4,9 Tagen (Bereich: 1–28). 43,2% benötigten keine postoperative Analgesie. 53,5% erhielten NSAID, 3,3% Opioide. Wundinfektionen (13,6%) waren die häufigste lokale postoperative Komplikation. Chirurgische Interventionen aufgrund von Nachblutungen waren in 2,8% der Fälle erforderlich. Keine der Blutungen waren hämoglobinrelevant oder lebensbedrohlich. Nahtdehiszenzen und Nekrosen waren selten (0,6%).SchlussfolgerungenDie Tumeszenz‐Lokalanästhesie ist für Hautkrebsoperationen bei älteren Menschen eine effektive Anästhesiemethode. Durch den Verzicht auf eine Vollnarkose können die Behandlungsabläufe optimiert und anästhesiologische Risiken minimiert werden. Lokale postoperative Komplikationen treten eher selten auf und sind gut behandelbar. Die langanhaltende Analgesie führt zu einem geringeren Analgetikabedarf und selteneren Medikamenteninteraktionen.
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Affiliation(s)
| | - Claus Garbe
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
| | | | - Vincent Walter
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
| | | | - Julia Huynh
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | | | - Alexander Scheu
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Huynh J, Ghoreschi FC, Häfner HM, Scheu A. Tumescent local anesthesia in geriatric patients with head and neck skin cancer - a retrospective study of 782 patients. J Dtsch Dermatol Ges 2024; 22:210-221. [PMID: 38243888 DOI: 10.1111/ddg.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/28/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES Due to frailty, dermatosurgery in the elderly is preferably performed under tumescent local anesthesia, but data is limited. The aim was to evaluate tumescent local anesthesia for skin cancer surgery in the elderly with focus on clinical benefits (treatment processes, pain management) and local postoperative complication risk. PATIENTS AND METHODS Investigation of patients ≥ 75 years with inpatient head and neck skin cancer surgery under tumescent local anesthesia. RESULTS 2,940 procedures in 782 patients (mean age 83.3 years) were performed with the aim of complete tumor resection during the inpatient stay. 3.8 (range: 1-20) interventions were done over an average of 4.9 days (range: 1-28). 43.2% did not require any postoperative analgesia. 53.5% received NSAIDs, 3.3% opioids. Infection (13.6%) was the most common local postoperative complication. Surgical intervention due to bleeding was required in 2.8%. None was hemoglobin relevant or life-threatening. Suture dehiscence and necrosis were rare (0.6%). CONCLUSIONS Tumescent local anesthesia is an effective method for skin cancer surgery in the elderly. By avoiding general anesthesia, treatment processes can be optimized and anesthesiologic risks minimized. Local postoperative complications are still low and well treatable. The long-lasting analgesia results in a reduced need for analgesics and drug interactions.
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Affiliation(s)
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | | | - Julia Huynh
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Huynh J, Leiter U, Garbe C, Shiderova G, Walter V, Eigentler T, Scheu A, Häfner HM, Schnabl SM. Sentinel lymph node biopsy for lentigo maligna melanoma under local anaesthesia. J Eur Acad Dermatol Venereol 2024; 38:84-92. [PMID: 37611257 DOI: 10.1111/jdv.19456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Lentigo maligna melanoma is mainly localized in the head and neck region in elderly patients. Due to its slow horizontal growth, it has a good prognosis compared to other melanoma subtypes, but specific data are rare. OBJECTIVES The aim of this study was to investigate sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia and to discuss the benefit. METHODS Investigation of patients with lentigo maligna melanoma and tumour thickness ≥1 mm treated at the Department of Dermatology, University Medical Centre Tuebingen, between January 2008 and October 2019. RESULTS In total, 204 patients (126 SLNB, 78 non-SLNB) with a median age of 75.7 years (SLNB: 73.3 years, non-SLNB: 79.7 years) could be included. Sixteen of 126 (12.7%) sentinel lymph nodes were positive. Five-year overall survival was 87.9% (88.5% SLNB; 87.4% non-SLNB) and 5-year distant metastasis-free survival was 85.8% (85.4% SLNB; 86.7% non-SLNB). There was no significant difference for distant metastasis-free survival (p = 0.861) and overall survival (p = 0.247) between patients with and without sentinel lymph node biopsy. CONCLUSIONS Sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia is a safe and simple method, even in very old patients. However, LMM has a very good 5-year overall survival. In high-risk patients with high tumour thickness and/or ulceration, adjuvant immunotherapy can now be offered without the need to perform this procedure.
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Affiliation(s)
- Julia Huynh
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Leiter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Galina Shiderova
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
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Boeer B, Helms G, Pasternak J, Roehm C, Kofler L, Haefner HM, Moehrle M, Heim E, Fischer H, Brucker SY, Hahn M. Back to the future: breast surgery with tumescent local anesthesia (TLA)? Arch Gynecol Obstet 2023; 308:935-940. [PMID: 36872392 PMCID: PMC10348980 DOI: 10.1007/s00404-023-06938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Breast surgery is usually performed under general anesthesia. Tumescent local anesthesia (TLA) offers the possibility to anesthetize large areas with highly diluted local anesthetic. METHODS In this paper, the implementation, and experiences with TLA in the field of breast surgery are discussed. CONCLUSION For carefully selected indications, breast surgery in TLA represents an alternative to ITN.
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Affiliation(s)
- B Boeer
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| | - G Helms
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - J Pasternak
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Roehm
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - L Kofler
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - H M Haefner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - M Moehrle
- Praxisklinik Haut Und Venen, Tuebingen, Germany
| | - E Heim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - H Fischer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - M Hahn
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
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Höper R, Rosen M, Kofler K, Häfner HM, Kofler L. Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery-A prospective observational study. J Eur Acad Dermatol Venereol 2023; 37:1906-1913. [PMID: 37246474 DOI: 10.1111/jdv.19228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Perioperative management of antiplatelet and anticoagulant (AP/AC) therapy is a matter of balancing the risks of bleeding and thromboembolic events. Reliable data for dermatosurgery are still lacking, especially for direct oral anticoagulants (DOAC). OBJECTIVES The aim was to prospectively evaluate the influence of AP/AC-medication on bleeding risk in dermatosurgery with focus on exact intervals between DOAC intake and procedure performed on post-operative bleeding. METHODS Patients with or without AP/AC-therapy were included in the study without randomization. Exact times of DOAC-intake, procedure performed and post-operative bleeding were documented. Data collection was prospectively and standardized done by one person. RESULTS We evaluated 1852 procedures in 675 patients. Post-operative bleeding occurred after 15.93% (n = 295) of all procedures, but only a few of them were severe (1.57%, n = 29). Compared to patients without AP/AC-medication, severe post-operative bleeding occurred significantly more often under dual antiplatelet therapy (11.76%, n = 2; p = 0.0166) and bridging of either vitamin K antagonist (9.09%, n = 2; p = 0.0270) or DOAC (15.38%, n = 2; p = 0.0099). There was no significant difference in the frequency of severe bleeding regarding to the preoperative DOAC-free period. CONCLUSIONS Although AP/AC-therapy is associated with a significant higher rate of post-operative bleeding, no life-threatening bleeding was recorded. Long preoperative pausing or bridging of DOAC does not lead to significantly less severe bleeding events.
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Affiliation(s)
- Rabea Höper
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Michael Rosen
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
- skin+more MVZ GmbH, Biberach, Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
- skin+more MVZ GmbH, Biberach, Germany
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Kofler K, Häfner HM, Forchhammer S, Kofler L. [Surgical treatment of nevi in children in a dermatological surgery center : Histopathology and complications]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05147-0. [PMID: 37119200 DOI: 10.1007/s00105-023-05147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The indication for surgical management and histological diagnosis of melanocytic nevi in children is a major challenge in clinical routine. In consultations with children and parents, the exclusion of malignant findings, on the one hand, and the risk of complications, on the other hand, are important. PATIENTS AND METHODOLOGY Included were 946 children under the age of 10 years who underwent surgery with a suspected diagnosis of melanocytic nevus at the University Department of Dermatology, Tübingen, Germany, between 2008 and 2018. Dermatohistopathologic findings and postoperative complications were recorded. RESULTS A clinical diagnosis of melanocytic nevus was histologically confirmed in 93.2% (882/946) of cases, whereby there were 41 Spitz nevi and 18 pigmented spindle cell tumors. Melanoma was diagnosed in 2 of the children (0.2%). In another 6.6%, non-melanocytic findings (e.g., nevus sebaceous, epidermal nevi) were diagnosed. The complication rate was low at 3%. The most common complication was the occurrence of postoperative wound infection in 1.7%. CONCLUSION It is possible to take a biopsy or surgically remove congenital nevi of different sizes even in infants. Serial excision of congenital nevi is an important tool for this purpose. In the investigated cohort, the complication rate was low. Histological confirmation is essential in case of clinically suspicious or atypical findings.
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Affiliation(s)
- Katrin Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a.d.R., Deutschland.
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Stephan Forchhammer
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a.d.R., Deutschland
- Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
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Kofler K, Häfner HM, Kofler L. Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life. J Eur Acad Dermatol Venereol 2023; 37:1215-1220. [PMID: 36807362 DOI: 10.1111/jdv.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. METHODS All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. RESULTS Overall, a cumulative total area of 38.65 cm2 could be removed on average within the first year of life (trunk: 67 cm2 , head: 21.2 cm2 , legs: 21.6 cm2 , arms: 13.2 cm2 ). A cumulative maximum area reduction of 406.9 cm2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5 months (0.46-10.7 months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesia-related complications occurred. CONCLUSION We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.
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Affiliation(s)
- Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Eckardt J, Ghoreschi FC, Häfner HM, Scheu A. Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer. J Eur Acad Dermatol Venereol 2023; 37:65-74. [PMID: 36152007 DOI: 10.1111/jdv.18588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. OBJECTIVES The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. METHODS Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. RESULTS In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1-102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old-old group (≥75-84 years) included 491 patients and the oldest-old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow-up period was 4.9 days (range 1-28 days). 92.0% (719/782) suffered from pre-existing comorbidities. Systemic complications occurred in 10.2% (80/782; old-olds: 8.6%, oldest-olds: 13.1%). Hypertensive crisis (>180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life-threatening complications directly related to tumescent local anaesthesia were found. CONCLUSIONS Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre-existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high-tumescent concentrations or volume quantities.
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Affiliation(s)
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | | | - Julia Eckardt
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Walz B, Pfefferle V, Häfner HM, Kofler L. [Cosmetic and functional results after resection of cutaneous neurofibroma in neurofibromatosis type 1 : Operation of neurofibroma improves quality of life while having moderate complications]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 74:961-968. [PMID: 37728798 PMCID: PMC10661718 DOI: 10.1007/s00105-023-05220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neurofibromatosis type 1, also known as Recklinghausen's disease, is a neurocutaneous tumor syndrome that is genetically determined and is associated with infestation of the integument with neurofibromas (nerve sheath tumors). The occurrence of neurofibromas can be very stressful for patients and often contributes to a reduced quality of life for patients, especially if externally visible body parts are affected. The aim of this study is to show to what extent the resection of cutaneous neurofibromas can improve patients' quality of life. MATERIALS AND METHODS For this study, we conducted a retrospective data collection via questionnaire on the quality of life before and after the surgical removal of cutaneous neurofibromas at the Department of Dermatology, University Hospital of Tübingen. An adapted dermatological quality of life index and a postoperative questionnaire on patient satisfaction were used. In addition, patient data were taken from doctor's notes, surgical reports, and outpatient documentation. A total of 30 patients with neurofibromatosis type 1 who underwent inpatient or outpatient surgery for cutaneous neurofibromas at the Tübingen dermatology hospital between 2016 and 2020 were surveyed. The survey results were statistically analyzed and represented as absolute and relative frequencies. RESULTS Our study indicates an improved quality of life after surgery for cutaneous neurofibromas, especially regarding limitations in everyday life, self-consciousness, the choice of clothing, and leisure activities. The majority of our patients showed no new occurrence of neurofibromas in the surgical area and postoperative bleeding or wound infections were rare. CONCLUSION In relation to the high level of satisfaction with the surgical and cosmetic results and also the positive influence on quality of life, our study indicates a favorable risk-benefit ratio for the resection of cutaneous neurofibromas in neurofibromatosis I.
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Affiliation(s)
- Benjamin Walz
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - Vanessa Pfefferle
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Zentrum für Seltene Hauterkrankungen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Hautzentrum skin+more, Holzmarkt 6, 88400, Biberach an der Riss, Deutschland
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Saur A, Stenger F, Pfefferle V, Häfner H, Kofler L. Operative Therapie kongenitaler Nävi mittels
Power‐Stretching
‐Technik an der Stirn. J Dtsch Dermatol Ges 2022; 20:1526-1529. [DOI: 10.1111/ddg.14868_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Saur A, Stenger F, Pfefferle V, Häfner H, Kofler L. Surgical therapy of congenital nevi using power‐stretching technique on the forehead. J Dtsch Dermatol Ges 2022; 20:1527-1529. [DOI: 10.1111/ddg.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Eckardt J, Häfner HM, Kofler K, Mroz G, Scheu A, Schulz C, Kofler L. Postoperativer Verlauf von 150 Patienten nach Wächterlymphknotenbiopsie in Tumeszenz‐Lokalanästhesie. J Dtsch Dermatol Ges 2021; 19:536-544. [PMID: 33861008 DOI: 10.1111/ddg.14351_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Julia Eckardt
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | | | - Katrin Kofler
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Gabi Mroz
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Alexander Scheu
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Claudia Schulz
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Lukas Kofler
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
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Commentary on Incidence of Epinephrine Reactions With Local Anesthesia in Mohs Micrographic Surgery. Dermatol Surg 2021; 47:292-293. [PMID: 33565780 DOI: 10.1097/dss.0000000000002664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Eckardt J, Häfner HM, Kofler K, Mroz G, Scheu A, Schulz C, Kofler L. Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia. J Dtsch Dermatol Ges 2021; 19:536-543. [PMID: 33565235 DOI: 10.1111/ddg.14351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. PATIENTS AND METHODS We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. RESULTS 32 % of the patients reported post-operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA. CONCLUSIONS SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.
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Affiliation(s)
- Julia Eckardt
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Hans-Martin Häfner
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Katrin Kofler
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Gabi Mroz
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Alexander Scheu
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Claudia Schulz
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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15
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Risk of General Anesthesia in Pediatric Skin Procedures with Projection on Tumescent Anesthesia. Dermatol Res Pract 2020; 2020:9327152. [PMID: 32550845 PMCID: PMC7277072 DOI: 10.1155/2020/9327152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful. Aim The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures. Methods We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability. Results A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00). Conclusion Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.
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Volc S, Götz A, Breuninger H, Häfner H. Management von kongenitalen Riesennävi beim Säugling durch Exzisionen in Lokalanästhesie. J Dtsch Dermatol Ges 2020; 18:396-399. [DOI: 10.1111/ddg.14061_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Angelika Götz
- Universitätsklinik für Anästhesiologie und IntensivmedizinUniversitätsklinikum Tübingen
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17
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Volc S, Götz A, Breuninger H, Häfner H. Management of giant congenital nevi in infants by excision under local anesthesia. J Dtsch Dermatol Ges 2020; 18:396-399. [DOI: 10.1111/ddg.14061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sebastian Volc
- Department of DermatologyUniversity Medical Center Tübingen Germany
| | - Angelika Götz
- Department of Anesthesiology and Intensive Care MedicineUniversity Medical Center Tübingen Germany
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