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Schiltz D, Diesch ST, Kiermeier N, Eibl D, Felmerer G, Schreml S, Biermann N, Prantl L, Taeger CD. Digital Volumetric Measurements Based on 3D Scans of the Lower Limb: A Valid and Reproducible Method for Evaluation in Lymphedema Therapy. Ann Vasc Surg 2024; 105:209-217. [PMID: 38579911 DOI: 10.1016/j.avsg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Exact quantification of volumetric changes of the extremities is difficult and often error-prone. The aim of this study was to establish a standardized method based on 3-dimensional (3D) scans. Furthermore, this study tests the method in terms of reproducibility and evaluates volume changes after surgical therapy in patients suffering from lymphedema on the lower extremity. METHODS 3D scans of the lower limb were performed with a mobile 3D scanner; "repeatability" and "interobserver reliability" of digital volumetry were tested. Furthermore, the method was applied on 31 patients suffering from chronic lymphedema. RESULTS Calculations of repeatability of the volume based on 20 3D scans of the same lower leg showed a mean volume of 2.488 ± 0.011 liters (range: 2.470-2.510). The mean volume of the different examiners did not differ significantly (F(2,18) = 1.579, P = 0.233). The paired t-test showed a significant mean volume decrease of 375 mL (95% confidence interval = 245/505 mL) between pretreatment and post-treatment (t (30) = 5.892, P < 0.001). CONCLUSIONS 3D volumetry is a noninvasive, easy, and quick method to assess volume changes of the lower leg. Other than the low costs, it is reproducible and precise and therefore ideal for evolution of therapy in lymphedema.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany; Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, Berlin, Berlin, Germany.
| | - Sophia Theresa Diesch
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Natalie Kiermeier
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Dominik Eibl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Gunther Felmerer
- Division of Plastic Surgery, Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Niedersachsen, Germany
| | - Stephan Schreml
- Department of Dermatology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
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Schiltz D, Eibl D, Mueller K, Biermann N, Prantl L, Taeger CD. Therapist versus Machine-Immediate Effects of Manual versus Mechanical Lymphatic Drainage in Patients with Secondary Lymphedema. J Clin Med 2024; 13:1277. [PMID: 38592094 PMCID: PMC10931544 DOI: 10.3390/jcm13051277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Complex decongestive therapy (CDT) is the standard and basic therapy for lymphedema. The central component of CDT is manual lymphatic drainage (MLD). In addition to CDT, other measures such as intermittent pneumatic compression therapy (IPCT) (active compression machine therapy) are available. In this prospective research study, the objective and subjective effects of MLD and IPCT on lymphedema of the lower extremity were investigated and both therapies were directly compared. Furthermore, the patients' body mass index (BMI) and stage of lymphedema were tested for their effect on the respective therapy. Methods: Patients participating in the study received both therapies (MLD and IPCT) on the same lymphedema-affected limb at an interval of two days. The objective volumetric therapy effect was measured by the digital volume measurement of the affected limb. The subjective effects of the therapies were measured using two specially designed questionnaires. Results: A total of 40 patients were included in the study. There was no significant difference in the volume differences between the interventions, BMI categories, lymphedema, or treatment order regarding the immediate and two-day effect. Conclusions: No significant difference was found in the subjective or objective therapy efficacy of the two methods. Intermittent pneumatic compression therapy is considered a comparable therapeutic procedure when properly indicated.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany
| | - Dominik Eibl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Christian Dirk Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
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Diesch ST, Schiltz D, Kammermeier J, Prantl L, Taeger CD. Comparing the effectiveness of novel high-end compression garment with common compression garment and kinesio tape in preventing edema and improving tissue perfusion in lower extremities. Clin Hemorheol Microcirc 2024; 86:253-261. [PMID: 37718791 DOI: 10.3233/ch-238111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
CONTEXT Global sales of compression garments have risen sharply in recent years. Due to the availability of a wide range of compression garments, this study aims to evaluate the effect of two types of compression garments and kinesio tape on edema formation and tissue perfusion in the lower extremities. Over-the-counter compression knee stockings and kinesio tape were compared with a prototype of high-end compression stockings that combine kinesio tape and a common knee bandage. The high-end compression stockings were designed by Cube with the aim of combining the positive effects of kinesio tape and compression garments on edema formation and tissue perfusion. DESIGN Clinical cross-over study. METHODS Before and after a 6-hour compression period, the knee regions on both, the treated and non-treated leg, of participants were examined using a 3-D scan to detect changes in volume. Also measured were local temperature (°C), oxygen saturation (SpO2), perfusion index (Pi), blood pressure (mmHg), compression pressure (mmHg), range of motion, body-mass-index (BMI) and limb-circumference (cm). Two different types of compression garments were examined: a novel high-end compression stocking (A) and a common compression stocking (B). In addition, kinesio tape was compared to compression garments (C). After each experimental day, a one-day break was taken to prevent an unwanted overlay effect. Male and female participants between the ages of 18 and 60 were randomly selected. RESULTS The high-end compression garment (A) showed a statistically significant (P = 0.009) reduction of edema intraindividually. Comparing the three treatment groups, compression (A) lead to a reduction of edema. However, the reduction was not statistically significant (P = 0.585). The compression garment B and kinesio tape showed an increase in edema in the lower limb. There was a positive correlation between the highest compression pressure (A: 9.8 mmHg) and volume decrease over the period of 6 hours. Lighter compression (B: 8.2 mmHg) led to an increase in leg volume after compression application over 6 hours. There was no significant difference in tissue oxygen saturation with the two types of compression and kinesio tape. The tissue temperature below the compression garment was highest in the compression group A. Nevertheless, we could not demonstrate a statistically significant correlation between tissue temperature and volume difference.The range in motion of the lower limb decreased after 6 hours with both compression A and B and with kinesio tape. CONCLUSION The novel bandage showed a statistically significant reduction in edema when compared intraindividually, but no statistically significant advantage was found when compared with the other compression garment B and kinesio tape.Despite the widespread use of kinesio tape, we did not find any improvement in the range of motion, edema prevention and circulation in the lower limb after application of kinesio tape.
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Affiliation(s)
- Sophia T Diesch
- Center for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Schiltz
- Center for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Julian Kammermeier
- Center for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Center for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christian D Taeger
- Center for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Schiltz D, Sokolow AJ, Minck N, Schreml S, Moser L, von Fritschen U. The phyllodes menace-Variation in course, therapy, and appearance of phyllodes tumors in a case series of three patients. Clin Case Rep 2023; 11:e7836. [PMID: 37663819 PMCID: PMC10474313 DOI: 10.1002/ccr3.7836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/13/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Key Clinical Message Early and complete surgical resection is the most important therapeutic and diagnostic measure. Adjuvant radiation is suggested for malign phyllode tumors, phyllode tumors larger than 10 cm or those with a low distance to the resection margins. Abstract Phyllodes tumors are rare fibroepithelial tumors of the breast. Histologically, they are usually classified as benign, borderline or malignant, though these classifications do not necessarily reflect the clinical course of the disease. These tumors may stay undetected for years, or show sudden and rapid progression. There is currently no consistent therapy recommendation based upon histological findings, the localization of the tumor and/or whether it is recurrent. Using the examples of three patients, we show how courses and therapy may differ widely, and discuss this in the context of the current state of the literature.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
| | - Alexander Jan Sokolow
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
| | - Natalya Minck
- Department of PathologyHelios Hospital Emil von BehringBerlinGermany
| | - Stephan Schreml
- Department of DermatologyUniversity Hospital RegensburgGermany
| | - Lutz Moser
- Department of RadiotherapyHelios Hospital Emil von BehringBerlinGermany
| | - Uwe von Fritschen
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
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Hartmann R, Weiherer M, Schiltz D, Baringer M, Noisser V, Hösl V, Eigenberger A, Seitz S, Palm C, Prantl L, Brébant V. Correction to: New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry. Arch Gynecol Obstet 2021; 305:1629. [PMID: 34652466 PMCID: PMC9166819 DOI: 10.1007/s00404-021-06275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Robin Hartmann
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Daniel Schiltz
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Magnus Baringer
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vivien Noisser
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Hösl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Schiltz D, Kiermeier N, Müller K, Diesch ST, Wenzel C, Biermann N, Prantl L, Taeger CD. Quality of Life evaluation and lack of correlation with volumetric results after lymphovenous anastomoses in lymphedema therapy of the lower extremity. J Vasc Surg Venous Lymphat Disord 2021; 10:436-444.e1. [PMID: 34352420 DOI: 10.1016/j.jvsv.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chronic primary or secondary lymphedema has a huge impact on quality of life (QOL) because of associated swelling, pain, decreased range of motion, depression and anxiety, and generally requires numerous adaptations. Many studies have shown a positive objective effect of lymphovenous anastomoses (LVAs) on chronic lymphedema. In this study, we assessed the effect of LVAs on QOL in patients with primary or secondary lymphedema of the lower extremity 6 months after surgery, and examine the correlation between changes in QOL and volumetric measurements. METHOD Only patients with either primary or secondary lymphedema of the lower extremity who had LVAs were included in the study. To assess QOL, a specially designed questionnaire based on the "Lymphedema Quality of Life Inventory" (LyQLI) was used to evaluate the subjective therapeutic results from the patients' perspectives. Objective therapy success was assessed by 3D volumetric measurements of the lower leg. Measuring points, for both subjective and objective measurements, were the day before and 6 months after therapy. RESULTS The mean volume change 6 months after LVAs was -6.5% (sd 5.6, p < 0.001). A significantly better quality of life in terms of physical (37.6%, sd 25.2) and psychosocial (27.0%, sd 43.0) suffering as well as practical restrictions (22.3%, sd 24.8) was found (p values < 0.001). No correlation was found between QOL improvement and volume decrease (p values > 0.05). CONCLUSION In patients suffering from lymphedema of the lower extremity, lymphovenous anastomoses lead to a significant volumetric decrease and quality of life improvement six months after treatment with no demonstrable relationship between QOL improvement and volume reduction.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Natalie Kiermeier
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | - Sophia T Diesch
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Carina Wenzel
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
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Schiltz D, Lenhard J, Klein S, Anker A, Lonic D, Heidekrueger PI, Prantl L, Jung EM, Platz Batista Da Silva N, Kehrer A. Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP). J Clin Med 2021; 10:jcm10112427. [PMID: 34070779 PMCID: PMC8198546 DOI: 10.3390/jcm10112427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany;
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Jasmin Lenhard
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Silvan Klein
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Alexandra Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Paul I. Heidekrueger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (E.-M.J.); (N.P.B.D.S.)
| | | | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
- Correspondence: ; Tel.: +49-941-9446763
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Schiltz D, Koch C, Schingale FJ, Prantl L, Taeger CD. Reduction Scrotoplasty in 100 kg Scrotums. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractScrotal elephantiasis is a rare form of lymphedema of the scrotum. Its pathophysiology is diverse and often not clear, as there are only a few diagnostic tools available. Primary therapy consists, as usual for lymphedema, of conservative measures. However, due to anatomical and physiological findings, conservative therapy options are not always applicable. Although the only possible therapy in severe cases is the surgical resection, there is a lack in the literature regarding a standardized surgical approach. Surgical treatment of massive scrotal elephantiasis was performed in two patients according to a standardized strategy. After computed tomography and planning the operation, the penis and testicles were first exposed. Then, the reduction of the scrotum was performed, by holding the lateral flaps to the contralateral side and setting the cutoff line to the center. The cranial flap was decreased as in a modified abdominoplasty. After surgical treatment following the standardized approach, both patients showed functionally and esthetically positive results. Scrotal elephantiasis has a huge impact on life quality of the affected patients. With the described combination of intense conservative therapy and a standardized surgical procedure, these challenging patients can be helped.
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Taeger CD, Wallner S, Martini T, Schiltz D, Kehrer A, Prantl L, Biermann N. Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study. Cells 2021; 10:cells10040732. [PMID: 33810232 PMCID: PMC8065450 DOI: 10.3390/cells10040732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible. Sometimes, late or undetected bacterial infections and postoperative bleeding result in repetitive surgery, thus prolonging inpatient time. With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded. Methods: The aim of this pilot study was to analyze rinsing fluid samples (0.9% sodium chloride) from the NPWTi device in patients with acute and chronic wounds. In 31 consecutive patients a standardized laboratory analysis was performed to evaluate cellular composition and potassium, phosphate, lactate dehydrooxygenase, pH and total protein levels. Results: While there was an increase in the total cellular amount and the number of polymorphonuclear cells, the number of red blood cells (RBC) decreased after surgery. Potassium and pH showed no significant changes in the first three postoperative days, whereas total protein showed an undulant and partially significant course. Conclusion: We were able to quantify cellular metabolites by analyzing the rinsing fluid of NPWTi. We propose the analysis of this material as a novel and potentially promising tool to monitor wound status without removal of the dressing. The establishment of reference values might help to improve the NPWTi therapy.
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Affiliation(s)
- Christian D. Taeger
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
- Correspondence: ; Tel.: +49-941-944-6763
| | - Stefan Wallner
- Institute for Clinical Chemistry, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
| | - Teresa Martini
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Daniel Schiltz
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Andreas Kehrer
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Lukas Prantl
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Niklas Biermann
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
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Hartmann R, Weiherer M, Schiltz D, Seitz S, Lotter L, Anker A, Palm C, Prantl L, Brébant V. A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging. Aesthetic Plast Surg 2020; 44:1980-1987. [PMID: 32405724 PMCID: PMC7683456 DOI: 10.1007/s00266-020-01749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome's symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. METHODS Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. RESULTS Statistical analysis revealed that there is no difference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). CONCLUSION This study's findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes' optical symmetry was detected between autologous and alloplastic approaches. Level of evidence Level IV. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Robin Hartmann
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Daniel Schiltz
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Luisa Lotter
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Alexandra Anker
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
- Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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11
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Hartmann R, Weiherer M, Schiltz D, Baringer M, Noisser V, Hösl V, Eigenberger A, Seitz S, Palm C, Prantl L, Brébant V. New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry. Arch Gynecol Obstet 2020; 303:721-728. [PMID: 33184690 PMCID: PMC8519833 DOI: 10.1007/s00404-020-05862-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022]
Abstract
Purpose In this trial, we used a previously developed prototype software to assess aesthetic results after reconstructive surgery for congenital breast asymmetry using automated anthropometry. To prove the consensus between the manual and automatic digital measurements, we evaluated the software by comparing the manual and automatic measurements of 46 breasts. Methods Twenty-three patients who underwent reconstructive surgery for congenital breast asymmetry at our institution were examined and underwent 3D surface imaging. Per patient, 14 manual and 14 computer-based anthropometric measurements were obtained according to a standardized protocol. Manual and automatic measurements, as well as the previously proposed Symmetry Index (SI), were compared. Results The Wilcoxon signed-rank test revealed no significant differences in six of the seven measurements between the automatic and manual assessments. The SI showed robust agreement between the automatic and manual methods. Conclusion The present trial validates our method for digital anthropometry. Despite the discrepancy in one measurement, all remaining measurements, including the SI, showed high agreement between the manual and automatic methods. The proposed data bring us one step closer to the long-term goal of establishing robust instruments to evaluate the results of breast surgery. Level of evidence: IV.
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Affiliation(s)
- Robin Hartmann
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Daniel Schiltz
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Magnus Baringer
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vivien Noisser
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Hösl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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12
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Lotter L, Brébant V, Eigenberger A, Hartmann R, Mueller K, Baringer M, Prantl L, Schiltz D. "Topographic Shift": a new digital approach to evaluating topographic changes of the female breast. Arch Gynecol Obstet 2020; 303:515-520. [PMID: 33079242 PMCID: PMC7858205 DOI: 10.1007/s00404-020-05837-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans. METHOD The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. RESULTS The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm). CONCLUSION The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté.
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Affiliation(s)
- Luisa Lotter
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayrische Technische Hochschule Regensburg, Regensburg, Germany
| | - Robin Hartmann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Magnus Baringer
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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13
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Schiltz D, Tschernitz S, Ortner C, Anker A, Klein S, Felthaus O, Biermann N, Schreml J, Prantl L, Schreml S. Adipose Tissue in Multiple Symmetric Lipomatosis Shows Features of Brown/Beige Fat. Aesthetic Plast Surg 2020; 44:855-861. [PMID: 32157376 PMCID: PMC7280331 DOI: 10.1007/s00266-020-01666-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
Introduction Multiple symmetric lipomatosis (MSL) (syn.: Launois–Bensaude Syndrome, benign symmetric lipomatosis) is a rare disease of fatty tissue. The pathophysiology of MSL still remains unclear, although several approaches have been described in order to understand it. Beside morphological characteristics and some molecular cell biological approaches, little is known about the histological and immunohistochemical characterization of adipose tissue from patients with MSL. Methods From the 45 patients with MSL in our database, 10 were included in the study. Fat tissue samples were collected from affected and unaffected areas. The forearm served as a control area as this area is not affected in MSL. The specimens were analyzed after selected stainings were taken (hematoxylin–eosin = HE, Elastica van Gieson, Ladewig, CD200, CIDEA, myf5, p107, Prdm16, Sca-1, syndecan, UCP1, MAC387, Glut4).
Results In patients suffering from MSL, no macroscopic or microscopic morphological difference could be found between affected and unaffected adipose tissue in HE stainings. The majority of samples showed positivity for UCP1 (9/10 clinically affected tissues, 7/10 clinically unaffected tissues) and CD200. Conclusion Marker profiles support the hypothesis that affected adipose tissue derives from brown or beige adipose tissue rather than from white fat. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-020-01666-6) contains supplementary material, which is available to authorized users.
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Biermann N, Ruewe M, Zeman F, Geis S, Schiltz D, Prantl L, Taeger CD. The Influence of Pulsed Electromagnetic Field Therapy on Lymphatic Flow During Supermicrosurgery. Lymphat Res Biol 2020; 18:549-554. [PMID: 32250722 DOI: 10.1089/lrb.2019.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The influence of pulsed electromagnetic field therapy (PEMFT) on medium-sized vessels as well as capillary microcirculation is well known. Effects on lymphatic vessels, however, are difficult to visualize and have not been investigated to date. One of the operative treatment options in primary and secondary lymphedemas is lymphovenous anastomoses using supermicrosurgery. To prove patency of the anastomosis, the lymphatic flow is visualized by fluorescence using indocyanine green. The aim of this study was to investigate the influence of PEMFT on the lymphatic microcirculation, and compare it with conventional manual lymphatic drainage (MLD) during supermicrosurgery. Methods and Results: Ten patients with lymphedema were included. Indocyanine green was injected before the operation for intraoperative visualization of the lymphatic vessels using a microscope equipped with an integrated near-infrared illumination system (Zeiss). The PEMFT system (Bio-Electro-Magnetic-Energy Regulation [BEMER]) was used as our standard device during a single 2-minute application period (AP) followed by MLD or vice versa. The mean light intensity in the calibration period (CP) was 46.53 ± 24.3 and 33.41 ± 12.92 for PEMFT and MLD, respectively. During the AP, the mean light intensity changed to 45.61 ± 24.40 for PEMFT and 57.05 ± 18.80 during MLD. This change between CP and AP did not differ significantly for the PEMFT application (p = 0.26), but showed an increase in light intensity during MLD (p < 0.001). Conclusion: We found a light intensity enhancement equivalent to a flow increase during MLD of 78.7% ± 45.7% (range 20%-144%) and no significant difference during the PEMFT application. A single period application of PEMFT did not affect the lymphatic flow.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Geis
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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15
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Biermann N, Geissler EK, Brix E, Schiltz D, Muehle C, Prantl L, Taeger CD. Pressure distribution and flow characteristics during negative pressure wound therapy. J Tissue Viability 2020; 29:32-36. [DOI: 10.1016/j.jtv.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023]
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16
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Schiltz D, Taeger CD, Biermann N, Ranieri M, Klein S, Prantl L, Geis S. Transcutaneous oxygen measurement using ratiometric fluorescence imaging as a valid method for monitoring free flap transplants. Clin Hemorheol Microcirc 2019; 73:113-123. [PMID: 31561353 DOI: 10.3233/ch-199225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reconstruction of soft tissue defects with free flaps is a common procedure in plastic and reconstructive surgery. Most postoperative complications occur within the first 48-72 hours after surgery. After postoperative complications, short perfusion restoration times may improve flap survival rates by up to 30-50%. Ratiometric fluorescence imaging is an additional or alternative method of postoperative flap monitoring. OBJECTIVE To test the efficacy and utility of transepidermal oxygen flux imaging to evaluate postoperative skin oxygenation of free and local flaps in the first 48 hours after surgery. METHODS The study included 32 patients (aged between 18 and 80 years; mean age 52.9) with a tissue defect covered with a free flap transplant at the Department of Plastic and Reconstructive Surgery of the University Medical Center Regensburg. Postoperative oxygen flux was measured with the 'VisiSens system' placed on the vascular pedicle as well as on the peripheral and central part of the flap. RESULTS Values of oxygen flux were higher in case of flap congestion (0.069±0.012) or flap necrosis (0.155±0.083) than in cases without any complications (0.061±0.006). Flux values of different areas of the same flap showed only minimal differences (central part: 0.065±0.008, peripheral part: 0.070±0.009, vascular pedicle: 0.056±0.004); the level of significance was p = 0.904. CONCLUSION Imaging transepidermal oxygen flux by ratiometric luminescence seems to be a reliable alternative, indirect method of postoperative flap monitoring with regard to microcirculatory function and flap viability.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Niklas Biermann
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Marco Ranieri
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Silvan Klein
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
| | - Sebastian Geis
- Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Regensburg, Germany
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Biermann N, Geissler EK, Brix E, Schiltz D, Prantl L, Kehrer A, Taeger CD. Oxygen levels during negative pressure wound therapy. J Tissue Viability 2019; 28:223-226. [PMID: 31500929 DOI: 10.1016/j.jtv.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY Negative pressure wound therapy (NPWT) has become an established treatment modality when dealing with chronic and infected wounds. The underlying mechanism of action is still under discussion and remains controversial. Evidence exists showing rather hypoxic conditions as the main reason for the positive results and bacterial clearance. In an attempt to further explain the mechanism of action, we investigated oxygen levels within the foam interface of a NPWT device. MATERIALS AND METHODS We used an optical sensor based on the principle of dynamic fluorescence quenching and tested five different commonly available NPWT systems used during our daily clinical routine. All measurements were done in an in vitro experimental design for at least 24 h and multiple vacuum intensities were investigated. RESULTS Oxygen levels decreased as much as 22.8% and the amount of vacuum applied inversely correlated with the oxygen reduction. A stepwise increase in vacuum of 25 mmHg showed a linear mean drop of 2.75% per setting. All devices were able to maintain a constant level of negative pressure, and no significant difference between the various dressings was found (p > 0.05). CONCLUSION Therefore, oxygen levels are decreased within the foam of NPWT dressings, likely leading to oxygen deprivation effects in the underlying wound tissue.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | | | - Eva Brix
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
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18
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Schiltz D, Wenzel C, Brix E, Prantl L, Taeger CD. Salvage of both feet after complete resection of large carcinomas and local infection using a new negative pressure wound dressing in combination with intermittent instillation therapy. J Tissue Viability 2019; 28:120-123. [DOI: 10.1016/j.jtv.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
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19
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Lamby P, Wolff D, Mielke S, Grigoleit GU, Ljungman P, Hilgendorf I, Holler E, Holler B, Weber D, Herr W, Schiltz D, Klein S, Graf S, Bjornhagen-Safwenberg V, Dolderer J, Prantl L. Allogeneic donor split skin grafts for treatment of refractory ulcers in cutaneous chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation-a retrospective analysis on seven patients. Ann Hematol 2019; 98:1867-1875. [PMID: 30993415 DOI: 10.1007/s00277-019-03687-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/06/2019] [Indexed: 12/19/2022]
Abstract
Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.
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Affiliation(s)
- P Lamby
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - D Wolff
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany.
| | - S Mielke
- Allogeneic Stem Cell Transplantation Section, Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany.,Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - G U Grigoleit
- Allogeneic Stem Cell Transplantation Section, Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany
| | - P Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - I Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Deutschland, Germany
| | - E Holler
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - B Holler
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - D Weber
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - W Herr
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - D Schiltz
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - S Klein
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - S Graf
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | | | - J Dolderer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
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20
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Aung T, Taeger C, Geis S, Schiltz D, Brix E, Wenzel C, Lamby P, Kehrer A, Prantl L, Brebant V. WITHDRAWN: The use of integrated indocyanine green fluorescence microscope camera for intraoperative lymphography of supermicrosurgery. Clin Hemorheol Microcirc 2018:CH189311. [PMID: 30347608 DOI: 10.3233/ch-189311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- T Aung
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - C Taeger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - S Geis
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - D Schiltz
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - E Brix
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - C Wenzel
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - P Lamby
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - L Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - V Brebant
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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21
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Felthaus O, Schön T, Schiltz D, Aung T, Kühlmann B, Jung F, Anker A, Klein S, Prantl L. Adipose tissue-derived stem cells from affected and unaffected areas in patients with multiple symmetric lipomatosis show differential regulation of mTOR pathway genes. Clin Hemorheol Microcirc 2018; 69:141-151. [PMID: 29758934 DOI: 10.3233/ch-189107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multiple symmetric lipomatosis is a rare disease characterized by the excessive growth of uncapsulated masses of adipose tissue. Although the etiology has yet to be elucidated, a connection to brown adipose tissue has been proposed recently. The mTOR pathway which is found to be regulated in lipomatous tissue as well as associated with brown adipose tissue can be inhibited by a compound called rapamycin. METHODS We isolated adipose tissue derived stem cells from both affected and unaffected tissue and treated these cells with different concentrations of rapamycin. RESULTS The differences in both proliferation and differentiation between adipose tissue derived stem cells (ASCs) from lipomatous and normal tissue decreased after mTOR pathway inhibition. In some patients regulation of mTOR genes was opposed in the ASCs from the two different tissues. CONCLUSIONS Treatment with rapamycin might be a novel therapeutical approach for patients suffering from multiple symmetric lipomatosis.
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Affiliation(s)
- Oliver Felthaus
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Teresa Schön
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thiha Aung
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Britta Kühlmann
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Kantstrasse, Teltow, Germany
| | - Alexandra Anker
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Silvan Klein
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Ranieri M, Wohlgemuth W, Müller-Wille R, Prantl L, Kehrer A, Geis S, Klein S, Lamby P, Schiltz D, Uller W, Aung T, Dolderer JH. Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment. Clin Hemorheol Microcirc 2018; 67:355-372. [PMID: 28885203 DOI: 10.3233/ch-179216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.
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Affiliation(s)
- M Ranieri
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Wohlgemuth
- Department of Radiology, University Hospital Regensburg, Germany.,Institute of Radiology, University Hospital Halle, Germany
| | - R Müller-Wille
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany
| | - L Prantl
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - A Kehrer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Geis
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Klein
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - P Lamby
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - D Schiltz
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - T Aung
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - J H Dolderer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
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23
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Dolderer JH, Geis S, Mueller-Wille R, Kelly JL, Lotter O, Ateschrang A, Prantl L, Schiltz D. New reconstruction for bone integration of non-vascularized autogenous bone graft with better bony union and revascularisation. Arch Orthop Trauma Surg 2017; 137:1451-1465. [PMID: 28825132 DOI: 10.1007/s00402-017-2775-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Phalangeal defects are often seen after tumor resection, infections, and in complex open hand fractures. In many cases, reconstruction is difficult and amputation is performed to avoid prolonged rehabilitation that is often associated with a poor outcome. In these cases, the maintenance of length and function presents a reconstructive challenge. METHODS We reviewed 11 patients who underwent extensive phalangeal reconstruction with non-vascularized bone graft from the iliac crest using a key-in-slot-joint technique to provide acceptable function and bony union. RESULTS In each case, non-vascularized bone graft with a length of 1.4-6.0 cm was used to reconstruct the phalanx. Follow-up ranged from 6 weeks to 5 months, and in all cases, there was bony union after 6 weeks. We evaluated range of motion, function, and as well pain and grip strength of the fingers. CONCLUSIONS This case series suggests that a key-in-slot technique allows non-vascularized bone graft to be used in complex large phalangeal bone defects. Due to better bone contact, a sufficient perfusion and revascularisation of the non-vascularized bone graft can be achieved for a quicker and stable bony union. This method appears to be an alternative to amputation in selected cases with a satisfactory soft-tissue envelope.
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Affiliation(s)
- J H Dolderer
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - S Geis
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - R Mueller-Wille
- The Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - J L Kelly
- The Department of Plastic and Reconstructive Surgery, University Hospital Galway, Newcastle Rd., Galway, Ireland
| | - O Lotter
- The Department of Trauma Surgery, BG Trauma Center, University Hospital Tuebingen, Tuebingen, Germany
| | - A Ateschrang
- The Department of Trauma Surgery, BG Trauma Center, University Hospital Tuebingen, Tuebingen, Germany
| | - L Prantl
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - D Schiltz
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Drewes C, Kirkovits T, Schiltz D, Schinkoethe T, Haidinger R, Goldmann-Posch U, Harbeck N, Wuerstlein R. EHealth Acceptance and New Media Preferences for Therapy Assistance Among Breast Cancer Patients. JMIR Cancer 2016; 2:e13. [PMID: 28410189 PMCID: PMC5369631 DOI: 10.2196/cancer.5711] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 01/13/2023] Open
Abstract
Background Electronic health (eHealth) and mobile communication-based health care (mHealth) applications have been increasingly utilized in medicine over the last decade, and have facilitated improved adherence to therapy regimens in patients with chronic conditions. Due to the long duration of breast cancer therapy, and the long course of disease in metastatic breast cancer, a need for more intensified physician-patient communication has emerged. Various support mechanisms, including new media such as mHealth and eHealth, have been proposed for this purpose. Objective The aim of this study was to analyze the correlation between sociodemographic factors, as well as health status of breast cancer patients, and their current utilization of new media, or their willingness to use Internet and mobile phone apps for improvement of therapy management. Methods The survey for this study was conducted anonymously during the 2012 Mamazone Projekt Diplompatient meeting (Augsburg, Germany), which hosted approximately 375 participants per day. A total of 168 questionnaires were completed. The questionnaire aimed to assess sociodemographic status, disease patterns, and current use of new media (ie, Internet, mobile phone, and mobile phone apps) in breast cancer patients. Habits and frequency of use for these new technologies, as well as patients’ affinity towards eHealth and mHealth tools for therapy management improvement, were investigated. Results Almost all participants used the Internet (95.8%, 161/168), with 91.5% (151/165) also utilizing this technology for health-related issues. Approximately 23% (38/168) of respondents owned a mobile phone. When asked about their preferences for therapy assistance, 67.3% (113/168) of respondents were interested in assistance via the Internet, 25.0% (42/168) via mobile phone, and 73.2% (123/168) via call center. Patients diagnosed with breast cancer <5 years before the survey were significantly more interested in a call center than patients diagnosed >5 years before survey participation. Conclusions The vast majority of breast cancer patients accept the Internet for therapy assistance, which indicates that eHealth is a promising medium to improve patient-physician communication. Such technologies may improve individual disease management and ultimately lead to an enhanced adherence to therapy regimens.
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Affiliation(s)
- Caroline Drewes
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
| | - Thomas Kirkovits
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
| | - Daniel Schiltz
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
| | - Timo Schinkoethe
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
| | | | | | - Nadia Harbeck
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics, CCC of LMU, Munich, Germany
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Wuerstlein R, Kirkovits T, Drewes C, Schiltz D, Bauerfeind I, Haidinger R, Paradies K, Goldmann-Posch U, Schinkoethe T, Harbeck N. Abstract P2-10-05: eHealth in modern breast cancer treatment: New possibilities in communication between patients, doctors and nursing staff. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-10-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Lack of compliance and adherence in oral and s.c. treatment of breast cancer (BC) are huge problems leading to significant impacts in morbidity and mortality. During long term treatment, constant patient contact can’t be secured and possible side effects not be treated adequately. Where conventional mailing systems failed, as reported in the PACT program, eHealth could be a possible solution to increase adherence among patients and to ameliorate the communication between patients, oncologist and nurses.
The objective of this study is to investigate the actual internet usage habits and property of new media among BC patients, their oncologists and the nursing staff to find new possible ways to improve compliance and adherence in long term treatment.
Methods:
By using 3 different questionnaires (33 items), the actual usage of internet and modern media among BC patients and their healthcare professionals (oncologists and nursing staff) is surveyed. Also, the equipment of media (computer, smartphone, etc.) in private as well as in business use is investigated. Huge care and attention is given to possible future eHealth systems for additional patient support. The collected data also includes age, sex, workplace and, in case of medical professionals, their emphasis.
Patients completed the questionnaire at two patient conventions and before consultations, oncologists and nurses were asked to answer the questionnaire at several local BC meetings.
Results:
631 patients, 120 oncologists and 96 nurses completed the questionnaire in 2013.
The internet usage in general and for health related issues is very high among all three subgroups (patients: 93% and 77%, respectively; oncologists: 100% and 98%; nurses: 92% and 93%). Among patients, even above age 60, 51% report to use the internet every day. Taking a look at participant’s equipment of new media, the property of a personal computer is very high (78%; 99%; 95%).
Medical professionals as well as the majority of patients can imagine getting additional support during long term therapy using eHealth technologies (e.g. for monitoring of and interventions concerning side effects) (see table).
Discussion:
This survey, which is the first BC specific study representing internet usage habits among BC patients and their medical professionals, shows high acceptance of new interactive ways of communication between patients, doctors and nurses who are all taking part in treatment of BC. Introducing eHealth may help increase compliance and improve and individualize the doctor-patient-relationship which will possibly lead to decreased mortality and higher patient and staff satisfaction.
Table 1 PatientsDoctorsNursing StaffNumber of participants63112096Internet usage in general92.7% (495/534)100% (119/119)91.7% (88/96)Property of media:PC77.7% (490/631)99.2% (119/120)94.8% (91/96)Smartphone25.5% (161/631)70.8% (85/120)45.8% (44/96)Wish for additional patient support:via Internet53.8% (276/513)66.4% (79/119)56.8% (54/95)via Smartphone24.2% (119/49251.3% (60/117)31.1% (28/90)Registration of side effects via electronic devices41.1% (204/497)71.2% (84/118)56.1% (51/91)
Citation Format: Rachel Wuerstlein, Thomas Kirkovits, Caroline Drewes, Daniel Schiltz, Ingo Bauerfeind, Renate Haidinger, Kerstin Paradies, Ursula Goldmann-Posch, Timo Schinkoethe, Nadia Harbeck. eHealth in modern breast cancer treatment: New possibilities in communication between patients, doctors and nursing staff [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-10-05.
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Affiliation(s)
| | | | - Caroline Drewes
- 1Brustzentrum am Klinikum der Universitaet Muenchen, CCC of LMU
| | - Daniel Schiltz
- 1Brustzentrum am Klinikum der Universitaet Muenchen, CCC of LMU
| | | | | | | | | | | | - Nadia Harbeck
- 1Brustzentrum am Klinikum der Universitaet Muenchen, CCC of LMU
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Langston PF, Krous E, Schiltz D, Patel D, Emmert L, Markosyan A, Reagan B, Wernsing K, Xu Y, Sun Z, Route R, Fejer MM, Rocca JJ, Rudolph W, Menoni CS. Point defects in Sc2O3 thin films by ion beam sputtering. Appl Opt 2014; 53:A276-A280. [PMID: 24514227 DOI: 10.1364/ao.53.00a276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
We show that the concentration of oxygen interstitials trapped in Sc2O3 films by ion beam sputtering from metal targets can be controlled by modifying deposition conditions. We have identified point defects in the form of oxygen interstitials that are present in Sc2O3 films, in significantly high concentrations, i.e., ∼10(18) cm(-3). These results show a correlation between the increase of oxygen interstitials and the increase in stress and optical absorption in the films. Sc2O3 films with the lowest stress and optical absorption loss at 1 μm wavelength were obtained when using a low oxygen partial pressure and low beam voltage.
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Wuerstlein R, Kirkovits T, Drewes C, Bauerfeind I, Goldmann-Posch U, Roedder P, Peine AC, Schiltz D, Harbeck N, Schinkoethe T. Abstract P1-11-01: eHealth in modern patient-caregiver-communication: High rate of modern media use in physicians as well as breast cancer patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Implementation of oral and s.c. medications for breast cancer (BC) led to new challenges for patients and physicians regarding optimal and continuous communication. For patients, irregular physician contact and communication is the challenge with more liberty and treatment self-management. For oncologists, lack of surveillance and counseling time is associated with these drug administration forms. Since regular physician contact is not mandatory as with standardized i.v. schedules, patients’ questions regarding treatment may not be answered in a timely fashion, side effects not be treated adequately. To close the gaps between each face to face consultation, to improve the doctor-patient relationship and to enhance patient compliance, new ways of communication, including eHealth and web-based programs, may thus be useful. The objective of our investigation is to evaluate actual use of internet and modern media (e.g. smartphones) in BC patients and their healthcare professionals.
Methods: We designed anonymous questionnaires (33 items) for patients and physicians. Both questionnaires analyze frequency and behavior of use of internet and modern media, available equipment at patients’ homes and doctors’ offices and opinions on future eHealth tools. Data also include age, sex, place of living, workplace, and modern media use in health related questions. Patients were asked to answer the questionnaire before consultations and at a BC patient conference (Mamazone, Augsburg 2012). Health care specialists were asked to complete the questionnaire at several regional BC meetings.
Results: So far, questionnaires have been completed by 120 BC-specialists and 631 patients. Up to the age of 50, 89% of patients use internet for health related issues. Even above age 70, more than the half use internet for health related purposes. Among doctors, 98% use internet for medical issues. Implementation of potential future eHealth tools would be highly accepted in both groups.
Table 1 patientsdoctorsNumber of participants631120internet usage in general92.7% (494/534)100% (119/119)internet usage for health related issues77.2% (461/597)98.3% (118/120)wish for support for patients via internet / via smartphone / via callcenter53.8% (276/513) / 24.2% (129/492) / 61.7% (311/521)66.4% (88/119) / 51.3% (60/117) / 49.1% (57/116)registration of side effects via electronic devices41.4% (204/497)71.2% (84/118)
Discussion: This survey shows a high rate of internet and modern media use among BC physicians and their patients, the latter surprisingly also in higher age-groups. Physicians and patients could well imagine web-based therapy support. In both groups, the additional possibility to regularly record side effects and manage them without face to face meetings is favored by a majority. The routine use of internet and modern media and trust in new interactive communication tools in both groups, may enable improvements in doctor-patient-relationship, compliance and adherence in oncology. Our data, which represent the first BC-specific survey, suggest that eHealth-tools may have a promising future in communication and treatment of BC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-11-01.
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Affiliation(s)
- R Wuerstlein
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - T Kirkovits
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - C Drewes
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - I Bauerfeind
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - U Goldmann-Posch
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - P Roedder
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - A-C Peine
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - D Schiltz
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - N Harbeck
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
| | - T Schinkoethe
- University Hospital Munich, Breast Center, Muenchen, Germany; TZM, Breast Group, Landshut, Germany; Mamazone, Augsburg, Germany
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Delbarre JC, Hulet C, Schiltz D, Aubriot JH, Vielpeau C. [Total hip arthroplasty after proximal femoral osteotomy: 75 cases with 9-year follow-up]. Rev Chir Orthop Reparatrice Appar Mot 2002; 88:245-56. [PMID: 12037480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE OF THE STUDY Clinical outcome and technical difficulties observed after total hip arthroplasty subsequent to osteotomy of the proximal femur were studied in 75 total hip arthroplasties. MATERIAL AND METHOD Sixty-four patients underwent 75 total hip arthroplasty procedures at the Caen University Hospital between 1978 and 1995. These patients were reviewed at least two years after implantation. The Postel Merle d'Aubigné (PMA) score was used to assess clinical outcome and the Lequesne criteria to determine acetabular and femoral parameters on the weight-bearing AP radiograph. Off-set of the femoral epiphysis was determined by measuring the relation between the femoral shaft axis and the digital fossa. The population was composed of young active subjects who had had several operations. The main underlying diseases were: congenital dislocation of the hip (32%), dysplasia (23%), and primary degenerative hip disease (34%). Two-thirds of the hips were stiff and more than three-quarters were unstable. There were 28 osteotomies for varisation, 19 medial translations, 20 osteotomies for valgisation, and 7 subtrochanteric osteotomies. All femoral pieces except one were cemented. Implantation required 39 trochanterotomies, 39 Hardinge approaches, and 5 deosteotomies. RESULTS The medial offset of the digital fossa compared with the diaphysis led to operative difficulties and femoral complications: Their were eight femoral fractures: 7 of these occurred with a digital fossa situated medially to the diaphysis. The Postel-Merle-d'Aubigné score at last follow-up was satisfactory in 57 cases (76%). Among the 18 non-satisfactory results, there was 7 failures requiring surgical revision, 5 potential loosenings, and 6 stiff hips in patients with congenital dislocation. For the 7 revisions (9.3%), 3 were for infection (2 late hematogenous), 1 for early dislocation, 2 for aseptic acetabular loosening, and 1 for aseptic femoral loosening. Medial translation of the digital fossa led to a larger number of varus positions (44%). For femoral cementing, 10 hips showed a non-progressive secondary lucent line; these prostheses were considered as potentially loose. Among them, varisation osteotomies has been performed in 5 cases, and in 8 the digital fossa was medial to the diaphyseal axis. There was only one aseptic femoral loosening requiring surgical revision. Implant survival, established according to the actuarial method, was 94.9% at 10 years. DISCUSSION The almost 95% implant survival at 10 years observed in our patients is comparable with most reports in the literature and slightly better than those reported at the 1997 SOFCOT symposium on total hip arthroplasty after 50 years (84%). The most important factor determining surgical difficulty and operative complications at the femoral level was the position of the digital fossa, more than the type of initial osteotomy. CONCLUSION Indications for osteotomy must account for subsequent total hip arthoplasty. Implantation is difficult after subtrochanteric osteotomy which can cause important technical problems. The rate of failure is very high. The risk of femoral complications and misalignment of the femoral stem, irrespective of the type of initial osteotomy, is greater when the digital fossa lies medially to the diaphyseal axis. We prefer trochanterotomy or desosteotomy for such cases. Osteotomy did not rule out arthroplasty for any of the femurs. There were however important operative difficulties and the frequency of complications suggest we should be most prudent about careful preoperative planning in the frontal plane.
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Affiliation(s)
- J C Delbarre
- Département d'Orthopédie, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Pierre A, Hulet C, Locker B, Schiltz D, Delbarre JC, Vielpeau C. [Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament]. Rev Chir Orthop Reparatrice Appar Mot 2001; 87:661-8. [PMID: 11845069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE OF THE STUDY The purpose of this retrospective analysis was to study clinical and radiological outcome of 95 stable meniscal tears left in place after arthroscopic reconstruction of the anterior cruciate ligament with a free patellar autograft (with or without a lateral component). MATERIAL AND METHODS We reviewed 86 patients who had undergone arthroscopic treatment for chronic anterior laxity (56% solely anterior laxity) with at least one meniscal lesion left in place after ligamentoplasty. IKDC criteria and ARPEGE scores were recorded. A total of 95 stable meniscal lesions had been left in place: 35 lateral lesions (80% longitudinal tears and 77% posterior lesions) and 60 medial lesions (55% peripheral disinsertions and 90% posterior lesions). The lesions measured a mean 10 mm (range 5-20 mm) for the lateral and medial menisci. Mean follow-up was 4 years (range 3-9 years). These patients were young (mean age 26 years), and predominantly men (75%). The right knee was involved in 53% of the cases. RESULTS At last follow-up, 26% of the patients were grade A, 65% B, 7% C and 2% D according to the IKDC criteria. No revision procedure was required for lateral menisci despite the large size of the lesions left in place in certain cases. Among the 60 medial lesions left in place, 10 (17%) had become symptomatic (8 bucket-handle, 1 longitudinal tear, 1 posterior fragment) and required surgery a mean 3 years (range 1-6 years) after ligamentoplasty. There was no statistical difference between functional score, residual laxity, or type of stabilization in patients who had revision surgery for symptomatic meniscal lesions and the others. Inversely, these lesions were statistically larger (p=0.038) than the others (mean 13 mm versus 9.8 mm). CONCLUSION Outcome of stable meniscal lesions left in place after treatment for anterior laxity depends on the meniscus involved. For the lateral meniscus, irrespective of the size of the lesion, therapeutic abstention has no clinical impact at 4 years. Inversely, for the medial meniscus, 37.5% of the lesions measuring more than 10 mm that were left in place required revision while only 9% of those measuring less than 10 mm necessitated subsequent surgery. Beyond 10 mm, therapeutic abstention led to a revision procedure in 17% of the cases, suggesting the usefulness of a discussion on other indications. Stable lesions of the medial meniscus should not be left in place if they measure more than 10 mm.
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Affiliation(s)
- A Pierre
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Caen, avenue Côte de Nacre, 14033 Caen Cedex
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Hulet C, Sabatier JP, Schiltz D, Locker B, Marcelli C, Vielpeau C. [Dual x-ray absorptiometry assessment of bone density of the proximal tibia in advanced-stage degenerative disease of the knee]. Rev Chir Orthop Reparatrice Appar Mot 2001; 87:50-60. [PMID: 11240537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
PURPOSE OF THE STUDY Axial deformity secondary to degenerative joint disease of the knee can modify stress forces. Certain studies have reported an inversely proportional relationship between degenerative disease and osteoporosis. The aim of this prospective study was to quantify the horizontal linear distribution of bone density using dual x-ray absorptiometry (DXA) of the proximal tibia as a function of the femoral neck bone density in patients with knee osteoarthritis. MATERIAL AND METHODS Between September 1996 and March 1998, 90 cases of primary degenerative joint disease of the knee were programmed for total knee arthroplasty. Prior to the procedure, the patients were assessed clinically and radiologically according to the International Knee Society (IKS) criteria. The mechanical femorotibial angle was measured in all patients and the varus angles were recorded. Most of the patients were women (65 p. 100) with a mean age of 70 +/- 5 years. Valgus knees were excluded from this series. The mean mechanical femorotibial angle was 172 +/- 5 degrees. Fifteen patients had a normal axis (16 p. 100), 32 had a varus measuring 4 degrees to 10 degrees (35 p. 100) and 43 had a varus measuring 10 degrees or more (48 p. 100). The overall varus distance was 6.4 +/- 2 cm. All patients had two DXA explorations: femoral neck to determine the bone status according to the WHO criteria (normal, osteopenia, osteoporosis), knee to determine the linear distribution of bone density of the proximal tibia. A 7 mm high band including 7 regions of interest covering the width of the tibia were explored in the area where the tibial cut was to be made. These 7 regions of interest were: R1, R2 under the lateral compartment, R6, R7 under the medial compartment, and R3, R4, R5 on either side of the tibial spines. The level of significance was set at 5 p. 100. RESULTS The mean Z score (0.54 +/- 1) in the 90 patients showed a symmetrical distribution. These patients were representative of their age range. Their T score was - 1.40 +/- 1 (m +/- SD) and most had osteopenia (54 p. 100) according to the WHO criteria, although 16 p. 100 had osteoporosis. Mean bone density of the knee was 0.898 +/- 0.163 g/cm(3) and was correlated with that of the femoral neck (r=0.61, p=0.001). There were significant correlations between the differences in the bone densities of the knee compartments (R6-R2, R7-R1) and the mechanical femorotibial angle [(r=0.39, p=0.0001); (r=0.52, p=0.001)]. Irrespective of the overall bone density, there was a strong medial compartment overloading, which correlated with the degree of varus deformation. CONCLUSION DXA assessment of bone mineral density of the proximal tibia is a simple, reliable, precise and reproducible method. The distribution of bone density in the degenerative knee depends on the degree of deformation. The average level depends on the subject's general state of mineralization. Osteoporosis does not protect against degeneration of the knee joint since 16 p. 100 of our patients had osteoporosis according to the WHO criteria.
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Affiliation(s)
- C Hulet
- Département de Chirurgie Orthopédique et Traumatologique, avenue de la Côte-de-Nacre, CHU de Caen, 14033 Caen Cedex
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Abstract
We reviewed 74 partial medial meniscectomies in 57 patients with stable knees, to assess the long-term functional and radiological outcome. The International Knee Documentation Committee score and the residual laxity were assessed in both knees. At the time of surgery the mean age of the patients was 36 ± 11 years and the mean follow-up was 12 ± 1 years. All had a limited medial meniscectomy. The anterior cruciate ligament was intact in all cases. The meniscal tear was vertical in 95% and complex in 5%. The posterior part of the meniscus was removed in 99%. A peripheral rim was preserved in all cases. After 12 years 95% of the patients were satisfied or very satisfied with their knee(s). Objectively, 57% had grade A function and 43% were grade B. The outcome correlated only with the presence of anterior knee pain at final follow-up. In the 49 cases of arthroscopic meniscectomy for which there was a contralateral normal knee there was narrowing of the ‘joint-space’ in 16% of the operated knees. There was no correlation between this and other parameters such as age or different meniscal pathologies.
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Affiliation(s)
- C. H. Hulet
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
| | - B. G. Locker
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
| | - D. Schiltz
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
| | - A. Texier
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
| | - E. Tallier
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
| | - C. H. Vielpeau
- Department of Orthopaedics, Caen University Hospital, Avenue Côte de Nacre, 14033 Caen Cedex, France
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Abstract
We reviewed 74 partial medial meniscectomies in 57 patients with stable knees, to assess the long-term functional and radiological outcome. The International Knee Documentation Committee score and the residual laxity were assessed in both knees. At the time of surgery the mean age of the patients was 36 +/- 11 years and the mean follow-up was 12 +/- 1 years. All had a limited medial meniscectomy. The anterior cruciate ligament was intact in all cases. The meniscal tear was vertical in 95% and complex in 5%. The posterior part of the meniscus was removed in 99%. A peripheral rim was preserved in all cases. After 12 years 95% of the patients were satisfied or very satisfied with their knee(s). Objectively, 57% had grade A function and 43% were grade B. The outcome correlated only with the presence of anterior knee pain at final follow-up. In the 49 cases of arthroscopic meniscectomy for which there was a contralateral normal knee there was narrowing of the 'joint-space' in 16% of the operated knees. There was no correlation between this and other parameters such as age or different meniscal pathologies.
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Affiliation(s)
- C H Hulet
- Department of Orthopaedics, Caen University Hospital, France
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Hulet C, Schiltz D, Locker B, Beguin J, Vielpeau C. [Lateral meniscal cyst. Retrospective study of 105 cysts treated with arthroscopy with 5 year follow-up]. Rev Chir Orthop Reparatrice Appar Mot 1998; 84:531-8. [PMID: 9846327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
UNLABELLED A retrospective study was performed on 122 patients with 124 lateral meniscal cysts, selected from a series of 8100 knee arthroscopies (1.5 per cent). Eight of the patients were lost for follow up, 11 patients had chronic anterior cruciate ligament deficiency or previous medial meniscectomy. Therefore 105 of 124 patients were included in this study. Average follow-up was 5 years (range of 1 to 12.5 years). MATERIAL AND METHODS Mean age was 33 years (range of 12 to 69 years). All patients had pain over the joint line with a palpable mass. All were noted to have a meniscal tear at the time of surgery and 60 (57 per cent) had a horizontal cleavage component. They were all arthroscopically treated. RESULTS Meniscal tears were treated by arthroscopic partial meniscectomy in 104 cases and meniscal repair in one case. Cysts were treated by intra-articular debridement in 91 cases and open cystremoval in 14 cases. Eleven cysts recurred and a second arthroscopy was required. The clinical results, including cysts recurrence, were excellent or good in 87 per cent of cases. Osteoarthritis following treatment of these meniscal cysts occurred in 9 per cent of cases. CONCLUSION When there is a cyst and no other intra-articular damage, the prognosis was excellent at 5 year follow-up. For lateral meniscal cysts; arthroscopic partial meniscectomy with intra-articular debridement yields predictable results.
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Affiliation(s)
- C Hulet
- Département d'Orthopédie, CHU de Caen
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Hulet C, Schiltz D, Vielpeau C, Locker B, Richter D, Aubriot JH. [Incidence of arthrosis in the results of the treatment of coxarthrosis in the young adult with Chiari's osteotomy. Retrospective study of 52 hips with 10.5 years of follow-up]. Rev Chir Orthop Reparatrice Appar Mot 1998; 84:41-50. [PMID: 9775021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF THE STUDY Fifty two of 53 Chiari pelvic osteotomies performed between 1974 and 1991 were reviewed clinically and radiographically with an average follow-up of 10.5 years. MATERIAL AND METHODS In more than 46 per cent of cases, the osteotomy was performed on a dysplastic painful hip with severe osteoarthritis. Major complications were rare. The Chiari's osteotomy fixation screw was removed in 16 cases. Technically, the average displacement was 22 mm. A ascending osteotomy, related to the level of the osteotomy (p = 0.001), provided good displacement. RESULTS The functional results were very good or good in 65 per cent of the patients and lasted more than 10 years. Seventy five per cent of the hips were pain free. Radiographically, the center edge angle and the femoral head covering were corrected by the procedure. Degenerative changes of the hip joint were improved or stabilized in 63.5 per cent of the cases. Fifteen hips had undergone secondary total hip replacement, seven during the first five years and 8 after 13 years. DISCUSSION Factors associated with a positive outcome included: age under 30 at the time of surgery (80 per cent of survivorship up to 15 years of follow up), low stage (I or II) of osteoarthritis, and a technically perfect Chiari osteotomy. The outcome of initial stage III or IV initial osteoarthritis were not as long lasting. Chiari osteotomy functional results were good for the initial 10 years, after this time they deteriorated quickly. CONCLUSION Chiari pelvic osteotomy is an alternative procedure to early total hip replacement for severe painful dysplastic hips with low stage of osteoarthritis in young patients.
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Affiliation(s)
- C Hulet
- Service d'Orthopédie B, C.H.U. de Caen
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