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Karamitros G, Kontoes P, Wiedner M, Goulas S. The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis. Aesthetic Plast Surg 2023; 47:2889-2901. [PMID: 37253842 PMCID: PMC10228894 DOI: 10.1007/s00266-023-03389-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world. METHODS We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons. RESULTS The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006). CONCLUSIONS Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement. LEVEL OF EVIDENCE V 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 http://www.springer.com/00266 .
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Affiliation(s)
- Georgios Karamitros
- Department of Plastic Surgery, University Hospital of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece.
- Medical School, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece.
| | - Paraskevas Kontoes
- International Society of Aesthetic Plastic Surgery, Mount Royal, NJ, USA
| | - Maria Wiedner
- International Society of Aesthetic Plastic Surgery, Mount Royal, NJ, USA
| | - Sofoklis Goulas
- Brookings Institution, Washington DC, USA
- World Bank, Washington DC, USA
- Aletheia Research Institution, Palo Alto, CA, USA
- Hoover Institution, Stanford University, Stanford, CA, USA
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Wiedner M, Richter DF. Invited Discussion on: Breast Equalization Augmentation: The Use of Ultrasonic-Assisted Liposuction for Correction of Primary Breast Asymmetry with Bilateral Augmentation. Aesthetic Plast Surg 2022; 46:675-676. [PMID: 35048146 DOI: 10.1007/s00266-021-02707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022]
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Wiedner M, Richter DF. Invited Discussion on: Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring. Aesthetic Plast Surg 2021; 45:1113-1114. [PMID: 33469700 DOI: 10.1007/s00266-020-02094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
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Mittal P, Heuft T, Richter DF, Wiedner M. Venous Thromboembolism (VTE) Prophylaxis After Abdominoplasty and Liposuction: A Review of the Literature. Aesthetic Plast Surg 2020; 44:473-482. [PMID: 31858207 DOI: 10.1007/s00266-019-01576-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this review article was to study recent articles and summarise the guidelines, indications, risks and benefits of using VTE prophylaxis in patients undergoing abdominoplasty and liposuction. METHODS A search of PubMed was performed using selected keywords related to the topic. Based on the inclusion and exclusion criteria, a total of 25 articles were included in the review. RESULTS Abdominoplasty has the highest occurrence of VTE among aesthetic procedures. A higher incidence of VTE was noted when abdominoplasty was combined with liposuction. Circumferential procedures, obesity and HRT (hormone replacement therapy) were found to be independent risk factors for VTE. The 2005 Caprini/Davison risk assessment model is the most appropriate model for risk stratification in plastic surgery patients. Newer oral anticoagulants hold promise. CONCLUSIONS Preoperative risk stratification should be performed for all patients. Chemoprophylaxis should be considered in cases with a Caprini RAM score > 7 or in those with independent risk factors. Administering regional blocks for anaesthesia and avoiding full muscle paralysis help reduce the risk of VTE. LEVEL OF EVIDENCE III 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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Wiedner M, Aghajanzadeh D, Richter DF. Lipödem – Grundlagen und aktuelle Thesen zum Pathomechanismus. Phlebologie 2020. [DOI: 10.1055/a-1109-5870] [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: 10/25/2022]
Abstract
ZusammenfassungDas Lipödem ist eine schmerzhafte, chronisch-fortschreitende Erkrankung, die durch eine symmetrische Unterhautfettgewebsvermehrung mit Flüssigkeitseinlagerung an den Beinen und/oder Armen gekennzeichnet ist. Durch Unkenntnis über das Krankheitsbild wird die Erkrankung häufig nicht erkannt oder fehlgedeutet. Eine korrekte Diagnostik und Behandlung ist jedoch wichtig, da die Prognose der Erkrankung beeinflusst werden kann. Eine kausale Therapie für das Lipödem ist nicht bekannt, da die genaue Ätiologie noch nicht vollständig geklärt ist. Aufgrund einer beschriebenen familiären Häufung der Erkrankung wird eine erbliche Komponente vermutet. Da das Lipödem fast ausschließlich bei Frauen auftritt und der Erkrankungsbeginn häufig mit Einsetzen von hormonellen Veränderungen in Zusammenhang steht (Pubertät, Schwangerschaft, Menopause), wird außerdem dem Östrogen eine entscheidende Bedeutung für die Entstehung zugemessen. In der vorliegenden Arbeit präsentieren wir einen Überblick über die Symptome und klinischen Merkmale des Lipödems, seine Differenzialdiagnosen, die Behandlungsmöglichkeiten und zuletzt die aktuellen Hypothesen zur Pathogenese des Lipödems.
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Affiliation(s)
- Maria Wiedner
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
| | - Donia Aghajanzadeh
- Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Plastische Chirurgie
| | - Dirk F. Richter
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
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Durchschein F, Moazedi-Fuerst F, Kielhauser S, Lackner A, Wiedner M, Koch H, Justich I, Eherer A. Helpful, albeit hazardous! Esophageal stem-cell injection in systemic sclerosis. Ther Adv Musculoskelet Dis 2019; 11:1759720X19863618. [PMID: 31360239 PMCID: PMC6637824 DOI: 10.1177/1759720x19863618] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Over 90% of patients with systemic sclerosis suffer from gastroesophageal reflux. Esophageal motility disturbances are associated with a reduced life quality and may force interstitial lung disease progression. We wanted to determine whether we can improve gastroesophageal reflux in these patients by esophageal stem-cell injection. Methods We performed a pilot study including eights patients with systemic sclerosis and symptomatic gastroesophageal reflux. Sampling of adipose tissue was performed by an experienced plastic surgeon under local anesthesia. The collected fat was injected into the submucosa of the distal esophagus, each time 1 ml in all four quadrants starting 2, 4 and 6 cm proximal to the Z line (ending up to a total volume of 12 ml). Before the intervention, 3, 6 and finally 12 months after the procedure, patients answered the Gastroesophageal Reflux Disease Health-Related Quality of Life Questionnaire (GERD HRQL) and a high-resolution manometry was performed to quantify changes in motility function. Results All patients showed an improvement in the GERD HRQL score after the stem-cell injection and a lower dosage of proton-pump inhibitors. The manometric findings showed no change throughout the time. A serious adverse event occurred, as one patient developed multiple cerebellar embolic infarcts. Conclusion Because of the favorable effect in all patients, a safe route for esophageal fat injection needs to be developed.
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Affiliation(s)
| | - Florentine Moazedi-Fuerst
- Division of Rheumatology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Sonja Kielhauser
- Division of Rheumatology, Medical University Graz, Graz, Austria
| | - Angelika Lackner
- Division of Rheumatology, Medical University Graz, Graz, Austria
| | - Maria Wiedner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria
| | - Horst Koch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria
| | - Ivo Justich
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria
| | - Andreas Eherer
- Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
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Abstract
Lipoedema is a painful, chronic progressive disorder of adipose tissue, characterised by symmetrical swelling of the lower and/or upper limbs. Due to a lack of awareness, lipoedema is frequently misdiagnosed. However, accurate diagnosis and treatment are essential since they determine the patient's prognosis. There is no known causal therapy because the exact aetiology of the disease is not fully understood at this time. Familial aggregation is common, which suggests a genetic disorder. Since lipoedema is almost exclusively found in women and manifests around hormonal changes (puberty, pregnancy, menopause), oestrogen is believed to play a decisive role in its pathogenesis. This review aims to summarise the symptoms and clinical features of lipoedema, its differential diagnosis, treatment options, and current theories on the pathogenesis of lipoedema.
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Affiliation(s)
- Maria Wiedner
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
| | - Donia Aghajanzadeh
- Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Plastische Chirurgie
| | - Dirk F Richter
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
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Goltz J, Anton S, Wiedner M, Kleemann M, Barkhausen J, Stahlberg E. Endovaskuläre Therapie aorto-iliaker Aneurysmata: initiale Single Center Erfahrung mit einer neuartigen iliakalen Bifurkationsprothese. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Goltz
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - S Anton
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - M Wiedner
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck
| | - M Kleemann
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck
| | - J Barkhausen
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - E Stahlberg
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
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Stahlberg E, Planert M, Panagiotopoulos N, Horn M, Wiedner M, Kleemann M, Barkhausen J, Goltz JP. Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures. Eur J Vasc Endovasc Surg 2016; 53:269-274. [PMID: 27965020 DOI: 10.1016/j.ejvs.2016.10.016] [Citation(s) in RCA: 5] [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: 05/04/2016] [Accepted: 10/21/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE/BACKGROUND The aim was to evaluate the feasibility and efficacy of a new method for pre-operative calculation of an appropriate C-arm position for iliac bifurcation visualisation during endovascular aortic repair (EVAR) procedures by using three dimensional computed tomography angiography (CTA) post-processing software. METHODS Post-processing software was used to simulate C-arm angulations in two dimensions (oblique, cranial/caudal) for appropriate visualisation of distal landing zones at the iliac bifurcation during EVAR. Retrospectively, 27 consecutive EVAR patients (25 men, mean ± SD age 73 ± 7 years) were identified; one group of patients (NEW; n = 12 [23 iliac bifurcations]) was compared after implementation of the new method with a group of patients who received a historic method (OLD; n = 15 [23 iliac bifurcations]), treated with EVAR before the method was applied. RESULTS In the OLD group, a median of 2.0 (interquartile range [IQR] 1-3) digital subtraction angiography runs were needed per iliac bifurcation versus 1.0 (IQR 1-1) runs in the NEW group (p = .007). The median dose area products per iliac bifurcation were 11951 mGy*cm2 (IQR 7308-16663 mGy*cm2) for the NEW, and 39394 mGy*cm2 (IQR 19066-53702 mGy*cm2) for the OLD group, respectively (p = .001). The median volume of contrast per iliac bifurcation was 13.0 mL (IQR: 13-13 mL) in the NEW and 26 mL (IQR 13-39 mL) in the OLD group (p = .007). CONCLUSION Pre-operative simulation of the appropriate C-arm angulation in two dimensions using dedicated computed tomography angiography post-processing software is feasible and significantly reduces radiation and contrast medium exposure.
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Affiliation(s)
- E Stahlberg
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
| | - M Planert
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - N Panagiotopoulos
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - M Horn
- Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - M Wiedner
- Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - M Kleemann
- Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - J Barkhausen
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - J P Goltz
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
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Goltz J, Planert M, Horn M, Wiedner M, Kleemann M, Barkhausen J, Stahlberg E. Retrograde Transpedal Access for Revascularization of Below-the-Knee Arteries in Patients with Critical Limb Ischemia after an Unsuccessful Antegrade Transfemoral Approach. ROFO-FORTSCHR RONTG 2016; 188:940-8. [DOI: 10.1055/s-0042-110101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J. Goltz
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - M. Planert
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - M. Horn
- Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - M. Wiedner
- Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - M. Kleemann
- Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - J. Barkhausen
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - E. Stahlberg
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
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Goltz J, Stahlberg E, Loesaus J, Wiedner M, Kleemann M, Barkhausen J, Planert M. Retrograd transpedale und transtibiale Zugänge zur endovaskulären Revaskularisierung kruraler Gefäßverschlüsse nach erfolglosem transfemoralen Behandlungsversuch: initiale Single Center Erfahrung. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Planert M, Stahlberg E, Loesaus J, Horn M, Wiedner M, Kleemann M, Barkhausen J, Goltz J. Funktionsangiografie zur Detektion funktioneller Stenosen nach Stentimplantation in die Arteria poplitea. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The treatment of prominent eyes is still a challenging task. As well as the surgery, proper preoperative diagnosis differentiating between patients with and without Graves ophthalmopathy plays an important role. In functionally asymptomatic patients with Graves disease suffering from the aesthetic impairment of prominent eyes, the transpalpebral decompression by intraorbital fat removal technique has been proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon. This technique provides long-lasting results, leading to improvement not only in visual function but also in personal well-being and in the patient's social life, with a high benefit-to-risk ratio. The most powerful tool to treat the lower lid deformity and malar bags in patients without Graves disease is the subperiosteal midface lift. It shortens the lid-cheek junction and blends the retaining periorbital ligaments. Furthermore, it adds volume to the lower lid and gives a stable support. By the nature of the procedure, it also turns a negative into a positive vector. In experienced hands, Olivari's orbital decompression and Hester's midface lift are ideal options for the treatment of prominent eyes.
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Affiliation(s)
- Dirk F Richter
- Department for Plastic Surgery, Dreifaltigkeits-Hospital, Wesseling, Deutschland, Germany
| | - Nina Schwaiger
- Department for Plastic Surgery, Dreifaltigkeits-Hospital, Wesseling, Deutschland, Germany
| | - Maria Wiedner
- Department for Plastic and Reconstructive Surgery, University Clinic Graz, Graz, Austria
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Wiedner M, Tinhofer IE, Kamolz LP, Seyedian Moghaddam A, Justich I, Liegl-Atzwanger B, Bubalo V, Weninger WJ, Lumenta DB. Simultaneous dermal matrix and autologous split-thickness skin graft transplantation in a porcine wound model: a three-dimensional histological analysis of revascularization. Wound Repair Regen 2015; 22:749-54. [PMID: 25358670 DOI: 10.1111/wrr.12233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 09/04/2014] [Indexed: 01/01/2023]
Abstract
Despite the popularity of a simultaneous application of dermal matrices and split-thickness skin grafts, scarce evidence exists about the process of revascularization involved. In this study, we aimed at analyzing the progression of revascularization by high-resolution episcopic microscopy (HREM) in a porcine excisional wound model. Following the surgical procedure creating 5 × 5 cm(2) full-thickness defects on the back, one area was covered with an autologous split-thickness skin graft alone (control group), the other with a collagen-elastin dermal matrix plus split-thickness skin graft (dermal matrix group). Two skin biopsies per each group and location were performed on day 5, 10, 15, and 28 postoperatively and separately processed for H&E as well as HREM. The dermal layer was thicker in the dermal matrix group vs. control on day 5 and 28. No differences were found for revascularization by conventional histology. In HREM, the dermal matrix did not appear to decelerate the revascularization process. The presence of the dermal matrix could be distinguished until day 15. By day 28, the structure of the dermal matrix could no longer be delineated and was replaced by autologous tissue. As assessed by conventional histology and confirmed by HREM, the revascularization process was comparable in both groups, notably with regard to the vertical ingrowth of sprouting vessels. The presented technique of HREM is a valuable addition for analyzing small vessel sprouting in dermal matrices in the future.
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Affiliation(s)
- Maria Wiedner
- Research Unit for Tissue Regeneration, Repair, and Reconstruction, Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Kamolz L, Lumenta D, Parvizi D, Wiedner M, Justich I, Keck M, Pfurtscheller K, Schintler M. Skin graft fixation in severe burns: use of topical negative pressure. Ann Burns Fire Disasters 2014; 27:141-145. [PMID: 26170793 PMCID: PMC4441309] [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] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Indexed: 06/04/2023]
Abstract
Over the last 50 years, the evolution of burn care has led to a significant decrease in mortality. The biggest impact on survival has been the change in the approach to burn surgery. Early excision and grafting has become a standard of care for the majority of patients with deep burns; the survival of a given patient suffering from major burns is invariably linked to the take rate and survival of skin grafts. The application of topical negative pressure (TNP) therapy devices has demonstrated improved graft take in comparison to conventional dressing methods alone. The aim of this study was to analyze the impact of TNP therapy on skin graft fixation in large burns. In all patients, we applied TNP dressings covering a %TBSA of >25. The following parameters were recorded and documented using BurnCase 3D: age, gender, %TBSA, burn depth, hospital length-of-stay, Baux score, survival, as well as duration and incidence of TNP dressings. After a burn depth adapted wound debridement, coverage was simultaneously performed using split-thickness skin grafts, which were fixed with staples and covered with fatty gauzes and TNP foam. The TNP foam was again fixed with staples to prevent displacement and finally covered with the supplied transparent adhesive film. A continuous subatmospheric pressure between 75-120 mm Hg was applied (VAC®, KCI, Vienna, Austria). The first dressing change was performed on day 4. Thirty-six out of 37 patients, suffering from full thickness burns, were discharged with complete wound closure; only one patient succumbed to their injuries. The overall skin graft take rate was over 95%. In conclusion, we consider that split thickness skin graft fixation by TNP is an efficient method in major burns, notably in areas with irregular wound surfaces or subject to movement (e.g. joint proximity), and is worth considering for the treatment of aged patients.
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Affiliation(s)
- L.P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D.B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Wiedner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - I. Justich
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Keck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - K. Pfurtscheller
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - M. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Lars PKL, Giretzlehner M, Trop M, Parvizi D, Spendel S, Schintler M, Justich I, Wiedner M, Laback C, Lumenta D. The properties of the "ideal" donor site dressing: results of a worldwide online survey. Ann Burns Fire Disasters 2013; 26:136-141. [PMID: 24563639 PMCID: PMC3917148] [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] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Indexed: 06/03/2023]
Abstract
Split skin grafting is a widely used technique for reconstructing skin defects. Although a vast number of different coverage options for donor sites have become available in daily clinical practice, no optimum dressing material has been found to date. For this reason, we conducted a globally-distributed online survey to poll for the properties of such an "ideal" donor site dressing, possibly leading to an improved clinically-driven direction of future wound dressing developments. A total of 69 respondents from 34 countries took part in the questionnaire, resulting in a response rate of 13.8% (69/500) over a 1-month period. The majority of respondents rated the characteristics of an "ideal" donor site dressing to be either "essential" or "desirable" as follows: lack of adhesion to the wound bed ("essential": 31/69, 44.9%; "desirable": 30/69, 43.5%); pain-free dressing changes ("essential": 38/69, 55.1%; "desirable": 30/69, 43.5%); absorbency ("essential": 27/69, 39.1%; "desirable": 33/69, 47.8%); ease of removal ("essential": 37/69, 53.6%; "desirable": 27/69, 39.13%). With regard to the desired frequency of dressing changes, respondents preferred "no dressing change until the donor site has healed" (51/69, 73.9%) in the majority of cases, followed by "twice weekly" (10/69, 14.5%), "alternate days" (5/69, 7.2%) and "daily" (3/69, 4.3%). With regard to the design of the dressing material, the majority of participants preferred a one-piece (composite) dressing product (44/69, 63.8%). The majority of respondents also denied the current availability of an "ideal" donor site dressing (49/69, 71%). The strength of this study was the remarkable geographic distribution of responses; all parts of the world were included and participated. We believe that this globally conducted online survey has polled for the properties of the "ideal" donor site dressing and possibly will lead to an improved clinically-driven direction of future wound dressing development.
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Affiliation(s)
- P. Kamolz L.P. Lars
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Giretzlehner
- Research Unit for Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Austria
| | - M. Trop
- Pediatric Intensive Care Unit and Children’s Burns Unit, Department of Pediatrics, Medical University of Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - S. Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - I. Justich
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Wiedner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - C. Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D.B.. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Rappl T, Parvizi D, Friedl H, Wiedner M, May S, Kranzelbinder B, Wurzer P, Hellbom B. Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study. Clin Cosmet Investig Dermatol 2013; 6:211-9. [PMID: 24098087 PMCID: PMC3789632 DOI: 10.2147/ccid.s41537] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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] [Indexed: 11/23/2022]
Abstract
Background Three botulinum neurotoxin type A preparations (incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA) are widely approved in Europe and in the US for the treatment of glabellar frown lines. The purpose of this study was to determine and compare the time to onset and duration of treatment effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA for the treatment of glabellar frown lines. Subjects and methods Subjects aged 20–60 years with moderate to severe glabellar frown lines received one treatment of either 21 units (U) incobotulinumtoxinA, 21 U onabotulinumtoxinA, or 63 U abobotulinumtoxinA. Assessments were made over a period of 180 days. Onset of treatment effect was defined as the day that the observer noted a decrease in glabellar muscle activity compared with baseline photographs and videos. Duration of treatment effect was defined as the time until glabellar muscle action returned to the baseline level. Analyses were performed using a Weibull log(T) regression model. Results The study enrolled 180 subjects; 60 per group. For all three products, onset of treatment effect occurred earlier in female subjects compared to male subjects. For both sexes, a significantly earlier time to onset of treatment effect was seen for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; in female subjects these times were 3.02 days, 5.29 days, and 5.32 days, respectively. The duration of treatment effect was longer for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; for all products, treatment effect duration was longer in females than in males. Time to onset was not a predictor of treatment duration. Conclusion IncobotulinumtoxinA demonstrated a more rapid onset and a longer duration of treatment effect than onabotulinumtoxinA (1:1 dose ratio) and abobotulinumtoxinA (1:3 dose ratio). Onset of effect was faster and duration of effect was longer in female subjects compared to male subjects.
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Affiliation(s)
- Thomas Rappl
- Department of Plastic and Reconstructive Surgery, Medical University Graz, Graz, Austria
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Wiedner M, Justich I, Vasilyeva A, Parvizi D, Spendel S, Kamolz LP, Scharnagl E. Complications in body-contouring procedures with special regard to massive weight loss patients: personal observations. Eur Surg 2013. [DOI: 10.1007/s10353-012-0185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maurer-ertl W, Glehr M, Friesenbichler J, Sadoghi P, Wiedner M, Haas F, Leithner A, Windhager R, Zwick EB. No adverse affect after harvesting of free fibula osteoseptocutaneous flaps on gait function. Microsurgery 2012; 32:364-9. [DOI: 10.1002/micr.21959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/14/2011] [Accepted: 12/16/2011] [Indexed: 01/24/2023]
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Rappl T, Regauer S, Wiedner M, Wittgruber G, Schintler M, Scharnagl E. [Clinical experiences using the Versajet system in burns: indications and applications]. HANDCHIR MIKROCHIR P 2008; 39:308-13. [PMID: 17985272 DOI: 10.1055/s-2007-965312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Early debridement and early skin grafting are the "Gold standard" in the surgical treatment of burns. There are different debridement methods available. Concerning the treatment of burns, surgical-sharp debridement, laser ablation and hydrosurgery system are used. While in full thickness burns the sharp debridement is advisable, the Versajet shows its benefits in the treatment of partial thickness burns. Especially for debridement of difficult to treat areas - face, neck, lips, fingers, interdigital spaces, convex and concave areas the Versajet System shows its benefits. With the Versajet System, tissue excision is precise; moreover it helps to avoid the damage of viable tissue and its vascular supply.
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Affiliation(s)
- T Rappl
- Plastische und Rekonstruktive Chirurgie, Medizinische Universität Graz, Austria.
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21
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Rappl T, Regauer S, Schintler M, Wittgruber G, Laback C, Wiedner M, Scharnagl E. The use of versajet in plastic and reconstructive surgery. Burns 2007. [DOI: 10.1016/j.burns.2006.10.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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von der Hagen M, Laval SH, Cree LM, Haldane F, Pocock M, Wappler I, Peters H, Reitsamer HA, Hoger H, Wiedner M, Oberndorfer F, Anderson LVB, Straub V, Bittner RE, Bushby KMD. The differential gene expression profiles of proximal and distal muscle groups are altered in pre-pathological dysferlin-deficient mice. Neuromuscul Disord 2005; 15:863-77. [PMID: 16288871 DOI: 10.1016/j.nmd.2005.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 08/23/2005] [Accepted: 09/06/2005] [Indexed: 10/25/2022]
Abstract
The selective pattern of muscle involvement is a key feature of muscular dystrophies. Dysferlinopathy is a good model for studying this process since it shows variable muscle involvement that can be highly selective even in individual patients. The transcriptomes of proximal and distal muscles from wildtype C57BL/10 and dysferlin deficient C57BL/10.SJL-Dysf mice at a prepathological stage were assessed using the Affymetrix oligonucleotide-microarray system. We detected significant variation in gene expression between proximal and distal muscle in wildtype mice. Dysferlin defiency, even in the absence of pathological changes, altered this proximal distal difference but with little specific overlap with previous microarray analyses of dysferlinopathy. In conclusion, proximal and distal muscle groups show distinct patterns of gene expression and respond differently to dysferlin deficiency. This has implications for the selection of muscles for future microarray analyses, and also offers new routes for investigating the selectivity of muscle involvement in muscular dystrophies.
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Deng MC, Wiedner M, Erren M, Möllhoff T, Assmann G, Scheld HH. Arterial and venous cytokine response to cardiopulmonary bypass for low risk CABG and relation to hemodynamics. Eur J Cardiothorac Surg 1995; 9:22-9. [PMID: 7727142 DOI: 10.1016/s1010-7940(05)80044-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
During and after cardiopulmonary bypass (CPB), cytokines may affect cardiac performance and the immune response and are therefore of diagnostic and therapeutic interest. We have used EIA/EASIA kits to measure arterial and venous levels of interleukin-1-beta (IL-1-beta), IL-2, IL-2 receptor (IL-2-R), IL-6, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma in 12 men and 3 women (mean age 59.4 +/- 8.5 years, mean left ventricular ejection fraction 66 +/- 11%, average of 2.5 +/- 0.64 vessels affected by disease) undergoing elective coronary artery bypass grafting (CABG). On average each patient received 3 +/- 0.85 bypass grafts and required a postoperative maximum dopamine-dose of 3.8 micrograms/kg per min. Mean CPB and operation times were 60 +/- 21 min, and 132 +/- 16 min, respectively. During CPB, the venous levels of IL-2 temporarily decreased from 234 to 0 (p < 0.05) pg/ml and arterial and venous levels of IL-2-R temporarily decreased from 28 to 16, and 36 to 18 pM (p < 0.05), respectively. After termination of CPB, there was an increase in the arterial and venous levels of IL-6 from below 3 to 253 and 277 pg/ml (p < 0.05) and TNF-alpha from 1.1 to 5.7 and 0.7 to 4.0 pg/ml, respectively (p < 0.05). Tumor necrosis factor-alpha-increases peaked 30 min, and IL-6 increases peaked 4 h after termination of CPB. Twenty-four hours after the end of CPB, IL-6 showed a tendency to return to baseline, but still remained significantly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M C Deng
- Department of Thoracic and Cardiovascular Surgery, Westfalian Wilhelms-University, Münster, Germany
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