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Dietrich CK, Stucker M, Hartmann K, Hirsch T, Mattausch T, Wenzel HC, Zollmann P, Veltman J, Weiler TK, Lengfellner G, Müller L, Pannier F, Cussigh C, Uhlmann L, Müller-Christmann C. Compression therapy after endovenous laser ablation: Patient compliance and impact on clinical outcome. Phlebology 2024:2683555241249222. [PMID: 38712381 DOI: 10.1177/02683555241249222] [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: 05/08/2024]
Abstract
OBJECTIVES This study aimed to investigate the impact of post-interventional compression therapy on clinical outcomes after endovenous laser ablation (EVLA) of incompetent saphenous veins. METHODS This prospective, controlled, multicenter study in Germany involved 493 varicose vein patients followed-up for 6 months. RESULTS Compression therapy significantly reduced symptoms compared to no compression (VCSS: 1.4 ± 1.6 vs 2.2 ± 2.2; p = .007). Post-interventional therapy duration of up to 14 days was found to be most effective for improving patient-reported disease severity (p < .001) and higher quality of life (p = .001). Patient compliance was high (82%), and non-compliance was linked to worse disease severity (VCSS 1.4 ± 1.5 vs 2.1 ± 2.3, p = .009). CONCLUSION In conclusion, post-interventional compression therapy is beneficial by reducing symptoms and improving quality of life. High patient compliance with the therapy is observed, and non-compliance is associated with worse disease severity.
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Affiliation(s)
- Carmen K Dietrich
- Department for Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Markus Stucker
- Venenzentrum der Dermatologischen und Gefaßchirurgischen Kliniken, Bochum, Germany
| | | | - Tobias Hirsch
- Praxis fur Innere Medizin und Gefaßkrankheiten, Halle/Saale, Halle, Germany
| | | | | | | | | | | | | | | | | | - Christiane Cussigh
- Department for Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
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Hirsch T, Wahl U, Rabe E. Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies. VASA 2024; 53:172-184. [PMID: 38536202 DOI: 10.1024/0301-1526/a001116] [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: 05/07/2024]
Abstract
Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.
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Affiliation(s)
- Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competency Centre, Halle (Saale), Germany
| | - Uwe Wahl
- BG Hospital Bergmannstrost Halle, Department of Internal Medicine, Halle (Saale), Germany
| | - Eberhard Rabe
- Practice for Phlebology and Dermatology Dr. Pannier, Bonn, Germany
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Varnava C, Kueckelhaus M, Wellenbrock S, Hirsch T, Wiebringhaus P. One versus two vein anastomoses in breast reconstruction with a profunda artery perforator flap-does it make a difference. Microsurgery 2024; 44:e31179. [PMID: 38676605 DOI: 10.1002/micr.31179] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/20/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The profunda artery perforator (PAP) flap has gained popularity as a reliable alternative in breast reconstruction. Extensive research has focused on its vascular supply, dissection techniques, and broader applications beyond breast reconstruction. This study aims to investigate the correlation between the number of veins anastomosed for the PAP flap and postoperative complications. METHODS A retrospective study was conducted to evaluate the outcomes of breast reconstructions with PAP flaps at our institution between 2018 and 2022. A total of 103 PAP flaps in 88 patients were included. Statistical analysis was performed to compare outcomes between flaps with one vein anastomosis and those with two vein anastomoses. Patient characteristics, intra and postoperative parameters were analysed. RESULTS One vein anastomosis was used in 36 flaps (35.0%), whereas two vein anastomoses were used in 67 flaps (65.0%). No significant differences were found in patient characteristics between the one vein and two vein groups. The comparison of ischemia times between flaps with one versus two veins revealed no statistically significant difference, with mean ischemia times of 56.2 ± 36.8 min and 58.7 ± 33.0 min, respectively. Regarding outcomes, there were no statistically significant differences in secondary lipofilling, revision of vein anastomosis, or total flap loss between the two groups. Fat necrosis was observed in 5 (13.9%) one vein flaps and 5 (7.5%) two vein flaps, indicating no statistically significant difference between the two groups (p = .313). In the one vein group, the most frequently employed coupler ring had a diameter of 2.5 mm. In the two vein group, the most prevalent combination consisted of a 2.0 mm diameter with a 2.5 mm diameter. CONCLUSION Based on our study results, both one vein anastomosis and two vein anastomoses are viable options for breast reconstruction with PAP flap. The utilization of either one or two veins did not significantly affect ischemia time or flap loss. Fat necrosis exhibited a higher incidence in the single-vein group; however, this difference was also not statistically significant. These findings underscore the effectiveness of both approaches, providing surgeons with flexibility in tailoring their surgical techniques based on patient-specific considerations and anatomical factors.
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Affiliation(s)
- Charalampos Varnava
- Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Maximilian Kueckelhaus
- Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Sascha Wellenbrock
- Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Tobias Hirsch
- Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Philipp Wiebringhaus
- Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
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Hirsch T, Arns H, Schleinitz J, Fiedler HW. An innovative flat-knit compression garment for lymphoedema patients led to better outcomes: a multicentre study. J Wound Care 2024; 33:220-228. [PMID: 38573905 DOI: 10.12968/jowc.2024.33.4.220] [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: 04/06/2024]
Abstract
OBJECTIVE To evaluate the clinical performance, quality of life (QoL) and patient satisfaction with an innovative flat-knit compression garment for the daytime treatment of lymphoedema patients in daily routine. METHOD In a prospective multicentre observational study, patients with leg or arm lymphoedema (stage I-II, International Society of Lymphology (ISL) standards, 2016) received a made-to-measure flat-knit compression class 2 JOBST Confidence (BSN-JOBST GmbH, Germany) thigh-high stocking or arm sleeve. Primary endpoint was the oedema status as determined by the mean sum of the circumferences at the beginning and the end of the wearing period. Secondary endpoints included QoL-related parameters and patient satisfaction with product features assessed through questionnaires. The observation period lasted three weeks. RESULTS A total of 97 patients (87 females, 10 males), of which 65 had leg lymphoedema and 32 had arm lymphoedema, received the study device. The oedema status was effectively maintained (slight reduction in mean sum of circumferences by -3.1±7.3cm; p=0.0001). For QoL-related parameters, the patients reported fewer limitations in work, leisure and psychological wellbeing after wearing the stocking or arm sleeve (all p-values <0.0001). They also experienced less limitations in function and movement, feeling of tension and heaviness, and fewer difficulties wearing clothes, shoes, jewellery or watches at study end (all p-values <0.0001). In terms of pleasant feeling on the skin, moisture management, softness of material, range of motion, overall wearing comfort and heat build-up under the garment, patients were more satisfied with the tested compression garment than with previously worn compression garments (all p-values <0.001). CONCLUSION In this study, the tested innovative compression product increased patient satisfaction with the improved product features while the lymphoedema status was successfully maintained.
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Affiliation(s)
- Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Halle, Germany
| | - Helene Arns
- Practice for Vascular Diseases, Essen, Germany
| | - Jörg Schleinitz
- Practice for General Medicine, Phlebology and Lymphology, Lützen, Germany
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Wessel KJ, Varnava C, Wiebringhaus P, Hiort M, Hirsch T, Kückelhaus M. [Robot-assisted Microsurgery for Autologous Breast Reconstruction - Robotic Breast Reconstruction]. HANDCHIR MIKROCHIR P 2024; 56:114-121. [PMID: 38670084 DOI: 10.1055/a-2241-5737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND With the introduction of novel surgical robots and surgical microscopes for the special needs of open microsurgery, the concept of robotic-assisted microsurgery is gaining popularity. While initial preclinical studies indicate a steep learning curve, favourable ergonomics and improved precision, albeit with an increased operating time, data on the clinical application of the new systems is still limited. This study describes our first clinical experience with robotic-assisted autologous breast reconstruction and outlines the opportunities and limitations of the approach. PATIENTS AND METHODS Our retrospective data analysis included a total of 28 patients who underwent unilateral robotic-assisted autologous breast reconstruction between July 2022 and August 2023. We applied a combined approach using the Symani Surgical System together with the RoboticScope. Descriptive evaluation of patient characteristics, surgical data and complications was performed. RESULTS Average patient age was 54.3±11.1 years and average BMI was 26.5±3.5 kg/m2. Twenty-six patients received a DIEP flap and 2 patients received a PAP flap, the flaps being connected to the internal mammary artery in 22 cases, to a perforator of the internal mammary artery in 5 cases, and to a branch of the thoracodorsal artery in one case. The average incision-suture time was 267±89 min, with an average ischaemia time of 86±20 min and duration of the arterial anastomosis of 29±12 min. In two cases, immediate intraoperative anastomosis revision was performed, but no flap loss occurred. CONCLUSION The results of this study demonstrate the safe feasibility of robot-assisted autologous breast reconstruction using a combination of Symani and RoboticScope. In the future, special attention should be paid to minimally invasive techniques of flap harvest and connecting vessel preparation.
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Affiliation(s)
- Kai J Wessel
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Charalampos Varnava
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Philipp Wiebringhaus
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Mirkka Hiort
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Tobias Hirsch
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Maximilian Kückelhaus
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
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Wessel KJ, Stögner VA, Yu CT, Pomahac B, Hirsch T, Ayyala HS, Kueckelhaus M. Preclinical Performance of the Combined Application of Two Robotic Systems in Microsurgery: A Two-center Study. Plast Reconstr Surg Glob Open 2024; 12:e5775. [PMID: 38689940 PMCID: PMC11057809 DOI: 10.1097/gox.0000000000005775] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
Background Recent advancements in the development of robotic devices increasingly draw the attention toward the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial. Methods Six novices, residents, and experienced microsurgeons (n = 18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the anastomosis lapse index score, microsurgical skills using the Structured Assessment of Microsurgery Skills score, and surgical ergonomics using the Rapid Entire Body Assessment score. Results All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, whereas satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with fewer microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared with conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants. Conclusions The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. This two-center trial provides promising evidence for a steep learning curve upon introduction of robotic microsurgery systems, suggesting further pursuit of their clinical integration.
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Affiliation(s)
- Kai J. Wessel
- From the Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
| | - Viola A. Stögner
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
- Hannover Medical School, Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover, Germany
| | - Catherine T. Yu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Tobias Hirsch
- From the Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
| | - Haripriya S. Ayyala
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Maximilian Kueckelhaus
- From the Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
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Pehlke B, Oliveira F, Varnava C, Nehls F, Wiebringhaus P, Kueckelhaus M, Hirsch T, Dermietzel AF. Psychological well-being as a motive for and result of post-bariatric body contouring procedures. Obes Sci Pract 2024; 10:e719. [PMID: 38263992 PMCID: PMC10804339 DOI: 10.1002/osp4.719] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This study investigates whether psychological well-being in post-bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods An anonymous, nonrandomized, cross-sectional survey study was designed. Psychological well-being of four groups of post-bariatric-patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self-esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p < 0.001) and less insecure (p = 0.030) than patients who had not yet undergone body contouring procedures but sought it. Satisfaction with the result of the body contouring procedures was associated with lower depression levels (p < 0.001), higher self-esteem (p < 0.001) and a more positive body-image (p < 0.001). Conclusions Depressive symptoms or low self-esteem are not motivational factors for post-bariatric patients to seek body contouring procedures. Body contouring procedures are associated with improvement in psychological well-being in post-bariatric patients. Patients' satisfaction with the result of the body contouring procedures is significantly associated with positive psychological well-being.
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Affiliation(s)
- Britta Pehlke
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Filipa Oliveira
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Charalampos Varnava
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Fabian Nehls
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Philipp Wiebringhaus
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Maximilian Kueckelhaus
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Tobias Hirsch
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Alexander Frederik Dermietzel
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
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Varnava C, Wiebringhaus P, Hirsch T, Kueckelhaus M. Implementation of a Robotic System in Our Everyday Practice: Key Considerations Based on Preliminary Experience. Plast Reconstr Surg Glob Open 2023; 11:e5493. [PMID: 38111722 PMCID: PMC10727584 DOI: 10.1097/gox.0000000000005493] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Charalampos Varnava
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Philipp Wiebringhaus
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Tobias Hirsch
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Maximilian Kueckelhaus
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
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Küenzlen L, Wallmichrath JC, Küntscher MV, Rothenberger J, Laback C, Schaefer DJ, Schaff J, Bozkurt A, Djedovic G, Langer S, Hirsch T, Rieger U. [Choice of flaps for phalloplasty: what is the contemporary standard? Consensus Statement of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels]. HANDCHIR MIKROCHIR P 2023; 55:427-436. [PMID: 37783212 DOI: 10.1055/a-2134-5891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
The ever-expanding number of transmen as well as their surgeons share an increasing interest in the construction of a neophallus. While the indication for surgery and the positive effect of a phalloplasty on the quality of life, mental health and sexual function has already been thoroughly analysed, there is a lack of data comparing and evaluating the surgical steps. During the consensus conference on the "choice of flaps for phalloplasty" at the annual meeting of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels, the current literature was discussed and a consensus on the surgical technique of a phalloplasty was reached. This manuscript publishes jointly developed recommendations on the following topics: choice of flaps for phalloplasty, preoperative diagnostic tests before phalloplasty, urethral construction in the radial forearm flap and anterior lateral thigh flap, preformation of the urethra at the forearm or thigh, venous drainage of the radial forearm flap, innervation of the phallus, staged phalloplasty, coronaplasty and managing the donor site of a radial forearm flap.
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Affiliation(s)
- Lara Küenzlen
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Markus V Küntscher
- Plastische Chirurgie, Privatpraxis für Plastische & Ästhetische Chirurgie, Hohen Neuendorf, Germany
| | - Jens Rothenberger
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Christian Laback
- Klinische Abteilung für plastische, ästhetische und rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Austria
| | | | | | - Ahmet Bozkurt
- Klinik für Plastische, Ästhetische und Handchirurgie , HELIOS Universitatsklinikum Wuppertal, Wuppertal, Germany
| | - Gabriel Djedovic
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefan Langer
- Sektion Plastische, Ästhetische und Spezielle Handchirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Tobias Hirsch
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Fachklinik Hornheide eV, Munster, Germany
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirugie, Universitätsklinikum Münster, Munster, Germany
| | - Ulrich Rieger
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Aitzetmüller-Klietz ML, Busch L, Hamatschek M, Paul M, Schriek C, Wiebringhaus P, Aitzetmüller-Klietz M, Kückelhaus M, Hirsch T. Understanding the Vicious Circle of Pain, Physical Activity, and Mental Health in Lipedema Patients-A Response Surface Analysis. J Clin Med 2023; 12:5319. [PMID: 37629361 PMCID: PMC10455654 DOI: 10.3390/jcm12165319] [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: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Lipedema is a widespread disease with painful accumulations of subcutaneous fat in the legs and arms. Often, obesity co-occurs. Many patients suffer from impairment in mobility and mental health. Obesity and mental health in turn can be positively influenced by physical activity. In this study, we aimed to examine the interrelations between pain and physical activity on mental health in lipedema patients. In total, 511 female lipedema patients (age M = 40.16 ± 12.45 years, BMI M = 33.86 ± 7.80 kg/m2) filled in questionnaires measuring pain, physical activity, and mental health (PHQ-9; WHOQOL-BREF with subscales mental, physical, social, environmental, and overall health). Response surface analyses were calculated via R statistics. The explained variance was high for the model predicting depression severity (R2 = 0.18, p < 0.001) and physical health (R2 = 0.30, p < 0.001). Additive incongruence effects of pain and physical activity on depression severity, mental, physical, and overall health were found (all p < 0.001). In our study, physical activity and pain synergistically influenced physical, mental, and overall health. The pain not only led to low mental health but also interfered with the valuable potential of engaging in physical activity in lipedema patients.
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Affiliation(s)
- Marie-Luise Aitzetmüller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Lena Busch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Academy for Diagnostics and Prevention, 48149 Muenster, Germany
| | - Matthias Hamatschek
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
| | - Matthias Paul
- Academy for Diagnostics and Prevention, 48149 Muenster, Germany
- Department of Cardiovascular Medicine, Division Steinfurt, University Hospital Muenster, 48565 Steinfurt, Germany
| | - Carsten Schriek
- Academy for Diagnostics and Prevention, 48149 Muenster, Germany
| | - Philipp Wiebringhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Matthias Aitzetmüller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Maximilian Kückelhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Tobias Hirsch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
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Gorji S, Varnava C, Aitzetmüller M, Klietz ML, Hirsch T, Wiebringhaus P. [Stacked PAP flap for unilateral breast reconstruction: a case report]. HANDCHIR MIKROCHIR P 2023; 55:262-267. [PMID: 37348538 DOI: 10.1055/a-2084-0893] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In recent years, the PAP (profunda artery perforator) flap has gained popularity in reconstructive breast surgery. However, the tissue available for flap harvest is usually limited. Therefore, grafting two PAP flaps to form a stacked PAP flap for unilateral reconstruction of large breasts is a safe and reliable option. Patient We present the case of a 59-year-old patient arriving at our unit with prior bilateral nipple-sparing mastectomy and implant-based reconstruction after diagnosis of BRCA-2 mutation and breast cancer. Autologous reconstruction with a DIEP flap was the initial treatment suggested to our patient. Preoperative CT scans showed subpar perforators not suitable for anastomosis, ultimately resulting in unilateral DIEP flap reconstruction on the left side. After an uneventful postoperative period, the patient requested autologous conversion of the right side due to persistent symptomatic capsular contracture. To achieve symmetry with the contralateral breast, we decided to perform a stacked PAP flap for unilateral breast reconstruction. RESULTS The combined flaps provided enough tissue to achieve a satisfactory aesthetic result and symmetry and weighed 600 g in total, while the single DIEP flap on the left side weighed 716 g. There were no complications during the surgical procedure. Postoperative recovery was uneventful, and the patient was discharged after seven days. There were no signs of adipose tissue necrosis at the most recent check-up. On the left donor side, there was a small wound healing defect, which healed well non-surgically. The patient was satisfied with the results. CONCLUSION The PAP flap has become an established alternative to standard breast reconstruction procedures. The stacked PAP flap can provide a safe and efficient method for unilateral reconstruction of large breasts. Perfusion and drainage through the inferiorly anastomosed flap showed sufficient outflow and did not lead to increased adipose tissue necrosis. In our case, the total surgery time was not substantially longer than in single PAP flap surgery. Furthermore, the possibility of unilateral placement of two flaps may avoid follow-up operations such as multiple lipotransfers to equalise both breasts.
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Affiliation(s)
- Shaghayegh Gorji
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Charalampos Varnava
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Aitzetmüller
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Marie-Luise Klietz
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Tobias Hirsch
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Philipp Wiebringhaus
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
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Kirstein F, Hamatschek M, Knors H, Aitzetmueller-Klietz ML, Aitzetmueller-Klietz M, Wiebringhaus P, Varnava C, Hirsch T, Kueckelhaus M. Patient-Reported Outcomes of Liposuction for Lipedema Treatment. Healthcare (Basel) 2023; 11:2020. [PMID: 37510461 PMCID: PMC10379396 DOI: 10.3390/healthcare11142020] [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: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Lipedema, as a disabling and consequential disease, is gaining more awareness due to its potential omnipresence. Patients suffering from lipedema show a characteristic painful display of symmetric accumulations of adipose tissue. The combination of swelling, pain and decreased quality of life (QOL) is outstanding for the diagnosis. The aim of this study was to identify the effect of liposuction in terms of the QOL for patients and underline important factors of current and pending research regarding surgical therapy of lipoedema. METHODS Patients suffering from lipedema prior to and after receiving liposuction at our hospital were included in this study. Patients completed a lipedema-specific self-designed 50 item questionnaire: the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). A linear mixed model was used for outcome analysis. RESULTS In total, 511 patients completed a questionnaire prior to the surgery at primary presentation to the hospital and a total number of 56 patients completed a questionnaire after liposuction. A total of 34 of these patients filled in both questionnaires prior to and after surgery. The general characteristics of the disease, such as daily symptoms and psychological health, pertinently improved after surgery. CONCLUSIONS Liposuction can have a general improving effect on the QOL of patients, both in private and professional life. Liposuction may currently be the most evident and promising method in the treatment of lipedema.
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Affiliation(s)
- Fiona Kirstein
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
| | - Matthias Hamatschek
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
| | - Henning Knors
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Marie-Luise Aitzetmueller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Matthias Aitzetmueller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Wiebringhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Charalampos Varnava
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Tobias Hirsch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Maximilian Kueckelhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
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Seefeldt T, Aitzetmüller-Klietz ML, Kückelhaus M, Wiebringhaus P, Hirsch T, Harati K, Aitzetmüller-Klietz MM. Liposuktion beim Lipödem - Doch besser als ihr Ruf? J Dtsch Dermatol Ges 2023; 21:601-610. [PMID: 37338836 DOI: 10.1111/ddg.15064_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/19/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Tobias Seefeldt
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Marie-Luise Aitzetmüller-Klietz
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Maximilian Kückelhaus
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Philipp Wiebringhaus
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Tobias Hirsch
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Kamran Harati
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
| | - Matthias M Aitzetmüller-Klietz
- Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinikum Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskeletale Medizin, Westfälische Wilhelms-Universität Münster
- Abteilung für Plastische, Rekonstruktive, ästhetische Chirurgie und Handchirurgie, Fachklinik Hornheide, Münster
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Varnava C, Wiebringhaus P, Kampshoff D, Hirsch T, Kueckelhaus M. Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap. Front Surg 2023; 10:1050172. [PMID: 37284559 PMCID: PMC10239860 DOI: 10.3389/fsurg.2023.1050172] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/21/2023] [Indexed: 06/08/2023] Open
Abstract
Background Autologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV). Methods 150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated. Results In a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred. Conclusions Use of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.
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Affiliation(s)
- Charalampos Varnava
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - David Kampshoff
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
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Seefeldt T, Klietz-Aitzetmüller ML, Kückelhaus M, Wiebringhaus P, Hirsch T, Harati K, Aitzetmüller-Klietz MM. Breaking the circle-effectiveness of liposuction in lipedema. J Dtsch Dermatol Ges 2023. [PMID: 37190925 DOI: 10.1111/ddg.15064] [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: 11/12/2022] [Accepted: 02/19/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Lipedema is a common chronic fat distribution disorder often aligned with pain and reduced quality of life affecting 6-10% of the female population. Although lipedema has acquired more scientific attention in the last decade, validated diagnosis and treatment still remain challenging for specialists. PATIENTS AND METHODS In this article we evaluate the effect of liposuction on appearance, pain and coexisting diseases of 860 patients with lipedema. Comparison among stages of lipedema pre- and post-liposuction was performed by using t-Tests for independent samples and Kruskal-Wallis-Tests. RESULTS Our study demonstrates the positive effect on pain reduction in patients with lipedema after liposuction (NRS 2.24) compared with pre-liposuction pain perception (NRS 6.99) and pain perception of patients with conservative treatment (NRS 6.26). Significant differences were shown in the perception between the stages of lipedema and in the reduction of pain perception by liposuction. Furthermore we examined co-diseases in patients with lipedema, primarily menstruation complaints (43%), sleeplessness (36%) and migraine (35%). CONCLUSIONS A progress of lipedema disease leads not only to a change of appearance and proportion but also to a progressive increase of pain. Liposuction shows a significant effect on pain reduction -independent of the patients' stage of lipedema.
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Affiliation(s)
- Tobias Seefeldt
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Marie-Luise Klietz-Aitzetmüller
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Maximilian Kückelhaus
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Kamran Harati
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Matthias M Aitzetmüller-Klietz
- Division of Plastic Surgery, University Hospital Muenster, Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Muenster, Germany
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
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Varnava C, Bogusch M, Wellenbrock S, Hirsch T, Wiebringhaus P, Kueckelhaus M. Mastopexy Strategies for Ptotic Breasts in Patients Choosing Autologous Reconstruction Following Prophylactic Mastectomy. J Clin Med 2023; 12:jcm12093082. [PMID: 37176523 PMCID: PMC10178942 DOI: 10.3390/jcm12093082] [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: 02/19/2023] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Autologous breast reconstruction is a reliable solution for many patients after mastectomy. While this technique represents a standardized approach in many patients, patients with ptotic breasts may require a combination of procedures to achieve an aesthetically pleasing result. METHODS We reviewed the mastectomy and free-flap breast reconstruction procedures performed at our institution from 2018 to 2022 in patients with ptotic breasts. The technique used to address the ptosis was put in focus as we present the four strategies used by our reconstructive surgeons. We performed two different one-stage and two different two-stage procedures. The difference between the two-stage procedures was the way the nipple areola complex was treated (inferior dermal pedicle or free skin graft). The difference between the one-stage procedures was the time of execution of the mastopexy/breast reduction (before or after the mastectomy and autologous breast reconstruction). RESULTS The one-stage procedure was performed with a free NAC in three patients and with a pedicled NAC in five patients. The two-stage procedure was performed in seven patients, with six of them undergoing mastopexy before and one patient undergoing mastopexy after the bilateral mastectomy and autologous reconstruction. No flap loss or total loss of the nipple areola complex occurred. Partial NAC loss was observed in five breasts in the single-stage group without any occurrence in the double-stage group. CONCLUSIONS While both one- and two-stage procedures were performed in a safe fashion with satisfactory results at our institution, larger trials are required to determine which procedure may yield the best possible outcomes. These outcomes should also include oncological safety and patient-reported outcomes.
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Affiliation(s)
- Charalampos Varnava
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Miriam Bogusch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
| | - Sascha Wellenbrock
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
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17
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Aitzetmüller-Klietz MM, Raschke L, Hirsch T, Kückelhaus M, Wiebringhaus P, Aitzetmüller-Klietz ML, Harati K. Factors Influencing Quality of Life after Massive Weight Loss-What Makes the Difference? Healthcare (Basel) 2023; 11:healthcare11081147. [PMID: 37107981 PMCID: PMC10138039 DOI: 10.3390/healthcare11081147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/05/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Although weight reduction in obesity and morbid obesity has been shown to improve associated comorbidities, there is currently no information on what influences quality of life after a large reduction in body weight. The present study looks at differences in patients' quality of life classified by mode and amount of weight loss. MATERIAL AND METHODS A cross-sectional study was designed using a validated German version of the BODY-Q questionnaire. The internet-based questionnaire was distributed to patients via social media. RESULTS 460 patients (443 female, 17 male) were interviewed for this study via "Surveymonkey". The comparison of conservative and surgical weight loss showed no significant difference in the patients' quality of life (p > 0.05). A high BMI correlates negatively with body image (p = 0.023 *), as does the specific assessment of most body regions. For example, a negative correlation was found between a high BMI and satisfaction with skin appearance (p < 0.001 *) and satisfaction with the inner thigh (p = 0.011 *). CONCLUSION Increased weight loss is associated with a greater ability to maximise quality of life. The type of weight loss, whether conservative or surgical, can be neglected based on the present study. Bariatric surgery cannot be considered a universal solution to obesity. Body contouring interventions should also become a focus of therapy.
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Affiliation(s)
- Matthias Michael Aitzetmüller-Klietz
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Laura Raschke
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Tobias Hirsch
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Maximilian Kückelhaus
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Philipp Wiebringhaus
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Marie-Luise Aitzetmüller-Klietz
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Kamran Harati
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149 Muenster, Germany
- Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelian Wilhelms-University Muenster, 48149 Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
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18
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Varnava C, Wiebringhaus P, Hirsch T, Dermietzel A, Kueckelhaus M. Breast Reconstruction with DIEP Flap: The Learning Curve at a Breast Reconstruction Center and a Single-Surgeon Study. J Clin Med 2023; 12:jcm12082894. [PMID: 37109230 PMCID: PMC10140818 DOI: 10.3390/jcm12082894] [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: 02/13/2023] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Although microsurgical breast reconstruction represents a very interesting and rewarding field of plastic surgery, appropriate microsurgical training is not possible in every plastic surgery department. In this retrospective study, we present the learning curve of our plastic surgery department as a whole and of a single microsurgeon assessing breast reconstruction procedures with a deep inferior epigastric artery perforator (DIEP) flap between July 2018 and June 2021. The present study included 115 patients and 161 flaps. Cases were stratified into single DIEP/double DIEP groups and into early and late groups based on the flap order. Surgery times and postoperative complications were analyzed. Regarding the institution, the length of hospital stay was lower in the late group than in the early group (single 7.1 ± 1.8 vs. 6.3 ± 1.5 days, p = 0.019; double 8.5 ± 3.8 vs. 6.6 ± 1.4 days, p = 0.043). Apart from that, no statistically significant differences were found between the start and end of our study. In terms of the single surgeon, there was a significant improvement in the total surgery time (single 296.0 ± 78.7 vs. 227.5 ± 54.7 min, p = 0.018; double 448.0 ± 85.6 vs. 341.2 ± 43.1 min, p = 0.008), flap ischemia time (53.6 ± 15.1 vs. 40.9 ± 9.5 min, p = 0.007) and length of stay among the compared groups. There was no significant difference in flap loss rate or other complications between the early and late groups. Further performance of surgeries seemed to improve the surgeon's skills as well as the overall experience of the medical institution.
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Affiliation(s)
- Charalampos Varnava
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Alexander Dermietzel
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, 48149 Muenster, Germany
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19
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Gianesini S, Chi YW, Agüero C, Alqedrah D, Amore M, Barbati M, Baturone A, Black S, Borsuk D, Bottini O, Caprini J, Chamo M, Cherian M, Chernuka L, DE Maeseneer M, Diaz J, Garcia MJ, Gibson K, Gloviczki M, Gloviczki P, Golovina V, Goranova E, Grillo L, Gwozdz A, Hirsch T, Hussein E, Intriago E, Jalaie H, Jaworucka-Kaczorowska A, Jindal R, Josnin M, Khilnani NM, Kim DI, Latorre A, Lazarashvili Z, Lee BB, Leon L, Liew NC, Lobastov K, Lurie F, Maghetti A, Menegatti E, Miyake K, Mo M, Narayanan S, Neuhardt D, Pannier F, Prego A, Rabe E, Raffetto J, Raymond-Martimbeau P, Redman L, Reina-Gutierrez L, Rial R, Rockson S, Romanelli M, Santiago FR, Santiago RA, Sermsathanasawadi N, Shaydakov E, Simkin C, Sousa J, Stoughton J, Szuba A, Taha W, Ulloa J, Urbanek T, Vitale M, Vuylsteke M, Wang J, Weingartner J, Wilson S, Yamaki T, Ng Y, Zolotukhin I, Mansilha A. Fake-news-free evidence-based communication for proper vein-lymphatic disease management. INT ANGIOL 2023; 42:89-189. [PMID: 36930179 DOI: 10.23736/s0392-9590.23.05044-7] [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: 03/18/2023]
Abstract
Published scientific evidence demonstrate the current spread of healthcare misinformation in the most popular social networks and unofficial communication channels. Up to 40% of the medical websites were identified reporting inappropriate information, moreover being shared more than 450,000 times in a 5-year-time frame. The phenomenon is particularly spread in infective diseases medicine, oncology and cardiovascular medicine. The present document is the result of a scientific and educational endeavor by a worldwide group of top experts who selected and analyzed the major issues and related evidence-based facts on vein and lymphatic management. A section of this work is entirely dedicated to the patients and therefore written in layman terms, with the aim of improving public vein-lymphatic awareness. The part dedicated to the medical professionals includes a revision of the current literature, summing up the statements that are fully evidence-based in venous and lymphatic disease management, and suggesting future lines of research to fulfill the still unmet needs. The document has been written following an intense digital interaction among dedicated working groups, leading to an institutional project presentation during the Universal Expo in Dubai, in the occasion of the v-WINter 2022 meeting.
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Affiliation(s)
- Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy -
| | - Yung-Wei Chi
- University of California Davis, Sacramento, CA, USA
| | - Chantal Agüero
- Panamerican Society of Phlebology and Lymphology, Asunción, Paraguay
| | - Deena Alqedrah
- Dubai Health Authority-University of Sharjah, Dubai, United Arab Emirates
| | - Miguel Amore
- University of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Denis Borsuk
- Clinic of Phlebology and Laser Surgery (Vasculab LLC), Chelyabinsk, Russia
| | | | | | - Marylin Chamo
- Guatemala Society of Phlebology, Guatemala City, Guatemala
| | - Meena Cherian
- Geneva Foundation for Medical Education and Research, Geneve, Switzerland
| | - Larisa Chernuka
- O.O. Shalimov National Institute of Surgery and Transplantology, Kiev, Ukraine
| | | | - Josè Diaz
- Vanderbilt University, Nashville, TN, USA
| | | | | | | | | | - Veronika Golovina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Elena Goranova
- Alexandrovska University Medical Center, Sofia, Bulgaria
| | - Lorena Grillo
- UCIMED University of Medical Sciences, San José, Costa Rica
| | | | | | | | | | | | | | | | | | - Neil M Khilnani
- Weill Cornell Medicine, New York Presbiterian Hospital, New York, NY, USA
| | | | | | | | | | - Luis Leon
- University of Arizona, Phoenix, AZ, USA
| | - Ngoh C Liew
- University Putra Malaysia, Selangor, Malaysia
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Annalisa Maghetti
- Italian Association of Dietology and Clinical Nutrition, Bologna, Italy
| | - Erica Menegatti
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Makoto Mo
- Yokohama City University, Yokohama, Japan
| | - Sriram Narayanan
- The Harley Street Heart and Vascular Center, Singapore, Singapore
| | | | | | | | | | | | | | - Laura Redman
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | | | - Rodrigo Rial
- University Hospital HM Madrid-Torrelodones, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Wassila Taha
- Egypt Africa Venous Lymphatic Association, Cairo, Egypt
| | | | | | | | | | - Jinsong Wang
- Provincial People's Hospital of Guangdong, Guangdong, China
| | | | | | - Takashi Yamaki
- Women's Medical University Adachi Medical Center of Tokyo, Tokyo, Japan
| | - Yeejia Ng
- The Harley Street Heart and Vascular Center, Singapore, Singapore
| | - Igor Zolotukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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20
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Yeni B, Dermietzel A, Varnava C, Wiebringhaus P, Aitzetmueller M, Klietz ML, Hirsch T, Kueckelhaus M. Biomechanische Eigenschaften transgener Haut nach lebensrettender Regeneration der Epidermis durch kombinierte Gen- und Stammzelltherapie. J Dtsch Dermatol Ges 2023; 21:245-254. [PMID: 36929542 DOI: 10.1111/ddg.14978_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/23/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Burcu Yeni
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
| | - Alexander Dermietzel
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Charalampos Varnava
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Philipp Wiebringhaus
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Matthias Aitzetmueller
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Marie-Luise Klietz
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Tobias Hirsch
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
| | - Maximilian Kueckelhaus
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster
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21
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Yeni B, Dermietzel A, Varnava C, Wiebringhaus P, Aitzetmueller M, Klietz ML, Hirsch T, Kueckelhaus M. Transgenic skin biomechanical properties following first lifesaving epidermal regeneration using combined gene and cell therapy. J Dtsch Dermatol Ges 2023; 21:245-252. [PMID: 36772919 DOI: 10.1111/ddg.14978] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND In 2017, we reported the first life-saving regeneration of virtually an entire epidermis by combined gene and stem cell therapy. Recently, we demonstrated excellent long-term stability of this transgenic epidermis. Skin quality in this experimental approach and its potential application in other conditions were elucidated here regarding long-term outcomes of biomechanical properties. PATIENTS AND METHODS Analysis of biomechanical properties including skin elasticity, anisotropy and friction was performed on multiple body sites 24, 36 and 60 months following transplantation. Firstly, the sites were matched against and compared to remaining stable non-transgenic areas as well as to a control group of 13 healthy subjects. Parameters for skin elasticity, deformation and friction were assessed non-invasively. RESULTS Biomechanical properties of the transgenic epidermis showed encouraging results in comparison to both the remaining stable non-transgenic skin as well as healthy controls. Skin elasticity was comparable to the controls. Skin friction showed some decrease in both transgenic and non-transgenic areas as compared to the controls. CONCLUSIONS The excellent functional outcomes of the transgenic epidermis demonstrate stable long-term results of this novel combined gene and stem cell therapy for epidermal regeneration. Thus, other applications for this technology, such as treatment of specific burns, should be explored.
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Affiliation(s)
- Burcu Yeni
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Alexander Dermietzel
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Charalampos Varnava
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp Wiebringhaus
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Matthias Aitzetmueller
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Marie-Luise Klietz
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Tobias Hirsch
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Maximilian Kueckelhaus
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
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Moellhoff N, Prantl L, Behr B, Beier JP, Daigeler A, Dragu A, Eisenhardt SU, Fuchs PC, Germann G, Hirsch T, Horch RE, Infanger M, Jakubietz R, Kneser U, Langer S, Lehnhardt M, Machens HG, Mailänder P, Reichert B, Radtke C, Schaefer DJ, Siemers F, Vogt PM, Menke H, Giunta RE. [Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and Research Funding Report 2021/2022]. HANDCHIR MIKROCHIR P 2023; 55:95-105. [PMID: 36780931 DOI: 10.1055/a-2007-4475] [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: 02/15/2023] Open
Abstract
BACKGROUND Research is an integral part of academic medicine. In plastic surgery, it sets the course for innovations in the specialty. The purpose of this study is to present the research performance of plastic surgeons in Germany for the period 2021/2022 and to compare it with previous periods. MATERIALS AND METHODS The directors of plastic surgical academic institutions reported all requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was gathered within an established online database. In addition, the DFG´s public database GEPRIS was screened for plastic surgical research grants. Data was also collected regarding research infrastructure and organization at the participating centers. RESULTS 105 applications were reported to 54 different funding agencies from 20 plastic surgery centers. 37 funding applications were submitted to the major public funding agencies DFG, BMBF, BMWi, BMG, BMVg, G-BA and EU. Of these, 59,5% (22/37) were DFG, 13,5% (5/37) each BMBF and EU, 5,4% (2/37) BMWi, and 2,7% (1/37) each BMG, BMVg, and G-BA applications. The average funding volume of these proposals was 401,515 euros. Approved DFG proposals were most frequently assigned to the review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery (n=10/16, 62,5%). Over time, the research registry shows an increase in the number of proposals in general and those granted. 70,0% (14/20) of participating sites had their own experimental research laboratory, while only 40,0% (8/20) had their own clinical trial center. CONCLUSION The 2021/2022 Research Funding Report once again highlights the impressive research accomplishments of the plastic surgery community.
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Affiliation(s)
- N Moellhoff
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - L Prantl
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität Regensburg
| | - B Behr
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - J P Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen
| | - A Daigeler
- Klinik für Hand-, Plastische Chirurgie, Rekonstruktive und Verbrennungschirurgie der Eberhard Karls Universität/BG Unfallklinik Tübingen
| | - A Dragu
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Abteilung für Plastische und Handchirurgie, Carl Gustav Carus Universitätsklinikum an der TU Dresden
| | - S U Eisenhardt
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - P C Fuchs
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Schwerbrandverletztenzentrum -, Klinikum Köln-Merheim, Universität Witten/Herdecke
| | - G Germann
- ETHIANUM, Klinik für Plastische, Ästhetische und Präventive Medizin am Universitätsklinikum Heidelberg
| | - T Hirsch
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - R E Horch
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität Regensburg
| | - M Infanger
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - R Jakubietz
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen
| | - U Kneser
- Klinik für Hand-, Plastische Chirurgie, Rekonstruktive und Verbrennungschirurgie der Eberhard Karls Universität/BG Unfallklinik Tübingen.,UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Abteilung für Plastische und Handchirurgie, Carl Gustav Carus Universitätsklinikum an der TU Dresden
| | - S Langer
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - H G Machens
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Schwerbrandverletztenzentrum -, Klinikum Köln-Merheim, Universität Witten/Herdecke
| | - P Mailänder
- ETHIANUM, Klinik für Plastische, Ästhetische und Präventive Medizin am Universitätsklinikum Heidelberg
| | - B Reichert
- Plastische-, Rekonstruktive und Ästhetische Chirurgie, Fachklinik Hornheide, Plastische Chirurgie, Universitätsklinikum Münster
| | - C Radtke
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU
| | - D J Schaefer
- Klinik für Plastische, Wiederherstellungs-und Handchirurgie, Otto-von-Guericke-Universität, Magdeburg
| | - F Siemers
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie/ Sektion Plastische & Ästhetische Chirurgie/Universitätsklinikum Würzburg
| | - P M Vogt
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen
| | - H Menke
- Klinik für Plastische und Handchirurgie der Ruprecht-Karls-Universität Heidelberg
| | - R E Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
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Huelsboemer L, Kauke-Navarro M, Reuter S, Stoegner VA, Feldmann J, Hirsch T, Kueckelhaus M, Dermietzel A. Tolerance Induction in Vascularized Composite Allotransplantation-A Brief Review of Preclinical Models. Transpl Int 2023; 36:10955. [PMID: 36846605 PMCID: PMC9946984 DOI: 10.3389/ti.2023.10955] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
Pre-clinical studies are an obligatory tool to develop and translate novel therapeutic strategies into clinical practice. Acute and chronic rejection mediated by the recipient's immune system remains an important limiting factor for the (long-term) survival of vascularized composite allografts (VCA). Furthermore, high intensity immunosuppressive (IS) protocols are needed to mitigate the immediate and long-term effects of rejection. These IS regiments can have significant side-effects such as predisposing transplant recipients to infections, organ dysfunction and malignancies. To overcome these problems, tolerance induction has been proposed as one strategy to reduce the intensity of IS protocols and to thereby mitigate long-term effects of allograft rejection. In this review article, we provide an overview about animal models and strategies that have been used to induce tolerance. The induction of donor-specific tolerance was achieved in preclinical animal models and clinical translation may help improve short and long-term outcomes in VCAs in the future.
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Affiliation(s)
- Lioba Huelsboemer
- Division of Plastic and Reconstructive Surgery, School of Medicine, Yale University, New Haven, CT, United States
- Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
| | - Martin Kauke-Navarro
- Division of Plastic and Reconstructive Surgery, School of Medicine, Yale University, New Haven, CT, United States
| | - Stefan Reuter
- Division of General Internal Medicine, Nephrology and Rheumatology, Department of Medicine D, University Hospital Münster, Münster, Germany
| | - Viola A. Stoegner
- Division of Plastic and Reconstructive Surgery, School of Medicine, Yale University, New Haven, CT, United States
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hanover, Germany
| | - Jan Feldmann
- Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Alexander Dermietzel
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
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Varnava C, Klietz ML, Hirsch T, Wiebringhaus P, Kueckelhaus M. Comparison of surgical and patient-reported outcomes between 85 profunda artery perforator flaps and 122 deep inferior epigastric perforator flaps as first choice treatment for breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 80:168-177. [PMID: 37028244 DOI: 10.1016/j.bjps.2023.02.018] [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] [Received: 07/29/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The profunda artery perforator (PAP) flap for breast reconstruction was first published in 2012. Since then, many centers implemented its application as second-line treatment for breast reconstruction in cases where patient characteristics make the deep inferior epigastric perforator (DIEP) flap not feasible to perform. In our center, we established the PAP flap as a first-line procedure for a multitude of reasons for a specific patient population. This study describes perioperative measure, clinical outcomes, and patient-reported outcome measures in comparison to the gold standard, the DIEP flap. METHODS In this study, we analyzed all PAP flaps and DIEP flaps performed in a single center between March 2018 and December 2020. We present patient characteristics, surgical technique, perioperative care, surgical outcomes, and complications. The Breast-Q was used to assess patient-reported outcome measures. RESULTS A total of 85 PAP flaps and 122 DIEP flaps were performed within 34 months. Average follow-up was 11.6 ± 5.8 months for the PAP group and 11.1 ± 5.8 months for the DIEP group (p = 0.621). Patients' average body mass index was higher in the DIEP flap recipients. Operation time was shorter and ambulation faster in PAP flap recipients. DIEP flap application resulted in higher Breast-Q scores. CONCLUSIONS While the PAP flap demonstrated favorable perioperative measures, outcome measures were better with the DIEP flap. The PAP flap is fairly new and demonstrates high potential while still showing a need for refinement compared to the DIEP flap.
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Klietz ML, Mewe C, Wiebringhaus P, Hirsch T, Aitzetmüller MM, Kückelhaus M. Seasonal Impact on Free Flap Surgery in Terms of Flap Loss and Wound Healing Disorders: A Retrospective Cohort Study of 158 Free Flaps. Healthcare (Basel) 2023; 11:healthcare11030403. [PMID: 36766977 PMCID: PMC9914697 DOI: 10.3390/healthcare11030403] [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: 12/11/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Postoperative flap loss and wound healing disorders are severe complications after microsurgical free flap surgery. Despite multiple clinical observations, a possible influence of season and external temperature on outcome are largely missing. (2) Methods: Retrospectively, data were collected from 151 patients receiving microsurgical free flaps from March 2018 to August 2019. Patients were divided into two cohorts. The winter group includes all patients who underwent surgery from October 2018 to March 2019 and the summer group al those who underwent surgery from April 2018 to September 2018. Data included demographic information, pre-existing conditions, flap characteristics, and postoperative complications like flap losses and wound healing problems. External temperatures during the first 14 postoperative days were documented and the predictor of flap loss and wound healing disorders was detected. (3) Results: In the winter group (October-March; Ø 7.24 °C) 72 patients (46 female, 24 males; Ø 57.0 years) and in the summer group (April-September; Ø 18.79 °C) 81 patients (48 female, 33 males; Ø 56.0 years) received free flap surgery. There were no significant differences in demography (age: p = 0.593; gender: p = 0.419; BMI: p = 0.141). We found a significant increase in flap loss during summer (χ2(1) = 6.626; p = 0.010; V = 0.209) strengthened by logistic regression analysis (p = 0.037; Exp(B) = 9.655). Additionally higher average temperatures 14 days postoperatively represents another main driver (p = 0.023, Exp(B) = 1.161) for postoperative flap loss. (4) Conclusions: The data confirm a significantly higher postoperative flap loss in the summer group. This information may potentially contribute to optimization of perioperative management and planning of elective and semi-elective surgeries.
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Affiliation(s)
- Marie-Luise Klietz
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Chiara Mewe
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
| | - Philipp Wiebringhaus
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Tobias Hirsch
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Matthias Michael Aitzetmüller
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maximilian Kückelhaus
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Correspondence:
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Rapprich S, ter Balk H, Hirsch T. Das Lipödem in Abgrenzung zur Adipositas. Parallelen und Herausforderungen in der Praxis. Phlebologie 2022. [DOI: 10.1055/a-1935-5426] [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: 12/03/2022]
Abstract
ZusammenfassungDas Krankheitsbild Lipödem erfährt in den letzten Jahren vermehrte Aufmerksamkeit. Überschneidungen mit der Adipositas machen eine Abgrenzung mitunter schwierig. Diese ist aber für eine differenzierte zielgerichtete Therapie wichtig.
Definition und Klinik Beim Lipödem handelt es sich um eine schmerzhafte, anlagebedingte, übermäßige Fettgewebsvermehrung an den Extremitäten bei Frauen. Das führt zu einer Disproportion der Körpersilhuette. Erste Symptome manifestieren sich häufig in der Pubertät, der Verlauf ist meist progredient. Charakteristische Symptome sind Ruhe- und Druckschmerzen, Hämatomneigung, Spannungs- und Schwellungsgefühle, rasche Ermüdung der Muskulatur und Ödeme, die aber stadienabhängig inkonsistent sind. 25–88 % der Lipödem-Patientinnen leiden gleichzeitig an einer Adipositas.
Prävalenz Je nach Studie 5–9,7 %, entsprechend 2–4 Millionen Frauen in Deutschland.
Ätiologie Es besteht eine familiäre Disposition. Hormonelle Veränderungen sind Triggerfaktoren und lassen auf hormonelle Einflüsse schließen. Im Gewebe findet sich eine leichte chronische Entzündung (Silent Inflammation), welche die Symptomatik erklärt.
Diagnostik Die Diagnosestellung erfolgt klinisch und muss von anderen Fettverteilungsstörungen unterschieden werden. Der BMI ist nicht geeignet. Es sollte der Bauchumfang-Größen-Quotient (BCG = WHtR Waist to Height-Ratio) herangezogen werden.
Therapie interdisziplinärer Therapieansatz, der neben der konservativen Entstauungstherapie, der operativen Therapie mittels Liposuktion auch die Ernährungs-, Bewegungs- und Psychotherapie umfasst.
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Affiliation(s)
| | | | - Tobias Hirsch
- Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide,
- Sektion Plastische Chirurgie, Universitätsklinikum Münster,
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Hirsch T. Das pelvine Stauungssyndrom – Wie kann die Patientenversorgung mit der wissenschaftlich technischen Entwicklung Schritt halten? Phlebologie 2022. [DOI: 10.1055/a-1861-3132] [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: 10/15/2022]
Abstract
ZusammenfassungUnterleibsbeschwerden und atypische Varikose können Ausdruck eines pelvinen Stauungssyndroms sein. Die Erkrankung ist für Patientinnen häufig mit einer langwierigen Krankheitsgeschichte verbunden und stellt eine diagnostische und therapeutische Herausforderung für Phlebologen und Gefäßmediziner dar. Dabei stehen die technischen Möglichkeiten und auch die wissenschaftlichen Grundlagen eigentlich zur Verfügung.Ursachen sind die allgemeine Unterbewertung der Störung im ärztlichen Ausbildungskanon und das Fehlen einer flächendeckenden Versorgungsstruktur. Der ambulanten Abklärung sind versorgungsrechtliche Grenzen gesetzt und nur wenige Krankenhäuser verfügen über die entsprechende Behandlungsexpertise. Um diesem Versorgungsengpass entgegenzuwirken, wurde in der Deutschen Gesellschaft für Phlebologie der Beschluss gefasst, eine Arbeitsgemeinschaft ins Leben zu rufen, die drei Ziele verfolgt: die bundesweite Vernetzung ambulant tätiger Gefäßmediziner und spezialisierter Krankenhäuser, die Sensibilisierung anderen Fachrichtungen wie Gynäkologie und Urologie sowie die Datenerhebung im Rahmen eines Registers zur wissenschaftlichen Auswertung.
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Affiliation(s)
- Tobias Hirsch
- Venen Kompetenz-Zentrum, Praxis für Innere Medizin und Gefäßkrankheiten, Halle (Saale), Deutschland
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Hirsch T, Mendoza E. Ovarian vein embolization in recurrent varicose veins – how invasive should varicose treatment be? VASA 2022; 51:196-197. [DOI: 10.1024/0301-1526/a001014] [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: 11/19/2022]
Affiliation(s)
- Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre, Halle/Saale, Germany
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Fink C, Hartmann K, Mattausch T, Wenzel HC, Zollmann P, Veltman J, Weiler T, Lengfellner G, Müller L, Stücker M, Pannier F, Dietrich C, Uhlmann L, Hirsch T. Impact of a synchronous prophylactic treatment of the anterior accessory saphenous vein on the recurrent varicose vein rate in patients undergoing thermal ablation of an insufficient great saphenous vein (SYNCHRONOUS-Study): study protocol for a prospective, multicentre, controlled observational study. BMJ Open 2022; 12:e061530. [PMID: 35732403 PMCID: PMC9226876 DOI: 10.1136/bmjopen-2022-061530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION To date, there are no prospective studies evaluating the prevention of recurrent veins by the simultaneous treatment of a sufficient anterior accessory saphenous vein (AASV) in patients undergoing endovenous laser ablation (EVLA) of an insufficient great saphenous vein (GSV). This study will provide important information about the impact of the AASV on the development of recurrent veins after EVLA of the GSV. Additionally, it will be clarified whether patients benefit from a preventive ablation of a sufficient AASV. METHODS AND ANALYSIS This is a multicentre, prospective, controlled, exploratory clinical study in 1150 patients with a medical indication for EVLA of a refluxing great saphenous vein. Patients will be enrolled into two study groups: in half of the patients EVLA will be performed on the insufficient GSV only. In the other half of the patients EVLA will be performed on the insufficient GSV and additionally on the sufficient AASV. Within seven study visits, patients will be followed-up over a time period of 5 years. Primary study endpoint is the recurrence rate; secondary endpoints include inter alia, complication rate, postoperative pain intensity, quality of life and patient satisfaction. ETHICS AND DISSEMINATION Before initiation of the study, the protocol was presented and approved by the independent ethics committee of the medical faculty of the University of Heidelberg (Ethics approval number S-596/2018). This study was prospectively registered at the German Clinical Trial Register (https://www.germanctr.de/). Research findings will be disseminated in a peer-reviewed journal and at relevant conferences. TRIAL REGISTRATION NUMBER German Clinical Trial Registry (DRKS00015486).
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | - Lars Müller
- Department of Vascular Surgery, Dermatologikum Hamburg, Hamburg, Germany
| | - Markus Stücker
- Department of Dermatology, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Carmen Dietrich
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Venen Kompetenz-Zentrum, Halle (Saale), Germany
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Aitzetmueller MM, Kueckelhaus M, Hirsch T, Wellenbrock S. Plastische Deckung thorakaler Defekte. Z Herz- Thorax- Gefäßchir 2022. [DOI: 10.1007/s00398-022-00506-w] [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: 11/25/2022]
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Dermietzel A, Aitzetmüller M, Klietz ML, Kampshoff D, Varnava C, Wiebringhaus P, Hirsch T, Kueckelhaus M. Free flap breast reconstruction using a novel robotic microscope. J Plast Reconstr Aesthet Surg 2022; 75:2387-2440. [PMID: 35599224 DOI: 10.1016/j.bjps.2022.04.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/11/2021] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Robotic-assisted surgery (RAS) has evolved over the past decades. Currently, novel robotic systems for microsurgery are being launched onto the European market. This novel microscope (RoboticScope®, BHS, Innsbruck, Austria) is a high-definition camera system, connected to an augmented reality headset, projecting a clear image with high magnification in front of the surgeon's eyes. Motion tracking translates the surgeon's head movements onto the system via a multi-axis robotic arm. We report the first use of the robotic microscope for autologous breast reconstruction in humans. METHODS In May 2020, ten autologous breast reconstructions were performed by our Team. Five reconstructions (three PAP flaps, one bilateral DIEP flap) were conducted with the robotic microscope and matched to five reconstructions using a conventional microscope. We compared ischaemia times, times for arterial and venous anastomosis, and complications. RESULTS All procedures were performed successfully and safely. Overall time for anastomosis was 31 min (+/- 7 min) in the robotic group and 25 min (+/- 7 min, p = 0.30) in the control group. Flap ischaemia was 54 min (+/- 8 min) in the robotic group and 52 min (+/- 22 min, p = 0.87) in the control group. No intraoperative complications such as venous thrombosis or arterial embolism occurred. CONCLUSION Robotic microscopes provide the technology to combine flexibility to choose different angles during pedicle preparation and improve the stationary procedure of vessel anastomosis. Novel robotic systems tailored towards refinement in microsurgery hold great potential for implementation in Plastic Surgery procedures.
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Affiliation(s)
- Alexander Dermietzel
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Matthias Aitzetmüller
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Marie-Luise Klietz
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - David Kampshoff
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Charalampos Varnava
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Germany.
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Aitzetmüller MM, Raschke L, Klietz ML, Kueckelhaus M, Hirsch T, Wiebringhaus P, Harati K. After weight loss, what skin removal procedure has the most effect using Body Q metrics? Surg Obes Relat Dis 2022; 18:1049-1056. [DOI: 10.1016/j.soard.2022.04.019] [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: 03/13/2022] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
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Yang S, Lin X, Kückelhaus M, Hirsch T, Klietz ML, Aitzetmüller MM. Chances and challenges-analysis of trends in breast reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2584-2593. [PMID: 35606301 DOI: 10.1016/j.bjps.2022.04.005] [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: 09/16/2021] [Revised: 02/17/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION While breast reconstruction has become more and more important within the past decade, research focus areas as well as trends are in constant change. METHOD The publications from 2012 to 2021 were retrieved from the Web of Science Core Collection database. CiteSpace visualization analysis software was used to analyze the institutions, countries, regions, categories, and keywords on breast reconstruction research. RESULT A total of 3092 articles were selected. The number of articles published in the last 10 years showed an upward trend year by year. The journal "Plastic and Reconstructive Surgery" had the largest number of publications and citations, representing the core journal. The USA had the largest number of publications and the most extensive cooperation with other countries. The research highlights mainly focused on the improvement of surgical techniques, enhancing postoperative recovery, and oncological safety. CONCLUSION Over the past decade, research on breast reconstruction has developed steadily, and considerable achievements in the field of surgical techniques, postoperative recovery, and oncological safety were reached. Plastic surgeons should continue to strive for a higher level of evidence study designs, while also recognizing the importance of international and multiple-center cooperation.
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Affiliation(s)
- Siling Yang
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, Waldeyerstrasse 1, Muenster 48149, Germany
| | - Xixi Lin
- Division of Experimental Radiation Biology, Department of Radiation Therapy, University Hospital Essen, University of Duisburg-Essen, Hufeland Street 55, Essen 45122, Germany
| | - Maximilian Kückelhaus
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, Waldeyerstrasse 1, Muenster 48149, Germany; Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Germany; Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, Muenster 48157, Germany
| | - Tobias Hirsch
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, Waldeyerstrasse 1, Muenster 48149, Germany; Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Germany; Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, Muenster 48157, Germany
| | - Marie-Luise Klietz
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, Waldeyerstrasse 1, Muenster 48149, Germany; Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Germany; Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, Muenster 48157, Germany
| | - Matthias M Aitzetmüller
- Division for Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, Waldeyerstrasse 1, Muenster 48149, Germany; Department for Plastic and Reconstructive Surgery, Institute for Muskuloskeletal Medicine, Westfaelische Wilhelms-University Muenster, Germany; Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Dorbaumstrasse 300, Muenster 48157, Germany.
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Wahl U, Hirsch T. [The crucial role of color-coded duplex sonography before planning microvascular tissue transfer in the lower extremities]. Unfallchirurg 2022; 125:422-424. [PMID: 35312795 DOI: 10.1007/s00113-022-01164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Uwe Wahl
- Medizinische Klinik (Dir.: Dr. Friedrich Ernst), BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112, Halle (Saale), Deutschland.
| | - Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Leipziger Str. 5, 06108, Halle (Saale), Deutschland.
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Abstract
Because breast augmentation is one of the most popular cosmetic procedures, the issue of implant-related complications has been widely debated ever since the FDA approved the use of implants in 1962. Although decades have passed, breast implant illness (BII) still represents a poorly defined and controversial complication. With ongoing nonscientific discussion in the mainstream media and on social media, revealing the etiology of BII is urgent because knowledge of this subject ultimately influences patients' decisions. Little or no scientific research is currently available on BII and no final conclusions regarding its etiology, clinical manifestations, diagnostic criteria, or treatment have been made. This review aims to give an overview of the hypotheses on the etiology of BII and seeks inspiration to improve the conditions of BII patients.
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Affiliation(s)
- Siling Yang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Marie-Luise Klietz
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Anna Katharina Harren
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Qiang Wei
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Tobias Hirsch
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Matthias M Aitzetmüller
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
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Yang S, Klietz ML, Hirsch T, Wiebringhaus P, Aitzetmüller MM. Volumetry in Breast Reconstruction: Always New, Always Better? Aesthetic Plast Surg 2022; 46:2067-2069. [PMID: 35075506 DOI: 10.1007/s00266-021-02758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
Abstract
Although breast surgeries for aesthetic or reconstructive purposes are regularly performed, no focus has been laid on establishing an adequate and reliable volumetry method. While CT and MRI scan represent methods that are already in clinical use, the 3D scan is a novel and promising tool, easy to use with the possibility to measure the anatomic breast volume in an upright position. Nevertheless, its reliability is broadly underinvestigated. 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 www.springer.com/00266 .
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Kueckelhaus M, Rothoeft T, De Rosa L, Yeni B, Ohmann T, Maier C, Eitner L, Metze D, Losi L, Secone Seconetti A, De Luca M, Hirsch T. Transgenic Epidermal Cultures for Junctional Epidermolysis Bullosa - 5-Year Outcomes. N Engl J Med 2021; 385:2264-2270. [PMID: 34881838 DOI: 10.1056/nejmoa2108544] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Inherited junctional epidermolysis bullosa is a severe genetic skin disease that leads to epidermal loss caused by structural and mechanical fragility of the integuments. There is no established cure for junctional epidermolysis bullosa. We previously reported that genetically corrected autologous epidermal cultures regenerated almost an entire, fully functional epidermis on a child who had a devastating form of junctional epidermolysis bullosa. We now report long-term clinical outcomes in this patient. (Funded by POR FESR 2014-2020 - Regione Emilia-Romagna and others.).
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Affiliation(s)
- Maximilian Kueckelhaus
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tobias Rothoeft
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura De Rosa
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Burcu Yeni
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tobias Ohmann
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Christoph Maier
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lynn Eitner
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Dieter Metze
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorena Losi
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Secone Seconetti
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele De Luca
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tobias Hirsch
- From the Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide (M.K., B.Y., T.H.), and the Department of Dermatology, University of Muenster (D.M.), Muenster, the Department of Neonatology and Pediatric Intensive Care (T.R.) and the Department of Neuropediatrics (L.E.), University Children's Hospital, Ruhr-University Bochum (C.M.), Bochum, and the Research Department, BG Klinikum Duisburg, Duisburg (T.O.) - all in Germany; and Holostem Terapie Avanzate, Center for Regenerative Medicine Stefano Ferrari (L.D.R., A.S.S.), and the Unit of Pathology (L.L.) and the Center for Regenerative Medicine Stefano Ferrari (M.D.L.), Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
Objective: The main risk factors for cardiac events, and particularly for the development of atherosclerosis, are diabetes mellitus, arterial hypertension, dyslipidemia and smoking. Patients with a traumatic spinal cord injury (SCI) may present with autonomic nervous system dysfunction depending on their level of spinal cord injury. Studies have found a rise in cardiovascular mortality. A systematic review was conducted that focused on this patient group's predisposition to vascular risk. Methods: We performed a PubMed and Cochrane database search. After applying specific search criteria, 42 articles were included in our analysis out of a total of 10,784 matches. The articles were selected with the aim of establishing cardiovascular risk factors in patients with traumatic spinal cord injury. Results: Patients with SCI are at an increased risk for peripheral artery disease even in the absence of cardiovascular risk factors. Major vascular changes to the arteries of patients with SCI include: a reduction in lumen size, increased vessel wall tension, higher vascular stiffness, an impaired reactive hyperemic response, and a lack of reduced vascular resistance. The findings for carotid atherosclerosis were inconclusive. This group of patients also has a higher disposition for diabetes mellitus, lipid metabolism disorders and coronary artery disease. Paraplegics are more likely to suffer from dyslipidemia, obesity and PAD, while tetraplegics are more likely to have diabetes mellitus. Conclusions: Patients with SCI are more likely to have cardiovascular risk factors and have cardiovascular disease compared to the normal population. Peripheral circulatory disorders are particularly common. Patients with SCI are now considered to be a new risk group for cardiovascular disease; however, large epidemiological studies are needed to verify in more detail the cardiovascular risk profile of this patient group.
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Affiliation(s)
- Uwe Wahl
- Department of Internal Medicine, BG Hospital Bergmannstrost Halle, Halle/Saale, Germany
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre, Halle/Saale, Germany
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Kueckelhaus M, Gebur N, Kampshoff D, Hiort M, Varnava C, Harati K, Hirsch T, Wiebringhaus P. Initial experience with the superficial circumflex iliac artery perforator (SCIP) flap for extremity reconstruction in Caucasians. J Plast Reconstr Aesthet Surg 2021; 75:118-124. [PMID: 34509392 DOI: 10.1016/j.bjps.2021.05.069] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The superficial circumflex iliac artery perforator (SCIP) flap has been established in Asia to provide an excellent option for soft tissue defect coverage. The main advantage of this delicate flap is its very thin design. However, the adoption of this technique in other parts of the world has been rarely reported. METHODS In this retrospective study, we analyzed outcomes of 32 SCIP flaps in a Caucasian patient population. The procedures were performed at our institution between March 2019 and August 2020. We present patient characteristics, surgical technique, perioperative care, and flap applications as compared to the Asian approaches. RESULTS Patients' average BMI was 28.7. Flap anatomy and flap thickness at the superficial fascial plane differed significantly within our population. With 1.7 mm on average, the arterial diameter was higher than reported in the literature. Flaps were based on an axial perforator in 52% of cases. The SCIP flap was performed safely in the majority of cases. The surgical flap elevation approach was modified toward speedy perforator identification. CONCLUSIONS The SCIP flap offers superior opportunities for thin soft tissue defect coverage with excellent functional outcomes in Caucasian patients. Based on higher BMI and anatomical differences as compared to Asian patient populations, modifications of flap elevation were necessary to increase reliability. More outcome reports from outside Asia need to become available to advance SCIP flap application internationally.
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Affiliation(s)
- Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany.
| | - Nils Gebur
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - David Kampshoff
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - Mirkka Hiort
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - Charalampos Varnava
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - Kamran Harati
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany; Institute of Musculoskeletal Medicine, University Hospital Muenster, Germany
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Hirsch T. Das postthrombotische Syndrom – Häufigkeit, Diagnosestellung, Probleme bei der Klassifikation. Phlebologie 2021. [DOI: 10.1055/a-1427-0242] [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: 10/21/2022]
Abstract
ZusammenfassungDie Phlebothrombose und ihr chronischer Folgezustand, das postthrombotische Syndrom, besetzen in der Gefäßmedizin eine zentrale Position. Die Erkrankungen sind für die Betroffenen mit erheblichen Konsequenzen verbunden, die sich in vielen Fällen auf das gesamte weitere Leben auswirken. Obwohl das postthrombotische Syndrom eine Vielzahl typischer Symptome auslösen kann, ist die klinische Diagnosestellung nicht immer eindeutig und erfordert häufig zusätzliche technische Untersuchungsmethoden.Die immer tiefergehenden Erkenntnisse über die Pathophysiologie einerseits und die Weiterentwicklung diagnostischer und therapeutischer Verfahren andererseits haben gerade in den letzten 20 Jahren zu einer erheblich stärkeren Sensitivität gegenüber der Erkrankung geführt und die Etablierung neuer Methoden vorangetrieben. So hat die Duplexsonografie die Phlebografie als Goldstandard in der Bildgebung abgelöst und Katheter-Verfahren haben einen festen Stellenwert neben oder sogar anstelle der offenen Chirurgie eingenommen. Auch das Wissen über die seit Jahrzehnten etablierte Kompressionstherapie hat sich weiter vermehrt, sodass auch die konservativen Behandlungsstrategien einen Wandel erfahren haben.Während für die Diagnostik und Therapie der Venenthrombose und Lungenembolie Leitlinien vorliegen, existieren keine aktuellen Empfehlungen, die die modernen Entwicklungen für das postthrombotische Syndrom berücksichtigen.Der Übersichtsartikel befasst sich mit dem diagnostischen Vorgehen unter der besonderen Berücksichtigung der Duplexsonografie und ordnet die weiteren zur Verfügung stehenden bildgebenden und funktionsdiagnostischen Methoden ein.
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Affiliation(s)
- Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Halle (Saale)
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Hirsch T, Vöhringer O, Macherauch E. Der Einfluß des Kugelstrahlens auf die Biegeschwingfestigkeit von AlCu5Mg2 in verschiedenen Wärmebehandlungszuständen. ACTA ACUST UNITED AC 2021. [DOI: 10.1515/htm-1986-410313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Klietz ML, Kückelhaus M, Wiebringhaus P, Raschke MJ, Hirsch T, Aitzetmüller MM. [The influence of harvesting and processing on the regenerative potential in fat grafting]. HANDCHIR MIKROCHIR P 2021; 53:412-419. [PMID: 33530127 DOI: 10.1055/a-1306-0566] [Citation(s) in RCA: 1] [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
The autologous lipotransfer represents an established method in the field of Plastic Surgery. As a reliable and safe method for breast reconstruction and breast augmentation it offers an alternative to established methods such as implants and flap surgery.Survival rate of adipose derived stromal cells limits success or failure of fat grafting. Slight changes in the fat grafting process can lead to huge changes in ADSC-survival rate.This review wants to optimize the fat-grafting process to ensure best outcomes.
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Affiliation(s)
- Marie-Luise Klietz
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster
| | - Maximilian Kückelhaus
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster.,Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
| | - Philipp Wiebringhaus
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster.,Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
| | - Michael J Raschke
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
| | - Tobias Hirsch
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster.,Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
| | - Matthias M Aitzetmüller
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster.,Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster.,Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
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Hirsch T, Bertsch T. Leserbrief zu: Zetzmann K, Ludolph I, Horch R, et al. Bildgebende Diagnostik zur Therapieplanung bei Lip- und Lymphödem. Phlebologie 2020; 2(49): 72–78. Phlebologie 2021. [DOI: 10.1055/a-1217-0973] [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: 10/22/2022]
Affiliation(s)
- Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Venen Kompetenz-Zentrum Halle (Saale)
| | - Tobias Bertsch
- Europäisches Zentrum für Lymphologie im Schwarzwald, Földiklinik Hinterzarten
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Hirsch T, Klemenz A. Die Anatomie des retroperitonealen und pelvinen Venensystems. Phlebologie 2020. [DOI: 10.1055/a-1277-3596] [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: 10/23/2022]
Abstract
ZusammenfassungVenenleiden sind nicht auf die Extremitäten beschränkt. Einerseits können Erkrankungen der Beinvenen wie Varikose und Phlebothrombose auch die Venen der Beckenorgane und des Retroperitoneums mit betreffen, andererseits sind pelvine und abdominelle Symptome mitunter auch phlebogen erklärbar. Als Pendant zur chronischen venösen Insuffizienz der Beinvenen hat sich der Begriff des chronischen pelvinen Stauungssyndroms etabliert, der die Komplexität der Störung weder anatomisch noch funktionell adäquat erfasst.Die klinische Diagnostik und die Bildgebung, insbesondere die Duplexsonografie der retroperitonealen Venen, sind erheblich schwieriger als die der Beinvenen. Darüber hinaus sind die Gefäße sehr variantenreich. Die fundierte Kenntnis der Anatomie der pelvinen und retroperitonealen Gefäße ist unersetzlich, um die möglichen Befunde deuten zu können. Das Wissen um die wichtigsten embryologischen Entwicklungsschritte erleichtert das Verständnis pathophysiologischer Mechanismen.
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Affiliation(s)
- Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Venen-Kompetenz-Zentrum®, Halle (Saale)
| | - Albrecht Klemenz
- Institut für Anatomie und Zellbiologie der Martin-Luther-Universität Halle-Wittenberg
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Moellhoff N, Prantl L, Behr B, Beier JP, Daigeler A, Dragu A, Eisenhardt SU, Fuchs PC, Germann G, Hirsch T, Horch RE, Infanger M, Jakubietz R, Kneser U, Langer S, Lehnhardt M, Machens HG, Mailänder P, Reichert B, Radtke C, Schaefer DJ, Siemers F, Stark GB, Steinau HU, Vogt PM, Giunta RE. [Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2019/2020]. HANDCHIR MIKROCHIR P 2020; 53:110-118. [PMID: 32977347 DOI: 10.1055/a-1267-0388] [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: 10/23/2022] Open
Abstract
BACKGROUND Since 2015/16 the DGPRÄC collects, evaluates and publishes the research activities of academic sections, departments and clinics for plastic surgery at university hospitals in Germany, in order to raise the awareness of plastic surgical research performance. MATERIALS AND METHODS The directors of plastic surgical academic institutions were contacted via the DGPRÄC and asked to report any requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was collected in our previously established online database: https://docs.google.com/forms/d/e/1FAIpQLSe6F5xmTyw-k7VKJx_2jkPA4LBXsA0sgBGMrC3rx_4bHj6uzQ/viewform?usp=sf_link. In addition, applications were identified via the DFG's public database GEPRIS. RESULTS A total of 41 funding applications to the public funding institutes DFG, BMBF, BMWi, BMG and EU were identified. 75.6 % (31/41) of the applications had already been approved at the time of data collection, of which 77.4 % (24/31) were DFG, 9.7 % (3/31) were BMWi, 6.5 % (2/31) were EU and 3.2 % (1/31) were BMBF or BMG applications. The average funding amounted to 358 301 Euro. In 50.0 % (12/24) of the cases, the approved DFG proposals were assigned to the subject review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery. CONCLUSION The continuous publication of plastic surgical research funding reports submitted by the convention of university plastic surgeons of the DGPRÄC portraits the excellent, collaborative research activity in the field of plastic surgery.
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Affiliation(s)
- N Moellhoff
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - L Prantl
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität Regensburg
| | - B Behr
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Universitätsklinik Bergmannsheil
| | - J P Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen
| | - A Daigeler
- Plastische Chirurgie, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls Universität/BG Unfallklinik Tübingen
| | - A Dragu
- Abteilung für Plastische und Handchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - S U Eisenhardt
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - P C Fuchs
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Schwerbrandverletztenzentrum, Klinikum Köln-Merheim
| | - G Germann
- ETHIANUM, Klinik für Plastische, Ästhetische und Präventive Medizin am Universitätsklinikum Heidelberg
| | - T Hirsch
- Plastische-, Rekonstruktive und Ästhetische Chirurgie, Fachklinik Hornheide, Plastische Chirurgie, Universitätsklinikum Münster
| | - R E Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU
| | - M Infanger
- Klinik für Plastische, Wiederherstellungs- und Handchirurgie, Otto-von-Guericke-Universität, Magdeburg
| | - R Jakubietz
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie/Sektion Plastische & Ästhetische Chirurgie/Universitätsklinikum Würzburg
| | - U Kneser
- Klinik für Hand-, Plastische & Rekonstruktive Chirurgie/Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen.,Klinik für Plastische und Handchirurgie, Ruprechts-Karls-Universität Heidelberg
| | - S Langer
- Abteilung für Plastische-, Ästhetische- und spezielle Handchirurgie, Universitätsklinikum Leipzig - AöR
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Universitätsklinik Bergmannsheil
| | - H G Machens
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie/Klinikum rechts der Isar, Technische Universität München
| | - P Mailänder
- Abteilung für Plastische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - B Reichert
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Nürnberg-Süd, Universitätsklinik der Paracelsus Medizinischen Privatuniversität
| | - C Radtke
- Klinische Abteilung für Plastische und Rekonstruktive Chirurgie, Universitätsklinik für Chirurgie MedUni Wien
| | - D J Schaefer
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel
| | - F Siemers
- Klinik für Plastische Chirurgie und Handchirurgie, Brandverletztenzentrum, Berufsgenossenschaftliche Kliniken Bergmannstrost, Martin-Luther-Universität Halle-Wittenberg
| | - G B Stark
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - H U Steinau
- Universitätsklinik für Unfallchirurgie/Orthopädie, Plastische und Rekonstruktive Chirurgie Schwerpunkt Sarkomchirurgie, WTZ
| | - P M Vogt
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
| | - R E Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
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Hirsch T. Liebe Kolleginnen und Kollegen,. Phlebologie 2020. [DOI: 10.1055/a-1170-6397] [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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Rabe E, Partsch H, Morrison N, Meissner MH, Mosti G, Lattimer CR, Carpentier PH, Gaillard S, Juenger M, Urbanek T, Hafner J, Patel M, Wu S, Caprini J, Lurie F, Hirsch T. Response to letter to editor regarding: "Risks and contraindications of medical compression treatment - a critical reappraisal. An international consensus statement PHLEB-19-150.R1". Phlebology 2020; 35:838-839. [PMID: 32746724 DOI: 10.1177/0268355520947605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Hugo Partsch
- Department of Dermatology, 27271Medical University of Vienna, Vienna, Austria
| | | | - Mark H Meissner
- Department of Surgery, Harborview Medical Center, Seattle, WA, USA
| | - Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca, Italy
| | - Christopher R Lattimer
- Josef Pflug Vascular Laboratory, West London Vascular and Interventional Centre, Ealing Hospital & Imperial College, London, UK
| | - Patrick H Carpentier
- Centre de Recherche Universitaire de La Léchère, Equipe THEMAS, Université Joseph Fourier, Grenoble, France
| | | | - Michael Juenger
- Department of Dermatology, University of Greifswald, Greifswald, Germany
| | - Tomasz Urbanek
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Juerg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Malay Patel
- First Choice Vascular, Swastik Society, Ahmedabad, India
| | - Stephanie Wu
- Department of Podiatric Surgery & Applied Biomechanics, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Joseph Caprini
- Department of Vascular Surgery, The University of Chicago, Chicago, IL, USA
| | - Fedor Lurie
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Halle, Germany
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Hirsch T, Wohlgemuth WA. Pelvines Stauungssyndrom: Wie wird die Diagnose gesichert, wer muss behandelt werden? Phlebologie 2020. [DOI: 10.1055/a-1195-4284] [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: 10/23/2022]
Abstract
ZusammenfassungUnterleibsbeschwerden waren lange Zeit die Domäne von Gynäkologen, Internisten und Urologen. Die Erkenntnis, dass auch eine venöse Abstrombehinderung im kleinen Becken bzw. im Abdomen ähnliche Beschwerden hervorrufen kann, hat dazu geführt, dass in den letzten Jahren auch Gefäßmediziner in die Diagnostik und Behandlung einbezogen werden.Das pelvine Stauungssyndrom kann eine Vielzahl von auch nichtspezifischen Beschwerden verursachen. Die differenzialdiagnostische Abgrenzung zu gynäkologischen, internistischen oder auch orthopädischen Störungen stellt damit eine Herausforderung dar. Die akribische Anamneseerhebung und Symptombeschreibung sind von übergeordneter Bedeutung. In der weiteren Diagnostik kommt der Sonografie die wichtigste Bedeutung zu, die durch radiologische Schichtbildverfahren ergänzt werden kann. Wird vor allem eine Varikose im Genitalbereich beklagt, ist zu klären, ob es sich um eine venöse Insuffizienz im Bereich der Vena iliaca interna bzw. der Vena ovarica handelt oder ob postthrombotische Veränderungen eine Rolle spielen. Bei pelvinen und abdominellen Schmerzzuständen müssen zusätzlich die Nierenvenen und die untere Hohlvene beurteilt werden.Nur wenn die Störung differenzialdiagnostisch sicher abgegrenzt werden kann, ist eine invasive Behandlung durch Katheterverfahren und/oder Schaumsklerotherapie angezeigt.
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Affiliation(s)
- Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Venen-Kompetenz-Zentrum®, Halle (Saale)
| | - Walter A. Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle (Saale)
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Puscz F, Dadras M, Dermietzel A, Jacobsen F, Lehnhardt M, Behr B, Hirsch T, Kueckelhaus M. A chronic rejection model and potential biomarkers for vascularized composite allotransplantation. PLoS One 2020; 15:e0235266. [PMID: 32589662 PMCID: PMC7319338 DOI: 10.1371/journal.pone.0235266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic rejection remains the Achilles heel in vascularized composite allotransplantation. Animal models to specifically study chronic rejection in vascularized composite allotransplantation do not exist so far. However, there are established rat models to study chronic rejection in solid organ transplantation such as allogeneic transplantation between the rat strains Lewis and Fischer344. Thus, we initiated this study to investigate the applicability of hindlimb transplantation between these strains to imitate chronic rejection in vascularized composite allotransplantation and identify potential markers. METHODS Allogeneic hindlimb transplantation were performed between Lewis (recipient) and Fischer344 (donor) rats with either constant immunosuppression or a high dose immunosuppressive bolus only in case of acute skin rejections. Histology, immunohistochemistry, microarray and qPCR analysis were used to detect changes in skin and muscle at postoperative day 100. RESULTS We were able to demonstrate significant intimal proliferation, infiltration of CD68 and CD4 positive cells, up-regulation of inflammatory cytokines and initiation of muscular fibrosis in the chronic rejection group. Microarray analysis and subsequent qPCR identified CXC ligands 9-11 as potential markers of chronic rejection. CONCLUSIONS The Fischer344 to Lewis hindlimb transplantation model may represent a new option to study chronic rejection in vascularized composite allotransplantation in an experimental setting. CXC ligands 9-11 deserve further research to investigate their role as chronic rejection markers.
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Affiliation(s)
- Flemming Puscz
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Alexander Dermietzel
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Frank Jacobsen
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Tobias Hirsch
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
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Wahl U, Hirsch T. The importance of antiphospholipid syndrome testing in venous thromboembolism after varicose vein surgery. J Vasc Surg Venous Lymphat Disord 2020; 8:1097-1101. [PMID: 32381473 DOI: 10.1016/j.jvsv.2020.03.008] [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: 01/15/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Anticoagulation treatment after a venous thromboembolism event is usually managed on a case-by-case basis. The risk of thrombosis must be weighed against the risk of bleeding. Identifying patients who could benefit from anticoagulation therapy requires the thromboembolism event to be assessed with respect to its presentation and the severity of the triggering factors. A case report is employed to explain the important aspects of practical approaches to venous thromboembolism events after vein surgery. The Trial on Rivaroxaban in AntiPhospholipid Syndrome (TRAPS) study has prompted new considerations for anticoagulation management. Patients with antiphospholipid syndrome need to be identified early to lower the risk of thromboembolism also during anticoagulation treatment.
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Affiliation(s)
- Uwe Wahl
- Department of Internal Medicine, BG Hospital Bergmannstrost Halle, Halle, Germany.
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre Halle, Halle, Germany
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