[Accident-related and workplace-related vascular disorders of the hand]. / Unfall- und arbeitsplatzbezogene Erkrankungen der Hand mit gefäßmedizinischem Hintergrund.

BACKGROUND: Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. AIM OF THE PAPER: The occupational diseases hypothenar/thenar hammer syndrome (occupational disease 2114) and vibration-induced vasospastic syndrome (occupational disease 2104) are presented on the basis of their etiological and pathogenetic characteristics, taking aspects of occupational medicine and expert opinion into consideration. DISCUSSION: Blunt force trauma to vascular structures of the hand can damage the tunica intima of the affected thenar or hypothenar arteries. Chronic exposure of the arms, hands and fingers to vibration can lead to the injury of nerve and vascular structures. Thermometry and pallesthesiometry are used in the diagnostics alongside methods of vascular medicine. CONCLUSION: Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.

[The Body Dysmorphic Disorder in Plastic Surgery - A Systematic Review of Screening Methods]. / Die körperdysmorphe Störung in der Plastischen Chirurgie ­ Eine systematische Übersicht der Screening-Methoden.

BACKGROUND: The body dysmorphic disorder (BDD) is considered to be a sub-form of somatoform disorders. BDD can express itself in a delirious experience, an excessive evaluation and employment of the external appearance, in particular the face. Preliminary results suggest that individuals with BDD do not benefit from plastic surgery, so that aesthetic surgery often results in aggravation of their symptoms. Thus, the identification of signs for a BDD is crucial, whether a patient should be operated plastically-aesthetically. This overview explains the often difficult diagnostics of the BDD by summarizing the current literature on its screening. STUDY DESIGN: Systematic overview METHODS: An electronic search was conducted in the German and English-language literature in order to identify all screening instruments for the BDD. The specific development RESULTS: Six different screening instruments were identified for the BDD. Only two of these were evaluated in a cosmetic setting: the "Body Dysmorphic Disorder Questionnaire Dermatology Version" (BDDQ-DV) and the "Dysmorphic Concern Questionnaire" (DCQ). The influence on the subjective results after a plastic-aesthetic procedure was measured only for the DCQ. CONCLUSION: The limited availability of validated screening instruments for BDD in plastic surgery is markedly in contrast to the supposedly high prevalence of the disease of 2.4 %. Among the currently used screening tools, the BDDQ-DV and the DCQ appear to be most suitable. Further research efforts are needed to establish better screening methods for the BDD in the plastic surgical patient population and to examine the effects of BDD on treatment results.

[Acute scaphoid fractures : Management under consideration of the new S3-level guideline]. / Die frische Skaphoidfraktur : Management unter Berücksichtigung der neuen S3-Leitlinie.

BACKGROUND: Scaphoid fractures represent the most common carpal fractures and are often problematic and frequently lead to nonunion with osteoarthritis and collapse of the wrist. The reasons for the nonunion are manifold. Therefore, the main goal of diagnosis and therapy of acute fractures is to achieve bony union and to restore the anatomic shape of the scaphoid. In the long run, only this can preserve the normal function of the wrist. METHODOLOGY: The given recommendations are based on the new S3-level guideline of the AWMF (Association of the Scientific Medical Societies). This guideline was established with involvement of all relevant medical societies based on a comprehensive and systematic review of the literature and after a process of formal consent. The focus of the guideline is recommendations regarding diagnosis and therapy of acute scaphoid fractures. MAIN STATEMENTS: After careful clinical examination consequent imaging must be performed, starting with X­rays in three standard projections. Computed tomography is indispensable for proof of a fracture and for therapy planning. The classification of Herbert and Krimmer is based on the CT under special consideration of instability and displacement of the fracture. Thus, indication for operative and non-operative treatment is mainly CT-dependent. Non-operative treatment may be indicated only for stable fractures (type A). However, operative treatment is strongly recommended for all unstable fractures (type B). For fixation, double-threaded headless screws are preferred. The operative technique depends on the fracture morphology. CONCLUSION: Diagnosis and therapy of acute scaphoid fractures are primarily aimed at the prevention of nonunion and arthritic carpal collapse with painful impairment of the wrist function. To achieve this, the S3-level guideline contains explicit recommendations.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and Research Funding Report 2021/2022]. / Register Forschungsförderung der Deutschen Gesellschaft für Plastische, Rekonstruktive und Ästhetische Chirurgie (DGPRÄC) und Forschungsförderungs-Bericht 2021/2022.

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.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2019/2020]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungsbericht 2019/2020.

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.

[Therapy standards after flexor tendon and nerve injuries of the hand: results from a survey of German centres for hand surgery]. / Therapiestandards nach Beugesehnen- und Nervenverletzungen der Hand : Ergebnisse einer Umfrage zur Immobilisationsdauer unter deutschen handchirurgischen Zentren.

BACKGROUND: There is little evidence for the ideal aftercare of combined nerve and flexor tendon injuries of the hand. The aim of this study was to elicit whether concomitant nerve injuries are changing the individual treatment plans after flexor tendon repair in a survey of German centres for hand surgery. METHODS: A questionnaire about aftercare of isolated and combined nerve and flexor tendon injuries of the hand was distributed to members of three German Societies of hand, trauma and plastic surgery. RESULTS: Isolated flexor tendon injuries in zones II to IV are treated by early mobilization in all centres, whereas isolated digital nerve repair is usually followed by immobilization (10% no immobilization, 22.5% up to 1 week, 52.5% for 2 weeks and 15% for 3 weeks). The duration of immobilization increases with lesions of the median or ulnar nerves by about 1 week. In 55% of cases concomitant nerve injury does not influence the early onset of dynamic splinting and mobilization after flexor tendon injuries. CONCLUSION: There seem to be no uniform treatment guidelines for flexor tendon repair if concomitant nerve injury is present. Against the background of the current literature early controlled mobilization after tendon and nerve repair seems to be justified.

[Wnt signaling in cutaneous wound healing]. / Wnt-Signalwege bei kutaner Wundheilung.

Human skin is an efficient barrier that protects the organism from noxious substances. Wounds destroy this barrier. Wound healing is a phased physiological regeneration of the destroyed tissue that ideally leads to occlusion of a wound, in particular by regeneration of connective tissue and capillaries. The Wnt signaling pathway is a highly conserved signal transduction cascade across the animal kingdom that controls basic cellular interactions in multicellular organisms. Accordingly, through the Wnt signaling path many processes, e. g. as the balance between proliferation and differentiation or apoptosis, coordinated. Wnt signaling is activated by a wound and participates in each subsequent phase of the healing process, beginning with inflammatory control and programmed cell death, to the mobilization of stem cells within the wound. Endogenous Wnt signaling is an attractive therapeutic approach to assist in the repair of skin wounds, as the complex mechanisms of the Wnt signaling pathway have become increasingly understood over the years. This review summarizes current data to clarify the role of Wnt signaling in the wound healing process of the skin.

Hibernoma-case report and literature review.

Hibernoma is an uncommon benign fatty tumor that arises from the vestiges of fetal brown fat. We present a case report of a hibernoma of the back in a symptomatic 42-year-old man and describe the important clinical, histopathologic, and imaging findings. Computed tomography shows a well-defined hypodense mass with septations. Magnetic resonance imaging shows intermediate T1 and bright T2 signal of the mass and also demonstrates the characteristic marked contrast enhancement.

[Treatment of hand burns]. / Die Behandlung der brandverletzten Hand.

Although burn injuries of the hand only account for approximately 2.5-3% of the total body surface area (TBSA), they are of great importance due to functional outcome, appearance and economic aspects. Initial treatment and diagnosis are important factors, which influence the further course of thermal injuries of the hand and which are found in up to 80% of treated burn injuries. Early decision-making is necessary if escharotomy or skin grafting is indicated. After preliminary evaluation and wound management a differentiation between non-surgical and surgical procedures is necessary. In the case of full thickness thermal injuries, debridement and skin grafting should be carried out. Further interdisciplinary management involves different professional groups as surgeons and physical therapists. Fitting pressure garments and treatment of scar formation are integral parts of the successful rehabilitation of hand burns.

[Antibiotic treatment of infections in burn patients - a systematic review]. / Antibiotikatherapie von Infektionen bei Verbrennungspatienten ­ Eine systematische Übersichtsarbeit.

BACKGROUND: Due to the loss of the natural skin barrier function with reduced immune competence as a result of a plasma loss and the numerous intensive care interventions, burn patients are particularly at risk for infection. STUDY DESIGN: systematic review METHODS: A systematic review of German and English literature between 1990 and 2018 analyzes the epidemiological and diagnostic aspects as well as the therapeutic use of antibiotics in infections of burn patients in clinical trials. RESULTS: A total number of 53 randomized controlled clinical trials met the inclusion criteria. Various types / forms of application of antibiotic prophylaxis in burn wounds were investigated: topically, systemically (generally), systemically (perioperatively), nonabsorbable antibiotics (= selective intestinal decontamination), locally (inhaled) and all forms of administration versus control. Early postburn prophylaxis was studied in low-severity patients (six studies) and severe burn patients (seven studies). Antimicrobial prophylaxis has shown no effectiveness in the prevention of toxic shock syndrome in low grade burns, but can be useful in patients with severe burns in need for mechanical ventilation. Perioperative prophylaxis has been studied in ten studies. CONCLUSION: The benefit of long-term systemic antibiotic prophylaxis in the majority of burn patients is not evident. Mild infections in stable clinical conditions should be closely monitored, while in severe infections, international sepsis guidelines and the Tarragona principle are recommended.

[Regulation of bone metabolism by the Wnt signaling pathway]. / Regulation des Knochenstoffwechsels durch den Wnt-Signalweg.

The development and homeostasis of multicellular organisms depends on a complex cellular interaction between proliferation, migration, differentiation, adhesion, and cell death. Wnt signaling pathways coordinate these different cellular responses. Wnt signaling plays a role as a regulatory pathway in the osteogenic differentiation of mesenchymal stem cells. The Wnt signaling pathway is an attractive therapeutic target with the potential to directly modulate stem cells responsible for the regeneration of skeletal tissue. Recent studies indicate that Wnt ligands are capable of promoting bone growth, suggesting that Wnt factors could be used to stimulate bone healing in osteogenic disorders.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2017/2018]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungs-Bericht 2017/2018.

INTRODUCTION: This report serves to publicize the research of academic institutions for Plastic Surgery within our society DGPRÄC in 2017/2018 and sequels the funding report of 2015/2016. Applications to public, non-public, or industrial funding organizations were evaluated. At the same time, this paper analyses the number of approved DFG applications in Plastic, Thoracic and Vascular Surgery in the GEPRIS system. Contrary to these specialties, Plastic Surgery is not classified as an independent speciality in the subject structure of the DFG review board which results in a lack of transparency concerning Plastic Surgery research work. MATERIALS AND METHODS: Our previously established online database (https://docs.google.com/forms/d/1OaSnHyKTysawiI1ie7kfUxDf7nJP_RiTUJTsnb7Mq_E/edit) for reporting requested/ approved and rejected research applications to public, non-public and industrial funding organizations was continued and evaluated together with applications found in the DFG's public database GEPRIS. RESULTS: Compared to the previous year's report, the number of approved applications from public research organizations (DFG, BMBF, BMWi, EU) was increased from 23 to 27. We identified 19 approved DFG applications from Plastic Surgery, as compared to 9 and 8 applications by Thoracic and Vascular Surgery, respectively. SUMMARY: Taken together, this data emphasizes that our research is at least equal to that of other newly established surgical specialties within the framework of the DFG. Accordingly, we hope to provide further arguments for an adaptation of the DFG review boards subject structure to include Plastic Surgery as an independent specialty as it is for Vascular Surgery and Thoracic Surgery.

[Psychological and behavioural impairment following thermal injury in childhood]. / Psychosoziale Aspekte thermischer Verletzungen im Kindes- und Jugendalter.

BACKGROUND: Thermal injuries are a major hazard in the early childhood. The aim of our study was to determine psychological behavioural disorders following burn and scald injuries in the childhood and to estimate their dependence on the formation of scar tissue and the social background of the children. PATIENTS: 83 patients aged 0 to 18 years who had been treated for thermal injuries in our clinic between September 2002 and December 2005 were included in the follow-up study. The standardised questionnaires CBCL/4-18 and TACQOL-PF were used to evaluate psychological behavioural disorders and quality of life. The follow-up examinations also served to gain information about the social status of the patient's parents and the current physical complaints. Scars were assessed by the Vancouver Scar Scale (VSS). RESULTS: 50 out of 83 patients took part in our follow-up examinations. 21 children suffered from physical complaints following thermal injury. Dryness of the skin as well as heat and cold intolerance were named most frequently. Internalising (p < 0.04) and externalising (p < 0.03) behavioural problems correlated significantly with the severity of scar formation defined by the VSS. Quality of life and social status were inferior to the comparison group. CONCLUSION: The incidence of thermal injuries is highest in the first three years of childhood. The risk for burn and scald injuries is augmented by a poor social status. In children who suffered such injuries we observed a higher rate of internalising and externalising behavioural problems which correlated with the extent of scar formation.

[Heterotopic ossifications: a severe complication following extensive burn injury]. / Heterotope Ossifikationen - eine schwerwiegende Komplikation bei ausgedehnten Brandverletzungen.

Heterotopic ossifications in periarticular tissue can appear after severe head injury, spine trauma or local joint trauma. Following extensive burns, heterotopic ossifications are a rare, severe complication with an unclear pathogenesis. We report one case with this kind of complication in a 50-year old male patient who sustained full and partial thickness burn injuries over 60 % of the body. The thermal injury was accompanied by a severe inhalation injury.

[Mesenteric ischemia: a severe complication in burn patient]. / Mesenterialinfarkt - eine schwerwiegende Komplikation bei Schwerbrandverletzten.

Gastrointestinal complications are a common problem in severe burned patients. Reported complications include paralytic ileus, gastrointestinal tract bleeding, gastric ulcers and acute necrotizing cholecystitis. Although there are no exact data concerning the frequency and outcome of acute intestinal necrotizing ischemia in severe burned patients, it is a well known complication in specialized burn centers. The most common reason for acute intestinal ischemia are arterial embolism, arterial thrombosis, venous thrombosis and non-occlusive disease. The overall survival differs between 81 % and 34 %. The therapy aims at arterial re-perfusion of life-threatening intestinal regions and resection of necrotic tissue. A 45-year-old male patient attempted suicide by inflaming himself with gasoline. He sustained partial and full thickness burn injury of the face and the throat. Additional burn injuries were found at the chest region, both arms and the abdominal wall. The total burn surface area (TBSA) was 42 % including an severe inhalation injury trauma. The ABSI-score (Abbreviated burn severity index) was 10. The combination of a thrombus at the aortic valve with an tachycardic dysrhythmia was the cause for an embolisation with acute intestinal ischemia. The necrotic part of the small intestine was resected, the further course was uncomplicated.

[Management of finger-level avulsion injuries]. / Fingeravulsionsverletzungen.

BACKGROUND: In avulsion-type injuries of the fingers recovery of blood circulation is one of the major obstacles. The indication for finger reconstruction is discussed controversely, being influenced by the patient's needs, the degree of damage to the soft tissue and the prospects of success of the healing process. In this study we present our results after reconstruction of avulsion-type injuries of the fingers. Indications for finger reconstruction will be assessed in consideration of the expected outcome. PATIENTS AND METHODS: From 1999 to 2006 we treated 18 patients with finger level avulsion injuries. 15 casualties were caused by rings and three by ropes looped around a digit. The median age at injury was 23 (12 - 66) years. All patients were examined by an independent observer, who did not participate in the operation. Criteria were functional outcome and patient's complaints and satisfaction. Sensibility was evaluated by 2-point discrimination applying the Greulich star. Finger mobility was assessed with the Buck-Gramcko goniometer. RESULTS: According to the classification of Urbaniak as modified by Kay, 2 patients ranked in class II, 3 in class III and 13 suffered from complete avulsion-amputations (class IV). Of the latter, 8 allowed primary reconstruction of the blood circulation. Two fingers required early or late secondary amputation. After finger reconstruction, patients spent a median time of 18 (12 - 32) days in hospital while primary amputation resulted in a shorter stay of 4 (2 - 5) days. Active motion after replantation in the proximal interphalangeal joint was reduced on average to 64 (25 - 100) degrees. The distal interphalangeal joint nearly ankylosed in all patients following replantation except for one case with an active motion of 40 degrees . Good sensibility could be achieved in one case, protective sensibility in three and none in two patients. All patients with preserved fingers would again decide in favour of finger replantation. CONCLUSION: In specialised centres replantation of complete avulsion-type finger amputations can be achieved. The decision for or against replantation should only be made after microsurgical assessment of the severed soft tissue and in consideration of the patient's specific demands. With the right indication for reconstruction, the patient's satisfaction often outweighs even poor functional outcomes.

[The Body Dysmorphic Disorder in Plastic Surgery - A Systematic Review of Screening Methods]. / Die körperdysmorphe Störung in der Plastischen Chirurgie ­ Eine systematische Übersicht der Screening Methoden.

BACKGROUND: The body dysmorphic disorder (BDD) is considered to be a sub-form of somatoform disorders. BDD can express itself in a delirious experience, an excessive evaluation and employment of the external appearance, in particular the face. Preliminary results suggest that individuals with BDD do not benefit from plastic surgery, so that aesthetic surgery often results in aggravation of their symptoms. Thus, the identification of signs for a BDD is crucial, whether a patient should be operated plastically-aesthetically. This overview explains the often difficult diagnostics of the BDD by summarizing the current literature on its screening. STUDY DESIGN: Systematic overview METHODS: An electronic search was conducted in the German and English-language literature in order to identify all screening instruments for the BDD. The specific development and validation processes are assessed whether the screening instruments have a positive predictive value for the BDD. RESULTS: Six different screening instruments were identified for the BDD. Only two of these were evaluated in a cosmetic setting: the "Body Dysmorphic Disorder Questionnaire Dermatology Version" (BDDQ-DV) and the "Dysmorphic Concern Questionnaire" (DCQ). The influence on the subjective results after a plastic-aesthetic procedure was measured only for the DCQ. CONCLUSION: The limited availability of validated screening instruments for BDD in plastic surgery is markedly in contrast to the supposedly high prevalence of the disease of 2.4 %. Among the currently used screening tools, the BDDQ-DV and the DCQ appear to be most suitable. Further research efforts are needed to establish better screening methods for the BDD in the plastic surgical patient population and to examine the effects of BDD on treatment results.

The Role of Current Techniques and Concepts in Peripheral Nerve Repair.

Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies.