Dynamic cultivation of human mesenchymal stem/stromal cells for the production of extracellular vesicles in a 3D bioreactor system.

PURPOSE: 3D cell culture and hypoxia have been demonstrated to increase the therapeutic effects of mesenchymal stem/stromal cells (MSCs)-derived extracellular vesicles (EVs). In this study, a process for the production of MSC-EVs in a novel 3D bioreactor system under normoxic and hypoxic conditions was established and the resulting EVs were characterized. METHODS: Human adipose-derived MSCs were seeded and cultured on a 3D membrane in the VITVO® bioreactor system for 7 days. Afterwards, MSC-EVs were isolated and characterized via fluorescence nanoparticle tracking analysis, flow cytometry with staining against annexin V (Anx5) as a marker for EVs exposing phosphatidylserine, as well as CD73 and CD90 as MSC surface markers. RESULTS: Cultivation of MSC in the VITVO® bioreactor system demonstrated a higher concentration of MSC-EVs from the 3D bioreactor (9.1 × 109 ± 1.5 × 109 and 9.7 × 109 ± 3.1 × 109 particles/mL) compared to static 2D culture (4.2 × 109 ± 7.5 × 108 and 3.9 × 109 ± 3.0 × 108 particles/mL) under normoxic and hypoxic conditions, respectively. Also, the particle-to-protein ratio as a measure for the purity of EVs increased from 3.3 × 107 ± 1.1 × 107 particles/µg protein in 2D to 1.6 × 108 ± 8.3 × 106 particles/µg protein in 3D. Total MSC-EVs as well as CD73-CD90+ MSC-EVs were elevated in 2D normoxic conditions. The EV concentration and size did not differ significantly between normoxic and hypoxic conditions. CONCLUSION: The production of MSC-EVs in a 3D bioreactor system under hypoxic conditions resulted in increased EV concentration and purity. This system could be especially useful in screening culture conditions for the production of 3D-derived MSC-EVs.

Retroauricular lymph node flap: An anatomic and surgical feasibility study.

BACKGROUND: The study investigated the anatomy of the retroauricular lymph node (LN) flap and evaluate its surgical feasibility as a new donor site for a free LN flap in lymphedema surgery. METHODS: Twelve adult cadavers were examined. The course and perfusion of the anterior auricular artery (AAA) and the location and sizes of the retroauricular LNs were studied. RESULTS: The AAA was available in 87% and absent in 13% specimens. The AAA's origin had a mean vertical distance of 12.2 ± 6.9 mm and a mean horizontal distance of 19.1 ± 4.2 mm from the superior attachment of the ear. The mean diameter of the AAA was 0.8 ± 0.2 mm. The mean number of LN per region was 7.7 ± 2.3, with an average LN size of 4.1 ± 1.9 × 3.2 ± 1.7 mm. The LN were categorized into anterior (G1) and posterior (G2) groups, with a total of 59 and 10 LN, respectively. In a cluster analysis, three LN clusters could be detected across the anterior group (G1). CONCLUSIONS: The retroauricular LN flap is a delicate but feasible flap with reliable anatomy, containing a mean of 7.7 LNs.

Monitoring intra-abdominal pressure after liver transplantation in children.

IAH after LTX can impair perfusion and threaten graft viability. This study aimed to assess the feasibility of longitudinal IAP measurements as an IAH screening method in children after LTX. A cohort of 23 children with a mean age (range) 3.1 (3 months-14 years) who underwent LTX between May 2017 and February 2018 were evaluated retrospectively. Longitudinal IAP measurements were compared to bedside Doppler US monitoring data. In total, 425 IAP measurements and 257 US examinations were performed. The mean ± SD (range) time expenditure for IAP measurement was 1.9 ± 0.4 (0.5-3.2) minutes. The mean post-operative IAP was 7.9 ± 3.6 (1-25) mm Hg. IAH (IAP ≥ 10 mm Hg) was noted in 102 (24%) of 257 measurements. Agitation had a significant impact on IAP (estimate: 9.3 mm Hg, CI: 6.72-11.97, P < .01). In patients with TAC, IAP was increased (6.7 ± 2.1 vs 8.7 ± 3.1 mm Hg, P = .02) while peak portal venous velocities decreased (38 ± 27 vs 26 ± 22 cm/s, P = .03) after patch reduction. An abdominal compartment syndrome with severely impaired vascular flow was noted in one patient. Episodes of elevated IAP were noted in a large proportion of patients, underscoring the need for IAP monitoring in pediatric liver transplant recipients. The safety and low time expenditure associated with IAP measurement could be included easily into standard nursing procedures for these patients.

Arterial catheterisation in neonates can result in severe ischaemic complications but does not impair long-term extremity function.

AIM: We evaluated the incidence of arterial catheterisation and analysed the risk factors and the extent and outcome of ischaemic complications in neonates. METHODS: This was a retrospective cohort study of 1506 neonates admitted to two, ten-bed neonatal intensive care units (NICUs) at the Medical University of Vienna, Austria, between 1 January 2011 and 31 December 2014. Medical charts, daily reports and photo documentation were reviewed for arterial catheterisation and ischaemic complications. Patients with severe ischaemic complications were followed up to evaluate extremity function, scaring and cosmetic results. RESULTS: There were 542 arterial catheterisations in 485 patients, including 275 born below 28 weeks, which resulted in severe complications in 19 of 485 (4%) patients. Three died before follow-up. Patients with complications had a significantly lower birthweight, lower postmenstrual age and higher rates of intracranial haemorrhage, retinopathy of prematurity and necrotising enterocolitis. They had also undergone multiple arterial catheterisations more often, needed longer inotropic support and had longer NICU stays than patients without complications. Extremity function was unimpaired in ten of 16 patients with severe ischaemic complications. CONCLUSION: Severe ischaemic complications in neonates following arterial catheterisation were rare events, but could cause devastating damage. Most patients didn't show impaired extremity function at follow-up.

Wound Healing Effect of Conditioned Media Obtained From Adipose Tissue on Human Skin Cells: A Comparative in Vitro Study.

BACKGROUND: Split-thickness skin grafting is the gold standard to cover extensive acute and chronic wounds with a well-vascularized wound bed. Although some headway has been made in developing biological agents to speed up healing, there is still no treatment that sufficiently replaces skin grafts to date. The use of secretory factors of adipose tissue may be a feasible approach to developing topical wound applications for faster wound healing. METHODS: In this study, the effect of conditioned media (CMs) of human adipose-derived stem cells (ASCs), adipocytes, or adipose tissue on human skin cells was evaluated for viability, proliferation, and migration in vitro. Differentiation potential of stem cells treated with CM was monitored by AdipoRed staining and qualitative real-time polymerase chain reaction. Angiogenic potential of human endothelial cells treated with CM was tested via sprouting assay. RESULTS: The CM of adipose tissue significantly enhanced ASC proliferation (P < 0.01). Treatment with CM showed no inductive effect on ASC differentiation into adipocytes but, at the same time, significantly induced cell sprouting of endothelial cells (P < 0.001). We show for the first time that CM of adipose tissue is a potent inducer of proliferation of ASCs and angiogenesis, with comparable effects with those of stem cell-enriched CM. CONCLUSIONS: We suggest the use of the secretome of adipose tissue to produce CM for topical application on wounds, rather than working with adipose tissue or including the difficult process of enriching the patients' stem cells in vitro.

Osteopontin promotes aromatase expression and estradiol production in human adipocytes.

Breast and endometrial cancer are often estrogen dependent, and their incidence and mortality are increased by obesity in postmenopausal women. Osteopontin (OPN) is a cytokine strongly upregulated in adipose tissue (AT) in obesity. OPN function is potentiated by cleavage by matrix metalloproteinases (MMP). OPN and MMPs play a role in cancer development and are prognostic markers in breast cancer progression. While induction of the estrogen-synthesizing enzyme aromatase by TNFa and IL1 has been shown in preadipocytes, an impact of OPN on aromatase expression in AT has not been investigated yet. Gene expression was determined in AT samples of 21 morbidly obese and matched non-obese subjects. Primary human adipocytes were treated with full-length OPN or MMP-cleaved OPN (cOPN). Protein and mRNA expressions were analyzed from cell lysates, or cells were subsequently supplied with testosterone to determine estradiol production and for indirect co-culture with the estrogen-dependent MCF-7 cell line. Aromatase expression strongly correlated with gene expression of OPN and various MMPs in visceral and MMPs in subcutaneous AT, but not with TNFα expression in both tissues. In vitro, cOPN more effectively than full-length OPN upregulated aromatase mRNA in adipocytes and significantly increased aromatase protein level and estradiol production, leading to increased MCF-7 growth in indirect co-culture. OPN and MMPs are upregulated in AT in obesity, and MMP-cleaved OPN is particularly effective in inducing aromatase activity in human adipocytes. Thereby, obesity-induced OPN expression in AT may contribute to estradiol production and thus to the association of obesity with estrogen-dependent cancers.

[Hairiness and Skin Colouration after Breast Reconstruction with a Deep Inferior Epigastric Perforator Flap and Reconstruction of the Nipple-Areolar Complex]. / Behaarungszustand und Hautkolorit nach Brustrekonstruktion mittels Deep Inferior Epigastric Perforator-Lappenplastik und anschließender Rekonstruktion des Mamillen-Areolen-Komplexes.

INTRODUCTION: Although DIEP (deep inferior epigastric perforator) is the gold standard for breast reconstruction, long-term results with a view to postoperative hairiness and flap skin colouration have rarely been described in the literature. METHODS: Patients who underwent DIEP flap breast reconstruction followed by NAC reconstruction between 2010 and 2019 were invited to our clinic for a survey and a clinical examination. A total of 781 patients were invited. The survey included the BREAST-Q and a study-specific questionnaire. The clinical examination contained specific measurements regarding postoperative hairiness and skin colouration. RESULTS: A total of 179 patients were examined, with 203 breasts having been reconstructed. Only breasts with a visible flap skin island were taken into further evaluation. A total of 109 DIEP flap and 77 NAC reconstructions were evaluated. In the patient-reported survey, 27.5% (30 of 109) reported additional flap hairiness and 62.4% (68 of 109) reported differences in flap skin colouration compared with the surrounding skin. The clinical examination revealed a significant difference between the skin colouration of the flap compared with the surrounding skin and the skin colouration of the reconstructed NAC compared with the existing original NAC. In both cases, the reconstructions appeared significantly "lighter" (p<0.05). No significant difference was found between patients with and without hair in terms of overall satisfaction evaluated by using the BREAST-Q. Neither did the colour difference have a significant influence on patients' satisfaction. CONCLUSION: Additional breast hairiness and different skin colouration is relevant and should be communicated preoperatively.

Spheroid trilineage differentiation model of primary mesenchymal stem/stromal cells under hypoxia and serum-free culture conditions.

Due to their unique properties, human mesenchymal stem/stromal cells (MSCs) possess tremendous potential in regenerative medicine, particularly in cell-based therapies where the multipotency and immunomodulatory characteristics of MSCs can be leveraged to address a variety of disease states. Although MSC-based cell therapeutics have emerged as one of the most promising medical treatments, the clinical translation is hampered by the variability of MSC-based cellular products caused by tissue source-specific differences and the lack of physiological cell culture approaches that closely mimic the human cellular microenvironment. In this study, a model for trilineage differentiation of primary adipose-, bone marrow-, and umbilical cord-derived MSCs into adipocytes, chondrocytes and osteoblasts was established and characterized. Differentiation was performed in spheroid culture, using hypoxic conditions and serum-free and antibiotics-free medium. This platform was characterized for spheroid diameter and trilineage differentiation capacity reflecting functionality of differentiated cells, as indicated by lineage-specific extracellular matrix (ECM) accumulation and expression of distinct secreted markers. The presented model shows spheroid growth during the course of differentiation and successfully supports trilineage differentiation for MSCs from almost all tissue sources except for osteogenesis of umbilical cord-derived MSCs. These findings indicate that this platform provides a suitable and favorable environment for trilineage differentiation of MSCs from various tissue sources. Therefore, it poses a promising model to generate highly relevant biological data urgently required for clinical translation and therefore might be used in the future to generate in vitro microtissues, building blocks for tissue engineering or as disease models.

The use of a polylactide-based copolymer as a temporary skin substitute in deep dermal burns: 1-year follow-up results of a prospective clinical noninferiority trial.

Deep dermal burns can be covered with different kind of materials and techniques; one of them is a polylactide-based temporary skin substitute. The aim of this study was to intraindividually compare its 1-year outcome with the results obtained by use of autologous skin grafts in patients suffering from deep dermal burns. A prospective noninferiority trial was designed in order to assess skin quality and scar formation by use of subjective (Vancouver Scar Scale; Patient and Observer Scar Assessment Scale) and objective (noninvasive cutometry) burn scar assessment tools. All items of the Patient and Observer Scar Assessment Scale, except vascularity, were found to be noninferior in the areas covered with the temporary skin substitute vs. autologous skin. Results of objective scar evaluation showed comparable viscoelastic parameters without reaching noninferiority. Overall, the outcome of deep dermal burns covered with a polylactide-based temporary skin substitute revealed satisfactory results in terms of scar formation and skin quality as compared with autologous skin. This paper supports its use in deep dermal burns, where autologous skin donor sites require either to be reserved for coverage of full-thickness skin defects in severe burns or to be saved for reduction of additional morbidity in selected patient collectives.

Decreasing Time Intervals in Recurring Capsular Contracture? A Single Center Retrospective Study over 6 Years.

Although breast implants of the current generation can, in principle, remain in the body for life, follow-up operations of the augmented or reconstructed breasts are regularly necessary. Capsular contracture is the leading cause for revisional surgery. The aim of this study was to evaluate indications and changes in time intervals between consecutive implant replacements with a focus on capsular contracture. Methods: In the period from 2012 to 2017, all patients with breast implant replacements or removals at our institution were identified. From the medical file, the time of the first implantation and earlier replacements were analyzed for indication and timing of surgery. Results: A total of 498 operations for implant replacement or removal were analyzed in 323 patients. Including prior operations, 717 procedures could be evaluated. If capsular contracture was the indication, revision surgery was performed on average 14.3 years or 8.4 years in aesthetic or reconstructive cases, respectively. In patients with more than one implant removal or replacement, we saw a reduction in the time interval between the first, second, and third follow-up operation. Conclusions: The main indication to perform implant replacements or removals was capsular contracture recurring at increasingly shorter intervals. Patients must be informed about this possible progression when changing implants, but also before the first operation. If capsular contracture occurs after a rather short time period in reconstructive cases, the opportunity of an alternative approach (eg, autologous reconstruction) instead of a renewed implant change should be discussed with the patient.

[Comparison of Two Umbilicoplasty Techniques in 72 Patients after Breast Reconstruction with a Free DIEP Flap] / Vergleich zweier Techniken der Umbilikoplastik bei 72 Patientinnen nach Brustrekonstruktion mit freier DIEP-Lappenplastik.

INTRODUCTION: The appearance of the umbilicus after DIEP flap surgery or abdominoplasty plays an important role in aesthetic perception (1). Although the umbilicus has no function, there is no doubt about the importance of its shape for the self-esteem of patients, especially after breast cancer (2). In the present study, we compared two of the preferred techniques described in the literature on 72 patients in terms of aesthetic outcome, complications and sensitivity: the caudal flap (domed shape) and the oval shape of the umbilicus. PATIENTS AND METHODS: Seventy-two patients who underwent a DIEP flap for breast reconstruction between January 2016 and July 2018 were retrospectively included in this study. Two techniques for umbilical reconstruction were compared: the transverse oval shape of the umbilicus and umbilicoplasty using a caudal flap, which results in a dome shape of the umbilicus. To compare the aesthetic results, an evaluation by the patients and an assessment by three independent plastic surgeons were carried out at least 6 months postoperatively. Patients and surgeons were asked to rate the general appearance of the umbilicus, including scarring and shape, on a scale from 1 to 6 (1=very good, 2=good, 3=fair, 4=sufficient, 5=poor, 6=insufficient). Furthermore, the occurrence of wound healing disorders was examined, and patients were asked about the sensitivity of the umbilicus. RESULTS: Both techniques showed similar degrees of aesthetic satisfaction (p=0,49) as part of the patients' self-assessment. The plastic surgeons gave the caudal flap technique a significantly better rating than the umbilicus with a transverse oval shape (p=0,042). More wound healing disorders occurred in the caudal lobule (11,1%) compared with the transverse oval umbilicus. However, this was not significant (p=0,16). A surgical revision was not necessary. The caudal flap umbilicus showed a tendency to improved sensitivity (60 vs. 45%), but this was not significant (p=0,19). CONCLUSION: Patient satisfaction showed similar results for the two methods of umbilicoplasty. On average, both techniques were given a good rating for their results. However, surgeons rated the caudal flap umbilicoplasty as more aesthetically pleasing.

Coenzyme Q10 does not enhance preadipocyte viability in an in vitro lipotransfer model.

BACKGROUND: Autologous fat is an attractive soft-tissue filler in plastic and reconstructive surgery. The success of the procedure relies strongly on the technique of transferring viable preadipocytes. Among other factors, preadipocyte viability is impaired by local anesthetics. Application of coenzyme Q10 is being performed by aesthetic plastic surgeons to enhance the success of lipotransfer. The aim of this study was to evaluate the effect of Q10 on preadipocyte viability with special regard to impairment after lidocaine treatment. METHODS: Preadipocytes were pretreated with coenzyme Q10 or vehicle control followed by incubation with lidocaine for 30 min. Viability and apoptosis were assessed by FACS analysis and Western blot. RESULTS: Coenzyme Q10 did not improve viability nor have any effect on investigated apoptosis parameters. Preadipocyte viability was reduced after lidocaine treatment. Surface binding of annexin V, cleavage of caspase-3, and abundance of subdiploid cells were not detectable though, suggesting that necrosis rather than apoptosis is the cause for reduced preadipocyte viability. CONCLUSION: Our results indicate that Q10 does not improve preadipocyte viability. Preadipocyte cell death induced by lidocaine is not caused by apoptosis but by necrosis, which cannot be prevented by coenzyme Q10. These findings should be taken into account when searching for solutions to improve preadipocyte viability in the context of soft tissue engineering and autologous fat transfer.

Sichere Diagnostik der Implantatrotation im hochauflösenden Ultraschall in Abhängigkeit vom Implantathersteller.

Rotation of an anatomical breast implant may require revisional surgery. High-resolution ultrasound can help determine the exact implant alignment. However, the directional markings of anatomical implants are implemented very inconsistently by manufacturers. Therefore, a definite diagnosis is often not possible without precise knowledge of the expected imaging. The aim of this work is a differentiation of the imaging of common implant brands in high-resolution ultrasound. Methods To simulate an authentic imaging, anatomical implants were viewed through abdominal skin thinned to 1.5-2 cm, which was obtained during a classic abdominoplasty. Implants from the companies Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech and Sebbin were compared. The marking positions and dimensions were documented by ultrasound. Results Based on placement and shape, a clear allocation between alignment and manufacturer is basically possible among the implants used. The base plate and caudal markers could be clearly visualised for all brands. In Polytech implants, however, the visible structural change is limited to a very small central area. The visualisation of directional marks, base plate and implant shell also allow conclusions to be drawn about the manufacturer. In high-resolution ultrasound, a fast and reliable diagnosis of implant alignment is possible for all implants examined. Also it was possible to make a clear allocation between implant and manufacturer in this context. Flip over of the implant can also be reliably depicted. The cataloguing of the markings summarised here can be used to determine the exact alignment of the implant and thus provide diagnostic certainty, especially if the brand is unknown.

Topische Applikation von Tranexamsäure im Rahmen der subkutanen Mastektomie bei Frau-zu-Mann Transidentität.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic drug that can be used to treat and prevent bleeding. Its application in plastic and reconstructive surgery has been very limited to date. To our knowledge, there is a lack of published data on the topical application of TXA in transgender patients undergoing subcutaneous mastectomy. METHODS: We performed a retrospective data analysis of female-to-male transgender patients who underwent subcutaneous mastectomy. A total of 22 patients were treated with topical TXA, while 29 patients served as controls. The primary endpoint was the amount of wound secretion in the first 48 hours after surgery. Secondary endpoints were the duration of drainage and the occurrence of postoperative bleeding. RESULTS: Within the first 48 hours, the TXA group had an average drain volume of 97±50 ml compared with 180±111 ml in the control group (p<0.01). There was a significantly lower flow rate over the entire period in the group of TXA patients (113±86 ml vs. 265±197 ml). The time of drains in situ was 2.3±0.7 days in TXA patients, while the drains in the control group were in place for an average of 3.4±1.3 days (p<0.01). In the group of patients treated with TXA, there was a tendency towards a lower number of postoperative bleeding and haematoma (9vs. 17%). DISCUSSION: There was a significant reduction in the amount of drain fluid within the first 48 hours and over the entire period after topical application of TXA. Also there was a reduction in the length of time patients had a drain in place in the TXA-treated patients. This study demonstrated a significant advantage for the topical application of TXA in subcutaneous mastectomy in female-to-male transgender patients.

Electrical injury: a long-term analysis with review of regional differences.

Due to its relatively small share among burn injuries, published data on electrical injuries remain scarce, and differ in patient collectives due to infrastructural differences. We have retrospectively analyzed records of 56 patients who were admitted because of electrical injury to our burn center from 1994 to 2008, compared results with the current literature, and focused our review on regional differences. Patients in our collective were predominantly young men (71%, n = 40/56) and those who resulted from work-related accidents (59%, n = 33/56). The mean total burn surface area was 26%. In all, 93% of patients needed at least 1 operation, with 43% of patients requiring at least 1 surgical intervention during a follow-up hospital stay. The mean length-of-stay was 44 days. Two patients died, accounting for a mortality rate of 3.6%. When comparing high to low-voltage injuries, patients in the former group were significantly younger, had more operations, and required a longer length-of-stay. With respect to work-related high-voltage injuries, job-specific male-predominance explains for the demographic distribution of admissions. Low-voltage injuries continue to have low mortality rates in this part of Europe, most likely as a result of established high security standards as well as access to emergency treatment with subsequent intensive and specialist surgical care.

Adipose tissue engineering: three different approaches to seed preadipocytes on a collagen-elastin matrix.

BACKGROUND: Millions of plastic and reconstructive surgical procedures are performed each year to repair soft-tissue defects that result from significant burns, tumor resections, or congenital defects. Tissue-engineering strategies have been investigated to develop methods for generating soft-tissue. Preadipocytes represent a promising autologous cell source for adipose tissue engineering. These immature precursor cells, which are located between the mature adipocytes in the adipose tissue, are much more resistant to mechanical stress and ischemic conditions than mature adipocytes. To use preadipocytes for tissue-engineering purposes, cells were isolated from human adipose tissue and seeded onto scaffolds. Once processed, preadipocytes become subject to the human tissue act and require handling under much tighter regulations. Therefore, we intended to identify any influence caused by processing of preadipocytes prior to seeding on the reconstructed adipose tissue formation. MATERIAL AND METHOD: Human preadipocytes were isolated from subcutaneous adipose tissue obtained from discarded tissue during abdominoplasties of healthy men and women. Preadipocytes were divided into 3 groups. Cells of group I were seeded onto the scaffold directly after isolation, cells of group II were proliferated for 4 days before seeding, and cells of group III were proliferated and induced to differentiate before seeded onto the scaffold. A 3-dimensional scaffold (Matriderm, Dr. Otto Suwelack Skin and Health Care GmbH, Billerbeck, Germany) containing bovine collagen and elastin served as a carrier. Fourteen days after isolation, all scaffolds were histologically evaluated, using hematoxylin and eosin, anti-Ki-67 antibody, as well as immunofluorescence labeling with Pref-1 antibody (DLK (C-19), peroxisome proliferator-activated receptor gamma antibody, and DAPI (4',6-diamidino-2-phenylindole). RESULTS: Cells of all groups adhered to the scaffolds on day 21 after isolation. Cells of groups I (freshly isolated preadipocytes) and II (proliferated preadipocytes) adhered well and penetrated into deeper layers of the matrix. In group III (induced preadipocytes), penetration of cells was primarily observed to the surface area of the scaffold. DISCUSSION/CONCLUSION: : The collagen-elastin matrix serves as a useful scaffold for adipose tissue engineering. Freshly isolated preadipocytes as well as proliferated preadipocytes showed good penetration into deeper layers of the scaffold, whereas induced preadipocytes attached primarily to the surface of the matrix. We conclude that there might be different indications for each approach.

[Treatment of phyllodes tumours of the breast: evaluation of 66 cases and literature review]. / Zur Therapie von Phylloides-Tumoren der Brust ­ eine Aufarbeitung von 66†Fällen mit Literaturübersicht.

Phyllodes tumours (PTs) of the breast are classified as benign, borderline and malignant based on the constellation of defined histological parameters. Surgical excision is the primary therapy, but the need to maintain certain safety margins is still controversially discussed for all three categories.This paper aims to provide a critical opinion on the existing recommendation on safety margins for resection.In our breast centre, all patients with phyllodes tumours were identified retrospectively on the basis of the histopathological documentation from 1999 to 2018. The cases were evaluated, in particular, with a view to recurrences and the occurrence of multicentricity.A total of 66 patients were diagnosed with a PT. In 38 cases, the tumours were benign, in 15 borderline and in 13 malignant. Local recurrences were observed in one benign PT, 7 borderline and 5 malignant PTs. Two PTs that were initially classified as borderline tumours progressed to malignant PTs. Multicentricity occurred in about 20 % of borderline and malignant PTs but only in 5 % of benign PTs.The resection margins for phyllodes tumours should be chosen depending on dignity and recurrence. The key question to be challenged is whether or not there is a need to maintain a certain safety margin in benign PTs. In case of recurrence of borderline or malignant PTs, a mastectomy should be considered early.

[How well are patients informed on the websites of German university breast centres about the possibilities of breast reconstruction?] / Wie gut werden Patientinnen auf Internetseiten von deutschen universitären Brustzentren über die Möglichkeiten der Brustrekonstruktion informiert?

INTRODUCTION: In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities? METHODS: A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling. RESULTS: A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Of those homepages, 20 % contain a direct link. 91 % of the homepages describe the possibility of breast reconstruction in general, 80 % of the websites the use of autologous tissue. In 51 % of the cases, a free tissue transfer is mentioned, whereas only 23 % describe the procedures like DIEP flap, TMG, or I-GAP in more detail. Only two centres use detailed illustrations. Six websites (17 %) describe reconstruction by pedicled TRAM flap only. Breast reconstruction with a silicone implant is mentioned on 71 % of the websites. The possibility of lipofilling is discussed in 31 %. DISCUSSION: About half of the websites of university breast centres do not show any cooperation with a plastic surgeon. There are significant gaps in the information on free tissue transfer for breast reconstruction.

Viability of preadipocytes in vitro: the influence of local anesthetics and pH.

BACKGROUND: Autogenous fat transfer with lipoinjection for soft tissue augmentation is a commonly used surgical technique. Abundant donor tissue availability and relative ease of harvesting have made autologous fat an attractive soft tissue filler. The overall reliability of this technique is often disputed, and different authors describe different results after autologous fat transplantation despite using similar techniques. In this study, we examined the influence of different local anesthetics commonly used in fat harvest and the pH of the anesthetic solution on the viability of harvested preadipocytes. METHODS AND MATERIALS: Preadipocytes were incubated with 1% lidocaine, 1% articaine plus epinephrine 1:200,000, 0.75% ropivacaine, and 1% prilocaine or our standardized tumescent solution (1 L of 0.9% sodium chloride solution plus 25 mL of 1% articaine plus epinephrine 1:200,000 plus 25 mL of bicarbonate) for 30 minutes. Additionally, we incubated cells with the local anesthetics as described above but diluted 1:2 with phosphate buffered saline (pH 7.4). Viability was measured using trypan blue dying as well as propidium iodine staining and fluorescence-activated cell sorting analysis. RESULTS: There are significant differences in the viability of preadipocytes under the influence of various local anesthetics. DISCUSSION: Our data could partially explain the varying results after autogenous fat transfer.

Pathophysiology of burns.

Burn injury represents a significant problem worldwide. Advances in therapy strategies, based on better understanding of the pathophysiologic responses after burn injury have improved the clinical outcome of patients with burn injuries over the past years. This article describes the present understanding of the pathophysiology of a burn injury including both the local and systemic responses, focusing on the many facets of organ and systemic effects directly resulting from hypovolemia and circulating mediators following burn trauma.