Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients.

BACKGROUND: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. METHODS: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. RESULTS: The median body mass index was 35.2 kg/m2 (range 28.5-53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0-34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3-32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. CONCLUSION: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

Extended Perfusion Parameter Estimation from Hyperspectral Imaging Data for Bedside Diagnostic in Medicine.

Background: Hyperspectral Imaging (HSI) has a strong potential to be established as a new contact-free measuring method in medicine. Hyperspectral cameras and data processing have to fulfill requirements concerning practicability and validity to be integrated in clinical routine processes. Methods: Calculating physiological parameters which are of significant clinical value from recorded remission spectra is a complex challenge. We present a data processing method for HSI remission spectra based on a five-layer model of perfused tissue that generates perfusion parameters for every layer and presents them as depth profiles. The modeling of the radiation transport and the solution of the inverse problem are based on familiar approximations, but use partially heuristic methods for efficiency and to fulfill practical clinical requirements. Results: The parameter determination process is consistent, as the measured spectrum is practically completely reproducible by the modeling sequence; in other words, the whole spectral information is transformed into model parameters which are easily accessible for physiological interpretation. The method is flexible enough to be applicable on a wide spectrum of skin and wounds. Examples of advanced procedures utilizing extended perfusion representation in clinical application areas (flap control, burn diagnosis) are presented.

Impact of sympathetic renal denervation: a randomized study in patients after renal transplantation (ISAR-denerve).

BACKGROUND: Sympathetic overactivity is frequently observed following renal transplantation (RTx), and post-transplant hypertension is a major contributing factor to graft failure and cardiovascular morbidity. This process is perpetuated by preservation of sympathetic afferent activity from the native non-functional kidneys, in the absence of efferent feedback to the renal transplant, which would otherwise modulate neurohumoral activity. We investigated the feasibility and efficacy of renal sympathetic denervation (RDN) in renal transplant recipients. METHODS: Patients (n = 18) with post-transplant hypertension were randomized 1:1 to receive RDN or medical treatment alone. The primary efficacy end point was change in office systolic blood pressure (SBP) and mean 24-h ambulatory blood pressure monitoring (ABPM) at 6 months. Safety end points were changes in renal function or renovascular complications. RESULTS: After 6 months, patients in the RDN group had a significant reduction in office SBP of 23.3 ± 14.5 mmHg (P = 0.001 for change difference between the groups). In ABPM, nocturnal blood pressure was reduced in the RDN group by -10.38 ± 12.8 mmHg (P = 0.06), whereas no change was measured during the day. In the RDN group, significantly more patients converted from non-dippers to dippers (P = 0.035). There were no adverse safety events in either group. CONCLUSION: RDN is feasible and safe in renal transplant recipients. However, larger sham-controlled studies will be necessary to clarify the potential role of RDN in this population. CLINICAL TRIAL REGISTRATION: NCT01899456.

[Postbariatric plastic surgery for body reconstruction]. / Postbariatrische plastische Körperrekonstruktionen.

Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery.

The Impact of Technical Innovations and Donor-Site Mesh Repair on Autologous Abdominal-Based Breast Reconstruction-A Retrospective Analysis.

Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety.

First Preliminary Clinical Experiences Using Hyperspectral Imaging for Burn Depth Assessment of Hand Burns.

The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment, often subjective depending on the experience of the physician. Hyperspectral imaging (HIS) is intended to improve on this subjective diagnosis by accurate and objective analyses of perfusion parameters. The purpose of this study was to analyze the ability of technical burn depth assessment and to investigate a link between a certain value to burn depth versus the value of healthy skin references. One hundred and eighteen HSI analyses were included in this study between July 2017 and July 2019. We analyzed 74 recordings with dorsal hand burns and 44 recordings of healthy skin on the dorsal hand as control group. HSI recordings' investigation was performed with special interest to wound center, intermediate zone, and wound margin. The results indicate that a differentiation between burned tissue and healthy skin was feasible and also significant in almost all HSI analysis parameters (P < .05). No significant distinction between superficial and deep partial thickness burns could be determined. However, in the wound center, we recorded smaller values with a more pronounced tissue damage. Our preliminary results demonstrate that HSI can distinguish between normal and burned hands. However, as currently used, HSI could not accurately determine the depth of indeterminate burns.

Evaluation of hyperspectral imaging as a modern aid in clinical assessment of burn wounds of the upper extremity.

The most common burn wound assessment continues to be the clinical inspection and the tactile examination, which are subjective and remain challenging even for experienced burn surgeons. Recently, hyperspectral imaging camera systems have been increasingly used to support the evaluation of burn wounds. The aim of our study was to determine if hyperspectral imaging analysis differentiates and objectifies the assessment of burn wounds in burns of the upper extremities. We included 97 superficial partial, deep partial dermal burns, and full thickness burns. Hyperspectral imaging analysis was performed for all burns using proprietary software. The software recorded parameters for tissue oxygenation (StO2), tissue hemoglobin index, and near-infrared perfusion. These values were compared with the recordings for healthy, non-burned skin. We found that hyperspectral imaging analysis effectively differentiates burn wounds and shows the ability to distinguish even superficial partial burns from deep partial burns in the near-infrared perfusion analysis feature. Although, it was not possible to differentiate burn wounds in all features. Currently, it is important to optimize the respective reference values of the individual burn degrees for an objectified assessment.

3D-perfusion analysis of burn wounds using hyperspectral imaging.

BACKGROUND: Determination of the depth of burn wounds is still a challenge in clinical practise and fundamental for an optimal treatment. Hyperspectral imaging (HSI) has a high potential to be established as a new contact-free measuring method in medicine. From hyperspectral spectra 3D-perfusion parameters can be estimated and the microcirculatory of burn wounds over the first 72h after thermal injury can be objectively described. METHODS: We used a hyperspectral imaging camera and extended data processing methods to calculate 3D-perfusion parameters of burn wounds from adult patients. The data processing results in the estimation of perfusion parameters like volume fraction and oxygenation of haemoglobin for 6 different layers of the injured skin. The parameters are presented as depth profiles. We analyzed and compared measurements of wounds of different degrees of damage and present the methodology and preliminary results. RESULTS: The depth profiles of the perfusion parameters show characteristic features and differences depending on the degree of damage. With Hyperspectral Imaging and the advanced data processing the perfusion characteristics of burn wounds can be visualized in more detail. Based on the analysis of this perfusion characteristics, a new and better reliable classification of burn degrees can be developed supporting the surgeon in the early selection of the optimal treatment.

[Objective burn depth assessment of hand burns]. / Objektive Tiefenbestimmung von Verbrennungen der Hand.

The depth assessment of thermal wounds is subject to many variables. Therefore, technical systems are increasingly being used to determine severity. Particularly hand burns can have clinically relevant consequences in terms of function and aesthetic appearance. Hence, a secure assessment for an adequate treatment is necessary.Technical analyzes such as Hyperspectral Imaging, Laser-Doppler-Imaging or Laser-Speckle-Imaging are intended to simplify and objectify the examination by helping to determine the necessary depth of necrectomy and thus to define the skin transplantation area. Furthermore, the diverse technical devices are to improve the functional result, reduce the severity of scarring and cosmetic complaints, and facilitate the evaluation of inexperienced personnel in the field of burn medicine.Therefore, various technical approaches have been pursued, which are largely based on optical principles. The respective devices are not yet used in the standard diagnosis of burn wounds.In future studies it will be necessary to determine an algorithm for the measurement intervals based on the wound dynamics and to evaluate which methodology is superior to the specificity and sensitivity.

[Possibilities and limitations of enzymatic debridement in burns of the hand]. / Möglichkeiten und Grenzen der enzymatischen Lokaltherapie von Handverbrennungen.

Hands are often affected from burns, due to their unprotected exposure to thermal injuries. Burn injuries also pose a major threat for hands as there is a high risk of severe functional and aesthetical disabilities. Bromelain-based enzymatic debridement is a novel treatment alternative for early surgical excision of burn eschar. This case study describes three patients who were treated with enzymatic debridement in deep thermal burns of the hand.

Association of increased CD8+ and persisting C-reactive protein levels with restenosis in HIV patients after coronary stenting.

OBJECTIVES: The life expectancy of HIV-infected patients has recently been increasing. Although the mortality and morbidity associated with AIDS is decreasing, those associated with cardiovascular diseases and percutaneous coronary intervention (PCI) are receiving greater attention. Only limited data regarding coronary restenosis are available in these patients. DESIGN: In this prospective, systematic angiographic follow-up study, we enrolled HIV patients who underwent PCI for de-novo lesions and subsequent routine angiographic follow-up for 6-8 months. Angiographic restenosis was defined as stenosis of at least 50% of the in-segment area. METHODS: Univariate and multivariate analyses were performed to evaluate restenosis and its predictors. RESULTS: Between May 2002 and March 2014, 47 patients with HIV underwent PCI in two high-volume centers in Munich, Germany. Of these patients, 41 with 131 de-novo lesions underwent invasive surveillance. One-quarter of the lesions treated subsequently presented with restenosis. Univariate analysis indicated that CD8 T-cell levels (P = 0.006), serum cholesterol (P = 0.042) and low-density lipoprotein-cholesterol (P = 0.042) levels at baseline, total number of stents (P = 0.047), and C-reactive protein level (P = 0.001) at follow-up were associated with restenosis. Multivariate analysis indicated that CD8 T-cell levels (P = 0.006) and persistent C-reactive protein elevation at 6-month follow-up (P = 0.00013) were independent predictors of restenosis. CONCLUSION: Inflammation, represented by CD8 T-cell levels, and persistent C-reactive protein elevation are independent predictors of angiographic restenosis and should therefore be closely monitored in HIV patients undergoing PCI.