ABSTRACT
BACKGROUND: The aim of this study was to identify prognostic indicators of survival in patients with locally recurrent soft tissue sarcoma (STS) through a long-term follow-up. METHODS: We retrospectively assessed the relationship between post-recurrence survival (PRS) and potential prognostic factors in 135 patients who had experienced local recurrence, which was suitable for further surgical treatment. The median follow-up time after initial recurrence was 12.3 years (95% confidence interval (CI): 10.4-14.2 years). RESULTS: The 5-year estimate of the PRS rate was 53.1% (95% CI: 44.3-61.2%) for the entire series. Patients with negative margins after the final surgery experienced improved survival compared with patients with positive margins (5-year survival: 46.7% (35.2-57.5%) vs 35.5% (23.4-47.8%); P=0.01). In a multivariate analysis, the significant prognostic indicators for PRS were histologic grade, tumour site, time to initial recurrence, the number of recurrences and the surgical margin status attained at the last resection. CONCLUSIONS: Complete surgical resection with microscopically clear margins is desirable in patients with locally recurrent STS. However, when achieving clear surgical margins will require major functional impairment of the extremity, a radical surgical approach should be weighed for the patient in each case.
Subject(s)
Sarcoma/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Prognosis , Prospective Studies , Retrospective Studies , Sarcoma/surgery , Survival Analysis , Survivors , Young AdultABSTRACT
OBJECTIVE: Extravasations account for most iatrogenic injuries. The aim of the study was to analyse the results of surgery in patients with extravasations and to draw conclusions for future treatment. MATERIALS AND METHODS: 24âpatients with soft-tissue defects after extravasations were treated between 1999 and 2009 in our hospital. The cases were analysed retrospectively. We looked at the drugs causing tissue necrosis and the localisation in relation to the number of interventions and reconstruction complexity. RESULTS: In 83â% (nâ=â20) of cases tissue necrosis was caused by chemotherapeutic agents, in 8â% (nâ=â2) by contrast mediums and in 4â% (nâ=â1) by antibiotics and insulin. 70â% of the cases involved the upper extremity, in 30â% the thoracic wall was affected. 38â% of the extravasations occurred over venous access ports. In mean 2â±â1.5âinterventions were necessary for defect coverage. Two patients died as a direct result of the extravasations, one due to sepsis originating from an infected necrosis area and one due to right-heart failure with prior pulmonary damage. CONCLUSION: Most extravasations can be treated without surgery. In cases of toxic extravasations or pressure-caused ischaemia rapid surgical intervention is necessary to prevent the necrosis progressing to deeper tissue layers.
Subject(s)
Extravasation of Diagnostic and Therapeutic Materials/surgery , Iatrogenic Disease , Adult , Aged , Aged, 80 and over , Connective Tissue/pathology , Connective Tissue/surgery , Extravasation of Diagnostic and Therapeutic Materials/etiology , Female , Humans , Male , Middle Aged , Necrosis , Reoperation , Retrospective Studies , Skin/pathologyABSTRACT
STUDY DESIGN: Retrospective chart review. OBJECTIVES: This study was performed to compare the outcome, especially the mortality rate, in patients with and without spinal cord injury (SCI) and necrotizing fasciitis (NF). SETTING: Division of Spinal Cord Injury and Department of Plastic and Hand Surgery, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. METHODS: Twenty-five patients with SCI and thirty patients without SCI treated with NF were included in the study. Mean length of hospital stay, mean age, mean laboratory risk indicator for necrotizing fasciitis (LRINEC) score, mean number of surgical debridements, co-morbidity factors and mortality rate were compared between both groups. RESULTS: There were no differences for the mean LRINEC score (P=0.07), mean number of surgical debridements (P=0.18) and co-morbidities (odds ratio=2.32; 95% confidence interval =0.78-6.92) between both groups. Patients with SCI were significantly younger than patients without SCI (P=0.02). Patients without SCI had a higher mortality risk rate (n=9) than patients with SCI (n=2) (relative risk=1.71; 95% confidence interval =1.13-2.6). CONCLUSIONS: In conclusion, SCI patients have a lower mortality rate than patients without SCI. Age may influence the mortality rate. Nevertheless, we believe that further unknown risk factors might influence the mortality, especially in patients with SCI.
Subject(s)
Fasciitis, Necrotizing/mortality , Fasciitis, Necrotizing/surgery , Spinal Cord Injuries/mortality , Adult , Age Distribution , Comorbidity , Debridement/statistics & numerical data , Female , Humans , Immunocompromised Host/physiology , Length of Stay/statistics & numerical data , Length of Stay/trends , Male , Middle Aged , Postoperative Complications/mortality , Reoperation/statistics & numerical data , Reoperation/trends , Retrospective Studies , Risk Factors , Sex Distribution , Spinal Cord Injuries/immunology , Spinal Cord Injuries/physiopathology , Survival RateABSTRACT
Adequate surgical removal of soft tissue sarcomas of the trunk and extremities employing safety margins of 1-2 cm is the accepted basis of multidisciplinary treatment. In cases of high risk tumors (grades G2/G3) the tumor board decision should include radiochemotherapy under study conditions. Difficult peripheral locations or perioperative complications require additional techniques, such as hyperthermic perfusion with tumor necrosis factor alpha or the complete spectrum of reconstructive plastic procedures. Patients with soft tissue sarcoma of the trunk or of the extremities should always be referred to high volume centers.
Subject(s)
Plastic Surgery Procedures/methods , Sarcoma/surgery , Thoracic Neoplasms/surgery , HumansABSTRACT
Negative surgical margins (R0 resection) play a key role in the prevention of local recurrences of soft tissue sarcoma of the extremities in the multimodal therapy concept. The prognostic relevance for long-term survival is still under dispute. Despite the fact that numerous recommendations and guidelines have existed for over 100 years, strong evidence-based data from prospective randomized studies are still not available today. These studies should include parameters like tumor localization, subtype and biological aggressiveness. Recommendations as to surgical therapy diverge considerably. They range from amputation and compartment resection to centimetre and millimetre surgical margins. The present article analyses currently available data and definitions and discusses the impact on functional restriction, lymph drainage, local recurrence and the perioperative irradiation field. In the absence of surgical standards, it is doubtful whether existing studies and multicenter trials currently underway are valid. Close co-operation between surgeon and pathologist is imperative to further substantiate the significance of histological examinations and resection margins.
Subject(s)
Extremities/surgery , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/prevention & control , Neoplasm, Residual/pathology , Neoplasm, Residual/prevention & control , Sarcoma/pathology , Sarcoma/surgery , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgery , Amputation, Surgical , Chemotherapy, Adjuvant , Combined Modality Therapy , Humans , Muscle, Skeletal/pathology , Muscle, Skeletal/surgery , Neoadjuvant Therapy , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/radiotherapy , Neoplasm Staging , Neoplasm, Residual/drug therapy , Neoplasm, Residual/radiotherapy , Prognosis , Radiotherapy, Adjuvant , Sarcoma/drug therapy , Sarcoma/radiotherapy , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/radiotherapyABSTRACT
Due to social and demographic changes as well as new leisure activities, the number of frostbite injuries in the general population is on the increase. Because the injuries are primarily located on the hands and feet the consequences for those concerned are devastating. We provide help in grading and introduce concrete therapeutic regimes for frostbite which are illustrated by three case reports from our clinical experience with varying risk profiles.
Subject(s)
Foot Injuries/diagnosis , Foot Injuries/therapy , Frostbite/diagnosis , Frostbite/therapy , Leg Injuries/diagnosis , Leg Injuries/therapy , Child , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Plastic Surgery Procedures , Surgeons , Surgery, Plastic , Esthetics , Germany , Humans , RegistriesABSTRACT
OBJECTIVE: Daily wound assessment, including dressing changes and the removal of old ointments causes discomfort for the patient. We therefore developed a new thermoreversible and transparent gel formulation that allows for filling wounds of different shapes and depths. The aim of the study was to investigate the effect of a wound covering gel on wound healing and the skin's microcirculation. MATERIALS AND METHODS: Investigations were carried out in a standardized and reproducible wound model (hairless mice SKH1/hr, n = 30). Three groups were studied by intravital fluorescence microscopy: treatment with polihexanide-preserved wound covering gel, a formulation containing 3% povidone (PVP)-iodine, and physiological saline for control. Microcirculatory standard parameters were analysed. RESULTS: The non-perfused area vanished within 14 days due to angiogenesis. The venular diameter, oedema formation and functional capillary density showed no significant differences between the three groups. CONCLUSION: The use of the newly developed wound covering gel has no toxic effects on microcirculation and angiogenesis and reveals no significant differences in the overall assessment of microcirculation compared to the control group and the well-established PVP-iodine. The transparent antibacterial wound covering gel allows for direct wound assessment. Due to its thermoreversible gel formulation it enables good wound contact and easy handling.
Subject(s)
Anti-Infective Agents, Local/adverse effects , Hexanes/adverse effects , Microcirculation/drug effects , Polymers/adverse effects , Wound Healing/drug effects , Animals , Ear Auricle/injuries , Male , Mice , Mice, Hairless , Occlusive Dressings , Wounds, Penetrating/drug therapyABSTRACT
BACKGROUND: An ideal topical formulation for wound therapy does not exist. The aim of this study was to develop a novel improved therapeutic option for the treatment of acute and chronic wounds. METHODS: A transparent wound gel which is in a liquid state below and in a gel state at or above room temperature was developed. Forty-four patients were included in this open randomized controlled single-center study. Flammazine served as control in the treatment of skin graft donor sites. Wounds were assessed for time of dressing change and overall satisfaction of patients and health care providers. The data were analyzed using the nonparametric Mann-Whitney test. RESULTS: The wound gel proved to be superior in comparison with Flammazine with respect to wound assessment (p = 0.002), staining (p = 0.007), leaking (p = 0.032) and smell (p = 0.034). Flammazine showed favorable results regarding the parameters dehydration of the dressings (p = 0.012) and wound adherence (p = 0.005). The evaluation of the overall dressing change process showed no significant differences. CONCLUSION: The thermoreversible wound gel containing polyhexanide allows for good handling and wound assessment. This study demonstrated a high satisfaction level of patient and health care providers, and the wound gel proved an effective alternative to commonly used treatments.
Subject(s)
Biguanides/therapeutic use , Skin Transplantation , Wounds and Injuries/therapy , Adult , Aged , Anti-Infective Agents, Local/therapeutic use , Bandages , Biguanides/chemistry , Female , Gels , Humans , Informed Consent , Male , Middle Aged , Ointments , Patient Selection , Safety , Silver Sulfadiazine/chemistry , Silver Sulfadiazine/therapeutic use , Viscosity , Wounds and Injuries/pathologyABSTRACT
PURPOSE: The aim of this study was to examine the clinical course of patients with the rare finding of regional lymph node metastasis (RLNM) from soft tissue sarcoma. MATERIALS AND METHODS: Data from 28 out of 1,597 consecutive soft tissue sarcoma patients with RLNM were from the patients' charts and interviewing patients and general practitioners. Survival, including possible influencing factors, was statistically calculated. RESULTS: RLNM was seen in 21.4% for epithelioid sarcoma and 17.6% for clear cell sarcoma. All other entities presented RLNM rates below 10%. At follow-up after an average of 9.6 years, only three patients were alive with no evidence of disease. Survival was independent from surgical resection status of the primary tumor and the RLNM as well as from adjuvant radiation and chemotherapy. Tumor entity as well as the length of the time period from primary to RLNM affect survival. CONCLUSIONS: Surgical treatment as well as radiation and chemotherapy may improve survival in selected cases but probably have their value much more in terms of local disease control and improvement life quality of patients who probably already suffer from an aggressive systemic disease at time of nodal involvement.
Subject(s)
Lymphatic Metastasis/pathology , Sarcoma/pathology , Soft Tissue Neoplasms/pathology , Adolescent , Adult , Chemotherapy, Adjuvant , Child , Child, Preschool , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Staging , Prospective Studies , Radiotherapy, Adjuvant , Sarcoma/drug therapy , Sarcoma/mortality , Sarcoma/radiotherapy , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/mortality , Soft Tissue Neoplasms/radiotherapy , Young AdultABSTRACT
PURPOSE: The objective assessment of wound healing is a challenging task especially in the context of clinical trials. Because the clinical evaluation of wounds and the wound-healing quality is often influenced by the subjective view of the physician, there is great need for a reliable, quantitative and objective wound model that would help to obtain statistically useful data. Here, we present a wound model and non-invasive analysis techniques to evaluate human wound healing. The model described was used in a clinical trial on 167 patients treated with a new wound therapeutic agent. METHODS: The study was conducted on 167 patients receiving split-thickness mesh grafts (1 : 1.5 and 0.1 mm) after reconstructive procedures. The re-epithelialization of the mesh holes and the leakage of wound serum served as the main parameters of wound healing. The quantitative evaluation of the epithelialization rate was performed by photoplanimetry and impedance measurement. These data were correlated with the clinical wound assessment of two independent physicians. RESULTS: The study showed that computer-aided photoplanimetry, in combination with impedance measurement, is a feasible and very useful method to evaluate the re-epithelialization rate of mesh skin grafts. CONCLUSION: The model described is a viable method to evaluate human wound healing in clinical trials.
Subject(s)
Dermoscopy/methods , Outcome Assessment, Health Care/methods , Plethysmography, Impedance/methods , Skin Transplantation/methods , Skin Transplantation/pathology , Skin/pathology , Skin/physiopathology , Wound Healing/physiology , Clinical Trials as Topic/methods , Female , Humans , Male , Treatment OutcomeABSTRACT
OBJECTIVE: Tissue hypoxia after blood loss, replantation and flap reperfusion remains a challenging task in surgery. Normovolemic hemodilution improves hemorheologic properties without increasing oxygen carrying capacity. Red blood cell transfusion is the current standard of treatment with its attendant risks. The aim of this study was to investigate the potential of the chemically modified hemoglobin, MP4, to reduce skin flap necrosis and its effect on selected blood markers and kidneys. MATERIALS AND METHODS: Tissue ischemia was induced in the ear of hairless mice (n=26). Hemodilution was performed by replacing one third of blood volume with the similar amount of MP4, dextran, or blood. The extent of non-perfused tissue was assessed by intravital fluorescent microscopy. RESULTS: Of all groups, MP4 showed the smallest area of no perfusion (in percentage of the ear +/- SEM: 16.3% +/- 2.4), the control group the largest (22.4% +/- 3.5). Leukocytes showed a significant increase in the MP4 and dextran group (from 8.7 to 13.6 respectively 15.4*109/l). On histology no changes of the kidneys could be observed. CONCLUSION: MP4 causes an increase of leukocytes, improves the oxygen supply of the tissue and shows no evidence of renal impairment.
Subject(s)
Cell Hypoxia/drug effects , Hemoglobins/pharmacology , Maleimides/pharmacology , Necrosis/drug therapy , Polyethylene Glycols/pharmacology , Skin/drug effects , Animals , Dextrans/administration & dosage , Dextrans/pharmacology , Disease Models, Animal , Ear/blood supply , Ear/pathology , Hemodilution , Hemoglobins/administration & dosage , Injections , Leukocytes/drug effects , Maleimides/administration & dosage , Mice , Mice, Hairless , Polyethylene Glycols/administration & dosage , Regional Blood Flow/drug effects , Skin/pathology , Surgical Flaps/pathologyABSTRACT
PURPOSE: The aim of this study was to evaluate the in vivo tissue response to low-pressure plasma-pretreated collagen-I-coated titanium implant in a middle-term mouse model. METHODS: Plasma-treated collagen-coated titanium implants were transplanted into the dorsal skinfold chambers of BALB/c mice. Untreated, regular titanium implant material served as control. The neovascularization (functional vessel density) of the implant border zone and of the surrounding muscle tissue was analysed by intravital fluorescence microscopy. Additional histological analysis was performed to observe the inflammatory reaction. RESULTS: Statistical analysis revealed that the vessel density in the border zone of the implants was significantly enhanced in the plasma-treated collagen-I-coated group compared to controls. The histological examination of the two groups confirmed that the inflammatory response to the collagen-coated titanium implants was reduced compared to controls. CONCLUSION: Plasma pretreatment and collagen I coating of titanium implant material leads to an enhanced tissue vascularization and a reduced inflammatory response.
Subject(s)
Collagen Type I/pharmacology , Implants, Experimental/adverse effects , Neovascularization, Physiologic/drug effects , Titanium/pharmacology , Alloys , Animals , Coated Materials, Biocompatible/adverse effects , Female , Materials Testing , Mice , Mice, Inbred BALB C , Microscopy, Fluorescence , RatsABSTRACT
Silicone implant material is widely used in the field of plastic surgery. Despite its benefits the lack of biocompatibility this material still represents a major problem. Due to the surface characteristics of silicone, protein adsorption and cell adhesion on this polymeric material is rather low. The aim of this study was to create a stable collagen I surface coating on silicone implants via glow-discharge plasma treatment in order to enhance cell affinity and biocompatibility of the material. Non-plasma treated, collagen coated and conventional silicone samples (non-plasma treated, non-coated) served as controls. After plasma treatment the change of surface free energy was evaluated by drop-shape analysis. The quality of the collagen coating was analysed by electron microscopy and Time-Of-Flight Secondary Ion Mass Spectrometry. For biocompatibility tests mouse fibroblasts 3T3 were cultivated on the different silicone surfaces and stained with calcein-AM and propidium iodine to evaluate cell viability and adherence. Analysis of the different surfaces revealed a significant increase in surface free energy after plasma pre-treatment. As a consequence, collagen coating could only be achieved on the plasma activated silicone samples. The in vitro tests showed that the collagen coating led to a significant increase in cell adhesion and cell viability.
Subject(s)
Biocompatible Materials , Cell Adhesion , Silicones , 3T3 Cells , Animals , Mice , Microscopy, Electron, Scanning , Microscopy, Fluorescence , Rats , Spectrometry, Mass, Secondary Ion , Surface PropertiesABSTRACT
PURPOSE: Local skin antiseptics are the standard of care for chronic and non-healing wounds. However, little is known about their potential toxic properties. This study investigates the impact of three commercially available and widely used antiseptics on vitality and proliferation of human cutaneous cells. MATERIAL AND METHODS: Three antiseptics, Lavasept (PHMB), Octenisept (octenidine) and Betaisodona (PVP-iodine) were tested for their cytotoxic effects towards HaCaT cells, primary human keratinocytes and fibroblasts using MTT assay and BrDU ELISA. RESULTS: Lavasept showed only slight to moderate toxic effects on cellular vitality and proliferation. Ocentisept and Betaisodona induced severe reduction of cell vitality (p<0.05) to 0% surviving fibroblasts at 7.5% (Betaisodona) and 12.5% Octenisept, respectively. Furthermore, poliferative activity was reduced to 0% in keratinocytes at 7.5% concentration of Betaisodona and Ocentisept. CONCLUSION: This study shows that frequently used wound- and skin antiseptics show severe cytotoxic effects towards cutaneous cells. Furthermore, antimicrobial efficacy and toxic properties must be included in the clinical decision process for optimal therapy of chronic wounds. The PHMB solution Lavasept showed best results regarding toxicity in this study.
Subject(s)
Anti-Infective Agents, Local/toxicity , Cell Division/drug effects , Cell Survival/drug effects , Fibroblasts/drug effects , Keratinocytes/drug effects , Biguanides/toxicity , Cell Line , Dose-Response Relationship, Drug , Humans , Imines , In Vitro Techniques , Povidone-Iodine/toxicity , Pyridines/toxicityABSTRACT
BACKGROUND AND AIMS: Synchronous and heterochronous multiple soft tissue sarcoma of the extremities is very rare. Out of 1,201 of our patients, 4 patients presented with symmetrical bilateral soft tissue sarcoma of the extremities. The aim of this study was to identify possible reasons for this unusual manifestation of sarcomas. MATERIALS AND METHODS: The patients' data was acquired by review of the patients' charts and follow-up information was gathered by phone calls to the patients or their relatives and their general practitioners. RESULTS: All tumours were located at the extremities and were diagnosed as leiomyosarcoma in two patients, malignant fibrous histiocytoma and clear cell sarcoma in one patient each. No other individual or family history of cumulation of neoplasms was known in the patients. The median interval between the diagnoses was 3 1/2 years (range: 4 months to 9 1/2 years). In two patients a second primary sarcoma of the same entity was considered the most likely diagnosis, whereas in one patient a contralateral lymph node metastasis and in one other patient an atypical soft tissue metastasis had to be taken into account. A positive family history with a father with malignant fibrous histiocytoma may indicate a hereditary predisposition in one patient. Aside from irradiation effects, exposition to other carcinogenic agents or genetic predisposition, the reasons for the clustering of soft tissue sarcoma in one same patient remain still unclear. Only one patient, although suffering from disseminated metastatic disease was living at follow-up time, the other three patients had already died. CONCLUSION: The interpretation of the bilateral manifestation of soft tissue sarcoma remains open, but predicts an unfavourable outcome.
Subject(s)
Extremities/surgery , Neoplasms, Second Primary/surgery , Sarcoma/surgery , Soft Tissue Neoplasms/surgery , Adolescent , Adult , Aged , Biomarkers, Tumor/analysis , Female , Follow-Up Studies , Histiocytoma, Malignant Fibrous/pathology , Histiocytoma, Malignant Fibrous/surgery , Humans , Leiomyosarcoma/pathology , Leiomyosarcoma/surgery , Lymphatic Metastasis , Male , Middle Aged , Mitotic Index , Necrosis , Neoplasm Staging , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Neoplasms, Second Primary/pathology , Prognosis , Retrospective Studies , Sarcoma/pathology , Sarcoma, Clear Cell/pathology , Sarcoma, Clear Cell/surgery , Soft Tissue Neoplasms/pathology , Young AdultABSTRACT
The skin plays an important role in the human immune system, working as a barrier to pathologic influences. A chronic wound breaks that barrier and eliminates that function. Affected patients can suffer from significant reductions in quality of life and become socially isolated. The inability to work may have serious economic consequences for the individual and the community. Treating these wounds with novel, evidence-based techniques can accelerate wound healing while reducing the length of in- and outpatient treatment and thereby the overall costs. This article discusses current and future treatment options in wound conditioning, therapy, and regeneration.
Subject(s)
Wounds and Injuries/therapy , Chronic Disease , Forecasting , Humans , Medical Laboratory Science/trends , Negative-Pressure Wound Therapy/instrumentation , Research/trends , Wound Healing/physiology , Wound Infection/etiology , Wound Infection/therapy , Wounds and Injuries/etiologyABSTRACT
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.
Subject(s)
Plastic Surgery Procedures , Registries , Surgeons , Surgery, Plastic , EstheticsABSTRACT
Skin is a substantial immune organ and represents the most important barrier against the potentially hostile environment. Its first line of defense are effector molecules of the innate immune system, which in contrast to the adaptive immune system reacts immediately against penetrating pathogenic microbes. Antimicrobial peptides represent the basis of the phylogenetically oldest part of the immune system. New studies show that reduced local cutaneous expression of antimicrobial peptide in burned skin is involved in the higher incidence of wound infections. The epithelium has an essential function in recognizing colonies of micro-organisms and in initial antimicrobial defenses.
Subject(s)
Anti-Infective Agents/therapeutic use , Bacterial Infections/drug therapy , Immunity, Innate/immunology , Peptides/therapeutic use , Wound Infection/drug therapy , Animals , Antimicrobial Cationic Peptides/physiology , Antimicrobial Cationic Peptides/therapeutic use , Bacterial Infections/immunology , Humans , Immunity, Active/immunology , Neovascularization, Physiologic/immunology , Neutrophils/immunology , Skin/immunology , Skin/microbiology , Wound Infection/immunologyABSTRACT
Despite new techniques and better health programs in western industrialized nations, the numbers of amputations on the lower extremity remain constant. Approximately 100,000 amputations are performed annually in the U.S. and about 10,000 in Germany, more than 90% for gangrene resulting from ischemia and/or infection. Micro- and macroangiopathic changes in diabetes are the major cause of ischemia in the leg. The preservation of limb length and construction of an end bearing stump are important criteria for the functional outcome after amputation. Especially in trauma and tumor patients with "planned" amputations, all effort should be made to achieve an end bearing stump with sufficient length respectively an amputation level that is suitable for orthosis instead of prosthetic supplementation. After amputation, an interdisciplinary approach is mandatory to achieve sufficient soft tissue coverage or stump distalization. In case of insufficient bearing ability of the stump, various reconstructive possibilities must be considered to assure optimal outcome.