[Decompression of the lateral femoral cutaneous nerve of the thigh : Treatment of meralgia paresthetica]. / Operative Dekompression des Nervus cutaneus femoris lateralis : Behandlung der Meralgia paraesthetica.

OBJECTIVE: Treatment of non-responding pain to conservative treatment located at the anterolateral thigh with surgical decompression of the lateral femoral cutaneous nerve of the thigh (LFCN). INDICATIONS: Compression syndrome of the LFCN; patients suffering from the following symptoms: pain (dysesthesia), numbness (paresthesia), hypersensibility to temperature (or temperature changes) along the course of the LFCN located at the anterolateral thigh. CONTRAINDICATIONS: A new or recrudescent hernia with additional pain or recent laparoscopic hernia repair as a supposed iatrogenically induced compression of the LFCN. SURGICAL TECHNIQUE: Dissection and release of the LFCN of connective tissue, scar tissue, bone rims, and retraction located along the passage underneath the inguinal ligament and distally. POSTOPERATIVE MANAGEMENT: Suture removal after 10-14 days, no sports for 2 weeks. Physiotherapy if necessary. Neurography 4 months after surgery (obligatory if symptoms are persistent). The patient should be followed up for about 24 months. RESULTS: Of the patients, 69% had a history of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses and 22% had previous falls. Postoperatively, a significant reduction of pain of 6.6 points on the numeric rating scale was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.

Ski- and snowboard related open peroneal nerve injury: A 20-year retrospective case series study.

INTRODUCTION: Traumatic peroneal nerve injury (PNI) caused by ski or snowboard edges is a severe but scarcely reported accident. METHODS: In a 20-year retrospective study, all skiers and snowboarders with this injury treated surgically at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Innsbruck, Austria, were included, covering a period from 1999/2000 to 2018/2019. RESULTS: In total, 34 patients were included in this study (30 males (88.2%) and 4 (11.8%) females). Of these 34 injured skiers or snowboarders, 33 (97.1%) were recreational athletes and Non-Austrian citizens, and 21 (61.8%) patients sustained accidental injuries without collision. All of the injuries under investigation, i.e., open lacerations, most often with complete transection, were the patients' main injuries. Surgery was performed with direct coaptation in 24 patients (70.6%), and with a suralis nerve graft in the other 10 patients (29.4%). CONCLUSION: Traumatic laceration of the peroneal nerve at the knee level by sharp ski or snowboard edges is a rare but severe injury. Causes for this injury may be multifactorial. Recommendations to reduce the risk of such an injury may follow general instructions and warnings to skiers and snowboarders regarding equipment, familiarity with the region, as well as appropriate skills and training.

[Surgical decompression of the peroneal nerve at the level of the fibular head]. / Operative Dekompression des Nervus peroneus auf Höhe des Fibulaköpfchens.

OBJECTIVE: Functional and sensible regeneration of deficits related to common peroneal nerve palsy. INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait. CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma. SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L­Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage. POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months. RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.

Complex mincer hand injury in a 4-year-old girl: successful revascularization.

We report on a four-year-old girl who suffered a complex mincer injury to the left hand, resulting in a partial amputation of her hand. To salvage the injured hand, revascularization was performed. The indication, advantages and outcome of the procedure are discussed.

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago. In the early post-operative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At one-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2-year follow-up. Transplantation after long-standing amputation results in cortical reorganisation occurring over a two-year period.

[Xanthoma disseminatum: a rare case involving the upper extremity]. / Xanthoma disseminatum -- ein seltener Befall an der oberen Extremität.

We describe a dramatic case of class II non-Langerhans cell histiocytosis, xanthoma disseminatum, in a 30-year-old male patient with progressive involvement of the skin, vocal cords, eyes, bones and nerves in spite of chemotherapy with Vespesid and immunotherapy with interferon-gamma. At the age of 43 years, the patient required surgical clearance of airways, eyelids and peripheral nerves, but at present exhibits stable disease on a combination of lipid-lowering drugs including thiazolidinedione.

Facial reconstruction with a unique osteomyocutaneous DCIA perforator flap variant: a case report.

BACKGROUND: Anatomical variance of the deep circumflex iliac artery is of high clinical value in facial reconstruction using a deep circumflex iliac artery perforator (DCIAP) flap. METHODS: We present the case of a 76-year-old woman treated with an osteomyocutaneous DCIAP flap variant for facial reconstruction. We also review here the literature on DCIA perforator flaps and the different anatomical variances, which might bring clinical benefits. RESULTS: The observed anatomy in our patient offered the possibility to raise a free flap variant with high mobility of a large skin paddle and a long vascular pedicle combined with a variable osteomuscular portion. CONCLUSION: The characteristics of the flap thus raised help overcome the disadvantages of the conventional DCIAP flap and offer excellent options for facial reconstruction.

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

[Autologous fat grafting in breast surgery : results of a retrospective study]. / Lipofilling in Rahmen der Mammachirurgie : Ergebnisse einer retrospektiven Analyse.

BACKGROUND: Autologous fat has many qualities for an ideal filler and is widely used in reconstructive and aesthetic surgery, especially in the treatment of primary and secondary deformities of the breast. METHODS: From May 2007 to September 2012 298 autologous fat graftings were performed in 199 patients. Fat was harvested using the Tissue-Trans™ (Shippert Medical), Lipivage™ (Polytech) or a self-developed harvesting system and injected without any further processing into subcutaneous and/or intramuscular layers. RESULTS: The mean patient age was 45 years. Main indications were contour deformities and volume loss after breast cancer surgery as well as asymmetry, hypoplasia, Poland syndrome or tuberous breasts. The average volume of grafted fat was 90 ml per surgery. Most patients received one (42 %) or two (31 %) sessions of treatment. The infection rate was 2 % which was further treated with oral antibiotics. CONCLUSION: Autologous fat grafting represents an important tool for the management of deformities of the breast not only by filling deformities and adding volume, but also by improving the quality of scars. It is a simple, fast and effective treatment option with few complications.

Transplantation of tracheal epithelial cells onto a prefabricated capsule pouch with fibrin glue as a delivery vehicle.

OBJECTIVE: The purpose of this study was to investigate whether in vitro cultured tracheal epithelial cells can be transplanted onto a prefabricated capsule surface in vivo for possible use in tracheal reconstruction. METHODS: Tracheal epithelial cells from 12 donor inbred rats were harvested for culture and expansion. In 16 recipient inbred rats, 2 sterile cylinders made of silicone rubber were implanted in each rat bilaterally in the folds of both the left and right anterior rectus sheath by wrapping the sheaths around the cylinders to induce a capsule formation. Ten days later, the cell cultures were divided and suspended in 1 of 2 delivery vehicles (standard culture medium or fibrin glue) and implanted onto the capsule surface. To compare the 2 delivery vehicles, we used fibrin glue on one side and the standard culture medium on the other. RESULTS: After 2 (group 1, n = 8) and 4 (group 2, n = 8) weeks, histologic findings, immunohistochemical staining, and electron microscopy demonstrated the capsule to be covered with a tracheal neoepithelium in group 1 and additional ciliated cells and secretory cells in a confluent layer in group 2 but only on the side with fibrin glue as the delivery vehicle. No viable epithelial cells were identified on the side with the standard culture medium in either group. CONCLUSION: We conclude that cultured epithelial cells can be successfully transplanted onto a prefabricated capsule surface with fibrin glue, which will differentiate into morphologic, nearly normal epithelium, showing potential for tracheal reconstruction.

Breast reconstruction facilitated by vertical banded gastroplasty.

BACKGROUND: Vertical banded gastroplasty (VBG) causes weight loss, which is often associated with redundant abdominal tissue. This redundant tissue can be used successfully for breast reconstruction or breast augmentation in case of mastectomy or ptotic hypotrophic breasts. METHOD: One patient with bilateral mastectomy is described in whom the weight fell from BMI 52 to BMI 26 after VBG, giving the patient an abdominal "apron", which facilitated bilateral breast reconstruction. RESULTS: Bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction after weight reduction following VBG resulted in an esthetic pleasing result with additional correction of the cutis laxa abdominis. CONCLUSION: Autologous breast reconstruction can be performed safely with the methods used today, after successful weight loss following obesity surgery.

A comparative study of three different biomaterials in the engineering of skeletal muscle using a rat animal model.

Defects caused by traumatic or postsurgical loss of muscle mass may result in severe impairments of the functionality of skeletal muscle. Tissue engineering represents a possible approach to replace the lost or defective muscle. The aim of this study was to compare the suitability of three different biomaterials as scaffolds for rat myoblasts, using a new animal model. PKH26-fluorescent-stained cultured rat myoblasts were either seeded onto polyglycolic acid meshes or, alternatively, suspended in alginate or in hyaluronic acid-hydrogels. In each of the eight Fisher CDF-344 rats, four capsule pouches were induced by subcutaneous implantation of four silicone sheets. After two weeks the silicone sheets were removed and myoblast-biomaterial-constructs were implanted in the preformed capsules. Specimens were harvested after four weeks and examined histologically by H&E-staining and fluorescence microscopy. All capsules were well-vascularized. Implanted myoblasts fused by forming multinucleated myotubes. This study demonstrates that myoblasts seeded onto different biomaterials can be successfully transplanted into preformed highly vascularized capsule pouches. Our animal model has paved the way for studies of myoblast-biomaterial transplantations into an ectopic non-muscular environment.

Muscle prelamination with urothelial cell cultures via fibrin glue in rats.

The purpose of the study was to transplant autologous cultured urothelial cells onto a muscle via fibrin glue as a delivery vehicle to create a vascularized, living matrix lined with urothelium that could subsequently be used for urinary reconstruction. Bladder tissue specimens from male Wistar rats (n = 32; 350--500 g) were harvested for urothelial tissue culture. After 8--10 days when the primary cultures became confluent, the cultured urothelial cells were injected underneath the rectus sheath onto the rectus muscle. As delivery vehicle we compared standard culture media and fibrin glue. At 1- and 4-week intervals following urothelial cell grafting, sections of the muscle were analyzed for urothelial graft take using Hematoxylin & Eosin and immunohistochemical staining. The histology demonstrated viable, multilayered clusters of urothelium cells on the muscle surface only in the group using the fibrin glue delivery vehicle. We conclude that a muscle can be successfully prelaminated with autologously cultured urothelial cells via fibrin glue and has therefore potential for urinary reconstructions.

Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap.

BACKGROUND: Different methods for managing pilonidal disease have been described in the literature. Recurrence impairs the success of all forms of therapy, but the lowest rates have been reported for reconstructions involving local flaps. Nevertheless, treatment of pilonidal disease with a fasciocutaneous V-Y flap is not a well-established procedure. We have modified the surgical technique and used it selectively for complicated recurrent cases. Our experience with this method is analyzed, and its validity is evaluated. METHODS: Twenty-four patients with recurrent pilonidal sinus undergoing radical excision and reconstruction with our modified fasciocutaneous V-Y advancement flap between 1986 and 1993 were studied retrospectively. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Furthermore, an excellent functional result and acceptable scar pattern were obtained in all twenty-four patients, with a mean follow-up of 4.5 years. Neither evidence of recurrence nor impairment of daily life activity was noted. CONCLUSIONS: Treatment of complicated recurrent pilonidal sinus with the described technique offers a safe but demanding method for definite reconstruction, and we support a more common application.

Treatment of chronic thoracic duct fistula with the sternocleidomastoid muscle flap.

Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. The fistulae can be difficult to treat, and several techniques, both operative and nonoperative, are advocated. We present a simple technique for the treatment of chronic thoracic duct fistula where other procedures have failed. After identification and ligation of the duct, the area is covered with the clavicular head of the sternocleidomastoid muscle.

Autologous breast reconstruction after breast-conserving cancer surgery.

Breast-conserving therapy, which aims to reduce trauma by preserving as much of a patient's natural appearance as possible, does not necessarily lead to an optimal cosmesis. We hypothesized that combining plastic and oncologic surgeries would greatly reduce the physical and psychological traumas and produce an optimal cosmesis without impairing the oncologic outcome. We performed breast reconstruction on 40 cancer patients. Of those 40 patients, 15 received combined plastic and oncologic surgeries. Procedures depended on breast size: mammareduction plasty in cases with sufficient volume, and reconstruction using myocutaneous latissimus dorsi flaps for those with less volume. Cosmetic results were rated good to poor. Of the 15 primary reconstruction patients, 86.7 percent of the cases showed good results and 13.3 percent fair; in the secondary cases, 68 percent were good, 16 percent fair, and 16 percent poor. Through a follow-up and cosmetic evaluations by both surgeons and patients, the study showed that combining aesthetic improvements and oncologic surgery does not compromise patient safety, reduces mental and physical trauma, and frequently results in superior cosmesis, thereby improving the patient's overall health.

The instep free flap to resurface palmar defects of the hand.

Large and deep soft-tissue defects of the hand require adequate resurfacing by free or distant pedicle flaps. A free flap of suitable size corresponding to the extended palm defect may be harvested from the instep region without encroaching on the weight-bearing area. Following Gillies's concept that "losses must be replaced in kind," and taking into consideration all possibilities of a free-flap reconstruction of the hand, we can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, and color and thus an optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity.

New technique for scarless umbilical reinsertion in abdominoplasty procedures.

The most visible scar in the conventional abdominoplasty procedure or TRAM flap donor site closure is the scar around the reinserted umbilicus. In an attempt to increase the aesthetic outcome, the authors have introduced a new technique of umbilical reconstruction and reinsertion during abdominoplasty avoiding any paraumbilical scar, which results in a more natural appearance in that area. This new technique, potential pitfalls, and long-term results are reported.

Reconstruction of large palmar defects of the hand using free flaps.

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.