Tumescent local anaesthesia for early dermatosurgery in infants.

BACKGROUND: Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia, many other local anaesthetics do not bare any major risks for infants. OBJECTIVE: In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia (TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey. METHODS: Ninety-two infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%). RESULTS: Infants were mainly operated for removal of a melanocytic naevus (n = 54), followed by haemangioma (n = 23), naevus sebaceous (n = 6) and other lesions (n = 9). The lesions were located on the scalp or neck (n = 31), on the extremities (n = 31), on the trunk (n = 21), in the face (n = 6) or on the buttocks (n = 3). The median size of excision was 509 mm2 (range: 16 mm2 ; 3600 mm2 ). Primary defect closure was performed by intracutaneous (n = 68) or extracutaneous (n = 24) suture techniques. No side-effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound-healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%). CONCLUSIONS: The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side-effects and the benefit of prolonged postoperative analgesia.

A modified, improved, easy and fast technique for split-thickness skin grafting.

BACKGROUND: Large nonhealing ulcers and wounds frequently pose a great therapeutic challenge to clinicians and often require skin grafting. Various skin grafting methods are available to cover large skin defects that fail to epithelize. These methods include the use of small pinch grafts, full-thickness punch grafts, large-sized full-thickness grafts and split-thickness grafts. Large-sized full-thickness and split-thickness skin grafting requires expertise to produce cosmetically acceptable results and prevent cobblestoning, unlike small pinch and full-thickness punch grafts. OBJECTIVES: To describe a modified technique of split-thickness skin grafting that can be considerably faster than alternative methods. METHODS: We describe a method for split-thickness skin grafting using tumescent anaesthesia at the donor site and an electrodermatome and a polyurethane membrane without sutures at the site of the skin defect. RESULTS: Since 1997, we have practised a modified, improved, quick and easy split-thickness skin grafting method to cover large skin defects at the extremities. Complete healing is usually achieved 4-6 weeks after the split-thickness skin transplantation, and long-term results are aesthetically successful. CONCLUSIONS: We provide a sophisticated modified split-thickness skin graft procedure that has been practised for many years and provides cosmetically acceptable results while saving time.

Correlations between audiogram and objective hearing tests in sensorineural hearing loss.

Owing to its subjective nature, behavioral pure-tone audiometry often is an unreliable testing method in uncooperative subjects, and assessing the true hearing threshold becomes difficult. In such cases, objective tests are used for hearing-threshold determination (i.e., auditory brainstem evoked potentials [ABEP] and frequency-specific auditory evoked potentials: slow negative response at 10 msec [SN-10]). The purpose of this study was to evaluate the correlation between pure-tone audiogram shape and the predictive accuracy of SN-10 and ABEP in normal controls and in patients suffering from sensorineural hearing loss (SNHL). One-hundred-and-fifty subjects aged 15 to 70, some with normal hearing and the remainder with SNHL, were tested prospectively in a double-blind design. The battery of tests included pure-tone audiometry (air and bone conduction), speech reception threshold, ABEP, and SN-10. Patients with SNHL were divided into four categories according to audiogram shape (i.e., flat, ascending, descending, and all other shapes). The results showed that ABEP predicts behavioral thresholds at 3 kHz and 4 kHz in cases of high-frequency hearing loss. Also demonstrated was that ABEP threshold estimation at 3 kHz was not affected significantly by audiogram contour. A good correlation was observed between SN-10 and psychoacoustic thresholds at 1 kHz, the only exception being the group of subjects with ascending audiogram, in which SN-10 overestimated the hearing threshold.

[Psychosomatic medicine -- does it have the right to exist as a separate discipline?]. / Hat die Psychosomatik als eigenes Fach eine Existenzberechtigung?

In their "Recommendations for Clinical Research at Medical Schools and Universities" (1986), the Scientific Council of the Federal Republic of Germany described the quantity and quality of psychosomatic and psychotherapy-research generally as unsatisfactory. Although meanwhile in some fields, such as epidemiologic longitudinal studies, comparative therapy evaluation of controlled individual case studies, research has reached good-quality standard, essential deficits still remain. There are several reasons for the delay in implementing psycho-somatic-psychotherapeutic research after the establishment of departments of psychosomatic medicine and psycho-therapy at Medical Schools in the Federal Republic of Germany in 1970. For example 1.) psychosomatic research covers almost all disciplines of clinical medicine. Therefore, a variety of special knowledge is required. 2.) Global psychological theories that marked the beginning of psychosomatic medicine are obviously inadequate in providing useful approaches to causal explanations in psychosomatic medicine. The cultural complexity of mental life determining the substance of psychoanalytical hypo-theses is apparently not reflected in the comparatively simple, phylogenetically rooted psychic factors leading to pathophysiological processes. As a consequence, psychosomatic research will have to concentrate less on global theories and to focus more on heuristic models of limited range specific to the respective functional systems or illnesses. The need to carry out examinations on both mental and physical level requires knowledge of either methodology. In addition, the necessary access to patients and laboratories suggests that psycho-somatic departments should be closely connected with those of internal medicine or one of the other departments with many psychosomatic problems. Research and advanced training in psychotherapy, on the other hand, should be performed in close cooperation with the one department responsible for research and the provision of care for the mentally ill, with psychiatry. Thus it would be possible to definitely improve the present situation, which is characterized by an overburden of the usually small departments of psychosomatic medicine and psychotherapy with matters of psycho-therapeutic training, research training, clinical work and teaching. At any rate, psychosomatic medicine is having great prospects, in particular concerning research. The departments of psychosomatic medicine and psychotherapy should be better prepared and equipped for these future tasks.