Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas. / Interdisziplinäre Plastische und Rekonstruktive Chirurgie von Plattenepithelkarzinomen des Kopf-Hals-Bereichs.

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

Did implementation of three ligament tenodesis improve patient outcome after chronic scapholunate instability? A retrospective study.

INTRODUCTION: Scapholunate instability frequently leads to chronic pain or even severe osteoarthritis of the wrist. Most favored reconstruction techniques of chronic SL-ligament injuries are based on the usage of a tendon, although there is still a lack of consensus which technique is superior. MATERIALS AND METHODS: In a retrospective cohort analysis we compared 9 patients who underwent SL-ligament repair according to Van den Abbeele and 12 patients who underwent modified three ligament tenodesis according to Garcia-Elias, performed at a single institution. RESULTS: Follow-up of Van den Abbeele group was 36-120 months and 13-39 months in the Garcia Elias cohort. Although both techniques showed good functional outcome in most cases, modified three ligament tenodesis seemed to be advantageous regarding wrist range of motion (162°) compared to Van den Abbeele cohort (87°). Moreover, pain score showed significant differences between the two cohorts during follow up (VAS Van den Abbeele 4.2; VAS Garcia Elias 1.7). Interestingly, DASH-score (16.1 Van den Abbeele; 16.8 Garcia Elias) and modified mayo wrist score (72 Van den Abbeele; 69 Garcia-Elias) did not show any differences between the two patient cohorts. CONCLUSIONS: Via implementation of modified three ligament tenodesis as a standard of care for our patients we could improve the functional outcome after SL-ligament injuries and effectively decrease postoperative pain.

Sternal Reconstruction with the Omental Flap-Acute and Late Complications, Predictors of Mortality, and Quality of Life.

BACKGROUND: The omental flap is a reliable flap for the coverage of sternal defects. However, little is known about the predictors of mortality and the long-term outcome in such patients. METHODS: We, therefore, performed a retrospective study from 2002 to 2013, including all patients who underwent sternal reconstruction with the omental flap. RESULTS: A total of 50 patients were identified and mean follow-up was 3.8 years. Patient data was collected from the charts and 14 patients were available for telephone interviews. The majority of patients suffered from deep sternal wound infections. There was no complete flap loss and an overall success rate was 96%. In-hospital mortality was 14% and overall survival over follow-up was 50%. Significant predictors of mortality were age > 65, American Society of Anesthesiologists' status, defect size, prolonged ventilation, and the need for tracheotomy. Postoperative quality of life was reduced compared with other cohorts, especially with regard to bodily function. Pain was also a major problem for most patients along with herniation. CONCLUSION: The omental flap is a safe option even in patients with severe comorbidities. However, based on the data in this study, we would recommend the omental flap as a reserve option rather than first-line treatment for sternal defects.

Improvement of local microcirculation through intermittent Negative Pressure Wound Therapy (NPWT).

BACKGROUND: Negative Pressure Wound Therapy (NPWT) is widely used across different kinds of surgical disciplines. A controversial debate was raised by diverging results from studies that were conducted to examine the impact of NPWT on local perfusion. Thus, there is a lack of evidence for one important underlying factors that influences the physiology of wound healing under an applied NPWT-dressing. OBJECTIVE: To investigate the immediate local perfusion changes due to an applied intermittent NPWT protocol. MATERIAL AND METHODS: A NPWT dressing was applied to the antero-lateral thigh of seven healthy volunteers with two probes of both pressure and microcirculatory measuring devices. One of each probe was placed under the NPWT dressing, the other one in close proximity next to it. A protocol consisting of two cycles of 10 min of -125 mmHg pressure, followed by 10 min of 0 mmHg pressure was applied. Measurements of local pressure to the underlying tissue, as well as microcirculatory changes were performed continuously. RESULTS: Applied vacuum caused compressional forces (27.33 mmHg, p < 0.05) towards the underlying tissue. Blood Flow was increased after both suction periods (+52.5%, +108.7%; p < 0.05) and continued increasing until the end of measurements (+145.3%). This was accompanied by significant increase in Oxygen Saturation (+21.6%; p < 0.05) and Relative Hemoglobin Content (+16.7%). Red Blood Cell Velocity was found to be increased without statistical significance. Next to the dressing, changes were also significant but less pronounced. CONCLUSION: Intermittent NPWT improves local microcirculation with consecutive enhancement of oxygen supply.

[Remote Ischemic Conditioning - Endogenous Tissue Protection and its Possible Applications in Surgery]. / Remote ischemic Conditioning ­ endogene Gewebeprotektion und ihre Einsatzmöglichkeiten in der Chirurgie.

Tissue perfusion is pivotal to wound healing and tissue regeneration after surgery. Ischemia and reperfusion lead to inflammatory reactions with consecutive tissue damage and necrosis. Multiple conditioning techniques have been described to protect tissue from those damaging mechanisms in the perioperative period. However, most of these fail to meet the requirements of a good therapeutic effect, time and cost efficiency, non-invasiveness and applicability without the need for additional devices or drugs. Remote ischemic conditioning (RIC) is a technique to provide endogenous tissue protection, which fully meets those requirements. Repeated, short cycles of ischemia/reperfusion applied to a circumscribed vascular territory lead to the activation of endogenous signal pathways resulting in increased tolerance to hypoperfusion and limiting the damage caused by reperfusion, even in tissues located far away from the conditioned area. The non-invasive application of the conditioning stimulus requires no more than a pressure cuff, which is placed on the upper arm and is repeatedly inflated to suprasystolic pressures. Different concepts of remote ischemic pre-, peri- and postconditioning enable the usage in both elective and emergency surgical interventions. Based on encouraging experimental studies, the application of RIC has increased in the clinical setting. In addition to studies addressing cardio-, nephro- or neuroprotection there are some initial findings supporting a potential beneficial application in reconstructive microsurgery. This article aims to give an overview of the development, concepts and mechanisms of RIC with a focus on its clinical application in the field of surgery.

Curcumin and Viscum album Extract Decrease Proliferation and Cell Viability of Soft-Tissue Sarcoma Cells: An In Vitro Analysis of Eight Cell Lines Using Real-Time Monitoring and Colorimetric Assays.

BACKGROUND: The cytostatic effects of the polyphenol curcumin and Viscum album extract (VAE) were assessed in soft-tissue sarcoma (STS) cells. METHODS: Eight human STS cell lines were used: fibrosarcoma (HT1080), liposarcoma (SW872, T778, MLS-402), synovial sarcoma (SW982, SYO1, 1273), and malignant fibrous histiocytoma (U2197). Primary human fibroblasts served as control cells. Cell proliferation, viability, and cell index (CI) were analyzed by BrdU assay, MTT assay, and real-time cell analysis (RTCA). RESULTS: As indicated by BrdU and MTT, curcumin significantly decreased the cell proliferation of five cell lines (HT1080, SW872, SYO1, 1273, and U2197) and the viability of two cell lines (SW872 and SW982). VAE led to significant decreases of proliferation in eight cell lines (HT1080, SW872, T778, MLS-402, SW982, SYO1, 1293, and U2197) and reduced viability in seven STS lines (HT1080, SW872, T778, MLS-402, SW982, SYO1, and 1273). As indicated by RTCA for 160 h, curcumin decreased the CI of all synovial sarcoma cell lines as well as T778 and HT1080. VAE diminished the CI in most of the synovial sarcoma (SW982, SYO1) and liposarcoma (SW872, T778) cell lines as well as HT1080. Primary fibroblasts were not affected adversely by the two compounds in RTCA. CONCLUSION: Curcumin and VAE can inhibit the proliferation and viability of STS cells.

Epididymal leiomyoma: a benign intrascrotal tumour.

Physicians will be rarely confronted with epididymal tumours. These represent only 5% of intrascrotal tumours and are mostly (75%) benign. We report the case of a 50-year-old white male who was presented with a 5-year history of a slow-growing, left scrotal mass, noted through self-examination. Ultrasound study of the scrotum identified a well-circumscribed paratesticular mass. On inguinal surgical exploration, a solid, encapsulated, grey-white mass at the tail of the left epididymis was identified and excised, with intra-operative pathological consultation showing no signs of malignancy. The diagnosis of an epididymal leiomyoma was determined through subsequent immune-histopathological analysis. Diagnostic steps preceding operative exploration of a paratesticular, epididymal tumour are briefly analysed and physicians are encouraged to avoid a radical approach, without prior pathological consultation. Epididymal leiomyomas are benign tumours that can be cured through simple, organ-preserving surgical excision.

Albumin reduces the antibacterial efficacy of wound antiseptics against Staphylococcus aureus.

OBJECTIVE: The influence of proteins on the efficacy of antiseptic solutions has been rarely investigated even though exudate can contain high levels of protien. The aim of this study was to analyse the antibacterial efficacy of commonly used solutions in the presence of albumin protein. METHOD: Using Staphylococcus aureus in a standardised quantitative suspension assay, the antibacterial effects of poly (1-(2-oxo-1-pyrrolidinyl) ethylene)-iodine (PVP-I) and octenidin-dihydrochloride/phenoxyethanol (OCT/PE) were analysed in the presence of 0-3% bovine serum albumin (BSA). These were compared with previous results obtained with polyhexamethylene biguanide hydrochloride (PHMB). RESULTS: Presence of albumin caused a significant (p<0.001) decrease in antibacterial effect in the analysed solutions. The concentrations of albumin that provoked highly significant decreases in the bacterial reduction factors of the study agents were: 0.01875 % for PVP-I, followed by 0.75 % for OCT/PE. After addition of 3 % albumin, adequate antimicrobial effects were ensured for titrations to 5 % PVP-I and 8 % OCT/PE. As we could show before, it is not possible to titrate PHMB in order to assure adequate potency. CONCLUSION: This study demonstrates that albumin induces a significant decrease of the antibacterial potency of the analysed solutions.

Upper extremity ischemia is superior to lower extremity ischemia for remote ischemic conditioning of antero-lateral thigh cutaneous blood flow.

Remote ischemic conditioning (RIC) is known to improve microcirculation in various settings, but little is known about the impact of the amount of ischemic tissue mass or the limb itself. Since ischemia and subsequent necrosis of flaps is one of the most dreaded complications in reconstructive surgery, adjuvant methods to improve microcirculation are desirable. We therefore performed a randomized trial to compare the effect of arm versus leg ischemia for RIC of the cutaneous microcirculation of the antero-lateral thigh. Forty healthy volunteers were randomized to undergo 5 min of ischemia of either the upper or lower extremity, followed by 10 min of reperfusion.Ischemia was induced by a surgical tourniquet applied to the proximal limb, which was inflated to 250 mmHg for the upper and 300 mgHg for the lower extremity. This cycle was repeated a total of three times. Cutaneous microcirculation was assessed by combined laser doppler spectrophotometry on the antero-lateral aspect of the thigh to measure cutaneous blood flow (BF), relative hemoglobin content (rHb), and oxygen saturation (StO2). Baseline measurements were performed for 10 min, after which the ischemia/reperfusion cycles were begun. Measurements were performed continuously and were afterwards pooled to obtain a mean value per minute. Both groups showed significant increases in all three measured parameters of cutaneous microcirculation after three cycles of ischemia/reperfusion when compared to baseline (BF: 95.1% (P < 0.001) and 27.9% (P = 0.002); rHb: 9.4% (P < 0.001) and 5.9% (P < 0.001), StO2: 8.4% (P = 0.045) and 9.4% (P < 0.001). When comparing both groups, BF was significantly higher in the arm group (P = 0.019 after 11 min., P = 0.009 after 45 min). In conclusions, both ischemic conditioning of the upper and lower extremity is able to improve cutaneous BF on the ALT donor site. However, RIC of the upper extremity seems to be a superior trigger for improvement of cutaneous BF.

[Free fasciocutaneous parascapular flap. Coverage of extensive skin and soft tissue defects]. / Freie fasziokutane Paraskapularlappenplastik. Deckung ausgedehnter Haut-Weichteil-Defekte.

Coverage of extensive tissue defects is one of the tasks of plastic surgery. For the surgeon there are a series of possibilities differing in safety level and difficulty. With extensively exposed bones, however, there is mostly the indication for free tissue transfer. In the following case a possibility of wound closure of an extensive defect by one single free flap without preconditioning the tissue is demonstrated.

[Palliative plastic surgery in multidisciplinary therapeutic concepts]. / Palliative plastische Chirurgie im multimodalen Therapiekonzept.

BACKGROUND: Survival rates even in advanced tumour stage have been improved for some tumour entities due to progress in adjuvant and neoadjuvant therapeutic strategies. Nevertheless, painful, exulcerated or bleeding wounds can impair quality of life for palliative patients. Increasing evidence in palliative treatment has raised options for plastic-reconstructive surgery to be applied for treatment of local wounds which can improve quality of life for the remaining lifetime for the palliative patients in our institutions. METHODS: In this review the role of plastic surgery in the palliative treatment concept is highlighted as well as conservative and operative treatment options are discussed. With regard to the limited evidence, an analysis of the currently available literature was performed and data reviewed. These data were added to a case series of patients of our hospital. RESULTS: The analysis of the literature revealed only few data which all indicate an improvement of quality of life due to reconstructive procedures in the palliative situation. There are some studies dealing with plastic surgical operations in advanced tumour diseases. Plastic surgery procedures become relevant after failure of conservative treatment wound care. The most frequent entities are soft tissue sarcomas, squamous cell carcinomas and breast cancer. Safe and simple flaps should be preferred, but free flaps and tendon transfer are optional procedures, and resection of the thoracic wall can be justified in palliative indications with sufficient soft tissue coverage. The indications for major limb amputation should be restricted to selective cases because quality of life is highly reduced. Radiation is possible even after tissue transfer in some cases, and radiation-induced dermatitis with ulcerations can be treated additionally. DISCUSSION: Opportunities and limitations in plastic and reconstructive surgery should be continuously presented in tumour boards, to clarify these important procedures for palliative patients to all members of the tumour board. There is an increasing impact of plastic surgery for improving the quality of life in palliative patients in a multimodal therapeutical concept.

[Options for reconstructive surgery of the thoracic wall]. / Plastisch-chirurgische Möglichkeiten der Thoraxwandrekonstruktion.

The integrity of the thoracic wall and therefore the protection of the thoracic organs is paramount for survival. This integrity can be compromised by various factors, be it tumours, wound-healing disorders or injuries. An adequate surgical therapy for these entities often requires (partial) resections of the thoracic wall resulting in a loss of its protective function. A safe and timely reconstruction of the thoracic wall is therefore mandatory and can be achieved by means of reconstructive procedures. This article therefore aims to illustrate such reconstructive procedures utilising our own clinical cases while also giving a review of the literature in order to construct an algorithm for the reconstruction procedure.

[Plastic reconstructive options for chronic pilonidal disease]. / Plastische Rekonstruktionsmöglichkeiten beim chronischen Sinus pilonidalis.

INTRODUCTION: Chronic pilonidal disease represents an infectious disease of the gluteal cleft that often requires surgical resection. AIM: In this article, several plastic-surgical reconstructions are presented. METHODS AND RESULTS: Based on our experience and the current literature, different plastic surgical reconstructive methods are presented and discussed. Thorough debridement including sinus tracts and follicles represents an important step in the treatment algorithm. Subsequently, wide defects may remain that can require reconstructive surgery with local flaps. These may include a Karydakis procedure, Limberg transposition flap, V-Y advancement or rotation flap. CONCLUSION: After thorough debridement and adherence to plastic surgical principles, sufficient reconstructions can be obtained with the presented methods.

[Reconstruction options for pelvic defects after abdominal exenteration]. / Defektdeckungsoptionen nach Eviszeration.

Soft tissue defects after oncological pelvic exenteration still represent a significant problem. Because of the anatomic and functional peculiarities, the reconstruction of defects in the pelvic region is challenging and requires a differentiated approach. In this paper, current strategies and options for reconstructive procedures are presented considering preoperative conditions and factors related to surgical planning. The relevance of interdisciplinary collaboration and the resulting benefits are set out. The inclusion of the plastic surgeon already in the preoperative planning of tumour resection is recommended.

Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma.

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.

[Primary interdisciplinary reconstruction of perineal defects to reduce wound complications after abdominoperineal resection]. / Interdisziplinäre, primäre Rekonstruktion des Perineums zur Vermeidung von Wundkomplikationen nach abdominoperinealer Rektumexstirpation.

BACKGROUND: Multimodal treatment options for ultra-low neoplasms of the rectum or anal cancer include chemotherapy, radical abdominoperineal resection and/or radiation. Primary wound closure increases the risk of perineal wound complications that require secondary revision. Perineal wound complications may trigger delay of adjacent tumor therapy and thus have an impact on rate of local recurrence and long-term survival for rectal cancer. Simultaneous primary reconstruction of the perineal defect has been shown to reduce the incidence of perineal wound complications as well as hospital stay which enables timely adjacent therapy and may improve prognosis. PATIENTS AND METHODS: This study was designed to retrospectively evaluate wound complications after abdominoperineal resection by comparing a group with and one without primary perineal reconstruction. Between 2005 and 2011, patients were analysed and divided into cohorts 1 and 2. Cohort 1 included n = 33 patients without primary perineal reconstruction. Cohort 2 included n = 4 patients with primary perineal reconstruction. Risk factors were identified for increased wound complications and delay of adjacent therapy. RESULTS: Subgroup analysis revealed that 18 out of 33 patients of cohort 1 had wound complications. In five cases, prolonged wound healing resulted in a delay of adjacent therapies. Four patients suffered from progression of tumour, 2 out of these 4 patients had a history of delayed adjacent therapy. The main risk factor for prolonged wound healing due to postoperative complications was a history of neoadjuvant treatment resulting in a rate of 64.7 %. Cohort 2 undergoing primary reconstruction presented without wound complications or delay in adjuvant therapy. DISCUSSION: A primary perineal reconstruction after APRE can reduce the rate of perineal wound complications. Furthermore, neoadjuvant treatment was shown to carry a major risk for wound complications. Patients after radio-/chemotherapy should undergo a primary reconstruction to prevent procedure-related perioperative morbidity. Subsequently, delays in adjuvant therapy, and prolonged hospital stay can be inhibited. Moreover, quality of life can be increased. The interdisciplinary approach aims at identifying high-risk patients for perineal wound complications who may benefit from primary reconstruction in order to reduce rate of wound complications with potential impact on rate of local recurrence. All these measures contribute to an optimized surgical standard.

Methysergide attenuates systemic burn edema in rats.

BACKGROUND: Thermal injuries of more than 20% total body surface area result in systemic shock with generalized edema. Burn shock is induced by a variety of mediators, mainly immunomodulative cytokines. Administration of methysergide (Met), a serotoninergic receptor blocking agent, reduces generalized edema in endotoxemia in rats. In this study we evaluated the systemic effects of Met after thermal injury. METHODS: Donor rats (DR [n=8]) for positive controls and study groups underwent thermal injury (100°C water, 30% TBSA (Total Burn Surface Area), 12s). Shamburn plasma was harvested after a shamburn procedure ([n=4], 37°C water, 30% TBSA, 12s). Plasma was harvested 4h posttrauma and was transferred to healthy individuals. Recipient animals were randomized in 3 groups (1: burnplasma, 2: shamburn, 3: burnplasma plus methysergide (Bolus of 1mg/kg body weight)). Intravital microscopy was performed in mesenteric venules (0/60/120min). Edema was assessed by FITC-albumin extravasation. Leukocyte sticking (cells/mm(2)) and microhemodynamic parameters were assessed. RESULTS: Significant systemic capillary leakage was observed after burnplasma-transfer. Edema formation was significantly lower in negative controls. Application of methysergide reduced FITC-efflux to baseline levels. Adherent leukocytes increased in all groups, at 120min the amount of adherent leukocytes in positive controls was significantly higher in comparison to shamburn, differences to MET-groups were not significant. CONCLUSION: Burnplasma transfer to healthy individuals induces leukocyte activation and plasma extravasation and this effect is reduced by administration of Met. This may be attributed to leukocyte dependent as well as independent mechanisms. Evaluation of more specific serotoninergic antagonists is required to distinguish between systemic and local effects.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and Research Funding Report 2021/2022]. / Register Forschungsförderung der Deutschen Gesellschaft für Plastische, Rekonstruktive und Ästhetische Chirurgie (DGPRÄC) und Forschungsförderungs-Bericht 2021/2022.

BACKGROUND: Research is an integral part of academic medicine. In plastic surgery, it sets the course for innovations in the specialty. The purpose of this study is to present the research performance of plastic surgeons in Germany for the period 2021/2022 and to compare it with previous periods. MATERIALS AND METHODS: The directors of plastic surgical academic institutions reported all requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was gathered within an established online database. In addition, the DFG´s public database GEPRIS was screened for plastic surgical research grants. Data was also collected regarding research infrastructure and organization at the participating centers. RESULTS: 105 applications were reported to 54 different funding agencies from 20 plastic surgery centers. 37 funding applications were submitted to the major public funding agencies DFG, BMBF, BMWi, BMG, BMVg, G-BA and EU. Of these, 59,5% (22/37) were DFG, 13,5% (5/37) each BMBF and EU, 5,4% (2/37) BMWi, and 2,7% (1/37) each BMG, BMVg, and G-BA applications. The average funding volume of these proposals was 401,515 euros. Approved DFG proposals were most frequently assigned to the review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery (n=10/16, 62,5%). Over time, the research registry shows an increase in the number of proposals in general and those granted. 70,0% (14/20) of participating sites had their own experimental research laboratory, while only 40,0% (8/20) had their own clinical trial center. CONCLUSION: The 2021/2022 Research Funding Report once again highlights the impressive research accomplishments of the plastic surgery community.

Optimizing remote ischemic conditioning (RIC) of cutaneous microcirculation in humans: Number of cycles and duration of acute effects.

OBJECTIVE: Non-invasive Remote Ischemic Conditioning (RIC) offers an approach to reduce tissue damage in various organs/tissues. Besides attenuation of Ischemia-Reperfusion injury (I/R), beneficial effects on cutaneous microcirculation of free microsurgical flaps have been reported. Given the recency of this technique, there are considerable gaps in the current understanding of its mechanism of action. As a result, clinical transfer of RIC is prolongated in several fields. We aimed to optimize the RIC protocol by examination of different RIC-cycle numbers and its effect on changes of cutaneous microcirculation and duration. METHODS: 80 subjects were divided into groups (1, 3, 5, 7 RIC cycles). RIC was applied via an inflatable tourniquet. Cutaneous microcirculation was continuously assessed at the contralateral anterior lateral thigh utilizing a ©O2C-device continuously. RESULTS: RIC caused significant and sustained changes in microcirculation. Four hours after completion of RIC, a maximum increase of +80.8% (CI 1.395-2.221) in blood flow and +23.5% (CI 1.098-1.372) in tissue oxygen saturation was measured (three-cycle group). A higher number of applied cycles was accompanied with significant higher mean pain. CONCLUSION: Acute improvement of cutaneous microcirculation due to RIC lasted for at least 4 h after completion of the RIC-protocol. Dose-dependent effects of RIC are likely. With regard to the increase in pain, we recommend a RIC protocol of 3 cycles for future clinical application.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2019/2020]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungsbericht 2019/2020.

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.