Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: An anatomical study of flap pedicle modification.

BACKGROUND: Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE: This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS: Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS: Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS: By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap.

Plattenepithelkarzinom in Verbindung mit einer roten Tätowierung.

HINTERGRUND UND ZIELE: Obwohl Tätowierungen in den letzten Jahren außerordentlich beliebt geworden sind, wurde in der Literatur bisher nur über wenige Fälle schwerer Reaktionen berichtet, die zu einer malignen Transformation führten. Dies steht im Kontrast zu der praktisch unüberschaubaren Zahl an Tätowierungen weltweit. Die Zusammensetzung der für Tätowierungen verwendeten Farbstoffe variiert stark, und selbst gleiche Farbtöne können unterschiedliche Komponenten enthalten. Das Ziel unserer Studie war es zu untersuchen, auf welche Weise Tätowierungen möglicherweise Hautkrebs auslösen können. PATIENTEN UND METHODEN: Wir berichten über den seltenen Fall einer 24-jährigen Frau, bei der sich sieben Monate nachdem sie eine Tätowierung auf dem Fußrücken erhalten hatte in unmittelbarer Nähe des verwendeten roten Farbstoffs ein Plattenepithelkarzinom entwickelte. Die Komplikationen begannen mit einer unspezifischen Schwellung. Die Läsion wurde histologisch untersucht. Die Zusammensetzung des inkorporierten Farbstoffs wurde mittels Rasterelektronenmikroskopie in Kombination mit energiedispersiver Elementanalyse analysiert. Zur weiteren Charakterisierung wurden Thermogravimetrie und Pulverdiffraktometrie eingesetzt. ERGEBNISSE UND SCHLUSSFOLGERUNGEN: Der Tätowierungsfarbstoff enthielt hauptsächlich Bariumsulfat; Spuren von Al, S, Ti, P, Mg und Cl ließen sich ebenfalls nachweisen. Bei der Analyse zeigten sich Pigmentgranula unterschiedlicher Größe. In seltenen Fällen kann Tätowierungstinte karzinogene Effekte haben, die multifaktoriell zu sein scheinen.

Squamous cell carcinoma in association with a red tattoo.

BACKGROUND AND OBJECTIVES: Although tattoos have become exceedingly popular in recent years, only few cases of severe reactions leading to malignant transformation have been reported in the literature. This stands in contrast to the virtually innumerable number of tattoos worldwide. The composition of tattoo dyes is highly variable, and even the same colors may contain different compounds. The objective of our study was to investigate in what way tattoo dyes may potentially trigger skin cancer. PATIENT AND METHODS: We report the rare case of a 24-year-old woman who - seven months after getting a tattoo on the back of her foot - developed a squamous cell carcinoma in close proximity to the red dye used. Complications started in the form of nonspecific swelling. The lesion was histologically examined. The composition of the incorporated dye was analyzed using scanning electron microscopy in combination with energy dispersive element analysis. Thermogravimetry and powder diffraction were used for further characterization. RESULTS AND CONCLUSIONS: While the tattoo dye primarily consisted of barium sulfate, traces of Al, S, Ti, P, Mg, and Cl were also detected. The analysis showed pigment granules of varying sizes. In rare cases, tattoo inks may have carcinogenic effects, which appear to be multifactorial.

A multi-center study on the regenerative effects of erythropoietin in burn and scalding injuries: study protocol for a randomized controlled trial.

BACKGROUND: Although it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage. METHODS/DESIGN: This is a large, prospective, randomized, double-blind, multi-center study, funded by the German Federal Ministry of Education and Research, and fully approved by the designated ethics committee. The trial, which is to investigate the effects of EPO in severely burned patients, is in its recruitment phase and is being carried out in 13 German burn care centers. A total of 150 patients are to be enrolled to receive study medication every other day for 21 days (EPO 150 IU/kg body weight or placebo). A follow-up of one year is planned. The primary endpoint of this study is the time until complete re-epithelialization of a defined skin graft donor site is reached. Furthermore, clinical parameters such as wound healing, scar formation (using the Vancouver scar scale), laboratory values, quality of life (SF-36), angiogenic effects, and gene- and protein-expression patterns are to be determined. The results will be carefully evaluated for gender differences. DISCUSSION: We are seeking new insights into the mechanisms of wound healing in thermally injured patients and more detailed information about the role EPO plays, specifically in these complex interactions. We additionally expect that the biomimetic effects of EPO will be useful in the treatment of acute thermal dermal injuries. TRIAL REGISTRATION: EudraCT Number: 2006-002886-38, Protocol Number: 0506, ISRCT Number: http://controlled-trials.com/ISRCTN95777824/ISRCTN95777824.