RESUMEN
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.
Asunto(s)
Procedimientos de Cirugía Plástica , Cirujanos , Cirugía Plástica , Estética , Alemania , Humanos , Sistema de RegistrosRESUMEN
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.
Asunto(s)
Procedimientos de Cirugía Plástica , Sistema de Registros , Cirujanos , Cirugía Plástica , EstéticaRESUMEN
BACKGROUND: Tumor necrosis factor alpha (TNF) and melphalan-based isolated limb perfusion (TM-ILP) is one of the most effective treatment modalities for unresectable soft tissue sarcoma (STS) of the extremities. Liposarcomas (LS) are a large and heterogeneous subgroup of STS with different biological behavior and prognoses. The aim of this study was to evaluate LS and the different subentities with respect to their responsiveness towards TM-ILP. METHODS: We matched our ILP database with our pathology database to identify patients who received TM-ILP due to STS followed by resection of the residual tumor. We identified 126 patients who matched these inclusion criteria. In this patient group we identified 24 patients with a LS. Histopathological regression was assessed from all resection specimens and was compared between groups: LS vs. non-LS and for myxoid and non-myxoid LS subgroups. RESULTS: There were no significant differences in the overall tumor regression comparing non-LS (median 95%, mean 77%) and LS (median 90%, mean 74%). For the subgroup analysis, a higher grade of regression after TM-ILP was found in myxoid-LS (median 95%, mean 79% ± 31.5) compared to the non-myxoid LS (median 75%, mean 72% ± 24.6). Atypical lipomatous tumors (ALT) were less responsive to TM-ILP treatment (median 40%, mean 40%). CONCLUSION: The histopathological response of LS toward TM-ILP is equally good compared to non-lipomatous STS. Myxoid LS seem to have a tendency towards a better response to TM-ILP compared to non-myxoid LS and ALT showed the lowest response rate in the liposarcoma subgroup. Furthermore, we found that TM-ILP seems to facilitate successful R0 resection. Due to the low number of cases in the subgroups we advocate further research on this topic.
Asunto(s)
Quimioterapia del Cáncer por Perfusión Regional , Liposarcoma/tratamiento farmacológico , Liposarcoma/patología , Melfalán/administración & dosificación , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/patología , Factor de Necrosis Tumoral alfa/administración & dosificación , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Extremidades , Femenino , Humanos , Liposarcoma/cirugía , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Clasificación del Tumor , Neoplasia Residual/patología , Neoplasia Residual/cirugía , Neoplasias de los Tejidos Blandos/cirugíaRESUMEN
In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRÄC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.
Asunto(s)
Procedimientos de Cirugía Plástica , Sistema de Registros , Estética , Humanos , Cirujanos , Cirugía PlásticaRESUMEN
BACKGROUND: The aim of this study was to identify prognostic indicators of survival in patients with locally recurrent soft tissue sarcoma through a long-term follow-up. METHODS: We retrospectively assessed the relationship between post-recurrence survival (PRS) and potential predictive factors in 135 patients who had experienced local recurrence after 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. Synovial sarcoma and fibrosarcoma were associated with a significantly worse post-recurrence outcome compared with other STS histotypes. 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 carefully weighed out for the patient in each case.
Asunto(s)
Extremidades/cirugía , Microcirugia/métodos , Recurrencia Local de Neoplasia/cirugía , Procedimientos de Cirugía Plástica/métodos , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Extremidades/patología , Femenino , Estudios de Seguimiento , Alemania , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Reoperación , Estudios Retrospectivos , Sarcoma/mortalidad , Sarcoma/patología , Neoplasias de los Tejidos Blandos/mortalidad , Neoplasias de los Tejidos Blandos/patología , Análisis de Supervivencia , Adulto JovenRESUMEN
Sarcomas of the hand and wrist are rare malignancies, which should be referred to high-volume comprehensive cancer centres providing multidisciplinary treatment options. The tumour board should propose patient-oriented oncological pathways as well as sophisticated hand and plastic reconstructive procedures. In Addition, isolated limb perfusion with TNF-alpha and melphalan is likely to lead to preoperative tumour shrinkage allowing for R0 resection in sano. Our clinical results in long-term survivors demonstrate reduced amputation rates and salvage of basic hand function when a risk-adapted treatment rationale is applied.
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Neoplasias Óseas/terapia , Conducta Cooperativa , Mano/cirugía , Comunicación Interdisciplinaria , Procedimientos de Cirugía Plástica/métodos , Sarcoma/terapia , Neoplasias de los Tejidos Blandos/terapia , Muñeca/cirugía , Adolescente , Adulto , Amputación Quirúrgica/métodos , Neoplasias Óseas/patología , Quimioterapia del Cáncer por Perfusión Regional/métodos , Terapia Combinada , Femenino , Mano/patología , Humanos , Recuperación del Miembro/métodos , Masculino , Melfalán/administración & dosificación , Persona de Mediana Edad , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Sarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Factor de Necrosis Tumoral alfa/administración & dosificación , Muñeca/patologíaRESUMEN
With an incidence rate of 0.5-4 % and a mortality of up to 50 %, deep sternal wound infections are a rare but devastating complication after median sternotomy for cardiac surgery. Currently, no standard operating procedures exist. Long-term drainage with continuous lavage or negative pressure wound therapy should be used to condition the wound. After restabilization of the sternum and primary closure, the infection often reoccurs presenting deep cavities with an open, unstable thorax and an uncovered mediastinum. This article gives an overview of the different options for deep sternal wound infections in plastic reconstructive surgery. The key point for successful treatment is still the extent of debridement. Primary coverage with a pedicled flap can be made only if the wound debridement was performed radically enough. In the clinic of the author, in which over 120 patients with deep sternal wound infections were treated in 2.5 years, latissimus dorsi muscle flaps have been established as the gold standard.
Asunto(s)
Cardiopatías/cirugía , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/cirugía , Esternotomía , Infección de la Herida Quirúrgica/cirugía , Desbridamiento/métodos , Humanos , Colgajo Miocutáneo/cirugía , Osteomielitis/cirugíaRESUMEN
Complex three-dimensional defects with destruction of the external form, loss of functional stability and inner lining are associated with tactical and technical challenges in reconstructive plastic surgery. Causative factors are mutilating infections, resection of malignant tumors and trauma, predominantly located at the aerodigestive junction, the urogenital region and the extremities. Three-dimensional tissue constructions are preformed distant to the defect site allowing safe pedicled or microsurgical transfer into the defect.
Asunto(s)
Regeneración Tisular Dirigida/métodos , Procedimientos de Cirugía Plástica/métodos , Ingeniería de Tejidos/métodos , Adulto , Traumatismos por Explosión/cirugía , Cartílago/trasplante , Niño , Traumatismos Faciales/cirugía , Femenino , Genitales Masculinos/lesiones , Genitales Masculinos/cirugía , Humanos , Masculino , Microcirugia/métodos , Reoperación , Rinoplastia/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/cirugía , Tráquea/irrigación sanguínea , Tráquea/lesiones , Tráquea/cirugía , TraqueotomíaRESUMEN
Deep sternal infections with sternal osteomyelitis are rare conditions with extensive consequences for the patient. The incidence of complications after median sternotomy is as high as 0.4-8 %. Wound and sternal dehiscence and a septic course with mediastinitis leading to septic shock is a feared complication with a high mortality next to the chronic course of the infection with the clinical correlation of presternal fistulas. An early diagnosis and surgical intervention is decisive to enhance the prognosis of the disease, leading to a significant increase in the survival rate of patients.
Asunto(s)
Osteomielitis/diagnóstico , Osteomielitis/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Esternotomía , Esternón/patología , Esternón/cirugía , Enfermedad Crónica , Desbridamiento/métodos , Diagnóstico Precoz , Intervención Médica Temprana , Humanos , Osteomielitis/etiología , Complicaciones Posoperatorias/etiología , Reoperación , Factores de Riesgo , Succión , Colgajos Quirúrgicos/cirugía , Tapones Quirúrgicos de Gaza , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugíaRESUMEN
Multimodal treatment of malignant tumors of the musculoskeletal system with R0 in sano resection plays a key role in prevention of local recurrence in soft tissue and bone sarcoma. In cases of unavoidable neuromuscular or osseous defects, current plastic and orthoplastic reconstruction techniques avoid limb amputation in the majority of patients. Clinical long-term results demonstrate that large resection defects do not necessarily result in impaired limb function if multidisciplinary procedures are integrated. In oncologically necessary major limb amputation, segmental resection and replantation of distal limb parts should be considered which provide end-bearing long stump formation. The functional conditions of long-term surviving elderly patients should be integrated into surgical decision-making and rehabilitation efforts.
Asunto(s)
Neoplasias Óseas/psicología , Neoplasias Óseas/cirugía , Evaluación de la Discapacidad , Complicaciones Posoperatorias/diagnóstico , Calidad de Vida/psicología , Sarcoma/psicología , Sarcoma/cirugía , Actividades Cotidianas/clasificación , Actividades Cotidianas/psicología , Adolescente , Adulto , Amputación Quirúrgica/psicología , Neoplasias Óseas/patología , Terapia Combinada/psicología , Conducta Cooperativa , Femenino , Humanos , Comunicación Interdisciplinaria , Recuperación del Miembro/psicología , Persona de Mediana Edad , Estadificación de Neoplasias , Procedimientos Ortopédicos/psicología , Grupo de Atención al Paciente , Complicaciones Posoperatorias/prevención & control , Pronóstico , Reimplantación/psicología , Sarcoma/patología , Adulto JovenRESUMEN
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.
Asunto(s)
Sarcoma/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Sarcoma/cirugía , Análisis de Supervivencia , Sobrevivientes , Adulto JovenRESUMEN
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.
Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Enfermedad Iatrogénica , Adulto , Anciano , Anciano de 80 o más Años , Tejido Conectivo/patología , Tejido Conectivo/cirugía , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Reoperación , Estudios Retrospectivos , Piel/patologíaRESUMEN
Despite promising advances in antibiotic and surgical therapy osteomyelitis remians a severe disease with a high morbidity. Nowadays it occurs mainly after traumata. Typical clinical manifestations are signs of local infection, non-healing wounds, pathological fractures or loosening of orthopedic implants. Besides the clinical judgement the diagnosis is consolidated by imaging procedures, histopathological and microbiological examinations. Ideally, the treatment plan is based on an interdisciplinary approach. Besides the radical surgical debridement a test appropriate antibiotic therapy is essential. Defect reconstruction after surgical debridement and optimization of local microcirculation is essential to preserve limbs and to obtain a good functional result. Microsurgical free tissue transfer is often necessary to achieve healing. An optimal therapeutic management with stable long-term clinical results can be achieved by the interaction of different surgical and medical disciplines.
Asunto(s)
Osteomielitis/terapia , Procedimientos de Cirugía Plástica/métodos , Enfermedad Crónica , Terapia Combinada , Conducta Cooperativa , Diagnóstico por Imagen , Colgajos Tisulares Libres/cirugía , Humanos , Comunicación Interdisciplinaria , Microcirugia/métodos , Osteomielitis/diagnóstico , Osteomielitis/patología , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/terapiaRESUMEN
Lymph node metastases originating from soft tissue sarcomas are very rare and the reason for this is unclear. While this observation was less important in former times when ultraradical excision and amputation were the norm, modern reconstructive surgical treatment options have to take the possibility of lymphatic metastases into account.We attempted to identify parameters that may be predictive of lymphatic metastases in a cohort of 1,597 patients with soft tissue sarcomas of whom 26 patients (1.6 %) had regional lymph node (RLN) metastases. We studied these RLN metastases with recently described techniques that enabled us to histologically visualize lymphatic vessels.We conclude that sarcomas should not be evaluated from a histogenetic perspective but more on the basis of regional topography of the lymphatic vasculature. As we described previously, two different lymphatic systems should be differentiated: lymphatic vessel system I (LGS I) contains RLN and lymph vessels are mostly superficial; however, there are also vessels near large blood vessels of the extremities. System LGS II is more delicate and its vessels run into the musculature, a metastatic homing area of many sarcomas. Lymph vessels of system LGS II drain directly into veins without intervening lymph nodes. Sarcomas with LGS I drainage will form RLN metastases. In contrast, sarcomas with LGS II drainage will do so only after surgical resection if system LGS I has been opened.
Asunto(s)
Metástasis Linfática/patología , Sarcoma/patología , Sarcoma/secundario , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Estudios de Cohortes , Progresión de la Enfermedad , Extremidades/patología , Extremidades/cirugía , Humanos , Ganglios Linfáticos/patología , Vasos Linfáticos/patología , Músculo Esquelético/patología , Músculo Esquelético/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Reoperación , Factores de RiesgoRESUMEN
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.
Asunto(s)
Procedimientos de Cirugía Plástica , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Anciano , Amputación Quirúrgica , Biopsia , Quimioradioterapia Adyuvante , Terapia Combinada , Diagnóstico Diferencial , Extremidades/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Reoperación , Sarcoma/diagnóstico , Sarcoma/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/patología , Colgajos Quirúrgicos , Transferencia Tendinosa , Tomografía Computarizada por Rayos X , Torso/cirugía , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Necrotizing fasciitis (NF) and gas forming myonecrosis (GFM), both being subtypes of necrotizing soft tissue infection (NSTI), are life threatening conditions sharing certain similarities. Despite the necessity of early and radical surgical debridement in necrotizing infections, the distinction between these entities is of clinical relevance since gas forming myonecrosis in a number of cases results from an underlying abdominal cause and the focus of infection can be missed. This study was to evaluate the incidence and risk factors as well as the mortality rate in patients with NSTI and GFM. MATERIAL AND METHODS: All patients with NSTI treated in the authors' hospital between January 2005 and Decem-ber 2009 were enrolled in the study. Medical records, histological slides, microbiological and laboratory parameters as well as Computerized Tomography (CT) and magnetic resonance imaging (MRI) scans were reviewed for all patients. Differences between NF and GFM regarding hospital stay, number of surgical interventions and pre-existing comorbidities as well as mortality rate were analyzed. The laboratory risk factor for necrotizing fasciitis (LRINEC) score was calculated in all patients on admission. RESULTS AND CONCLUSIONS: Thirty patients (17 female, 13 male) with necrotizing fasciitis with a mean age of 55 years (SD 15.5) were included in the study. There was no statistically significant difference between survivors and deceased patients comparing the LRINEC score (n.s.). Patients with necrotizing fasciitis secondarily involving the trunk had a significantly higher mortality rate (OR 11.2; 95% CI=1.7-72.3). In the majority of cases (12 cases), minor skin lesions were identified as the site of origin. Amongst all necrotizing soft tissue infections six patients (female n=3; male n=3) with a mean age of 61.5 years (SD 12.2) with non-clostridial gas forming myonecrosis were identified. Three patients had a history of malignancy and in three patients the infection was secondary to major surgery. The mean LRINEC score was 8.5 (SD 1). Three patients (50%) died due to GFM. Early diagnosis and appropriate intervention is critical to provide accurate treatment decisions. Eradicating the differing primary sources of infection in GFM and NF will have a positive impact on outcome.
Asunto(s)
Fascitis Necrotizante/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/mortalidad , Femenino , Humanos , Incidencia , Tiempo de Internación , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Factores de Riesgo , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/mortalidad , Infecciones de los Tejidos Blandos/patologíaRESUMEN
OBJECTIVE: Extensive wounds of burn patients remain a challenge due to wound infection and subsequent septicemia. We wondered whether extracorporeal shock wave application (ESWA) accelerates the healing process. The aim of the study was to analyze microcirculation, angiogenesis and leukocyte endothelium interaction after burns by using ESWA with two types of low intensity. METHODS: Full-thickness burns were inflicted to the ears of hairless mice (n=51; area: 1.3 mm(2)). The mice were randomized into five groups: (A) low-energy shock waves after burn injury (0.04 mJ/mm(2)); (B) very low-energy shock waves after burn injury (0.015 mJ/mm(2)); (C) mice received burns but no ESWA (control group); (D) mice without burn were exposed to low-energy shock waves; (E) mice without burns and with no shock wave application. Intravital fluorescent microscopy was used to assess microcirculatory parameters, angiogenesis and leukocyte behavior. ESWA was performed on day 1, 3 and 7 (500 shoots, 1 Hz). Values were obtained straight after and on days 1, 3, 7 and 12 post burn. RESULTS: Group A showed accelerated angiogenesis (non-perfused area at day 12: 5.3% vs. 9.1% (group B) and 12.6% (group C), p=0.005). Both shock wave groups showed improved blood flow after burn compared to group C. Shock waves significantly increased the number of rolling leukocytes compared to the non-ESWA-treated animals (group D: 210.8% vs. group E: 83.3%, p=0.017 on day 7 and 172.3 vs. 90.9%, p=0.01 on day 12). CONCLUSION: Shock waves have a positive effect on several parameters of wound healing after burns, especially with regard to angiogenesis and leukocyte behaviour. In both ESWA groups, angiogenesis and blood flow outmatched the control group. Within the ESWA groups the higher intensity (0.04 mJ/mm(2)) showed better results than the lower intensity group. Moreover, shock waves increased the number of rolling and sticking leukocytes as a part of an improved metabolism.
Asunto(s)
Quemaduras/terapia , Leucocitos , Piel/irrigación sanguínea , Sonido , Cicatrización de Heridas , Animales , Adhesión Celular , Movimiento Celular , Endotelio , Ratones , Ratones Pelados , Microcirculación , Neovascularización FisiológicaRESUMEN
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.