[Soft tissue sarcoma : resection and plastic reconstruction]. / Bösartige Weichgewebsgeschwülste : Resektion und plastische Wiederherstellung.

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.

[Soft tissue sarcoma. Resection and plastic reconstruction]. / Bösartige Weichgewebsgeschwülste. Resektion und plastische Wiederherstellung.

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.

[Surgical margins in soft tissue sarcoma of the extremities]. / Resektionsgrenzen bei Weichgewebssarkomen der Extremitäten.

Negative surgical margins (R0 resection) play a key role in the prevention of local recurrences of soft tissue sarcoma of the extremities in the multimodal therapy concept. The prognostic relevance for long-term survival is still under dispute. Despite the fact that numerous recommendations and guidelines have existed for over 100 years, strong evidence-based data from prospective randomized studies are still not available today. These studies should include parameters like tumor localization, subtype and biological aggressiveness. Recommendations as to surgical therapy diverge considerably. They range from amputation and compartment resection to centimetre and millimetre surgical margins. The present article analyses currently available data and definitions and discusses the impact on functional restriction, lymph drainage, local recurrence and the perioperative irradiation field. In the absence of surgical standards, it is doubtful whether existing studies and multicenter trials currently underway are valid. Close co-operation between surgeon and pathologist is imperative to further substantiate the significance of histological examinations and resection margins.

[Surgical intensive care medicine. Current therapy concepts for septic diseases]. / Chirurgische Intensivmedizin. Aktuelle Therapiekonzepte septischer Erkrankungen.

The clinical appearance of septic disorders is characterized by an enormous dynamic. The sepsis-induced dysbalance of the immune system necessitates immediate and aggressive therapeutic interventions to prevent further damage progression of the disease to septic shock and multiple organ failure. This includes supportive therapy to normalize and maintain organ and tissue perfusion as well as the identification of the infection focus. In cases where an infectious focus is identified, surgical source control frequently is a key element of the treatment strategy besides pharmacologic and supportive measures. The integrative approach of the management of septic patients requires rapid communication between the involved medical disciplines and the nursing personnel. Therefore, this article outlines current therapeutic concepts of septic diseases as well as central nursing aspects.

[Importance of specialized centers in diagnosis and treatment of extremity-soft tissue sarcomas. Review of 603 cases]. / Die Bedeutung von Referenzzentren in Diagnose und Therapie von Weichgewebssarkomen der Extremitäten. Auswertung von 603 Fällen.

Correct histopathologic diagnosis is essential for adequate treatment of soft tissue sarcomas. Due to the disorder's rarity, multitude of subgroups, sometimes varying histopathologic appearance, and occasionally inadequate biopsy specimens, diagnosis and grading are challenging. The records of 603 patients with soft tissue tumors of the extremities were reviewed concerning mismatches in primary and definite diagnoses relating to entity, evaluation of primary or recurrent tumor specimens, and the diagnosing pathology institution. For second opinions we referred to the Institute of Pathology of the Ruhr University at the Bergmannsheil Hospital in Bochum, Germany, and to the Pathology Institute of the University of Jena, also in Germany. Liposarcoma and malignant fibrous histiocytoma were the most often diagnosed subgroups at 24% and 22.6%, respectively. In the eight most frequent sarcoma types, malignant peripheral nerve sheath tumors and leiomyosarcoma had the highest rates of false primary diagnosis, 78.4% and 74.2% of cases, respectively. The diagnostic error ratio for nonspecialized pathologists in practice, community hospital pathologists, and academic medical centers was over 60%. For optimal treatment of soft tissue sarcomas, we suggest obtaining expert second opinion to ensure adequate surgical therapy and precise indications for radiation and chemotherapy.

[Future treatment options for chronic wounds]. / Therapieoptionen der Zukunft bei chronischen Wunden.

The skin plays an important role in the human immune system, working as a barrier to pathologic influences. A chronic wound breaks that barrier and eliminates that function. Affected patients can suffer from significant reductions in quality of life and become socially isolated. The inability to work may have serious economic consequences for the individual and the community. Treating these wounds with novel, evidence-based techniques can accelerate wound healing while reducing the length of in- and outpatient treatment and thereby the overall costs. This article discusses current and future treatment options in wound conditioning, therapy, and regeneration.

[Anterolateral thigh flaps for reconstruction of traumatological and oncological defects]. / Der freie ALT-Oberschenkellappen in der traumatologischen und onkologischen Defektdeckung.

BACKGROUND: The anterolateral thigh flap (ALT) has become one of the most preferred options for soft tissue defect reconstruction in Asia with an increasing popularity in Europe. The article presents the authors' experience using the ALT flap for various indications in the upper and lower extremities. METHODS: Between January 2005 and March 2007, 60 free ALT flaps were operated for reconstruction of various soft tissue defects. The causes of soft tissue defects included trauma (13), infection (26), and sarcoma resection (21). We operated on 39 male and 19 female patients with an average age of 50.9 years (range: 16-84 years). RESULTS: The flap survival rate was 95.0% percent (57 of 60 flaps); 5% of the flaps died. The donor site was closed primarily in all cases. Donor site complications were minimal. The average operative time was 282 min (69-544 min). Flap-related major complications occurred in 35.0% of patients including reexploration of the anastomoses and partial flap necrosis. Minor complications, e.g., wound infection, hematoma, and swelling were seen in 23 cases. CONCLUSIONS: Our experience indicates that the free ALT flap is a reliable method for soft tissue defect reconstruction. The use of the ALT offers many advantages such as a long and large caliber vascular pedicle, a large skin island as well as minimal donor site morbidity. The surgery can simultaneously performed by two teams with the patient in a supine position.

[Typical bacteria in an intensive care burn unit in severely burned patients and their importance with regard to mortality: retrospective study 1995 - 2004]. / Typische Bakterien auf einer Schwerbrandverletztenintensivstation und ihre Bedeutung für die Mortalität - Retrospektive Studie 1995 - 2004.

The purpose of this study was to identify risk profiles for wound infection of severely burned patients in a retrospective analysis of patients of an intensive care burn unit during 1995 - 2004. The goal of this study was to identify risk factors on wound infection in severely burned patients. Possible influences on mortality were to be discussed. Inclusion criteria of the study population was a minimum age of 18 years and a body surface area burned of at least 40 % during the time period 1995 - 2004. 912 patients were screened and 96 patients were enrolled. Logistic regression was performed to investigate factors influencing wound infection and mortality in the study population. The initially detectable bacteria in the burn wounds were Staphylococcus aureus (21.1 %), Staphylococcus epidermidis (16.2 %) and Enterococcus faecalis (16.2 %). Of all swabs taken the most frequent initial discovered bacteria were Staphylococcus aureus (18.2 %), Staphylococcus epidermidis (12.7 %), Enterococcus faecalis (12.7 %) and Escherichia coli (13.3 %). The majority of positive swabs were the burn wound followed by nose and tracheal secretion. The risk of a wound infection was more likely in the period 2000 - 2004 in comparison to 1995 - 1999 with an Odds Ratio of 0.17 (95 % KI [0.05 - 0.63], p = 0.008). Wound infection was promoted by longer hospitalization on the burn intensive care unit with an Odds Ratio of 2.62 (95 % KI [1.34 - 5.11], p = 0.005) and by bacterial detection in the unburned parts of the body with an Odds Ratio of 5.36 (95 % KI [1.30 - 22.24], p = 0.02). Death was significantly promoted by age (over 50 years) with an Odds Ratio of 11.62 (95 % KI [2.76 - 48.92], p = 0.0008), wound infection with an Odds Ratio of 0.12 (95 % KI [0.03 - 0.52], p = 0.004) and inhalation injury with an Odds Ratio of 5.95 (95 % KI [1.72 - 20.55], p = 0.005). During the study period a rise of wound infections could be notified. Promoting factors were longer hospitalization on the burn intensive care unit and bacterial detection in the unburned parts of the body. Regarding mortality, higher age, wound infection and inhalation injury were prognostic factors.

[Effector molecules of the innate immune system for treatment of wound infections]. / Effektormoleküle des angeborenen Immunsystems zur Abwehr von Wundinfektionen.

Skin is a substantial immune organ and represents the most important barrier against the potentially hostile environment. Its first line of defense are effector molecules of the innate immune system, which in contrast to the adaptive immune system reacts immediately against penetrating pathogenic microbes. Antimicrobial peptides represent the basis of the phylogenetically oldest part of the immune system. New studies show that reduced local cutaneous expression of antimicrobial peptide in burned skin is involved in the higher incidence of wound infections. The epithelium has an essential function in recognizing colonies of micro-organisms and in initial antimicrobial defenses.

[Analysis of burn treatment for children at Bochum University Hospital]. / Verbrennungsbehandlung von Kindern. Eine Analyse am Klinikum der Universität Bochum.

BACKGROUND: A retrospective epidemiological multifactorial study of pediatric burn patients admitted to the Burn Center Bochum in the period of 1992-2002 was performed. METHODS: Data from 628 patients were analyzed and included age, sex, mortality, hospital stay, percent of total body surface area (TBSA) burned, localization of burns, number of surgical procedures, source of the burn as well as social standing of the families. RESULTS: The majority of patients (414) were between 0 and 3 years. The median age was 2.99. The median TBSA was 11.9%. There were 387 males (62%) and 241 females (38%, ratio of 1.6:1). The overall mortality rate was 1.4% (6/629). The main causes of injury were scald burns (435; 70%), followed by flame burns (153; 24%), electric injuries (17; 3%), and hot oil (21; 3%). Surgery was performed on 365 (58%) children. The others (263; 42%) were treated without surgery. DISCUSSION: The number of children with a background other than German was higher; moreover, a high number of injuries was not covered by health insurance. Having identified the high-risk group among the pediatric burn patients, we suggest that prevention programs should be directed towards these families in order to reduce further risk of pediatric burns.

[Otto Hilgenfeldt (1900 to 1983)--an unusual approach for finger reconstruction]. / Otto Hilgenfeldt (1900 bis 1983)--Ein ungewöhnliches Verfahren zum Fingerersatz.

Reconstructive surgery of detached extremities, especially fingers, has a long historical tradition. The first clinically correctly documented cases go back to the 19th century. During the first and second world wars numerous reports appeared about the surgical care of war victims. Pioneering innovative surgical methods were developed by especially motivated surgeons for the reconstruction of these disfiguring war injuries in Europe. Because of these particular circumstances and the prevailing revolutionary spirit, many innovations in surgery were developed. The report of Otto Hilgenfeldt (1950) described his unusual approach in reconstructing a finger by using the great toe.

[Secondary reconstruction after burns of the anogenital area]. / Sekundär rekonstruktive Eingriffe nach Verbrennungen im Ano-Genitalbereich.

The incidence of burns of the genitalia and peri-anal region which may cause a reconstructive intervention is very low. In the most cases the use of split thickness skin grafts yields a sufficient permanent wound closure. Upcoming problems such as painful scare formation require a reconstructive intervention (Z-plasty, full thickness skin grafting, pedicled flaps etc.). In case that the anal sphincter is involved with the consequence of incontinence or major damage of the genitalia occurred, sophisticated operative solutions are necessary.