How to evaluate scar colour after burn injuries - A clinical comparison of the Mexameter® and the subjective scar assessment (POSAS/VSS).

INTRODUCTION: Scarring after burn injuries remains one of the major challenges in burn medicine and is the subject of current research. Accurate and high-quality assessment of scars is needed to enable exact outcome evaluation of different treatments. Our aim was to evaluate the most common subjective scar evaluation scores-the POSAS (Patient and Observer Scar Assessment Scale) and VSS (Vancouver Scar Scale)-in comparison with the objective device Mexameter® for colour evaluation. METHODS: A prospective monocentre study was performed, which included 120 examined scar areas of 60 patients with third degree burns who had received skin grafts between 1975 and 2018 with a total burned surface area (TBSA) > 2%. Two different scar areas in comparison with one healthy skin area concerning 'colour', 'pigmentation', and 'vascularization' were evaluated by the Mexameter® MX 18, the OSAS, and the VSS by the same examiner, as well as the PSAS by the patient. RESULTS: The mean TBSA of the 60 patients was 24.3%. In the OSAS, 61% of the scars were evaluated as 'hyper-', 19% as 'hypo-', and 19% as 'mix-pigmented'. Furthermore, 65% of the scars were estimated as highly vascularized. In the Mexameter®, the melanin index values of the scar areas compared to the healthy skin areas showed a small difference of 12 (p < 0.05). The mean difference of erythema between the scar and the healthy skin areas was 84 (p < 0.001). For the Mexameter®, moderate correlations were found when comparing 'erythema' with the OSAS category 'vascularization' (r = 0.33, p < 0.05) and 'melanin' with the OSAS parameter 'pigmentation' (r = 0.28, p < 0.05). When comparing the Mexameter® measurements to the OSAS questionnaire, 27% of the scars were wrongly evaluated as 'hyperpigmented' by the observer and 21% as 'hypervascularized', while showing low measurements in the device. Additionally, a novel Mexameter® ordinal scare scale was calculated. CONCLUSION: In this study, we were able to show on a relatively large patient population that with the Mexameter®, the subjectivity of the scar colour assessment by examiner/patient can be overcome, but precise differentiation can still be ensured with subjective evaluation tools. We further introduced a novel Mexameter® Scar Scale. It is necessary to further investigate the vast range of objective devices and develop scar panels for with an incorporation of objective and subjective devices to further improve reliability with reduced bias in terms of scar assessment.

Impact of scapholunate dissociation on human wrist kinematics.

Neither the complex motions of the scapholunate joint, nor the kinematic changes that occur as a result of injury to it, are fully understood. We used electromagnetic tracking within affected bones to evaluate the physiologic motions in the planes of flexion and extension, and of radial and ulnar deviation of human cadaver wrists, before and after complete transection of the scapholunate ligaments. Despite individual variance between each wrist, we were able to establish a pattern in the changes that occurred after scapholunate ligament injury. During the motions examined, the scaphoid showed an increase in translational deviation in almost all motion axes. In contrast, the movement of the lunate seemed to be impaired, especially in radial-ulnar deviation.

[Research Assessment in Plastic and Reconstructive Surgery on a National Level: A 5-Years Systematic Review of Research Activity in German University Hospitals]. / Eine Analyse der Forschungsaktivität universitärer Kliniken für Plastische Chirurgie im nationalen Vergleich: Eine systematische 5-Jahres Evaluation der Forschungsaktivität in Deutschland.

BACKGROUND: In plastic surgery, a broad spectrum of research activity has been performed over the past decade. However, compared with other medical fields, there seems to be a lack of central coordination in the individual research areas. Also no comprehensive, periodical assessment has been undertaken to date. This study aims to provide an overview of German research activity in plastic surgery departments affiliated to medical universities. METHODS: We performed a 5-year interval (01/2010-12/2014) survey of PubMed-listed publications of plastic surgery departments in German university hospitals. For each university (n=11), statistical analyses of the following parameters were performed: distribution of research fields, number of publications, annual cumulative impact sum (IS) and impact factor (IF). RESULTS: For the above-mentioned period, a total of n=904 publications were analysed. Ranking among academic departments was as follows: number of publications: 1. Medizinische Hochschule Hannover 178 (annual average x̅=36/median x͂=34; 2. University Hospital of Erlangen 115 (x̅=23/x͂=23); 3. Bergmannsheil Bochum 90 (x̅=18/x͂=19). The annual impact sum (IS) averaged 33.51 (SD 11.088, p<0.05); separated IS: 1. Medizinische Hochschule Hannover x̅=74.66, x͂=62.22, 2. University Hospital of Erlangen x̅=53.24, x͂=50.84, 3. University Hospital RWTH Aachen x̅=46.12, x͂=44.67. The average impact factor per publication was: 1.98 (SD 0.31, p<0.05); separated IF: 1. University Hospital RWTH Aachen x̅=2.76, x͂=2.79; 2. University Hospital of Erlangen x̅=2.34, x͂=2.46; 3. Medizinische Hochschule Hannover x̅=2.08, x͂=2.05. The analysed publications were distributed as follows: 43% reviews, 20% cell biology/tissue engineering, 10% reconstruction, 27% others (including wound healing, vessel/nerve research, hand surgery, burn, aesthetics, oncology). CONCLUSION: Based on this comprehensive analysis, it seems that a periodical assessment of current research activity would be useful for the future. Data assessments should be started on European and international levels and should also be applied to other surgical and medical disciplines.

Improvement of facial scar appearance and microcirculation by autologous lipofilling.

BACKGROUND: Autologous lipofilling has become a standard procedure for many indications in plastic surgery. Single-case studies have reported improvements in scars, especially in burn patients, after autologous lipofilling. Despite its widespread use, little is known about the mechanisms responsible for this improvement. It is hypothesized that the mesenchymal stem cells and numerous growth factors contained in the lipoaspirate contribute to the skin and scar remodeling. MATERIAL AND METHODS: Between 2008 and 2012, 35 facial scars (n=35) on 26 patients (n=26) were treated by autologous lipofilling. The preoperative examinations and postoperative follow-up included use of the patient and observer scar assessment scale (POSAS), photo documentation, and laser Doppler spectrometry (O2C) measurements of tissue oxygen saturation, hemoglobin levels, and microcirculation on the second, seventh, and ninetieth postoperative days. RESULTS: The scar quality improved in all cases, leading to a high patient satisfaction rate at the final follow-up examination. The POSAS scores were significantly increased for pain (p=0.0331), color (p=0.0007), stiffness (p=0.0030), irregularity (p=0.0039), pigmentation (p=0.0282), and pliability (p=0.0404). In addition, we observed increased hemoglobin levels in the early postoperative period (second day) and a reduction in the microcirculation, which normalized to the preoperative values after 7-90 days. CONCLUSIONS: We demonstrated that autologous lipofilling represents a valuable technique for the treatment of facial scars. Further prospective observational studies are needed to better understand the mechanisms leading to scar enhancement and to make this procedure more reliable and predictable for patients.

[Biomechanical modelling of the wrist joint]. / Biomechanische Modellierung der Handwurzel.

BACKGROUND: The hand represents one of the most complex joint mechanisms of the human body. The hand is also an important communication medium. The spectrum of today's hand injuries reaches from minor damage up to complex traumata with loss of several functional aspects. Enormous subsequent economic costs result. The therapeutic re-establishment of the equilibrium between maximum stress and the actual applied stress is the condition for a lifelong joint function. MATERIAL AND METHODS: A literature review about biomechanical wrist models was realised. The previous models found in the literature were systematically analysed as well as verifying their suitability for clinical use regarding pathological changes, therapy approaches and modelling/simulation approaches, respectively, of wrist injuries. RESULTS: The return of the wrist joint biomechanics to the normal condition is a key factor for a successful therapy. Furthermore, it is important for the re-establishment of an unimpaired joint function. Currently, there exist only simplified descriptions and models of the wrist joint, approximated by technical joints and furthermore, they are partially contradictory. Therefore, no uniform validated biomechanical wrist model exists as yet. CONCLUSION: Regarding the arising complex clinical problems, however, a valid biomechanical wrist joint model would be necessary as assistance, in order to improve the success of systematised therapies on the basis of computer-aided model-based planning and intervention.

Micro-punch technique for treatment of Fordyce spots: a surgical approach for an unpleasant condition of the male genital.

Fordyce spots are ectopic sebaceous glands, ranging between 2 and 3 mm in diameter. These benign lesions are most frequently located in the oral mucosa and the genital skin. Especially in the male genital region they can cause itching, discomfort during sexual activities and are aesthetically unpleasant. So far, a variety of therapeutic procedures have been reported with varying success and recurrence rates. In the present retrospective study (n = 23 patients between 2003 and 2011), we present our surgical approach by means of the micro-punch technique. Using this effective method, we achieved very satisfactory functional and cosmetic results. There were no signs of recurrence during postoperative observations from 12 up to 84 months (median = 51.3 months).