Polychrome Bone Fluorescence: A valuable diagnostic tool for 4th degree calvarial burns. A Case report.

4th degree calvarial burns are complex in management with regards to determining bone vitality and subsequent choice of defect coverage. Distinguishing viable and nonviable bone can be challenging. Tetracycline bone fluorescence is well described and in common use in maxillofacial patients with bisphosphonate osteonecrosis and has been reported in septic orthopedic surgery specifically periprosthetic joint infection. On the basis that viable bone fluoresces, the concept of polychrome fluorescence was extrapolated as a diagnostic tool for calvarial burns. Bone fluorescence presents an efficient, non-invasive, and cost-effective diagnostic tool delineating exact necrotic margins in 4th degree burns ensuring targeted bone sparing debridement. This report describes the use of polychrome bone fluorescence as an intra-operative tool including a single-centre case report with 4th degree calvarial burns.

[Perioperative Management in Microsurgery - Consensus Statement of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels]. / Perioperatives Management in der Mikrochirurgie - Konsensus-Statement der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße.

Perioperative management of microsurgery is not well standardised. Due to a lack of evidence, different regimes are established in different microsurgical centres. However, trends towards less aggressive perioperative interventions can be identified in recent years, since treatment algorithms without systematic evidence are being progressively abandoned. The available evidence on perioperative issues, such as temperature control, fluid resuscitation, blood transfusions, application of vasodilators or - pressors, as well as anticoagulants, were discussed during the consensus conference on perioperative management at the annual meeting of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels. Common basic standards were identified and a consensus was reached that is described in the following manuscript.

[The latissimus dorsi myocutaneous free flap--a salvage option for abdominal wall reconstruction in complex incisional hernias]. / Die M. latissimus dorsi-Lappenplastik--Salvage-Option bei der komplizierten Rezidiv-Narbenhernie.

Complex incisional hernias are a serious burden for the patient and a challenge for the surgeon. The main problem is the covering of the defect after the resection of large proportions of low-grade tissue. In this work, we describe 2 patients who underwent complex reconstruction of recurrent incisional hernias using a bovine pericardium mesh (Tutomesh®) and a latissimus dorsi myocutaneous free flap.

Lip reconstruction: an anthropometric and functional analysis of surgical outcomes.

Postoperative evaluation of results of reconstructive procedures of the lips mainly consists of describing the technique, complications and subjectively interpreted patient photographs. The authors present a photo-assisted pre- to postoperative evaluation of reconstructive procedures of the lips based on anthropometric measurements and functional outcome. Forty-eight patients underwent partial or full thickness excision of tumours of the lips and subsequent reconstruction. An analysis of standardized pre- and postoperative photographs included measurements of intercanthal width, mouth width, philtrum width, lateral upper lip height, upper and lower lip height, cutaneous upper and lower lip height, upper and lower vermilion arc and upper and lower vermilion height. Assessment of functional outcome consisted of the evaluation of oral competence, changes of oral opening and sensation. The effects on the described parameters were analysed, when partial or full thickness reconstruction had to be performed. Intercanthal mouth width index, vermilion arc index, vermilion and cutaneous total lower lip height index showed statistically significant effects postoperatively which indicates a postoperative tightened lower lip, when full-thickness excision was performed. In all patients the indices were proven reproducible and reliable. The standardized measurements described are accurate and objective for evaluating postoperative results.

Evaluation of substitutes for bone: comparison of microradiographic and histological assessments.

We created defects of standard size in the frontal bones of adult pigs and filled them with four different materials. On six occasions (at 1, 2, 4, 8, 12, and 26 weeks), samples were harvested, and evaluated by computing microradiographic images. We examined the specimens histologically as controls. After insertion of anorganic materials, microradiographic evaluation was easy and precise, and there were no significant differences between them and the histological controls (p=0.2). A quantitative evaluation of chemically sterilised bone by computer was not possible for more than 4 weeks.