[Skin expansion screw and skin expander--modern techniques for increasing possibilities in adjacent flap-plasty and defect closure]. / Hautzugschraube und Hautexpander--Moderne Techniken zur Erweiterung der Möglichkeiten bei Nahlappenplastiken und Defektverschlüssen.

There are various techniques for reconstructing skin and soft-tissue defects, among them skin expansion. During the past three years, we have tested a skin-stretching device based on the lag-screw principle of Hirshowitz et al. (1993). We have compared both techniques. The complication rate of both groups was acceptably low.

[Diagnostic imaging of microcirculation of pedicled flap-plasties of the mandibulofacial area using the laser Doppler scanner]. / Bildliche Darstellung der Mikrozirkulation gestielter Lappenplastiken im Kiefer-Gesichtsbereich mit Hilfe des Laser-Doppler-Scanners.

Objective, non-invasive examination techniques in addition to clinical parameters are required to monitor the wound healing of flaps. With the new Laser-Doppler Scanner (LDI, PIM 1.0 Lisca Development AB, Sweden) it is possible to measure and visualize microcirculation continuously, non-invasively and without contact to the wound in an area of 12 x 12 cm. We performed measurements and simultaneous two-dimensional imaging of microcirculation 24, 48, 72 hours and five and 14 days postoperatively in 22 patients, who received reconstruction procedures with random or axial pattern flaps. The perfusion diagrams were correlated to the clinical aspect. Necrotic areas, venous stasis, and normal course of wound healing can be clearly visualized and differentiated. The new Laser-Doppler Imaging System (LDI) serves as an excellent aid for control and planning of flaps in plastic and reconstructive surgery.

Laser Doppler imaging of axial and random pattern flaps in the maxillo-facial area. A preliminary report.

Objective, non-invasive examination, techniques in addition to clinical parameters, are required to follow-up the wound healing of flaps. With the new laser Doppler Scanner (LDI DIM 1.0 Lisca Development AB, Sweden) it is possible, for the first time, to measure and image the microcirculation continuously, non-invasively and without contact with the wound, in an area of 12 cm square maximum. We performed measurements and simultaneous two-dimensional imaging of the microcirculation 24, 48, 72 h and 5 and 14 days postoperatively in 20 patients, who had had reconstruction procedures performed using random or axial pattern flaps. The perfusion diagrams were correlated to the clinical appearance. Necrotic areas, venous stasis and normal course of wound healing can be clearly visualized and differentiated from one another. The new laser Doppler imaging system seems to be an excellent aid for following up and planning of flaps in plastic and reconstructive surgery.

Stereolithographic modelling for reconstructive head surgery.

Until now, bounds of model creation of medical objects had to be set because of the limited capabilities of available manufacturing equipment. Recently, stereolithography was developed as an alternative to current milling operations. In this process the surface of a photohardening liquid plastic compound is traced by a laser beam and hardened in layers. The models thus produced are extremely accurate and retain excellent detail. Specific implants can be designed and prepared as is illustrated in a case report. If tissue-compatible plastics are used, custom-made implants could soon be manufactured directly with the technique described.

[Methods for simulation of surgical interventions in head and neck surgery]. / Methoden zur Simulation operativer Eingriffe in der Kopf- und Halschirurgie.

Preoperative evaluation of the operating site is essential in planning surgical procedures. The relationship of pathology to adjacent tissues and vital anatomical structures needs to be analyzed to determine the intraoperative procedures required. For this the surgeon mentally simulates the procedure planned. For complicated conditions or reconstructive surgery in extensive bony defects, surgery can be simulated with three-dimensional reconstruction on either a monitor screen or on an individually manufactured plastic model of the patient. For this purpose different procedures for 3 D representation and manipulation of tomographic image data have been developed in our departments and the technique of stereolithography used experimentally to create custom-made plastic model of patients. A computerized video image manipulator was also developed for simulation of aesthetic plastic surgical procedures.

[Stereolithographic model construction based on 3-dimensional reconstructed CT sectional image sequences]. / Stereolithographische Modellfertigung auf der Basis dreidimensional rekonstruierter CT-Schnittbildfolgen.

Techniques for 3D reconstruction of medical objects and production of models by CAM have been markedly improved. Milling tools have limited abilities to reproduce complex anatomical structures. Even if 5-axis milling systems are used, the problem of collisions between tool and object is not yet under control. An alternative is offered here by stereolithography. We performed a computed tomography (Somatom DRH, Siemens/Erlangen) of a child with extensive maxillary bone defect after surgical treatment of a congenital tumour. The bone defect was covered by an alloplastic implant. 3D reconstructions were performed by the aid of a conventional personal computer. Generated 3D volume data sets were transferred to a stereolithography system (3D Systems GmbH, Darmstadt/FRG). The produced model revealed high accuracy of the anatomical structures. Intraoperatively, the alloplastic prosthesis was removed and the shape of the new implant could be designed using the stereolithographic model.

Pediatric craniofacial surgery: comparison of milling and stereolithography for 3D model manufacturing.

To improve the planning phase for pediatric craniofacial surgery, 3D reconstructions of CT image series were performed on a personal computer. For construction of true models of the surgical site, two concepts were pursued. CT image data of six patients were used for model manufacturing by a conventional 2 1/2 axis milling system. The material used was polyurethane foam. Alternatively, in one patient a stereolithography was produced on the basis of the 3D reconstructed CT data. This new manufacturing device uses a photocurable monomer, hardened by a UV-laser. The spatial resolution of the system is about 0.1 mm. 3D-reconstructions were performed on a personal computer. Data were then transferred into a surface oriented structure to control a stereolithographic modeling device. Time for transfer was 70 min. The production of the modelled cranium took a total time of 59 h. Accuracy was found to be much higher in stereolithography than in milled models. The model served for surgical planning. The long time for production was caused by inadequate computer capacities, which are configured for much less complex objects in computer aided design. Furthermore the programs for the machine control are optimized for technical purposes. If these conditions are improved, stereolithography could be an attractive alternative to milling of medical models.

[Vascularization and resorption of different supporting tissues by the greater omentum in the formation of compound microvascular transplants]. / Zur Vaskularisation und Resorption unterschiedlicher Stützgewebe durch das Omentum majus bei der Bildung mikrovaskulärer kombinierter Transplantate.

In former investigations the author described the use of omentum majus in building microsurgical compound island flaps employing supporting tissue. Now different kinds of hard tissue, such as autogenous bone and cartilage, allogenous bone and cartilage (preserved by Cialit-solution), Teflon-Fluorocarbon Polymer (Proplast) and tri-calcium phosphate were presented in omentum-sandwich flaps in a histological investigation. We paid special attention to resorption and vascularisation of hard tissue. Allogenous cartilage grafts or artificial materials like Proplast were the most suitable to put into a compound omental island flap. There was good vascularisation with no resorption, especially with Proplast.