Use of a collagen-elastin matrix with split-thickness skin graft for defect coverage in complex wounds.

OBJECTIVE: Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation). METHOD: A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery. RESULTS: Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder. CONCLUSION: Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds.

[Evidence-based Research in Plastic and Aesthetic Surgery: Cross-sectional Analysis of Research Papers Between 2019 and 2021]. / Evidenzbasierte Forschung in der Plastischen und Ästhetischen Chirurgie: Querschnittsanalyse von Forschungsarbeiten im Zeitraum 2019­2021.

BACKGROUND: In the field of plastic and aesthetic surgery, continuous international publication is seen annually. However, the publication output is not regularly assessed for its level of evidence. In view of the strong publication activity, a regular assessment of the evidence level of the current publication years is reasonable and was the objective of this work. MATERIAL AND METHODS: We evaluated the Journal of Hand Surgery/JHS (European Volume Journal), the journal Plastic and Reconstructive Surgery/PRS and the journal Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla from January 2019 to December 2021. The authors' affiliation, the type of publication, the number of patients examined and the level of evidence with existing conflicts of interest were considered. RESULTS: A total of 1341 publications were evaluated. Of these, 334 original papers were published in JHS, 896 in PRS, and 111 in HaMiPla. The largest share were retrospective papers (53.5%, n=718). The further distribution was as follows: 18% (n=237) clinical prospective papers, 3.4% (n=47) randomised clinical trials (RCT), 12.5% (n=168) experimental papers and 6.5% (n=88) anatomic studies. The distribution of evidence levels of all studies was as follows: Level I: 1.6% (n=21), Level II: 8.7% (n=116), Level III: 20.3% (n=272), Level IV: 25.2% (n=338), Level V: 2.3% (n=31). In 42% (n=563) of the papers, there was no indication of the level of evidence. Most level I evidence was from university hospitals (n=16) in 76.2% (χ²-test 0.619, >0.05, 95% confidence interval). CONCLUSION: Although RCTs are inappropriate for many surgical questions, well-designed and conducted cohort or case-control studies could improve the evidence base. Many of the current studies tend to be retrospective and do not have a control group. Researchers in the field of plastic surgery should consider using a cohort or case-control design when an RCT is not feasible.

[The Impact of Industrial Sponsorship on Research Findings in Randomised Clinical Trials in Plastic and Aesthetic Surgery: a Cross- Section Analysis of the Past 12 Years]. / Der Einfluss von Industrie-Sponsoring auf Forschungsergebnisse randomisierter klinischer Studien in der Plastischen und Ästhetischen Chirurgie: Eine Querschnittsanalyse der letzten 12 Jahre.

BACKGROUND: Industry funding of research studies can cause the results in the field of plastic, reconstructive and aesthetic surgery to be biased towards the sponsors. This paper aims to review randomised clinical trials (RCTs) published by leading international journals in plastic, reconstructive and aesthetic surgery with respect to characteristics and possible industry-friendly conclusions in favour of those funding the study. MATERIAL AND METHODS: Characteristic data and funding of RCTs published by leading international plastic surgery journals from January 2010 to January 2022 were evaluated. The studies were categorised based on their thematic focus and the results in light of the existing funding. RESULTS: A total of 381 RCTs were included in the analysis, 68.5% of which were from a university (n=261). The larger proportion of studies did not disclose any information about the research funding. While 26% (n=98) of the studies analysed were funded by companies, 9.7% (n=37) were funded by universities/the government (p<0.05, 95% confidence interval). The overall focus of private clinics was aesthetics (n=32). Generally, the topic aesthetics (n=153) was funded by industry in 28 of 100 cases (28% industry/private sponsors compared with 9% university/government). Regarding reconstruction/burns/hand surgery, 9.2% of studies were funded by companies/private sponsors. Funding for research by university-based institutions was industry-sponsored in 25% (n=64) of cases. Regarding industry-sponsored studies, 73% (n=71) of the results were product-friendly in their conclusion (p<0.05, 95% confidence interval) and placed their thematic focus on therapeutic drug/product application (n=50, 75%). CONCLUSION: In terms of funding, industry and private sponsors take a leading role both in reconstruction and aesthetics. Nonetheless, the majority of the evaluated studies were not financed by the private sector. In cases where the research was funded by private companies, the results were significantly in favour of the product. Aesthetics as a focus is currently more frequently funded by industry than reconstruction, burn, and hand surgery.

Application of fibrin glue for hematoma prophylaxis in selective aponeurectomy in Dupuytren's disease.

INTRODUCTION: Fibrin glue (FG) can be applied in several surgical procedures at wound closure to reduce postoperative complications such as hematoma formation and wound impairment. The purpose of this study is to assess these preventive surgical benefits in Dupuytren's disease of the hand. PATIENTS AND METHODS: We performed a monocentric retrospective cohort study. All patients who underwent selective aponeurectomy for Dupuytren's disease between 2010 and 2020 were included. Patients were divided into two groups: either receiving or not receiving FG. The primary outcome variables were postoperative bleeding, wound healing impairment, and further pooled postoperative complications. RESULTS: One hundred and thirty-three patients were included in the analysis of which 108 patients were treated with FG, while 24 did not. There was no statistically significant difference in outcomes regarding postoperative bleeding, infections, or revision surgery. However, in the group receiving FG, there was a tendency toward higher wound healing impairment (13%, p = 0.07). The FG group showed a significantly higher pooled complication rate (18.5%, p < 0.02). Complication in general increased with higher Tubiana classification and number of resected cords. Smoking tripled the risk of impaired wound, while cardiovascular comorbidities increased postoperative bleeding by the factor of 11. CONCLUSION: FG did not show a preventive outcome regarding bleeding. The FG group had a tendency for a higher wound healing incidence. Smoking and arterial hypertension correlated with a higher postoperative complication rate. The overall incidence of complications was higher in the FG group. The quality of the surgical intervention as well as accurate hemostasis cannot be corrected by the application of FG.

[Plastic and Aesthetic Surgery in Times of Social Media: An Analysis of the Reach and Topic Focus of the Most Successful Channels on YouTube]. / Die Plastische und Ästhetische Chirurgie in Zeiten von Social Media: Eine Analyse der Reichweite und des Themenfokus der erfolgreichsten Kanäle auf YouTube.

BACKGROUND: The use of social media such as Facebook, YouTube and Instagram is becoming an integral part of communication in plastic and aesthetic surgery. The potential reach provides significant opportunities to share information and reach patients. It must therefore be increasingly considered as a modern tool for a new form of publication and as a data and knowledge bank. This work aims to investigate the leading YouTube channels of German plastic and aesthetic surgeons with a view to reach, characteristics and topic focus. MATERIAL AND METHODS: All leading German YouTube channels of specialists in plastic and aesthetic surgery were evaluated. The analysis was based on key figures (country ranking, number of uploads, reach with total views, daily new subscribers; association with university hospital, non-university hospital, private practice) and content with a consecutive classification of the topics of the most successful videos. RESULTS: With the keyword "plastic surgery", 376 German channels were identified, with 8 channels meeting the inclusion criteria. The most successful channels reached a median of 1.342.017 views (IQR 745.455-2.550.682). The daily views on the channels amount to a median of 718 views per channel (IQR 272-1.086). From a total of 290 of the most successful videos, 87% were about aesthetic procedures (n=253). A percentage of 87.5% (7/8) of the most successful channels were from plastic and aesthetic surgeons in private practice. CONCLUSION: The platform YouTube offers an enormous potential of reach for knowledge transfer and marketing. It is primarily used by aesthetic surgeons and here mainly by those from the private practice sector. There is still a lot of potential for expansion regarding the representation of university plastic and aesthetic surgery with all its fields such as reconstruction, hand surgery and burn surgery on this platform.

Correction to: Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis.

[This corrects the article DOI: 10.1007/s00238-020-01679-z.].

Evaluation of Patients' Preferences for Skin Grafting in Plastic-Surgical Defect Coverage.

BACKGROUND: Grafting split-thickness (STSGs) and full-thickness skin grafts (FTSGs) are common techniques to replace missing skin and to restore the skin barrier in burn, trauma and remaining skin defects after tumor resections. The defect coverage with skin grafts offer many advantages, but also disadvantages such as donor site morbidity like possible sensory disturbances, scarring, risk of infection, contour changes and pigment disorders. We aimed to assess the preferred distribution of donor site for STSGs and FTSGs in patient's skin grafting for plastic-surgical defect coverage. METHODS: Patients and their accompany persons referred to the Department of Plastic Surgery were interviewed for defect coverage with STSGs or FTSGs, the preference in donor site was investigated and the detailed advantages and disadvantages were clarified. RESULTS: We evaluated 85 participants (male=43, female=42) with a median age of 42 years (mean=46 years). The definition of the donor site (n=188 markings) was mainly based on the physicians recommendation (32.98%), mobility (23.40%), aesthetic results (22.34%) and pain (21.28%). Feared complications (n=152) were mainly wound healing disorders (32.24%), circulation disorders (28.29%), scars (20.39%) and bleeding risks (19.08%). Among all participants, 79 split-skin graft preferences were specified, while 32% favored the scalp as a donor site, as well as 29% the frontal part of the left thigh and 10% the frontal part of the right thigh. CONCLUSION: There were preferred anatomical donor sites for skin grafting. Nevertheless, in conscious patients, the donor site has to be selected in a consent talk and joint approval, preoperatively. The options of taking STSGs from the occipital region with all its advantages should be discussed intensively as it is an attractive graft donor site.

How to become a medical professor - a comparative analysis of academic requirements in Germany and the United States.

BACKGROUND: The acquisition of a medical professorship represents a significant step in a physician's academic career. The responsibility as well as the honor and the associated obligations are significant; however, the requirements to become a medical professor vary in Germany. OBJECTIVE: We analyzed the variable requirements for prospective medical professors in Germany, with special focus on the tenure track concept and the U.S. system. METHODS: Based on an online research, we queried German medical faculty regulations to obtain a medical professorship within Germany. RESULTS: We analyzed 35 German universities. On average, 11 publications are required after "venia legendi" to meet professorship (apl) prerequisites (median x̅ = 10, max = 24, min = 6, n = 16), whereas 6 publications with first or last authorship are required on average (x̅ = 6, max = 16, min = 4, n = 26). In most German universities, it takes an average of 4 years after gaining habilitation to apply for a professorship (x̅ = 5 years, max = 6 years, min = 2 years). Candidates for university chair positions, however, can shorten this period by an average of 38%. DISCUSSION: In the German academic system, the prerequisites to gain a professorship differ among universities. Due to different scientific cooperation and exchange programs, research and academic activities have reached an intense international exchange level. Yet there is no international or even national standardization, quality assurance, and comparability to gain a medical professorship.

Four Extremity Amputation and Bionic Prosthesis Supply after Disseminated Intravascular Coagulation: A Follow-Up on Functionality and Quality of Life after Bionic Prosthesis Supply.

BACKGROUND: Disseminated intravascular coagulopathy (DIC) is a rare symptom complex that causes embolisms within the microvasculature and extensive necrosis of the skin and the acres. During surgical decision-making, preserving functionally important structures must be weighed against radical debridement. The aim was to analyze functional recovery and quality of life of patients sustaining amputations from disseminated intravascular coagulopathy and supplied with bionic prostheses. METHODS: A monocentric, retrospective review of patients with disseminated intravascular coagulopathy after sepsis was conducted from 2016 to 2018. After initial reconstruction and intensive care treatment, patients were provided with bionic prosthetic devices. A follow-up survey measuring function and quality of life was performed. RESULTS: Three patients (mean: 45 years; median: 50 years) were analyzed. The first necrectomy and amputation were performed, on average, after >4 weeks post-symptom onset. All patients required re-amputation, averaging two or one re-amputations in the right or left upper extremity, respectively, and one in ​​the lower extremities. On average, 12 operations for reconstruction of skin defects were required (x͂=8). On average, patients tolerated their prostheses for 5.67 h per day. Satisfaction metrics were either sufficient (SF-36, x̅=69) or moderate (TAPES-R, x̅=4.7). Physical skills were rated poor to fair (average TAPES-R=2.67). CONCLUSION: Supplying bionic prostheses after DIC yielded sufficient to moderate results. However, prothesis weight, signal transmission disorders, and repeated functional failures were suboptimal. For extensive stump scarring, implantable signal electrodes may improve signal transmission.

[Imaging of bacteria in burn wounds treated with split-thicknessgrafts in MEEK/MESH technique: a pilot study with first experiences in clinical wound evaluation with autofluorescence]. / Visualisierung von Bakterien auf Verbrennungswunden und Spalthauttransplantaten nach der MEEK/MESH-Technik ­ Eine Pilotstudie mit ersten Erfahrungen der klinischen Wundbeurteilung durch Autofluoreszenz.

BACKGROUND: Partial and full thickness burns require surgical treatment, such as early débridement and skin transplantation in MEEK/MESH technique or further reconstructive surgery. Infections of burns or transplanted areas limit surgical success and increase patient mortality. For split-thickness grafts in MEEK technique a superficial silk is applied as a protective on-top dressing, whereas in MESH technique fatty gauze and foam are used as standard protective covers over five to seven days. However, wound occlusion by both materials provides the soil for growth of microorganisms. The timely identification of impending infections is necessary to initiate early removal in order to safe and preserve skin grafts. Early identification of infections and removal of foreign material should therefore be attempted. MATERIAL AND METHODS: Burn wounds treated with split-thickness skin grafts processed by MEEK/MESH technique and covered with silk or foam overlayers were analyzed for signs of bacterial infection using the MolecuLight i:X™ device. In addition, swaps for microbiological analysis where taken from fluorescent areas and correlated with florescent image results. RESULTS: We examined burn wounds (n = 14) of three different intensive care patients. The MolecuLight i:X™ camera showed a strong colonization of the transplanted areas and foreign materials, that were in line with microbiological analysis findings. The representation of the excitation load showed high values in the foreign materials. The take rate of MEEK-transplants was 90 % compared to MESH-transplanted with about 60 %. The positive predictive value was 81.8 % for detection of a wound infection with autofluorescence. The negative predictive value was 90.3 % with a sensitivity of 86.7 % and a specificity of 87.5 %. CONCLUSION: The representation of the fluorescence exciter load shows high concentrations of pathogens both in the MEEK silk layer as well as in foam linkers. Overall split-thickness grafts according to the MEEK technique showed a higher healing rate compared to MESH technique. Screening of burns wounds with autofluorescence imaging can be helpful for an additive wound assessment. Split-thickness graft covers should be applied only for a minimum time period required to ensure stable grafting.

[Emergencies in Plastic Surgery: Analysis of Emergency Presentation within a University Department for Plastic and Hand Surgery]. / Notfallaufkommen in der Plastischen Chirurgie - Auswertung der Notfallvorstellungen einer Universitätsklinik für Plastische Chirurgie und Handchirurgie.

BACKGROUND: Interdisciplinary emergency departments in Germany are seeing an increasing inflow of patients for several reasons. Since the number of patients in the emergency room cannot be planned, there may be a lack of capacity with prolonged waiting periods and delays. In particular, a significant amount of capacities is consumed by hand injuries. Also it is suspected for the discipline of plastic surgery that the majority of emergency presentations are unjustified. We provide a collection of data followed by an analysis of emergencies to better understand the increased number of patients with the aim of identifying possible solutions for the relief of emergency care. METHODS: We performed a retrospective analysis of documented patient cases seen in the interdisciplinary emergency room of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of a university hospital. Over the span of one year, we evaluated the diagnosis, waiting time and distribution of patients over 24 hours at 7 weekdays. Furthermore, we evaluated the justification of emergency presentation and the necessity of inpatient admission. RESULTS: We assessed a total of 2768 patients with an average age of 40 years (median = 37 years, male 59 %/ female 41 %) within one year (2016-2017). Of 2450 patients, 69 % were legitimate emergencies, defined by severity of trauma or disease. Proportionally, the most common cause of presentation for 2768 cases was upper extremity injury with cut and saw injuries amounting to 25 % (n = 697), followed by lacerations/bite injuries with 22 % (n = 611) and burns with 17 % (n = 477). Most services were performed between 09:00 a.m. and 01:00 p.m. There were no significant differences regarding the distribution over different weekdays. In 24 % (n = 583) of these cases, the patient was hospitalised for inpatient treatment. In 45 % of cases, there was no indication for hospitalisation after treatment. The waiting time for 2450 patients averaged 2:23 h (median = 01:43 h) until treatment. DISCUSSION: In face of these results it may be argued, that a majority of emergency cases could be selected through filter structures to be distributed to suitable facilities. This could cover a large proportion of the 45 % legitimate, but ambulatory emergencies. Furthermore a concentration of emergency departments should take place with a simultaneous supply of financial resources to expanding emergency departments with high patient flow.

[The Humboldtian model in Plastic and Reconstructive Surgery - a student survey on teaching and venia legendi]. / Das Humboldt'sche Bildungsideal in der Plastischen Chirurgie ­ Studentenumfrage zur Lehre und Venia Legendi.

BACKGROUND: The workload of university hospitals and hospitals with university association includes clinical patient care as well as teaching and research in particular. The current development with focus on financial issues leads to a reduction of teaching and research capacities. Economic focus in university medicine changes priorities of academic surgery. METHODS: An online survey questioned medical students with regard to subjective assessment of quality of the academic body of university hospitals and current teaching quality. Students evaluated the current quality of teaching of postdoctoral lecturers in relation to their career stage and made suggestions for quality of teaching improvement. RESULTS: A total of 166 students participated in the survey. Of 123 students, about 78 % stated that the reputation of postdoctoral lecturers increases with the habilitation but about 85 % stated that professional expectations also rise. About 43 % of the students aim to achieve a postdoctoral lecture qualification. DISCUSSION: Among students academic career is still attractive, but restructuring and modernization of established working models is an essential prerequisite.

Quality of life and reconstructive surgery efforts in severe hand injuries.

INTRODUCTION: Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process. MATERIALS AND METHODS: In this retrospective study, we evaluated patients with severe hand injuries from 2013 to 2016 who had completed surgical and non-surgical treatment. Measures included total period of therapy (TPT) in days, total duration of operations including anesthesia (TOA), total duration of all operations (TO), and total number of operations (TNO). We also determined total inpatient stay (TIS), total number of clinic presentations with interventions (TNPI), initial hand injury severity score (iHISS), and inpatient proceeds (IPP) in Euros (€). Correlation was assessed between iHISS and TOA, TNO, and TIS. Finally, these patients were reexamined in a follow-up inquiry and the life quality was assessed with the five-level version of the EuroQol five-dimensional (EQ-5D) descriptive system (EQ-5D-5L). RESULTS: We analyzed 12 patients with an average age of 44 years (min. 24 years, max. 75 years). Patients receiving reconstructive surgery experienced median ( x ˜ ) TPT of 175 days [interquartile range (IQR), 51-499], TOA of 13 h (IQR, 6-37), TO of 9 h (IQR, 4-25), and TNO of 5 (IQR, 3-11). Further, the patients' median TIS was 22 days (IQR, 9-86), TNPI was 4 (IQR, 2-8), and iHISS was 77 (IQR, 44-162). The median IPP was 14.595 € (IQR, 5.541-33.709 €). IHISS was positively correlated with Pearson's r for TIS (0.817), TOA (0.857), and TNO (0.871). The EQ-5D-5L index value resulted in a high level of life quality with a median of 0.898 (min. 0.8, max. 1). CONCLUSION: Severe hand injuries are related to high efforts for surgical and functional reconstructions, which result in high quality of life measured with the EQ-5D-5L assessment. However, for a defined collective of patients, myoelectric prosthetic functional replacement should be considered. Further studies are necessary to examine functional outcomes and quality of life after bionic prosthetic replacement. Also, a bionic reconstruction score to define hard criteria for taking an acute treatment decision is necessary.

[Careers in plastic and aesthetic surgery: a review of habilitation and professorship of members of the DGPRAEC]. / Karriere in der Plastischen und Ästhetischen Chirurgie ­ Untersuchung zur Habilitation und Professur der Mitglieder der DGPRÄC.

Background Over the last few decades plastic and aesthetic surgery careers aimed at holding a chair as head of the department or clinical director. The current career trend shows a drain of academic teaching staff to peripheral hospitals with sole clinical focus. The achievement of a doctorate in German university medicine or obtaining the venia legendi appears to be the termination of academic careers. This brain drain with loss of expertise and scientific output imposes a problem to future progress in clinical and scientific plastic and reconstructive surgery. The causative role of our present work profile, workload and financial compensation will be discussed in this paper. Methods In order to understand this brain drain, the scientific and clinical developments of all habilitands, Assistant Professors and University Directors enlisted in our specialist society (DGPRAEC) were analyzed. The evaluation included the duration of the residency, the time span from being a specialist physician to habilitation, as well as gaining a leadership position after habilitation. Finally, the current activity of the members at university and non-university institutions was evaluated. Results A total of 1238 members were analyzed. Among these, 177 (14.3 %) members had completed the habilitation. In total, 114 (9.21 %) were included based on full available CVs. Of the listed members, 80 members (6,5 %) had an APL professorship/university professorship in April 2017. 88 CVs showed an average time span of 4.2 years from specialization to habilitation. 80 CVs revealed a 5 year time span to achieve an APL professorship/university professorship. After an average of 4.2 years, leadership positions were held. Of the analyzed habilitations, 60 % were active in peripheral hospitals at the time April 2017. Discussion The loss of scientific and clinical expertise should be prevented in order to preserve academic plastic surgery with focus on patient care, academic education and research. This could be achieved by creating more attractive working conditions.

Free flaps in scar treatment.

INTRODUCTION: Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality. MATERIALS AND METHODS: We worked out the most common surgical approaches and treatment algorithm for a stepwise and effective approach. Part of this algorithm is a seven-step surgical approach. RESULTS: This article provides modern plastic and reconstructive surgery concepts with an algorithm for scar management. DISCUSSION: The treatment of scars follows an algorithm with the level of complexity of techniques adjusted to the individual case and the conditions. Disabilities induced by scarring can lead to further functional loss. In these cases, surgical strategies have to be considered.

Evaluation of optical coherence tomography as a non-invasive diagnostic tool in cutaneous wound healing.

BACKGROUND: The monitoring of wound-healing processes is indispensable for the therapeutic effectiveness and improved care of chronic wounds. Histological sections provide the best morphological assessment of wound recovery, but cause further tissue destruction and increase the risk of infection. Therefore, it is reasonable to apply a diagnostic tool that allows a non-invasive and reliable observation of morphological changes in wound healing. METHODS: Optical coherence tomography (OCT) is an imaging technique for in vivo evaluation of skin diseases with a resolution close to histopathology. The aim of this study was to investigate whether OCT is suited to display the phases of wound healing. For this purpose, six patients with chronic wounds were objectively characterized by OCT during a period of 2 weeks. RESULTS: Comparable results between histological findings and OCT were achieved. OCT allowed the detection of partial loss of the epidermis, vasoconstriction, vasodilatation and epithelialization. CONCLUSION: Consequently, OCT could be a potential non-invasive diagnostic tool for the characterization and monitoring of cutaneous wound-healing processes over time.

Optical coherence tomography for presurgical margin assessment of non-melanoma skin cancer - a practical approach.

In the clinical setting, optical coherence tomography (OCT) is applicable for the non-invasive diagnosis of skin cancer and may in particular be used for margin definition prior to excision. In this regard, OCT may improve the success rate of removing tumor lesions more effectively, preventing repetitive excision, which may subsequently result in smaller excisions. In this study, we have aimed to evaluate the applicability of OCT for in vivo presurgical margin assessment of non-melanocytic skin tumors (NMSC) and to describe the feasibility of different scanning techniques. A total number of 18 patients planned for excision of lesions suspicious of NMSC were included in this study. Based on OCT, we defined the specific tumor margins on 19 lesions preoperatively using different scanning modalities. Sixty-one margin points and five complete tumor margins were analysed on 18 patients with a total of 19 lesions including 63% basal cell carcinoma (BCC) (n = 12), 16% (n = 3) squamous cell carcinoma (SCC) and 21% of other types of skin tumors (n = 4) were classified. In 84% of the cases (n = 16), the OCT-defined lateral margins correctly indicated complete removal of the tumor. The surgical margins chosen by the surgeon never fell below the OCT-defined margin. Regarding the techniques of marginal definition, punctual tumor border scan in the perpendicular direction, with an extension of free-run scans for unsure cases can hardly be recommended. This study shows that suspected NMSC can effectively be confirmed, and furthermore, resection margin can be minimized under OCT control without reducing the rate of complete removal.