[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and Research Funding Report 2021/2022]. / Register Forschungsförderung der Deutschen Gesellschaft für Plastische, Rekonstruktive und Ästhetische Chirurgie (DGPRÄC) und Forschungsförderungs-Bericht 2021/2022.

BACKGROUND: Research is an integral part of academic medicine. In plastic surgery, it sets the course for innovations in the specialty. The purpose of this study is to present the research performance of plastic surgeons in Germany for the period 2021/2022 and to compare it with previous periods. MATERIALS AND METHODS: The directors of plastic surgical academic institutions reported all requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was gathered within an established online database. In addition, the DFG´s public database GEPRIS was screened for plastic surgical research grants. Data was also collected regarding research infrastructure and organization at the participating centers. RESULTS: 105 applications were reported to 54 different funding agencies from 20 plastic surgery centers. 37 funding applications were submitted to the major public funding agencies DFG, BMBF, BMWi, BMG, BMVg, G-BA and EU. Of these, 59,5% (22/37) were DFG, 13,5% (5/37) each BMBF and EU, 5,4% (2/37) BMWi, and 2,7% (1/37) each BMG, BMVg, and G-BA applications. The average funding volume of these proposals was 401,515 euros. Approved DFG proposals were most frequently assigned to the review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery (n=10/16, 62,5%). Over time, the research registry shows an increase in the number of proposals in general and those granted. 70,0% (14/20) of participating sites had their own experimental research laboratory, while only 40,0% (8/20) had their own clinical trial center. CONCLUSION: The 2021/2022 Research Funding Report once again highlights the impressive research accomplishments of the plastic surgery community.

Is there a need for postoperative monitoring after open carpal tunnel release under WALANT?

Open carpal tunnel release (OCTR) under wide-awake local anesthesia with no tourniquet (WALANT) is a common outpatient procedure in hand surgery worldwide. In our clinic, WALANT has replaced intravenous regional anesthesia with a tourniquet (IVRA, or 'Bier block') as standard practice in OCTR. We therefore wondered what the optimal postoperative setting after OCTR under WALANT is. In this study, we compared patient satisfaction in two postoperative settings: immediate discharge (ID) after the operation, or short postoperative monitoring (PM) period in the outpatient clinic. Our hypothesis was that older patients would prefer a brief postoperative surveillance. We retrospectively analyzed patient satisfaction with the two settings using an adjusted questionnaire based on the standard Swiss grading system. We also assessed postoperative pain, satisfaction with the perioperative preparations and the reasons for unscheduled postoperative consultations, as secondary outcomes. One hundred and nine patients (ID, n = 63; PM, n = 46) were included in this single-center retrospective observational study. Patients were highly satisfied with both postoperative settings (Mean: ID 5.1/6; PM 5.5/6; p = 0.07). Even patients aged ≥80 years reported extremely high satisfaction with both settings (ID 5.6/6; PM 6.0/6; p = 0.08). Fifteen patients (ID, n = 11 [17.5%]; PM, n = 4 [8.7%], p = 0.72) unexpectedly consulted a doctor after surgery. OCTR under WALANT as an outpatient procedure with immediate discharge was associated with high patient satisfaction. However, detailed postoperative monitoring could contribute to the patient's well-being and education on how to cope with the postoperative course, and help with any questions.

Objective evaluation of volumetric changes during breast augmentation using intraoperative three-dimensional surface imaging.

BACKGROUND: Breast volume estimation and implant size are crucial factors to achieve a symmetrical result in esthetic and reconstructive breast surgery. Although three-dimensional surface imaging (3DSI) has allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has been limited regarding intraoperative decision-making. OBJECTIVE: To validate the intraoperative use of a portable hand-held 3D surface imaging device as an objective tool to assess volumetric changes during breast augmentation surgery. METHODS: Patients receiving bilateral, submuscular breast augmentation were enrolled for this study. Intraoperative 3DSI was conducted using the Sense 3D scanner, allowing for digitalization of the operating field. Intraoperatively gauged volume changes caused by known implant volumes were compared with digital measurements calculated from 3D surface images of the operating field. Digital intraoperative breast volumes were compared to the pre- and postoperative Vectra XT reference system. RESULTS: Eighty individual breasts of 40 patients were successfully 3D imaged before incision and after wound closure. There was no significant difference between digital breast volumes by intraoperative and outpatient 3DSI. Intraoperative pre- to postoperative 3D breast volume change showed no significant difference to the known implant volume (p = 0.124, mean deviation of 5.8 ± 24.3 mL and 2.0 ± 9.0%). CONCLUSIONS: Our findings showed a high correlation regarding intraoperative digital breast volumetric changes. Intraoperative use of 3DSI yielded objective data during breast augmentation. This novel technique could beneficially impact future breast implant selection, especially in cases with breast asymmetry and the need for differently sized implants.

In vitro and in vivo detection of microbial gene expression in bioactivated scaffolds seeded with cyanobacteria.

Dermal replacement materials bioactivated with cyanobacteria have shown promising potential for wound regeneration. To date, extraction of cyanobacteria RNA from seeded scaffolds has not been described. The aim of this study was to develop a method to isolate total RNA from bioactivated scaffolds and to propose a new approach in determining living bacteria based on real-time PCR. Transgenic Synechococcus sp. PCC 7002 (tSyn7002) were seeded in liquid cultures or scaffolds for dermal regeneration in vitro and in vivo for 7 days. RNA was extracted with a 260/280 ratio of ≥2. The small subunit of the 30S ribosome in prokaryotes (16S) and RNAse P protein (rnpA) were validated as reference transcripts for PCR analysis. Gene expression patterns differed in vitro and in vivo. Expression of 16S was significantly upregulated in scaffolds in vitro, as compared to liquid cultures, whilst rnpA expression was comparable. In vivo, both 16S and rnpA showed reduced expression compared to in vitro (16S: in vivo Ct value 13.21 ± 0.32, in vitro 12.44 ± 0.42; rnpA in vivo Ct value 19.87 ± 0.41, in vitro 17.75 ± 1.41). Overall, the results demonstrate rnpA and 16S expression after 7 days of implantation in vitro and in vivo, proving the presence of living bacteria embedded in scaffolds using qPCR.

Uni-vs. bilateral DIEP flap reconstruction - A multicenter outcome analysis.

OBJECTIVE: Over the past decade numbers of bilateral mastectomy have increased steadily. As a result, bilateral breast reconstruction is gaining popularity. The presented study compares complications and outcomes of unilateral and bilateral DIEP free-flap breast reconstructions using the largest database available in Europe. METHODS: Female breast cancer patients (n = 3926) receiving DIEP flap breast reconstructions (n = 4577 free flaps) at 22 different centers were included in this study. Free flaps were stratified into two groups: a unilateral- (UL) and a bilateral- (BL) breast reconstruction group. Groups were compared with regard to surgical complications and free flap outcome. RESULTS: Mean operative time was significantly longer in the BL group (UL: 285.2 ± 107.7 vs. BL: 399.1 ± 136.8 min; p < 0.001). Mean ischemia time was comparable between groups (p = 0.741). There was no significant difference with regard to total (UL 1.8% vs. BL 2.6%, p = 0.081) or partial flap loss (UL 1.2% vs. BL 0.9%, p = 0.45) between both groups. Rates of venous or arterial thrombosis were comparable between both groups (venous: UL 2.9% vs. BL 2.2%, p = 0.189; arterial: UL 1.8% vs. BL 1.2%, p = 0.182). However, significantly higher rates of hematoma at the donor and recipient site were observed in the UL group (donor site: UL 1.1% vs. BL 0.1%, p = 0.001; recipient site UL 3.9% vs. BL 1.7%, p < 0.001). CONCLUSIONS: The data underline the feasibility of bilateral DIEP flap reconstruction, when performed in a setting of specialized centers.

Impact of body mass index on free DIEP flap breast reconstruction: A multicenter cohort study.

INTRODUCTION: Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. This study analyzed the largest series of microsurgical breast reconstructions in Germany using deep inferior epigastric perforator (DIEP) flaps, with a focus on the impact of patient body mass index (BMI). PATIENTS AND METHODS: A total of 3911 female patients underwent 4561 free DIEP flap breast reconstructions across 22 different centers. The cases were divided into five groups using World Health Organization BMI criteria: underweight group (BMI <18.5 kg/m2), normal weight/ control group (BMI: 18.5-24.9 kg/m2), overweight group (BMI: 25-29.9 kg/m2), moderately obese group (BMI: 30-34.9 kg/m2), and severely obese group (BMI ≥ 35 kg/m2). Surgical complications were accounted for and the five BMI groups were then compared. RESULTS: Overall, there was no significant difference regarding the rate of partial- and total flap loss between all BMI groups (p > 0.05). However, overweight and obese patients showed significantly higher rates of postoperative infections at the donor and recipient sites than the control group (donor site infections: overweight 0.6%; moderately obese 0.9%; severely obese 2.4% vs control 0.1%; all p<0.01; recipient site infections: overweight 0.5%; moderately obese 0.8%; severely obese 1.4% vs control 0.1%; all p < 0.05). The rate of medical complications also differed significantly between groups, with the highest rates in moderately and severely obese women (moderately obese: 8.4%; severely obese: 13.0% vs. control: 5.1%; p < 0.01). CONCLUSION: Our findings suggest that successful free tissue transfer can be achieved even in an underweight and severely obese population with acceptable risk for complications.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2019/2020]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungsbericht 2019/2020.

BACKGROUND: Since 2015/16 the DGPRÄC collects, evaluates and publishes the research activities of academic sections, departments and clinics for plastic surgery at university hospitals in Germany, in order to raise the awareness of plastic surgical research performance. MATERIALS AND METHODS: The directors of plastic surgical academic institutions were contacted via the DGPRÄC and asked to report any requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was collected in our previously established online database: https://docs.google.com/forms/d/e/1FAIpQLSe6F5xmTyw-k7VKJx_2jkPA4LBXsA0sgBGMrC3rx_4bHj6uzQ/viewform?usp=sf_link. In addition, applications were identified via the DFG's public database GEPRIS. RESULTS: A total of 41 funding applications to the public funding institutes DFG, BMBF, BMWi, BMG and EU were identified. 75.6 % (31/41) of the applications had already been approved at the time of data collection, of which 77.4 % (24/31) were DFG, 9.7 % (3/31) were BMWi, 6.5 % (2/31) were EU and 3.2 % (1/31) were BMBF or BMG applications. The average funding amounted to 358 301 Euro. In 50.0 % (12/24) of the cases, the approved DFG proposals were assigned to the subject review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery. CONCLUSION: The continuous publication of plastic surgical research funding reports submitted by the convention of university plastic surgeons of the DGPRÄC portraits the excellent, collaborative research activity in the field of plastic surgery.

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study.

PURPOSE: Immediate breast reconstruction (IBR) at the time of mastectomy is gaining popularity, as studies show no negative impact on recurrence or patient survival, but better aesthetic outcome, less psychological distress and lower treatment costs. Using the largest database available in Europe, the presented study compared outcomes and complications of IBR vs. delayed breast reconstruction (DBR). METHODS: 3926 female patients underwent 4577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups according to the time of reconstruction: an IBR and a DBR group. Surgical complications were accounted for and the groups were then compared. RESULTS: Overall, the rate of partial-(1.0 versus 1.2 percent of cases; p = 0.706) and total flap loss (2.3 versus 1.9 percent of cases; p = 0.516) showed no significant difference between the groups. The rate of revision surgery was slightly, but significantly lower in the IBR group (7.7 versus 9.8 percent; p = 0.039). Postoperative mobilization was commenced significantly earlier in the IBR group (mobilization on postoperative day 1: 82.1 versus 68.7 percent; p < 0.001), and concordantly the mean length of hospital stay was significantly shorter (7.3 (SD3.7) versus 8.9 (SD13.0) days; p < 0.001). CONCLUSION: IBR is feasible and cannot be considered a risk factor for complications or flap outcome. Our results support the current trend towards an increasing number of IBR. Especially in times of economic pressure in health care, the importance of a decrease of hospitalization cannot be overemphasized.

Influence of software parameters on measurements in automatized image-based analysis of fat tissue histology.

The understanding of fat tissue plays an eminent role in plastic surgery as well as in metabolic research. Histopathological analysis of tissue samples provides insight in free fat graft survival and culture experiments help to better understand fat tissue derived stem cells (ASCs). To facilitate such experiments, modern image-based histology could provide an automatized approach to a large amount of data to gain not only qualitative but also quantitative data. This study was designed to critically evaluate image-based analysis of fat tissue samples in cell culture or in tissue probes and to identify critical parameters to avoid bias in further studies. In the first part of the study, ASCs were harvested and differentiated into adipocytes in cell culture. Histology was performed with the fluorescent dye BODIPY and the obtained digital images were analyzed using Image J software. In the second part of the study, digitalized histology of a previous in vivo study was subjected to automatized fat vacuole quantification using Image J. Both approaches were critically reviewed, and different software parameter settings were tested. Results showed that automatized digital image analysis allows the quantification of fat tissue probes with enough precision giving significant results. But the testing of different software parameters revealed a significant influence of parameters themselves on calculated results. Therefore, we recommend the use of image-based analysis to quantify fat tissue probes to improve the comparability of studies. But we also emphasize to calibrate software using internal controls in every single experimental approach.

[Defect coverage after severe soft tissue infections: when and how?] / Defektdeckung nach schweren Weichteilinfektionen: wann und wie?

Severe infections frequently cause large soft tissue defects which require early defect coverage by plastic surgeons. A number of reconstructive treatment options are available, ranging from local flaps to microvascular free flap reconstructions. In this respect it is important that the selection of the optimal reconstructive technique is made based on individual patient characteristics and in a timely manner. Weeks of inpatient treatment with vacuum dressings often delay defect coverage and should be avoided as they burden both the patient and the healthcare system. Therefore, it is in the best interest of patients to receive early treatment by plastic surgeons. This manuscript presents the essential reconstructive treatment approaches based on highly informative case reports of patients from the plastic surgical practice at a university hospital.

K+ Accumulation and Clearance in the Calyx Synaptic Cleft of Type I Mouse Vestibular Hair Cells.

Vestibular organs of Amniotes contain two types of sensory cells, named Type I and Type II hair cells. While Type II hair cells are contacted by several small bouton nerve terminals, Type I hair cells receive a giant terminal, called a calyx, which encloses their basolateral membrane almost completely. Both hair cell types release glutamate, which depolarizes the afferent terminal by binding to AMPA post-synaptic receptors. However, there is evidence that non-vesicular signal transmission also occurs at the Type I hair cell-calyx synapse, possibly involving direct depolarization of the calyx by K+ exiting the hair cell. To better investigate this aspect, we performed whole-cell patch-clamp recordings from mouse Type I hair cells or their associated calyx. We found that [K+] in the calyceal synaptic cleft is elevated at rest relative to the interstitial (extracellular) solution and can increase or decrease during hair cell depolarization or repolarization, respectively. The change in [K+] was primarily driven by GK,L, the low-voltage-activated, non-inactivating K+ conductance specifically expressed by Type I hair cells. Simple diffusion of K+ between the cleft and the extracellular compartment appeared substantially restricted by the calyx inner membrane, with the ion channels and active transporters playing a crucial role in regulating intercellular [K+]. Calyx recordings were consistent with K+ leaving the synaptic cleft through postsynaptic voltage-gated K+ channels involving KV1 and KV7 subunits. The above scenario is consistent with direct depolarization and hyperpolarization of the calyx membrane potential by intercellular K+.

[Artificial intelligence in plastic surgery : Current developments and perspectives]. / Künstliche Intelligenz in der Plastischen Chirurgie : Aktuelle Entwicklungen und Perspektiven.

BACKGROUND: Artificial intelligence (AI) has long been established in various parts of everyday life due to the instrumentalization of machines and robotics in industry, autonomous vehicles and the rapid development of computer-based systems. OBJECTIVE: Demonstration of current developments and perspectives of AI in plastic surgery. MATERIAL AND METHODS: Evaluation of statistics, press releases and original articles from journals and discussion of reviews. RESULTS: In the healthcare system and in plastic surgery AI is particularly useful in the context of data analysis from digital patient files and big data from central registers. The use of 3D imaging systems provides objective feedback on surgical results in terms of volume and aesthetics. Intelligent robots assist plastic surgeons in microsurgical anastomoses of increasingly smaller vessels and the implementation of AI in the field of prosthetics enables patients to regain hand function following amputation injuries. CONCLUSION: For the benefit of the patients, it is the responsibility of experimental surgery to explore the opportunities, risks and limitations of applications with AI.

[A critical analysis of perception of plastic surgery in Germany]. / Kritische Perzeptionsanalyse der plastischen Chirurgie in Deutschland.

BACKGROUND AND OBJECTIVES: Plastic surgery includes a broad range of activities; however, there are no studies available in Germany which evaluated the specific role plastic surgeons play in providing patient care. The aim of the project was thus to analyze the public and professional perception of plastic surgery in Germany and to what degree the range of activities is appropriately represented. MATERIAL AND METHODS: An anonymous survey inquiring about demographic data and specific knowledge regarding plastic surgery procedures was conducted in various regions in German. Furthermore, factors that potentially influence the state of knowledge and personal perception were collated. The questionnaire was distributed among healthcare professionals and patients in plastic surgery. The statistical evaluation was performed using SPSS software. RESULTS: A total of 2100 people participated in the nationwide survey. While classical aesthetic operations were mostly assigned to plastic surgery, there was no uniformity as to whether other indications, such as reconstructive interventions and hand surgery were assigned to this specialty or not. In this context various factors could be elucidated, such as the place of residence, education and age of the survey participants and the respective knowledge, which influence the perception. CONCLUSION: Plastic surgery in Germany classically consists of the four pillars of general reconstruction, hand surgery, burn management and aesthetic procedures; however, the results of this survey revealed that plastic surgery in Germany is predominantly understood as burn management and aesthetic surgery. As a multidisciplinary specialty, plastic surgery could apparently benefit from a more positive lobby and from a better portrayal of its scope in the media and general public.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2017/2018]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungs-Bericht 2017/2018.

INTRODUCTION: This report serves to publicize the research of academic institutions for Plastic Surgery within our society DGPRÄC in 2017/2018 and sequels the funding report of 2015/2016. Applications to public, non-public, or industrial funding organizations were evaluated. At the same time, this paper analyses the number of approved DFG applications in Plastic, Thoracic and Vascular Surgery in the GEPRIS system. Contrary to these specialties, Plastic Surgery is not classified as an independent speciality in the subject structure of the DFG review board which results in a lack of transparency concerning Plastic Surgery research work. MATERIALS AND METHODS: Our previously established online database (https://docs.google.com/forms/d/1OaSnHyKTysawiI1ie7kfUxDf7nJP_RiTUJTsnb7Mq_E/edit) for reporting requested/ approved and rejected research applications to public, non-public and industrial funding organizations was continued and evaluated together with applications found in the DFG's public database GEPRIS. RESULTS: Compared to the previous year's report, the number of approved applications from public research organizations (DFG, BMBF, BMWi, EU) was increased from 23 to 27. We identified 19 approved DFG applications from Plastic Surgery, as compared to 9 and 8 applications by Thoracic and Vascular Surgery, respectively. SUMMARY: Taken together, this data emphasizes that our research is at least equal to that of other newly established surgical specialties within the framework of the DFG. Accordingly, we hope to provide further arguments for an adaptation of the DFG review boards subject structure to include Plastic Surgery as an independent specialty as it is for Vascular Surgery and Thoracic Surgery.

[Consensus of the Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) on Autologous Fat Grafting]. / Konsensus der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) zur Eigenfett-Transplantation.

On occasion of the Munich Plastic Symposium in Munich the board of the Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) together with a group of experts who were also involved in the preparation of the recently published S2K guideline "Autologous Fat Grafting", prepared a consensus statement from a plastic-surgical point of view so to evaluate current spects and taking into account the current legal framework: 1. Autologous Fat Grafting is a long established treatment in plastic surgery and does not differ from other tissue grafts. 2. Mechanical processing of autologous fat does not provide any substantial change tot he tissue. 3. If other treatment methods to enrich progenitor cells of autolous fat i. e. by an enzymatic process have evidence that autologous adipose tissue or cells were substantially changed, classification as a drug could come in question under current german law (application of AMG/ATMP).

[Overview and Introduction of a Treatment Concept for Postoperative Care and Mobilisation After Free Flap Transplantation in the Lower Extremity]. / Überblick und Vorstellung eines Behandlungskonzeptes zur postoperativen Therapie und Mobilisation nach freier Lappenplastik an der unteren Extremität.

Introduction: Free flap transplants for soft tissue reconstruction in the lower extremity are associated with a higher rate of complications compared with other areas. Mobilisation and the resulting hydrostatic pressure put strain on the flaps. In general, these effects are countered by slowly increasing hydrostatic pressure with the leg being compressed by elastic bandages. These postoperative regimes are also called dangling procedures or "flap training", but are not scientifically validated and therefore there is no consensus or guideline leading to a standard treatment regime. The goal of our study was to present an overview of currently performed regimes. Material and Methods: We conducted an email survey by sending a questionnaire to departments for plastic and reconstructive surgery in Germany, Austria and Switzerland, which perform free flap transplantations in the lower extremity. The questionnaire ascertained the starting point and the frequency of the dangling procedures, the introduction of weight-bearing on the operated extremity and the incidence of complications occurring during mobilisation. Results: We included 32 departments and compared them by the number of free flap transplantations performed per year. We found a wide variation between the postoperative treatment regimes. In most departments, flap training is started between the 3rd and 7th day after surgery and lasts between 5 and 15 min. The intervals with which flap training intensity is increased are inhomogeneous as well. The time until full weight-bearing is exerted on the operated extremity ranges from day 5 to week 3 postoperatively. Complications due to flap training were reported by one third of the participating departments. Conclusion: Elastic compression and patient mobilisation after free flap procedures in the lower extremity are considered to be very important in reducing complications and in protecting the flap from edema and volume overload. This article demonstrates that there is a wide variety in flap training regimes. It aims to help readers evaluate their own regimes and provides guidance for an individualised patient-oriented regime.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2015/2016]. / Register Forschungsförderung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und Forschungsförderungs-Bericht 2015/2016.

In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRÄC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.