Outcome of proximal interphalangeal joint replacement with pyrocarbon implants: a long-term longitudinal follow-up study.

INTRODUCTION: The aim of this study was to compare the short-, mid-, and long-term results of pyrocarbon PIPJ arthroplasty. MATERIALS AND METHODS: Twenty-seven consecutive patients (9 males, 18 females) had arthroplasty for 32 pyrocarbon PIPJ prostheses. Two patients (two joints) were lost for follow-up. Four implants were removed during follow-up. Fifteen patients (18 implants) were available for a long-term follow-up assessment on average 9.7 (9-10.8) years postoperatively and seven patients with eight implants had telephone interviews to calculate the implant survival and complications. Of the 15 patients who came to the latest follow-up, 12 (14 implants) passed each of the three follow-up visits for short-term (ø 19 months), mid-term (ø 54 months), and long-term follow-up (ø 9.8 years) to compare functional and radiological parameters longitudinally. RESULTS: In total, seven of the 30 joints (23%) required a revision surgery, all within the first 2 years postoperatively, including three arthrodesis due to early infection or dislocation, and one distal component removal due to primary loosening. Three patients required soft tissue revisions. The implant survival after 9 years was 87%. There was minimal pain at rest throughout the 9-year follow-up analysis; pain with activity was rated 1.9 at the short-term assessment, 1.5 at mid-term, and 1.6 at long-term. The average active range of motion was at short-, mid-, and long-term examination 49°, 50°, and 48° and grip strength averaged 24, 24, and 21 kg, respectively. The DASH score was stable with 35, 36, and 33 points. At the long-term follow-up, all evaluated implants showed radiological signs of implant loosening or migration. According to the PIP joint outcome score, 57% resulted finally in a "good" outcome. CONCLUSIONS: Pyrocarbon PIPJ arthroplasty has a risk of early complications necessitating revision surgeries. In spite of radiological implant migration, good pain relief, grip strength, and high quality-of-life ratings are stable for a long time.

The use of a polylactide-based copolymer as a temporary skin substitute in deep dermal burns: 1-year follow-up results of a prospective clinical noninferiority trial.

Deep dermal burns can be covered with different kind of materials and techniques; one of them is a polylactide-based temporary skin substitute. The aim of this study was to intraindividually compare its 1-year outcome with the results obtained by use of autologous skin grafts in patients suffering from deep dermal burns. A prospective noninferiority trial was designed in order to assess skin quality and scar formation by use of subjective (Vancouver Scar Scale; Patient and Observer Scar Assessment Scale) and objective (noninvasive cutometry) burn scar assessment tools. All items of the Patient and Observer Scar Assessment Scale, except vascularity, were found to be noninferior in the areas covered with the temporary skin substitute vs. autologous skin. Results of objective scar evaluation showed comparable viscoelastic parameters without reaching noninferiority. Overall, the outcome of deep dermal burns covered with a polylactide-based temporary skin substitute revealed satisfactory results in terms of scar formation and skin quality as compared with autologous skin. This paper supports its use in deep dermal burns, where autologous skin donor sites require either to be reserved for coverage of full-thickness skin defects in severe burns or to be saved for reduction of additional morbidity in selected patient collectives.

Coenzyme Q10 does not enhance preadipocyte viability in an in vitro lipotransfer model.

BACKGROUND: Autologous fat is an attractive soft-tissue filler in plastic and reconstructive surgery. The success of the procedure relies strongly on the technique of transferring viable preadipocytes. Among other factors, preadipocyte viability is impaired by local anesthetics. Application of coenzyme Q10 is being performed by aesthetic plastic surgeons to enhance the success of lipotransfer. The aim of this study was to evaluate the effect of Q10 on preadipocyte viability with special regard to impairment after lidocaine treatment. METHODS: Preadipocytes were pretreated with coenzyme Q10 or vehicle control followed by incubation with lidocaine for 30 min. Viability and apoptosis were assessed by FACS analysis and Western blot. RESULTS: Coenzyme Q10 did not improve viability nor have any effect on investigated apoptosis parameters. Preadipocyte viability was reduced after lidocaine treatment. Surface binding of annexin V, cleavage of caspase-3, and abundance of subdiploid cells were not detectable though, suggesting that necrosis rather than apoptosis is the cause for reduced preadipocyte viability. CONCLUSION: Our results indicate that Q10 does not improve preadipocyte viability. Preadipocyte cell death induced by lidocaine is not caused by apoptosis but by necrosis, which cannot be prevented by coenzyme Q10. These findings should be taken into account when searching for solutions to improve preadipocyte viability in the context of soft tissue engineering and autologous fat transfer.

Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis.

BACKGROUND: In out-of-hospital cardiac arrest, dispatcher-assisted chest-compression-only bystander CPR might be superior to standard bystander CPR (chest compression plus rescue ventilation), but trial findings have not shown significantly improved outcomes. We aimed to establish the association of chest-compression-only CPR with survival in patients with out-of-hospital cardiac arrest. METHODS: Medline and Embase were systematically reviewed for studies published between January, 1985, and August, 2010, in which chest-compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest. In the primary meta-analysis, we included trials in which patients were randomly allocated to receive one of the two CPR techniques, according to dispatcher instructions; and in the secondary meta-analysis, we included observational cohort studies of chest-compression-only CPR. All studies had to supply survival data. The primary outcome was survival to hospital discharge. A fixed-effects model was used for both meta-analyses because of an absence of heterogeneity among the studies (I(2)=0%). FINDINGS: In the primary meta-analysis, pooled data from three randomised trials showed that chest-compression-only CPR was associated with improved chance of survival compared with standard CPR (14% [211/1500] vs 12% [178/1531]; risk ratio 1·22, 95% CI 1·01-1·46). The absolute increase in survival was 2·4% (95% CI 0·1-4·9), and the number needed to treat was 41 (95% CI 20-1250). In the secondary meta-analysis of seven observational cohort studies, no difference was recorded between the two CPR techniques (8% [223/2731] vs 8% [863/11 152]; risk ratio 0·96, 95% CI 0·83-1·11). INTERPRETATION: For adults with out-of-hospital cardiac arrest, instructions to bystanders from emergency medical services dispatch should focus on chest-compression-only CPR. FUNDING: US National Institutes of Health and American Heart Association.

Objective quantification of subjective parameters in scars by use of a portable stereophotographic system.

INTRODUCTION: Current evaluation of scars predominantly relies on subjective evaluation and lacks objective evidence for quantification of therapeutic outcomes by methods suitable for application in daily clinical practice. The aim of this study was to analyze 3-dimensional parameters obtained by use of a portable stereophotographic system in conjunction with subjective clinical findings. METHODS: After validation of the stereophotographic system on plastic scar molds (n = 20), we analyzed subjective evaluations of patients' own, and lay and expert observers by a visual analog scale, and compared the findings for volume and surface irregularity to the objectively calculated values during follow-up of selected scars. RESULTS: Setup and image acquisition took 8 ± 2 seconds. Volumetric parameters highly correlated with real values (R2 = 0.9678). Expert's subjective evaluations were confirmed for volumetric calculations in 5 of 6 sample scars, but only in 2 of 6 for surface irregularity. DISCUSSION: Portable stereophotography can be used in a clinical setting and retains 3-dimensional features in digital reconstructions for subjective assessments, while simultaneously acquiring objective parameters. The objective parameters enabled to complement or even replace subjective clinical findings, and this method proved to be useful for follow-up of therapeutic outcomes in scars.

Adipose tissue engineering: three different approaches to seed preadipocytes on a collagen-elastin matrix.

BACKGROUND: Millions of plastic and reconstructive surgical procedures are performed each year to repair soft-tissue defects that result from significant burns, tumor resections, or congenital defects. Tissue-engineering strategies have been investigated to develop methods for generating soft-tissue. Preadipocytes represent a promising autologous cell source for adipose tissue engineering. These immature precursor cells, which are located between the mature adipocytes in the adipose tissue, are much more resistant to mechanical stress and ischemic conditions than mature adipocytes. To use preadipocytes for tissue-engineering purposes, cells were isolated from human adipose tissue and seeded onto scaffolds. Once processed, preadipocytes become subject to the human tissue act and require handling under much tighter regulations. Therefore, we intended to identify any influence caused by processing of preadipocytes prior to seeding on the reconstructed adipose tissue formation. MATERIAL AND METHOD: Human preadipocytes were isolated from subcutaneous adipose tissue obtained from discarded tissue during abdominoplasties of healthy men and women. Preadipocytes were divided into 3 groups. Cells of group I were seeded onto the scaffold directly after isolation, cells of group II were proliferated for 4 days before seeding, and cells of group III were proliferated and induced to differentiate before seeded onto the scaffold. A 3-dimensional scaffold (Matriderm, Dr. Otto Suwelack Skin and Health Care GmbH, Billerbeck, Germany) containing bovine collagen and elastin served as a carrier. Fourteen days after isolation, all scaffolds were histologically evaluated, using hematoxylin and eosin, anti-Ki-67 antibody, as well as immunofluorescence labeling with Pref-1 antibody (DLK (C-19), peroxisome proliferator-activated receptor gamma antibody, and DAPI (4',6-diamidino-2-phenylindole). RESULTS: Cells of all groups adhered to the scaffolds on day 21 after isolation. Cells of groups I (freshly isolated preadipocytes) and II (proliferated preadipocytes) adhered well and penetrated into deeper layers of the matrix. In group III (induced preadipocytes), penetration of cells was primarily observed to the surface area of the scaffold. DISCUSSION/CONCLUSION: : The collagen-elastin matrix serves as a useful scaffold for adipose tissue engineering. Freshly isolated preadipocytes as well as proliferated preadipocytes showed good penetration into deeper layers of the scaffold, whereas induced preadipocytes attached primarily to the surface of the matrix. We conclude that there might be different indications for each approach.

The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind.

INTRODUCTION: Accurate estimation of burn size is of critical importance, as it is incorporated in every resuscitation formula. The aim of this study was to investigate total burn surface area (TBSA) accuracy among burn specialists, evaluate the potential impact of incorrect evaluation on variations of resultant fluid resuscitation volumes and to discuss future possibilities to estimate or measure TBSA more precisely. METHODS: In a poll during two international burn meetings in 2010 and 2011 demonstrating three pictures of patients with different burn wound patterns and sizes we asked participants to estimate the total surface area burned in percentages. We then calculated resultant fluid volume differences based on established resuscitation formulas. RESULTS: In the polled 80 participants, the estimations for three patients demonstrated the following differences (DIF=MAX-MIN): for patient 1, 2 and 3 they were 22.5 (25-2.5), 16.5 (20-3.5) and 31.5 (40-8.5) %TBSA, respectively. Based on these differences we calculated the volume differences for patients 1,2 and 3, which were 1080ml (Cincinnati Formula), 5280ml (Parkland Formula) and 2016ml (Cincinnati Formula), respectively. CONCLUSIONS: The analysis showed high deviations of total body surface area among participants, also resulting in large variations of initial fluid resuscitation volumes. One option to address estimation variances is to perform more accurate assessments; also incorporating new technologies aiding to improve the quality of body surface estimations and related decisions.

The surgical treatment of rhinophyma-Complete excision and single-step reconstruction by use of a collagen-elastin matrix and an autologous non-meshed split-thickness skin graft.

INTRODUCTION: Rhinophyma is the most common clinical manifestation of phytamous rosacea. While conservative methods (e.g. topical or systemic antibiotics, retinoids) are effective for the treatment of acne rosacea, a surgical intervention is appropriate and required in established rhinophyma. A variety of surgical techniques to reduce proliferated tissue have been reported. However, a surgical "gold standard" for treating the distorting phymatous skin alterations has not yet been established. PRESENTATION OF CASE: This case report details a novel surgical approach: the combination of a bovine collagen-elastin with simultaneous autologous non-meshed split-thickness skin grafting. DISCUSSION: Our approach was based on the following considerations: deep excision facilitates complete removal of diseased tissue that ultimately reduces the risk of recurrence in contrast to commonly applied methods relying predominantly on superficial lesion removal with subsequent spontaneous re-epithelialization. The application of a dermal substitute to create a neodermis covered by split-thickness autologous skin grafting may serve as a functionally and aesthetically appropriate model without requiring the recruitment of donor sites for full-thickness skin grafts or even local flaps. CONCLUSION: The combination of deep excision and single-step replacement of epidermal-dermal components may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome.

Pediatric trauma in the Austrian Alps: the epidemiology of sport-related injuries in helicopter emergency medical service.

BACKGROUND/PURPOSE: We aimed to examine the epidemiological characteristics and injury patterns of pediatric trauma in helicopter emergency medical service (HEMS) caused by sports/outdoor activities in alpine environment. METHODS: This retrospective cohort study analyzed 912 primary HEMS missions for pediatric trauma (0-14 years of age) in Austrian Alps between 1 January 2006 and 30 June 2007. Children were stratified by age into toddlers (3-5 years), children in early (6-9 years), and late school age (10-14 years). RESULTS: The majority of pediatric sports-related trauma in alpine environment was caused by skiing (82.1%; n=749). Pediatric patients were predominately in late school age and boys (72.8%, n=664 and 61.0%, n=556, respectively) and a minority (16.0%, n=146) was severely injured. Overall, fracture (47.0%, n=429), contusion (17.9%, n=163), and traumatic brain injury (17.0%, n=155) were the most common prehospital diagnoses. The most frequent pattern of injury was related to the head/face and spine (36.3%, n=331). CONCLUSIONS: The knowledge about epidemiological characteristics of HEMS use for injured children in alpine environment may be essential for training requirements of HEMS crews and operational considerations of HEMS providers. The incidence of head and spinal injuries requires support for initiatives to promote helmet wear and appropriate risk behavior amongst skiers and snowboarders.

The properties of an "ideal" burn wound dressing--what do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists.

OBJECTIVE: Using Internet polling to classify characteristics of a burn wound dressing considered as "ideal" by burn care specialists for small sized burns (<20% TBSA). METHODS: Open, voluntary Internet-based cross-sectional survey with twenty non-compulsory questions and collection of information related to profession, staff grade, work location. RESULTS: In total one-hundred and twenty-one participants from 39 countries were included (response rate: 121/1000=12.1%) within the one month survey period (1-31st December 2011). The majority of respondents were surgeons (72.1%; 88/121), and most participants were from Europe 59.4% (72/121). According to the survey the following are the properties of an "ideal" burn wound dressing: non-adhesion ("essential": 55/120, 45.8%; "desirable": 50/120, 41.7%), absorbency ("essential": 41/120, 34.2%; "desirable": 64/120, 53.3%) and antimicrobial activity ("essential": 52/121, 43.0%; "desirable": 49/121, 40.5%). In addition, ease of removal, which would produce more pain-free dressing changes, was also considered to be an asset - ideally requiring dressing changes twice per week with a range of different dressing sizes available. As polled directly, most of the respondents thought that such a dressing was currently not available. CONCLUSION: This Internet-based survey provides a first insight into a 'wish list' of properties for burn wound dressings required by specialists in burn care from around the world. As with any kind of idealism, to date, no such burn wound dressing seems to be available in clinical practice according to the poll. Future scientific efforts need to focus on designing materials, which feature at least some of the properties revealed by this analysis.

Prehospital pediatric emergencies in Austrian helicopter emergency medical service - a nationwide, population-based cohort study.

INTRODUCTION: Arguably, the most challenging emergencies encountered by emergency medical service crews involve children. Because only scant data exist about the epidemiology of pediatric emergencies in helicopter emergency medical service (HEMS) on a population level, we sought to determine the epidemiological characteristics stratified by responding area in a large nationwide sample. METHODS: This was a retrospective cohort study including all pediatric patients (0-14 years of age) who were treated by HEMS in Austria from January 2006 to June 2007 (18 months). RESULTS: Pediatric emergencies accounted for 2207 (8.2%) of a total of 26.850 helicopter rescue missions. Of those, 69.9% (n = 1543) were not involved in life-threatening emergencies. The rate of critical pediatric emergencies was higher in urban than in rural or alpine environment (45.2%, 38.2% and 20.3%, respectively). The most common chief complaint was trauma; the frequency of injuries ranged from 54.2% (582/1074) in rural area and 60.3% (44/73) in urban area to 91.4% (969/1060) in alpine environment. Fracture and head trauma (34.9%; 557/1595 and 26.3%; 419/1595, respectively) were the most common injuries. Advanced life support measures like tracheal intubation, cardiopulmonary resuscitation and intraosseous access were rarely performed (3.7%; n = 82, 1.9%; n = 42 and 0.9%; n = 19, respectively). CONCLUSIONS: Pediatric emergencies in Austrian HEMS show different epidemiological characteristics in alpine, urban and rural operational environments. Because of challenges and infrequency of prehospital pediatric emergencies, HEMS crews need to maintain their skills in pediatric advanced life support and trauma care.