Dan mon O’Dey

Retrograde tracing and toe spreading after experimental autologous nerve transplantation and crush injury of the sciatic nerve: a descriptive methodological study.

Evaluation of functional and structural recovery after peripheral nerve injury is crucial to determine the therapeutic effect of a nerve repair strategy. In the present study, we examined the relationship between the structural evaluation of regeneration by means of retrograde tracing and the functional analysis of toe spreading. Two standardized rat sciatic nerve injury models were used to address this relationship. As such, animals received either a 2 cm sciatic nerve defect (neurotmesis) followed by autologous nerve transplantation (ANT animals) or a crush injury with spontaneous recovery (axonotmesis; CI animals). Functional recovery of toe spreading was observed over an observation period of 84 days. In contrast to CI animals, ANT animals did not reach pre-surgical levels of toe spreading. After the observation period, the lipophilic dye DiI was applied to label sensory and motor neurons in dorsal root ganglia (DRG; sensory neurons) and spinal cord (motor neurons), respectively. No statistical difference in motor or sensory neuron counts could be detected between ANT and CI animals. In the present study we could indicate that there was no direct relationship between functional recovery (toe spreading) measured by SSI and the number of labelled (motor and sensory) neurons evaluated by retrograde tracing. The present findings demonstrate that a multimodal approach with a variety of independent evaluation tools is essential to understand and estimate the therapeutic benefit of a nerve repair strategy.

Importance of the suprasternal notch to nipple distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: A retrospective analysis

BACKGROUND The superior pedicle, frequently used with vertical mammaplasty, bears some risk for vascular complications of the nipple areola complex (NAC) particularly in large breasts. The suprasternal notch to nipple distance (SSN:N), geometrically associated with the longitudinal axis of the breast and length of the superior pedicle, might be an indicative parameter to assess these complications. Importance of the SSN:N for vascular complication of the NAC was focussed upon in this study. MATERIAL AND METHODS Arterial and venous complications of 104 patients following the superior pedicle vertical mammaplasty were retrospectively evaluated both sided (n=208 breasts), according to the preoperatively measured SSN:N. Binary logistic regression (p≤0.05) was used for statistical evaluation. RESULTS Probability of vascular compromise of the NAC is influenced by the SSN:N within the context of the superior pedicle vertical mammaplasty. An SSN:N>30 cm (n=112 breasts) is subject to venous (p=0.002) as well as arterial (p=0.232) complications of the NAC, both of which may result in partial necrosis of the tissue (p=0.029). CONCLUSION The SSN:N measurement can be helpful to identify patients at risk for vascular complications of the superiorly stalked NAC. Modifications of the superior pedicle or other pedicles potentially providing enhanced vascular impact might be considered with an SSN:N beyond 30 cm to reduce vasculature-related complications of the NAC.

Perforator vessel anatomy of the papilla umbilicalis: topography and importance for reconstructive abdominal wall surgery

PurposeSeparation of midline abdominal wall components or other procedures involving the papilla umbilicalis within the context of abdominal wall reconstruction can significantly affect vasculature of the umbilicus. Adjusting dissection to the vascular anatomy of that region may evade such complications. For this purpose, an anatomic microdissection study was performed, focusing on the vascular architecture of the papilla umbilicalis in the midst of the stratigraphical anatomy of the midline abdominal wall.MethodsRamifications of the epigastric vessels were filled with dye on 27 abdominal walls originating from 15 female and 12 male corpses. Vascular architecture of the midline abdominal wall was examined by X-ray imaging and microdissection focusing region of the papilla umbilicalis.ResultsVasculature of the papilla umbilicalis is provided by both myocutaneous and septocutaneous perforator vessels originating from the medial branch of the arteria epigastrica inferior and accompanying veins. On their way to the inferiolateral basis of the papilla umbilicalis, these perforators prove an intimate and regular association with the rectus abdominis muscle, and different components of the rectus sheath.ConclusionsVasculature of the papilla umbilicalis is susceptible to damage resulting from separation of midline abdominal wall components or periumbilical dissections. To secure vasculature of the papilla umbilicalis, the integrity of the loose areolar fascia covering the posterior surface of the rectus abdominis muscle must be kept from being harmed by dissection. In addition, the musculo-fibrous-aponeurotic anatomy on either the left or the right side of the papilla umbilicalis must be left in structural continuity.

The Bivectorial Full-Thickness Superiorly Based NAC Flap: A New Option to Increase Plasticity and Decrease Tension in the Superior Pedicle Vertical Mammaplasty Technique

The standard split-thickness superior pedicle vertical mammaplasty technique sometimes suffers from tension on the nipple-areola complex (NAC). We suggest a bisected full-thickness superiorly based flap that offers two vectors for transposition within the context of superior pedicle vertical mammaplasty. The procedure increases both upper-pole fullness and projection of the breast while decreasing tension on the NAC. The surgical procedure presented contributes to a natural appearance of the breast. It should provide a useful and simple surgical option, increasing the versatility of the superior pedicle vertical mammaplasty technique.

Die Autositzheizung — eine potenzielle Verbrennungsgefahr für den Querschnittsgelähmten

The comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.ZusammenfassungBeheizte Autositze werden mit steigender Popularität in Anspruch genommen. Wir stellen den klinischen Fall einer schweren zweit- und drittgradigen Verbrennung der Sakroglutealregion eines 42-jährigen posttraumatisch Querschnittsgelähmten vor. Der Patient wurde in unserer Verbrennungsklinik aufgenommen und zahlreiche Operationen wurden notwendig. Querschnittsgelähmte Patienten sind durch ihre Sensibilitäts- und Schmerzempfindungsstörung einem erhöhten Verbrennungsrisiko durch Autositzheizungen ausgesetzt. Wir empfehlen eine frühzeitige adäquate Aufklärung der Patienten, Hersteller und aller Bezugspersonen zur Vermeidung derartig schwerwiegender Verbrennungsereignisse.SummaryThe comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.

Flächenhafte Fibromata pendulantia@@@Extensive fibromata pendulantia: Hydrochirurgie als Therapieoption mittels Versajet®-Technik@@@Hydrosurgery as a therapy option using the Versajet® technique

Fibromata pendulantia often appear as small filiform skin tags with a narrow pedicle in the neck, axilla and groin areas. Hitherto, extensive fibromata pendulantia were resected either surgically (curette, scissors, scalpel) or by laser. The present case study of an adipose patient with disseminated fibromata pendulantia in the axillary region in the setting of pseudoacanthosis nigricans introduces the Versajet hydrosurgery technique as an alternative method. It is able to remove tissue and rinse the wound simultaneously by means of a high-pressure water jet.ZusammenfassungFibromata pendulantia kommen häufig in Form kleiner filiformen Säckchen mit schmaler Basis („skin tags“) im Bereich des Halses, in den Achselhöhlen und Leistenbeugen vor. Bisher wurden flächenhafte Fibromata pendulantia chirurgisch (scharfer Löffel, Schere, Skalpell) oder mit einem Laser entfernt. Im vorliegenden Fall mit dem Krankheitsbild einer Pseudoacanthosis nigricans mit flächenhaften Fibromata pendulantia im Bereich der Achselhöhlen eines adipösen Patienten stellen wir die Versajet-Hydrochirurgietechnik als Alternativmethode vor. Durch einen Hochdruckstrahl wird hierbei gleichzeitig Gewebe entfernt und die Wunde ausgespült.AbstractFibromata pendulantia often appear as small filiform skin tags with a narrow pedicle in the neck, axilla and groin areas. Hitherto, extensive fibromata pendulantia were resected either surgically (curette, scissors, scalpel) or by laser. The present case study of an adipose patient with disseminated fibromata pendulantia in the axillary region in the setting of pseudoacanthosis nigricans introduces the Versajet® hydrosurgery technique as an alternative method. It is able to remove tissue and rinse the wound simultaneously by means of a high-pressure water jet.

Flächenhafte Fibromata pendulantia

Fibromata pendulantia often appear as small filiform skin tags with a narrow pedicle in the neck, axilla and groin areas. Hitherto, extensive fibromata pendulantia were resected either surgically (curette, scissors, scalpel) or by laser. The present case study of an adipose patient with disseminated fibromata pendulantia in the axillary region in the setting of pseudoacanthosis nigricans introduces the Versajet hydrosurgery technique as an alternative method. It is able to remove tissue and rinse the wound simultaneously by means of a high-pressure water jet.ZusammenfassungFibromata pendulantia kommen häufig in Form kleiner filiformen Säckchen mit schmaler Basis („skin tags“) im Bereich des Halses, in den Achselhöhlen und Leistenbeugen vor. Bisher wurden flächenhafte Fibromata pendulantia chirurgisch (scharfer Löffel, Schere, Skalpell) oder mit einem Laser entfernt. Im vorliegenden Fall mit dem Krankheitsbild einer Pseudoacanthosis nigricans mit flächenhaften Fibromata pendulantia im Bereich der Achselhöhlen eines adipösen Patienten stellen wir die Versajet-Hydrochirurgietechnik als Alternativmethode vor. Durch einen Hochdruckstrahl wird hierbei gleichzeitig Gewebe entfernt und die Wunde ausgespült.AbstractFibromata pendulantia often appear as small filiform skin tags with a narrow pedicle in the neck, axilla and groin areas. Hitherto, extensive fibromata pendulantia were resected either surgically (curette, scissors, scalpel) or by laser. The present case study of an adipose patient with disseminated fibromata pendulantia in the axillary region in the setting of pseudoacanthosis nigricans introduces the Versajet® hydrosurgery technique as an alternative method. It is able to remove tissue and rinse the wound simultaneously by means of a high-pressure water jet.

Merkel-Zell-Karzinom des Handrückens

ZusammenfassungEin 67-jähriger Patient entwickelte innerhalb kurzer Zeit mehrere hautfarbene Knoten an seinem linken Handrücken. Das histologische Gutachten ergab ein Merkel-Zell-Karzinom (MCC). Das MCC ist ein äußerst aggressiv wachsender kutaner Tumor, der von neuroendokrinen Zellen der Basalschicht der Epidermis ausgeht. Bekannte Risikofaktoren sind ein fortgeschrittenes Alter, Immunsuppression und UV-Exposition. Aktuelle Studien konnten ein neues Polyomavirus (MCPyV) in 75–85% der Neoplasien nachweisen, das eine zentrale Rolle in der Entstehung des MCC zu spielen scheint. Hier erhofft man sich neue und wirksamere Therapieoptionen.AbstractA 67-year old patient developed multiple flesh-colored nodules on the back of his left hand. Histological examination led to the diagnosis of a Merkel cell carcinoma (MCC). This highly aggressive primary cutaneous tumor is classified as a neuroendocrine carcinoma. It affects mostly elderly and immunosuppressed patients. Recently, a new polyomavirus (MCPyV) has been detected in about 75–85% of MCC and seems to play an important role in their pathogenesis. This new finding may help to develop new therapeutic options for MCC.A 67-year old patient developed multiple flesh-colored nodules on the back of his left hand. Histological examination led to the diagnosis of a Merkel cell carcinoma (MCC). This highly aggressive primary cutaneous tumor is classified as a neuroendocrine carcinoma. It affects mostly elderly and immunosuppressed patients. Recently, a new polyomavirus (MCPyV) has been detected in about 75-85% of MCC and seems to play an important role in their pathogenesis. This new finding may help to develop new therapeutic options for MCC.

Merkel-Zell-Karzinom des Handrückens@@@Merkel cell carcinoma

ZusammenfassungEin 67-jähriger Patient entwickelte innerhalb kurzer Zeit mehrere hautfarbene Knoten an seinem linken Handrücken. Das histologische Gutachten ergab ein Merkel-Zell-Karzinom (MCC). Das MCC ist ein äußerst aggressiv wachsender kutaner Tumor, der von neuroendokrinen Zellen der Basalschicht der Epidermis ausgeht. Bekannte Risikofaktoren sind ein fortgeschrittenes Alter, Immunsuppression und UV-Exposition. Aktuelle Studien konnten ein neues Polyomavirus (MCPyV) in 75–85% der Neoplasien nachweisen, das eine zentrale Rolle in der Entstehung des MCC zu spielen scheint. Hier erhofft man sich neue und wirksamere Therapieoptionen.AbstractA 67-year old patient developed multiple flesh-colored nodules on the back of his left hand. Histological examination led to the diagnosis of a Merkel cell carcinoma (MCC). This highly aggressive primary cutaneous tumor is classified as a neuroendocrine carcinoma. It affects mostly elderly and immunosuppressed patients. Recently, a new polyomavirus (MCPyV) has been detected in about 75–85% of MCC and seems to play an important role in their pathogenesis. This new finding may help to develop new therapeutic options for MCC.A 67-year old patient developed multiple flesh-colored nodules on the back of his left hand. Histological examination led to the diagnosis of a Merkel cell carcinoma (MCC). This highly aggressive primary cutaneous tumor is classified as a neuroendocrine carcinoma. It affects mostly elderly and immunosuppressed patients. Recently, a new polyomavirus (MCPyV) has been detected in about 75-85% of MCC and seems to play an important role in their pathogenesis. This new finding may help to develop new therapeutic options for MCC.

Die Autositzheizung — eine potenzielle Verbrennungsgefahr für den Querschnittsgelähmten@@@Heated car seats — a potential burn risk for paraplegics

The comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.ZusammenfassungBeheizte Autositze werden mit steigender Popularität in Anspruch genommen. Wir stellen den klinischen Fall einer schweren zweit- und drittgradigen Verbrennung der Sakroglutealregion eines 42-jährigen posttraumatisch Querschnittsgelähmten vor. Der Patient wurde in unserer Verbrennungsklinik aufgenommen und zahlreiche Operationen wurden notwendig. Querschnittsgelähmte Patienten sind durch ihre Sensibilitäts- und Schmerzempfindungsstörung einem erhöhten Verbrennungsrisiko durch Autositzheizungen ausgesetzt. Wir empfehlen eine frühzeitige adäquate Aufklärung der Patienten, Hersteller und aller Bezugspersonen zur Vermeidung derartig schwerwiegender Verbrennungsereignisse.SummaryThe comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.