Gerhard H. Weyandt

Split-skin grafting from the scalp: the hidden advantage.

BACKGROUND Split‐skin grafting is a routine reconstructive technique associated with large variation in practice. Grafts from the thigh, buttock, or abdomen take a long time to heal and may leave unpleasant, hypopigmented scars. Retrospective reports favor the scalp as a donor site in burn patients. OBJECTIVE Evaluation of duration of healing, cosmetic outcome, and safety of split‐skin grafting from the scalp in patients receiving dermatologic surgery. MATERIAL AND METHODS One hundred sixty‐six consecutive patients (85 men, 81 women) were treated for coverage of chronic leg ulcers or other large skin defects with a split‐skin graft taken from the posterior scalp. Area and thickness of the graft, healing time, and adverse events were documented. RESULTS Mean healing time until complete reepithelization was 5.4±1.0 days for a single harvest (median 5 days). No major complications occurred. Spotted alopecia was a rare event. Almost all (96.5%) of the patients would undergo split‐skin harvesting from the occipital scalp again if needed. CONCLUSIONS Advantages of the scalp as a donor site include rapidity of wound healing, low risk of complications, and excellent cosmetic results. The large number of hair follicles containing the epidermal stem cell pool can explain these advantages.

Kontrollierte schichtweise Abtragung anogenitaler Warzen mittels Argon-Plasma-Koagulation

Hintergrund: Bei ausgedehntem anogenitalen Warzenbefall werden nach den Leitlinien der Deutschen STD‐Gesellschaft als mögliche Behandlungsformen mit vergleichbaren Rezidivraten die Kryotherapie, exzidierende Verfahren, die Elektrodesikkation, CO2‐ und Nd:YAG‐Laserabtragung empfohlen. Bei diesen Verfahren besteht ein unterschiedlich hohes Risiko von Blutungen, Freisetzung potentiell infektionsfähiger Viruspartikel in die Raumluft, tiefer thermischer Destruktion, langer Wundheilungszeit und Vernarbung.

Low risk of contamination with human papilloma virus during treatment of condylomata acuminata with multilayer argon plasma coagulation and CO2 laser ablation

Multilayer argon plasma coagulation (APC) is a new effective method for the treatment of genital warts. We assessed the generation of aerosols containing human papilloma virus (HPV) DNA during treatment of genital warts with multilayer APC and with CO2 laser ablation. Surveillance petri dishes, swabs from the glasses and nasolabial folds of the operating physician, and swabs taken from the suction units used during CO2 laser ablation were tested by HPV PCR. HPV DNA corresponding to patient derived HPV types of genital warts was not found in any of the petri dishes and swabs obtained during APC treatment. HPV DNA was detected in none of the petri dishes obtained during CO2 laser treatment, but in suction filters. In conclusion, both CO2 laser ablation with plume suction and APC treatment seem to have a low risk of HPV contamination of the operation room.

Morbidity and oncologic outcome after saphenous vein-sparing inguinal lymphadenectomy in melanoma patients

BackgroundInguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate. Variations in surgical procedure, such as sparing of the saphenous vein, have been proposed to reduce surgical morbidity. While sparing of the saphenous vein has shown promising results in earlier studies, data for this procedure in melanoma patients are rare. In this retrospective study, we report 10-year findings on the effects of saphenous vein-sparing LND on surgical morbidity and oncologic outcomes in melanoma patients.MethodsA retrospective analysis of melanoma patients receiving inguinal LND in our facility between 2003 and 2013 was performed. Patients were divided into two groups: the saphenous vein resection group and the vein sparing group. Surgical morbidity, including wound infection, lymphatic fistula, severe bleeding, neurological complications, and chronic lymphedema, as well as regional recurrence-free survival were investigated.ResultsA total of 106 patients were included in this study; of these, the saphenous vein was spared in 41 patients (38.7%). The rate of lymphatic fistula was 51.6 vs. 48.8%, wound infection occurred in 31.3 vs. 24.4%, and patients suffered from chronic lymphedema in 30.0 vs. 26.5% in V. saphena magna resection vs. sparing group. Differences observed, however, were not significant. No difference in regional recurrence-free survival between the two study groups was detected.ConclusionsThe results of our retrospective analysis could not confirm the promising results reported in earlier studies. Thus, sparing of the saphenous vein appears to be optional.

Das anorektale Melanom—eine seltene Manifestation

ZusammenfassungHintergrund:Das anorektale Melanom ist eine seltene und oft tödlich verlaufende Erkrankung. Die 5-Jahres-Überlebensrate liegt zwischen 5 und 20%, die mittlere Überlebenszeit variiert zwischen 12 und 25 Monaten. Das chirurgische Vorgehen wird in der Literatur kontrovers diskutiert. Ziel dieser Arbeit war die Darstellung des eigenen Krankengutes und der Vergleich mit den Literaturdaten.Patienten und Methode:Im Zeitraum von 1990 bis 2003 wurden an der Chirurgischen Universitätsklinik Würzburg sechs Patienten, davon eine Frau, im mittleren Alter bei Erstdiagnose von 60,5 Jahren wegen eines anorektalen Melanoms behandelt. Die Unterlagen dieser Patienten wurden retrospektiv ausgewertet. Die Behandlungsergebnisse wurden mit den Daten der Literatur verglichen.Ergebnisse:Bei zwei Patienten wurde primär und bei zwei weiteren sekundär eine abdominoperineale Rektumexstirpation vorgenommen. Aufgrund eines lokal weit fortgeschrittenen Tumors war bei den übrigen Patienten keine chirurgische Primärtherapie möglich. Die Überlebenszeit variierte zwischen 1 und 38 Monaten, jeweils ohne operative Primärtherapie unter multimodaler Behandlung.Schlussfolgerungen:Das chirurgische Vorgehen hat keinen Einfluss auf die Überlebenszeit und sollte von der lokalen Tumorausdehnung abhängig gemacht werden. Die abdominoperineale Rektumexstirpation bietet bessere Möglichkeiten der lokalen Tumorkontrolle. Der Wert des Einsatzes adjuvanter Therapieformen ist im Vergleich zur Behandlung kutaner Melanome weder gesichert noch standardisiert, kann jedoch in Einzelfällen zu einer deutlichen Lebenszeitverlängerung beitragen.SummaryBackground:Anorectal melanoma is a tumor with an unfavorable prognosis. The surgical approach is still discussed controversially. The purpose of this study was to review our results in patients who received multimodal treatment for anorectal melanoma.Patients and Method:We reviewed the charts of six patients diagnosed to suffer from anorectal melanoma during a 13-year period.Results:Four patients underwent abdominoperineal resection (APR). Due to advanced local tumor progression in two patients no surgical procedure was performed.The overall survival ranged between one and 38 months.Conclusions:In our collective the surgical management did not influence the outcome substantially. The surgical removal should be considered in less advanced tumor stages. In theses cases the abdominoperineal resection seems to have a favorable prognostic influence rather than a wide local excision. Regarding the poor prognosis of anorectal melanoma we consider an adjuvant chemo-, immuno- or radiotherapy to be justified.

Impact of extended lymphadenectomy on morbidity and regional recurrence-free survival in melanoma patients

Abstract Introdurction: Current guidelines for malignant melanoma do not set a concrete cutoff limit for the number of lymph nodes to be resected during regional lymph node dissection (LND). Here, we investigate if extended LND (ext-LND) has an impact on surgical morbidity and oncological outcome in melanoma patients. Material and methods: A total of 245 melanoma patients receiving axillary or inguinal LND in curative intention were investigated retrospectively. Ext-LND was defined as axillary LND with 20 or more and inguinal LND with 10 or more resected lymph nodes. Surgical morbidity and regional recurrence-free survival were investigated. Results: Ext-LND did not lead to increased surgical morbidity in the overall study collective. After ext-LND, 55.4% of the patients experienced one of the investigated complications compared to 46.2% in the limited LND group (p = .2113). There was no difference in the occurrence of lymphatic fistula, wound infection, severe bleeding or neurological complications. In addition, patients with positive lymph node status showed improved regional recurrence-free survival following ext-LND (p = .0425). Conclusion: Ext-LND can be considered a quality marker of LND in melanoma patients.

S2k-Leitlinie: HPV-assoziierte Läsionen der äußeren Genitalregion und des Anus - Genitalwarzen und Krebsvorstufen der Vulva, des Penis und der peri- und intraanalen Haut (Kurzfassung): HPV-assoziierte Läsionen der äußeren Genitalregion und des Anus

Gerd E. Gross 1 * , Ricardo N. Werner 2 * , Jürgen C. Becker 3 , Norbert H. Brockmeyer 4 , Stefan Esser 5 , Monika Hampl 6 , Sara Hommel 7 , Johannes Jongen 8 , Dominik S. Mestel 9 , Thomas Meyer 10 , Karl U. Petry 11 , Andreas Plettenberg 12 , Klaus Püschel 13 , Peter Schneede 14 , Helmut Schöfer 15 , Karl Sotlar 16 , Gerhard Weyandt 17 , Ulrike Wieland 18 , Miriam Wiese-Posselt 19 , Alexander Nast 2

Large Nasal Defects with Exposed Cartilage: The Folded Transposition Flap as an Innovative Alternative to the Paramedian Forehead Flap

Background: Skin cancer removal surgery involving the tip or dorsum of the nose often results in large-sized defects with exposure of cartilage. In such cases, the paramedian forehead flap is a frequently used reconstruction technique; however, this method is complex and can result in a cosmetically unsatisfying outcome. Objective: To describe the folded transposition flap as an aesthetically pleasing alternative to the paramedian forehead flap for large nasal defects with exposed cartilage. Methods: The folded transposition flap is a 2-stage surgical modification of the transposition flap. In the first stage, an overlong axial cheek pedicle is used to cover the defect. In the second stage, the flap is thinned and the nasal scars are revised. Results: All 4 patients experienced aesthetically pleasing results. Conclusion: The folded transposition flap is an alternative for reconstructing large surgical defects of the nasal tip or distal dorsum of the nose.

Chronic perianal ulceration as the initial symptom of Langerhans cell histiocytosis in adults

Langerhans cell histiocytosis (LCH) mainly affects children and rarely occurs in adults [1]. Mostly, LCH presents as single system disease (SS) affecting only one organ system; in multisystem disease (MS), bone, skin, mucosae, lung, liver, spleen, bone marrow, lymph nodes, hypothalamus and the pituitary gland can be involved [1-3]. We report two patients with perianal skin ulcerations as the initial symptom of LCH. Both were successfully treated with intravenous vinblastine and oral prednisone, according [...]

Verbesserte präoperative Diagnostik im analen Kanal durch „soft touch“-Endosonographie

ZusammenfassungFragestellung und Hintergrund:Die endoanale Sonographie wird als wenig invasives Verfahren zur Lokalisation von Verletzungen des Sphinkterapparates und in der Dia gnostik von Fisteln und Abszessen eingesetzt. Schallkopfnahe Strukturen haben in der sonographischen Betrachtung des Analkanals wenig Beachtung gefunden, da sie zumeist der klinischen Untersuchung besser zugänglich scheinen und bei der endoanalen Sonographie mit größeren Schallköpfen durch Kompression nur eingeschränkt beurteilbar sind. Ziel der vorliegenden Untersuchung war es, die diagnostische Wertigkeit der analen Endosonographie mit einem 7-mm-Schallkopf zu evaluieren.Patienten und Methodik:In den letzten 4 1/2 Jahren untersuchten die Autoren 47 Patienten mit dem klinischen Verdacht auf Abszess-/Fistelleiden, Fissur oder Raumforderung im analen Kanal. Diese Patienten wurden mit einem 7 mm großen endoanalen Schallkopf und, wenn möglich, mit einem 20 mm großen endoanalen Schallkopf untersucht. Anschließend fand ein Vergleich zwischen klinischem, endosonographischem und intraoperativem Befund statt.Ergebnisse:Laut klinischer Untersuchung hatten 32 von 47 Patienten ein Abszess- und Fistelleiden, zehn eine Analfissur und fünf einen Tumor im analen Kanal. Mittels des endoanalen Ultraschalls mit der 7-mm-Sonde bestätigte sich bei 20 Patienten der Befund, bei 23 Patienten konnte die klinische Diagnose erweitert werden, und bei zwei Patienten ließ sich bei sehr aboralem Befund kein endosonographisches Korrelat finden. Zwei Patienten wiesen intraoperativ einen von Klinik und Sonographie abweichenden Befund auf. Bezogen auf die Genauigkeit der Diagnose zeigten sich für den 7-mm- und den 20-mm-Schallkopf eine Sensitivität von 91,1% versus 29,6% und eine Richtigkeit von 91,5% versus 37,9%.Schlussfolgerung:Die „soft touch“-Sonographie mit der endoanalen 7-mm-Sonde erlaubt eine eindeutigere Zuordnung schallkopfnaher pathologischer Veränderungen und vervollständigt somit die präoperative Diagnostik.AbstractBackground and Purpose:Anal endosonography as a minimally invasive procedure can be applied to localize injuries to the anal sphincter and to classify anal fistulae and abscesses. Structures abutting the probe have attracted less attention because clinical examination seems to be better and the sonographic image obtained with conventional probes is limited by compression. The purpose of the present study was to define the diagnostic value of a small 7-mm endoanal probe.Patients and Methods:Over the last 4 1/2 years, a retrospective study was conducted in 47 patients with the clinical diagnosis of fistula, fissure, and tumors of unknown dignity. These patients were examined with a 7-mm endoanal probe and, if possible, with a 20-mm probe. Afterwards, the clinical and the endosonographic findings were compared with the intraoperative state.Results:The 47 patients had clinically been diagnosed with anal fistula (n = 32), fissure (n = 10), and tumors of unknown dignity (n = 5). By endoanal sonography with the 7-mm probe, the diagnosis was confirmed in 20 patients, in 23 patients the clinical diagnosis could be specified, and in two patients with very aboral disease no endosonographic correlation could be found. Two patients showed an intraoperative state differing from the clinical and sonographic findings. In 67%, endoanal sonography with the 7-mm probe was superior to the 20-mm probe in terms of classification and localization of fistulae. With regard to the operative finding preoperative ultrasound with the 7- and the 20-mm probe showed a sensitivity of 91.1% versus 29.6% and an accuracy of 91.5% versus 37.9%.Conclusion:The “soft touch” endosonography with the 7-mm probe allows to differentiate pathologic findings of the abutting tissue with a high sensitivity and specificity and is a valid tool in the preoperative diagnostic evaluation.