Matthias Aust

Percutaneous Collagen Induction Therapy: An Alternative Treatment for Scars, Wrinkles, and Skin Laxity

Background: Skin laxity, rhytides, and photoaging are generally treated by ablative procedures that injure or destroy the epidermis and its basement membrane, at least in the beginning, and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis. Percutaneous collagen induction takes us closer to this ideal. Methods: The authors performed a retrospective analysis of 480 patients in South Africa and Germany with fine wrinkles, lax skin, scarring, and stretch marks treated with percutaneous collagen induction using the Medical Roll-CIT to produce tighter, smoother skin. Most patients had only one treatment, but some have had as many as four treatments. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively. Results: On average, patients in Germany rated their improvement between 60 and 80 percent better than before the treatment. Histologic examination was carried out in 20 patients and showed a considerable increase in collagen and elastin deposition at 6 months postoperatively. The epidermis demonstrated 40 percent thickening of stratum spinosum and normal rete ridges at 1 year postoperatively. Conclusions: Percutaneous collagen induction was started in 1997 and has proved to be a simple and fast method for safely treating wrinkles and scars. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the procedure can be repeated safely and is also suited to regions where laser treatments and deep peels cannot be performed.

Lipomas after blunt soft tissue trauma: are they real? Analysis of 31 cases

Background  Soft tissue trauma and lipomas are common occurrences in surgical practice. Lipomas are defined as benign tumours of adipose tissue with so far unexplained pathogenesis and aetiology. A link between preceding blunt soft tissue trauma at the site of the tumour and the formation of lipomas has been described earlier. These soft tissue tumours have been named ‘post‐traumatic lipomas’.

[Dermal subsitute with the collagen-elastin matrix Matriderm in burn injuries: a comprehensive review].

Matriderm is a dermal substitute consisting of a native (non-cross-linked) collagen matrix supplemented by a elastin hydrolysate. It is available in sheets of 1 mm and 2 mm thickness, and may be covered in a single step procedure with immediate split thickness skin grafting. Duration of the surgical procedures are only marginally increased. There is no diminished take of split thickness graft and only marginally prolonged healing time compared with the split thickness graft only. In experimental models the matrix reduces wound contracture, histologically collagen bundles in the scar are more randomly orientated. Clinical trials with a long-term clinical evaluation showed no difference in scar elasticity between the described dermal substitute and split thickness grafts alone. There is a lack of clinical data on the development of wound contracture.

Ersatzoperationen bei Ausfall motorischer Funktionen an der Hand

Nerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients. The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle. Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.ZusammenfassungNervenverletzungen der oberen Extremität führen oft zu schweren Funktionsbeeinträchtigungen. Ein wichtiges Kriterium für die Indikation zur Ersatzoperation ist das soziale und berufliche Profil des Patienten. Motorische Ersatzoperationen können in jeder Phase nach der Verletzung zu einer Wiederherstellung verlorener Nervenfunktionen und zur Besserung der Handfunktion führen. Sie bieten dem Patienten eine therapeutische Alternative zur dauerhaften Lähmung bzw. zur langfristigen Schienenbehandlung an und verkürzen die Rehabilitationsperiode. An der oberen Extremität sind für alle Stammnerven zahlreiche Ersatzoperationen bekannt, deren Prognose vom Lähmungsmuster, den lokalen Unfallschäden sowie den Eigenschaften des Spendermuskels abhängt. Auch bei komplexen Schädigungen mit geringerer Funktionswiederkehr als nach isolierten motorischen Ausfällen ermöglichen Ersatzoperationen einen wertvollen Funktionsgewinn. Obwohl leider viel zu selten angewandt, bieten motorische Ersatzoperationen auch bei mehr als 70% der Patienten mit Querschnittslähmung im Halsmarkbereich (Tetraplegie) die Möglichkeit zu einer gebesserten Handfunktion. Der Beitrag gibt einen Überblick über die in der Praxis bewährten Techniken der motorischen Ersatzoperationen an der Hand nach peripheren Nervenverletzungen und bei Tetraplegie und soll damit die Indikationsstellung zu diesen Operationen weiter stimulieren.AbstractNerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients. The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle. Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.

Insight in microcirculation and histomorphology during burn shock treatment using in vivo confocal-laser-scanning microscopy ☆,☆☆

PURPOSE Microcirculatory disturbances are well known during shock; however, the accompanied histomorphological alterations are widely unknown. We used high resolution confocal-laser-scanning microscopy for the evaluation of microcirculation and histomorphology during Burn Shock treatment. METHODS Confocal-laser-scanning microscopy was performed in 10 burn shock patients (4 women, 6 men; aged 40.6 +/- 11.4 years, burn extent >20% body surface area) initially and 24 hours after shock resuscitation. Ten matched hemodynamic stable burn intensive care unit patients served as controls. The following parameters were evaluated: quantitative blood cell flow, cell size of the granular layer, basal layer thickness, and epidermal thickness. RESULTS Quantitative blood cell flow in controls was 62.45 +/- 3.39 cells per minute. Burn shock significantly reduced blood cell flow to 37.27 +/- 3.64 cells per minute; fluid resuscitation effectively restored baseline blood flow (65.18 +/- 3.76 cells per minute) after 24 hours. Granular cell size was 793.61 +/- 41.58 microm(2) in controls vs 644.27 +/- 42.96 microm(2) during burn shock. Post resuscitation granular cell size measured 932.74 +/- 38.83 microm(2). Basal layer thickness was 14.84 +/- 0.59 microm in controls, 13.26 +/- 0.54 microm in burn patients at admission and before resuscitation, and 17.50 +/- 0.46 microm after resuscitation. Epidermal thickness in control patients was 49.60 +/- 2.36 microm, 37.83 +/- 2.47 microm in burn patients at admission and 69.50 +/- 3.18 microm after resuscitation. CONCLUSIONS Confocal-laser-scanning microscopy provides a noninvasive tool for simultaneous evaluation of microcirculation and tissue histomorphology. It may help to assess the adequacy of and response to resuscitation of burn patients early after trauma.

Percutaneous collagen induction therapy as a novel therapeutic option for Striae distensae.

Sir:The occurrence of striae distensae is a well-recognized, common skin condition that rarely causes any significant medical problems but is often a significant source of distress to those affected. Striae are atrophic linear plaques, most often found on the breasts, abdomen, hips, and thighs in th

Tendon transposition to restore muscle function in the hand

Nerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients. The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle. Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.ZusammenfassungNervenverletzungen der oberen Extremität führen oft zu schweren Funktionsbeeinträchtigungen. Ein wichtiges Kriterium für die Indikation zur Ersatzoperation ist das soziale und berufliche Profil des Patienten. Motorische Ersatzoperationen können in jeder Phase nach der Verletzung zu einer Wiederherstellung verlorener Nervenfunktionen und zur Besserung der Handfunktion führen. Sie bieten dem Patienten eine therapeutische Alternative zur dauerhaften Lähmung bzw. zur langfristigen Schienenbehandlung an und verkürzen die Rehabilitationsperiode. An der oberen Extremität sind für alle Stammnerven zahlreiche Ersatzoperationen bekannt, deren Prognose vom Lähmungsmuster, den lokalen Unfallschäden sowie den Eigenschaften des Spendermuskels abhängt. Auch bei komplexen Schädigungen mit geringerer Funktionswiederkehr als nach isolierten motorischen Ausfällen ermöglichen Ersatzoperationen einen wertvollen Funktionsgewinn. Obwohl leider viel zu selten angewandt, bieten motorische Ersatzoperationen auch bei mehr als 70% der Patienten mit Querschnittslähmung im Halsmarkbereich (Tetraplegie) die Möglichkeit zu einer gebesserten Handfunktion. Der Beitrag gibt einen Überblick über die in der Praxis bewährten Techniken der motorischen Ersatzoperationen an der Hand nach peripheren Nervenverletzungen und bei Tetraplegie und soll damit die Indikationsstellung zu diesen Operationen weiter stimulieren.AbstractNerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients. The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle. Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.

Gefäßchirurgische Interventionen und plastisch-rekonstruktive Chirurgie

ZusammenfassungTrotz der hohen Prävalenz arterieller Verschlusskrankheiten existieren nur wenige Untersuchungen über den Effekt interventioneller Maßnahmen zur Rekanalisierung von Extremitätengefäßen vor plastisch-chirurgischen Eingriffen. Ziel der Untersuchung war es, die Übereinstimmung von einfachen klinischen Untersuchungstechniken mit apparativer Diagnostik zur Diagnose von arteriellen Perfusionsstörungen zu prüfen und die Ergebnisse der Defektdeckung nach gefäßchirurgischer Intervention zu bewerten.In dieser retrospektiven Studie wurden 150 Patienten mit chronischen Wunden der unteren Extremität mittels Palpation der Fußpulse, Dopplersonographie und Verschlussdruckmessung im Hinblick auf eine pAVK untersucht und pathologische Befunde angiographisch überprüft. Dem plastisch-chirurgischen Wundverschluss wurde dann eine gefäßchirurgische Intervention zur Verbesserung der Perfusion vorgeschaltet.Bei allen 34 Patienten mit fehlenden Fußpulsen oder pathologischen Verschlussdrücken wurde die klinische Diagnose der peripheren arteriellen Verschlusskrankheit durch eine angiographische Gefäßdarstellung bestätigt. Es konnte stets postinterventionell eine Rekanalisierung der versorgenden Gefäße des Wundgebietes erzielt und anschließend ein Defektverschluss erreicht werden.Mittels einfacher klinischer Untersuchung konnte eine Minderdurchblutung der unteren Extremität schnell und sicher festgestellt werden. Durch die angiologische Intervention konnten die Behandlung von chronischen Wunden verkürzt und die Kosten gesenkt werden.AbstractDespite the high prevalence of arterial occlusive disease, only a few studies have investigated the benefit of interventions to recanalize extremity arteries prior to plastic operations to close chronic wounds. The purpose of this study was to investigate the correlation of simple clinical examinations and apparative diagnostics of arterial occlusive disease of the lower extremity in patients with chronic wounds and to evaluate the benefit of vascular procedures to optimize wound perfusion before surgical closure. A total of 150 individuals with chronic wounds were included in this retrospective study. All patients underwent palpation of their foot pulses, Doppler sonography, and measurement of occlusive pressure. Positive results were tested by angiography. All patients with peripheral extremity vessel occlusion underwent vascular interventions prior to plastic operations for definitive wound closure. In all 34 patients with missing foot pulses, the clinical diagnosis of arterial occlusion could be confirmed by angiography. Peripheral recanalization and improved wound perfusion could be achieved in all patients. Arterial insufficiency could be diagnosed rapidly and safely using simple clinical examination such as palpation of foot pulses or measurement of occlusive pressures combined with Doppler sonography. Thus this simple and straightforward algorithm helped to secure the success of surgical therapy by shortening the time until wound-healing and reducing the psychosocial burden on the patient and financial costs to the health care system.

Medical Needling – Perkutane Kollageninduktion

ZusammenfassungDie perkutane Kollageninduktion bietet die Möglichkeit einer effektiven Behandlung sowohl von Falten als auch von Narben, Striae und Verbrennungsnarben. Durch gezieltes Needling kommt es zu multiplen Mikroläsionen in der papillären Dermis, welche über die Aktivierung der postinflammatorischen Wundheilungskaskade die Kollagensynthese stimulieren. Hierdurch gelingt eine Regeneration der dermalen Hautschichten mit einer Verjüngung des Hautbilds und narbenloser Heilung. Das Kollagengerüst stellt sich postoperativ engmaschig vergittert dar, die epidermale Schichtdicke nimmt um bis zu 40% zu. Im Gegensatz zu anderen Antiaging-Verfahren (Peeling, Laser, Dermabrasion) kommt es nicht zu einer Ablation oder anderweitigen Schädigungen der Epidermis. Diese Effekte lassen sich histologisch und im Tiermodell unter anderem durch die Stimulation der Expression von „transforming growth factor“(TGF)-β und anderer Wachstumsfaktoren und Proteine erklären. Die Wahrscheinlichkeit postinterventioneller infektiöser Komplikationen sowie die Möglichkeit von Pigmentierungsstörungen werden minimiert. Zusammenfassend ist die Methode anderen dermabrasiven Methoden mit gleichem Anwendungsspektrum überlegen.AbstractPercutaneous collagen induction offers an antiaging modality to rejuvenate and improve the appearance of aging skin, scars, striae and burn scars. Targeted needling creates thousands of micro-lesions in the papillary dermis. The associated trauma induces regeneration of all dermal skin layers and a rejuvenation of the skin. Postoperatively the collagen structure is densely meshed, while epidermal thickness is increased by up to 40%. Unlike with other antiaging methods such as ablative laser treatments, peelings or dermabrasion, the epidermis remains intact and is not damaged. Animal studies as well as histological investigations have proved that this effect to be attributable to stimulated expression of TGF-β and other growth factors and proteins. The risk of postoperative infection and dyspigmentation is minimized. In conclusion, this method is superior to other dermabrasive treatments with the same spectrum of application.

Local burn versus local cold induced acute effects on in vivo microcirculation and histomorphology of the human skin

Background: The impact of burns and colds on human skin microcirculation and histomorphology has not been compared as yet. Reflectance confocal microscopy (RCM) enables in vivo insight in human skin on cellular and subcellular levels. We evaluated analogies and differences of thermal injuries on microcirculation and histomorphology in vivo using RCM. Methods: Local superficial burn (6 female, 4 male; aged 28.4 ± 2.9 years, burn group) versus superficial cold (4 female, 6 male; aged 30.4 ± 5.2 years, cold group) was induced on the dorsum of the hand in an experimental immersion hand model. In vivo RCM was performed prior (control), immediately (t1) and 15 minutes (t2) following thermal injury to evaluate: Individual blood cell flow (IBCF), functional capillary density (FCD), epidermal thickness (ET), and granular cell size (GCS). Results: In the burn group, IBCF was increased at t1 (78.02 ± 2.60/min) and remained elevated at t2 (84.16 ± 3.04/min). In the cold group, IBCF decreased at t1 (12.62 ± 2.12 min) and increased at t2 (74.24 ± 3.14/min, P < 0.05) compared to the controls (58.23 ± 3.21/min). FCD was 6.74 ± 0.52/mm2 in controls and increased at both t1 (7.82 ± 0.72/mm2) and t2 (8.02 ± 0.81/mm2) in the burn group. In the cold group, FCD decreased at t1 (2.60 ± 0.42/mm2) and increased at t2 (7.92 ± 0.44/mm2, P < 0.05). ET increased at both t1 (43.12 ± 4.08 μm, P > 0.05) and t2 (47.26 ± 4.72 μm, P < 0.05) in the burn group. In the cold group, ET decreased at t1 (39.92 ± 3.14 μm, P > 0.05) and increased at t2 (44.72 ± 4.06 μm, P < 0.05) compared to the controls (41.26 ± 3.82 μm). Control GCS was 726.9 ± 59.4 μm2 and increased at both t1 (739.8 ± 69.8 μm2, P > 0.05) and t2 (762.6 ± 71.4 μm2, P < 0.05) in the burn group. In the cold group, GCS decreased at t1 (712.4 ± 53.8 μm2, P > 0.05) and increased at t2 (742.6 ± 64.8 μm2, P < 0.05). Conclusions: Superficial burn induces more cellular destruction and cold leads to huge fluctuation in tissue perfusion, however, with moderate impact on histomorphology. The effect on dermal capillaries suggests a selective neural control and cold injuries might down‐regulate this system, much more than burns can activate it. Microsc. Res. Tech., 2011.