Max Meyer-Marcotty

Reflectance confocal-laser-scanning microscopy in vivo assessments of cigarette-induced dynamic alterations of cutaneous microcirculation on histomorphological level.

Objective: Until now, high resolution reflectance confocal‐laser‐scanning microscopy (CLSM) was used for observation of cutaneous morphology in vivo and in real time. We hypothesized that CLSM also allows observation of dynamic processes of cutaneous microcirculation. Methods: Reflectance CLSM (Vivascope1500; Lucid, Rochester, NY) was performed in 24 young male habitual smokers (23 years, range: 19–26, body mass index 23.9 ± 4.04) with relatively limited cigarette exposure (mean: 3.1 ± 2.4 pack‐years). Eight matched nonsmokers served as controls. The quantitative blood cell flow and the diameter of capillary loops were determined prior (baseline), during, as well as 5 and 10 min after smoking. Results: Baseline value for blood cell flow was 55.50 ± 2.33 cells/min, and decreased over 45% during smoking (30.43 ± 3.76/min; P = 0.02). They were still 22% lower (43.33 ± 2.45/min; P = 0.01) 5 min after smoking and exceeded baseline values 10 min after smoking by 13% (63.00 ± 3.10/min; P > 0.05). The baseline values for capillary loop diameter (9.03 ± 0.22 μm) decreased by 21% (7.18 ± 0.28 μm; P = 0.03) during smoking, remained about 9% (8.23 ± 0.18 μm; P = 0.01) lower 5 min after smoking and exceeded baseline values insignificantly by 4% (9.38 ± 0.28 μm; P > 0.05) 10 min after smoking. There were no significant differences to the controls. Conclusion: Reflectance CLSM enables qualitative and quantitative observation of dynamic processes of cutaneous microcirculation on histomorphological level. Microsc. Res. Tech., 2009.

Is there an association between comorbidities and the outcome of microvascular free tissue transfer

The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients.

In vivo reflectance-mode confocal microscopy provides insights in human skin microcirculation and histomorphology

PURPOSE Various approaches are used to study microcirculation, however, no modality evaluates microcirculation and histomorphology on cellular levels. We hypothesized that reflectance-mode confocal microscopy (RCM) enables simultaneous evaluation in vivo of both microcirculation and histomorphology. PRINCIPALS The forearm of 20 volunteers was exposed to either local heat stress (HS-group), or to local cold stress (CS-group). RCM was performed prior and after temperature stress to evaluate quantitative blood-cell flow, capillary loop diameter, granular cell size, and basal layer thickness. RESULTS In the HS-group, we observed significant increase in capillary loop diameter and increased blood-cell flow after heat stress. In the CS-group, significant decreases of capillary loop diameter and in blood-cell flow were determined following cold stress. Granular cell size and basal layer thickness differed insignificantly prior and after local temperature stress. CONCLUSIONS RCM provides real-time and in vivo high resolution imaging of temperature-dependent changes in the human skin microcirculation and histomorphology on cellular levels.

Postoperative insole-paedobarographic gait analysis for patients with flap coverages of weight-bearing and non-weight-bearing areas of the foot.

Functional results regarding shoe modifications, gait analysis and long-term durability of the reconstructed foot have not been reported using insole paedobarography. This article presents insole-paedobarographic gait analysis and discusses the various pressure distribution patterns following the reconstruction of the foot. This retrospective study reports on the clinical and functional results in 23 out of 39 patients who received flap coverage of their feet in our department in the period from 2001 to 2010. Mean follow-up time amounted to 46.6 months. Patients were separated into two groups, those with flap coverage to the sole of the foot (group 1) and those with flap coverage to non-weight-bearing areas of the foot (group 2). Gait analysis was accomplished by using insole paedobarography. The results of the gait analysis have shown that in both patient groups, when comparing affected feet with sound feet, the affected feet were exposed to significantly less support time (group 1; affected vs. sound feet: 0.44 ± 0.07 s vs. 0.55 ± 0.11 s, p = 0.047), (group 2; affected vs. sound feet: 0.47 ± 0.07 s vs. 0.54 ± 0.07 s, p = 0.029). In addition, in both patient groups, the analysis of peak-pressure distributions revealed greater pressures on the affected feet compared to the sound feet (group 1; affected vs. sound feet: 47.9 ± 10.13 N cm(-2) vs. 36.3 ± 7.5 N cm(-2), p = 0.008), (group 2; affected vs. sound feet: 38.08 ± 13.98 N cm(-2) vs. 32.92 ± 14.77 N cm(-2), p = 0.061). The insole paedobarography can contribute to a more precise gait analysis following a soft-tissue reconstruction not only of the sole but also of other foot regions as well. It can help to identify and correct movement sequences and peak-pressure distributions which are damaging to the flaps. The resulting potential minimisation of the ulceration rate can lead to a further optimisation in the rate of completely rehabilitated patients and a reduction in the revision rate.

Anatomical study of the human sole of the foot by 4-dimensional CT angiographic vascular imaging - its suitability as composite tissue allotransplantation graft for foot defects.

BACKGROUND The reconstruction of the weight-bearing sole is a challenge for every plastic surgeon. Composite tissue allotransplantation (CTA) of the sole of the foot may be a good therapeutic option for patients with large defects in the weight bearing area of the foot. As part of the preparation for a CTA of the sole, we sought to prepare for technical aspects related to preparation and perfusion of the human sole, on the basis of a systematic anatomical study, in combination with 4-dimensional computed tomography-angiography. MATERIAL/METHODS An anatomical study was performed on 10 cadaver feet. CT images of the feet were prepared in a GE light speed 16-line computed tomogram (CT) before and after the preparation of the sole. After each CT scan, contrast medium was injected in 0.2 ml steps over the posterior tibial artery. RESULTS Good images of the vessels of the sole from all 10 feet were achieved after recovery of the posterior tibial artery with accessory veins, the tibial nerve, the medial calcaneal branches from the posterior tibial artery, the abductor hallucis, digitorum brevis, abductor digiti minimi, lumbricales and interossea plantares muscles, even after preparation of the soles. CONCLUSIONS With this systematic anatomical preparation of the soles of the feet from human cadaver preparations, in combination with 4-dimensional CT angiography, we were able to demonstrate the technical feasibility of sole transplantation. CT angiography should be performed preoperatively, in order to demonstrate that the vessels are patent as pedicle for the sole of the foot.

Der Einfluss von standardisierter Kälte- und Kompressionstherapie auf Schwellung, Schmerzhaftigkeit und das funktionelle Ergebnis nach Spaltung des Retinaculum flexorum bei Karpaltunnelsyndrom

OBJECTIVE This prospective, randomised study examines the effect of standardised cold compression therapy on swelling, pain and functional outcome after division of the transverse carpal ligament in carpal tunnel syndrome in comparison to cooling alone. PATIENTS AND METHODS Fifty patients for division of the transverse carpal ligament were randomised into two groups. In group 1, postoperative conventional cooling therapy was performed. Group 2 was given standardised cooling and compression therapy with the Cryo/Cuff™-system (3 × 10 min twice daily). Follow-up examinations were performed on days 1, 8 and 21 after the operation. One patient in group 1 and 3 patients in group 2 could not be followed up. Test parameters were pain, swelling, mobility, strength, and the DASH and MHQ score. RESULTS There were no significant differences between the two groups at any time point. CONCLUSION In this study, no advantage could be demonstrated for standardised cooling and compression therapy with the Cryo/Cuff™-system in comparison with conventional cooling after division of the transverse carpal ligament.