Thomas Mücke
Ludwig Maximilian University of Munich
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Publication
Featured researches published by Thomas Mücke.
Journal of Cancer Research and Clinical Oncology | 2011
Thomas Mücke; Janett Koschinski; Herbert Deppe; Stefan Wagenpfeil; Christoph Pautke; David A. Mitchell; Klaus-Dietrich Wolff; Frank Hölzle
PurposeBisphosphonate-related osteonecrosis of the jaws (BRONJ) is now a well-recognised entity which is difficult to manage and often recurs. The aim of this study was to examine the success of resection of the necrotic bone and identify risk factors for recurrence in these patients.MethodsOne hundred and eight patients were evaluated prospectively and investigated at least twice. Multiple logistic regression analysis was used to determine factors independently associated with the dependent variable of recurrence of BRONJ.ResultsFactors influencing the development of recurrence of BRONJ were the presence of bacterial bone infection of the necrotic area (Pxa0=xa00.011), type of treatment (either conservative or surgical, Pxa0=xa00.001) with a lower recurrence rate for surgically treated patients, extent of surgical treatment with better outcome in larger resections (Pxa0<xa00.0001), number of debridements performed (Pxa0<xa00.0001), and the extent of radiographic appearance of osteolysis assessed by dental panoramic tomogram (Pxa0=xa00.028).ConclusionsAn increased risk for recurrence can be found in cases with bacterial bone infection of the necrotic area, type of conservative or surgical treatment, extent of surgical treatment with better outcome in larger resections, and the number of debridements performed. Microvascular tissue transfer should be considered in selected cases if other options have been exhausted.
Oral Oncology | 2009
Thomas Mücke; Stefan Wagenpfeil; Marco R. Kesting; Frank Hölzle; Klaus-Dietrich Wolff
The aim of this study was to investigate whether the recurrence interval influenced survival rate of patients with relapse of oral squamous cell carcinoma (OSCC). From 1992 to 2006, a total of 773 patients with OSCC treated at the Department of Oral and Maxillofacial Plastic Surgery of the Ruhr-University Bochum were reviewed. Statistical analysis included descriptive statistics, Kaplan-Meier survival analyses, receiver operating characteristic, the Youden-Index and analysis using the log-rank test and Cox-regression. The overall recurrence rate was 23.9%. Local recurrence was more common (64.9%) than locoregional recurrence (25.1%). Patients with relapse more than 18 months after completion of their primary treatment had significantly improved survival rates compared with those who relapsed within 18 months of initial treatment (20.5% vs 42.3%). A significant difference was noted in the survival rate between patients with local and locoregional recurrence (37.5% vs 21.5%). Overall survival rate after salvage was 31.9%. The interval from initial treatment to recurrence is an independent prognostic factor for OSCC patients. Patients with a recurrence interval of 18 months had a statistically significant higher probability of death than those with a recurrence interval >18 months. This information can help inform salvage treatment strategies and provide a classification of early and late recurrences.
Microsurgery | 2012
Thomas Mücke; K.-D. Wolff; Andrea Rau; Victoria Kehl; David A. Mitchell; Timm Steiner
Controversy exists over how long a free flap is dependent on its pedicle and if neovascularization is different between flap types, recipient sites, and irradiated and nonirradiated patients. An understanding of the timing of this process should optimize the safety of secondary procedures involving the flap. In a prospective clinical study, hemoglobin oxygenation and capillary flow were measured in 50 flaps (25 forearm flaps, 15 osteocutaneous fibula flaps, and 10 anterolateral thigh flaps) 4 and 12 weeks postoperatively. The flaps were located at the floor of the mouth, cheek, or tongue (n = 39) or at the hard or soft palate (n = 11). Measurements were carried out using the O2C monitoring system under temporary digital occlusion of the pedicle. After 4 weeks, 17 free flaps were found to be autonomized indicated by the O2C measurements comparing both values before and after digital compression of the vascular pedicle. After 12 weeks, 41 patients had completion of free flap autonomization, as indicated by the HbO2 and CF before and after pedicle compression. The location of free flap in the lower jaw (P < 0.0001 after 4 weeks, P = 0.013 after 12 weeks), fasciocutaneous radial forearm flaps after 4 weeks (P < 0.0001), and not irradiated recipient site after 4 weeks (P = 0.014) were found to be positive factors significantly influencing autonomization. In conclusion, free flap autonomization depends on several variables which should be considered before further surgery after free flap reconstruction as the transferred tissue can be still dependent on its pedicle.
Journal of Cranio-maxillofacial Surgery | 2013
Thomas Mücke; Anna Borgmann; Lucas M. Ritschl; Marco R. Kesting; Denys J. Loeffelbein; Klaus-Dietrich Wolff
Since microsurgical experience remains the most important skill in various surgical fields it should be in general part of the training program, either in medical studies or residency. This study compares the results of microsurgical education after completion of a comprehensive microsurgical course program between students and surgeons. 59 clinical medical students and 19 surgeons participated at a weekly 14-day microsurgical training course. Two examiners assessed the participants independently and blinded. Comparison between the groups demonstrated that the students achieved higher scores with a significant difference in tissue handling (pxa0=xa00.04). The surgeons had more days of absence from the course compared with the students. In the practical examination, the students scored a mean 13.71 points compared with 11.73 points for the surgeons (pxa0<xa00.0001). In the theoretical part students achieved 15.27 points compared to the mean of 13.50 points of the surgeons (pxa0=xa00.009). Prior to participation the students described an ambition to a career in a specialty performing microsurgery in 23 cases, after the microsurgical course following completion 50 participants worked in a surgical field. Microsurgical education can be part of undergraduate medical studies. The microsurgery training course influenced the students ambition in relation to microsurgery as a future career.
Microsurgery | 2011
Thomas Mücke; Anna Borgmann; Stefan Wagenpfeil; Ralf Günzinger; Christian Nöbauer; Rüdiger Lange; Julia Slotta-Huspenina; Frank Hölzle; Klaus-Dietrich Wolff
The question of how long a flap depends on its pedicle cannot be answered clearly from the available literature. To address this, we investigated the time to flap autonomization in the wound bed and the length of time to the point when flap necrosis is reduced to a clinically negligible level. The superficial epigastric flap was raised in 24 rats. After 3, 5, 7, or 10 days of wound healing, the pedicle was again exposed, ligated, and divided. Values of blood flow (flow), velocity (velocity), hemoglobin level (Hb), and oxygen saturation (SO2) were noninvasively measured using Laser spectrophotometry. The area of necrosis of the flap was 62.77 ± 1.71% after 3 days, 16.26 ± 0.86% after 5 days, 2.88 ± 0.14% after 7 days, and 1.64 ± 0.16% after 10 days (P < 0.001). Hb, flow, and velocity were found to be significant factors on developing flap necrosis at the preoperative and postoperative time point (P < 0.0001), whereas SO2 and flow were significant predictors of necrosis at the time of pedicle ligation (P < 0.0001). The percentage changes of SO2 (P < 0.0001), flow (P < 0.0001), and velocity (P = 0.001) between the different time points were significant predictors of flap necrosis. The time needed for the complete autonomization of vascularized free flaps in their wound beds has been found as completed between the 5th and 7th day postoperatively in this rat model. The area of flap necrosis depends on the present value of SO2, Hb, flow, and velocity at different time points, but, more importantly, also on the perioperative change of these parameters.
Journal of Surgical Oncology | 2009
Klaus-Dietrich Wolff; Thomas Mücke; Jutta Lehmbrock; Denys J. Loeffelbein; Marco R. Kesting; Frank Hölzle
In an irradiated and vessel depleted neck, we used the wrist carrier technique to provide flap perfusion until autonomisation took place. A combined anterolateral thigh‐ and osteocutaneous fibular flap was anastomosed to the radial vessels of an irradiated patient with a vessel depleted neck for reconstruction of the lower face. Periodical pedicle occlusion started immediately after surgery. On day 16, cutaneous blood flow and oxygenation were still reduced, but wound healing was uneventful. J. Surg. Oncol. 2009;99: 123–126.
Journal of Biomedical Materials Research Part B | 2009
Marco R. Kesting; Klaus-Dietrich Wolff; Thomas Mücke; Cedric Demtroeder; Kilian Kreutzer; Matthias Schulte; Frank Jacobsen; Tobias Hirsch; Denys John Loeffelbein; Lars Steinstraesser
The study was performed to evaluate the suitability of glycerol-cryopreserved human amniotic membrane (HAM) as a surgical patch, far from its common use in ophthalmic surgery. In vivo experiments in rat models were performed to study the degradation patterns, biocompatibility, postoperative tissue formation and its suitability for abdominal wall closure. Degradation and thickness of the membranes were assessed over a period of 60 days after subdermal implantation of monolayer and multilayer HAM in 96 immunocompetent and immunosuppressed rats. The tissue response was mild, and histological analysis evaluated that multilayer application and immunosuppression prolonged graft survival significantly. In a second rat model, another 18 animals were monitored over a period of 28 days after abdominal wall reconstruction with multilayered HAM. Polypropylene mesh (Prolene) and polyglactin910/polydioxanon patches (Ethisorb) served as controls. Gross examination and histological analysis proved that multilayer HAM was a sufficient material for abdominal wall closure in comparison with the polypropylene mesh and was superior to the polyglactin910/polydioxanon patch. Additionally, significantly reduced postoperative intraabdominal adhesions were observed when compared to the polyglactin910/polydioxanon patch. This study demonstrates that HAM is a biocompatible, resorbable surgical patch in a rat xenotransplantation model and serves as a mechanically sufficient material for abdominal wall closure in a small animal model. These findings are encouraging and justify further research for the use of cryopreserved human amniotic membrane in soft tissue repair.
Journal of Cancer Research and Clinical Oncology | 2012
Thomas Mücke; Janett Koschinski; Stefan Wagenpfeil; Klaus-Dietrich Wolff; Anastasios Kanatas; David A. Mitchell; Herbert Deppe; Marco R. Kesting
PurposePatient-reported outcomes following head and neck cancer are of great importance given the functional, psychological, and social impacts of the disease and its treatment. With an increasing number of publications on HRQOL following head and neck cancer and a growing awareness of the potential role of HRQOL in practice, it was our aim to investigate head and neck functional mobility that is often not taking into account in HRQOL scores.MethodsIn this prospective study, three different groups of 32 patients each were included. Any patient who had histologically confirmed invasive OSCC in the anterior floor of the mouth was eligible. All patients were examined by a standardized test assessing function, including the distance of mouth opening, extension, flexion, and rotation of the head.ResultsA total of 96 patients were included in this study. The mean age was 62.79xa0±xa08.93xa0years. Head and neck mobility measured in patients is presented and analyzed. Compared to the baseline, a significant reduction of mouth opening and head and neck mobility was noted in all groups.ConclusionsAlthough both treatment options (surgery and surgery with radiotherapy) were performed according to the tumor stage of patients, there are significant differences in the functional outcome of these patients as observed in this study. There is a lack of a measuring instrument that will be the “gold standard” in the assessment of head and neck functional mobility. This study will allow the reflection of our current practice and may stimulate further well-designed prospective studies.
Microsurgery | 2013
Thomas Mücke; Christian Reeps; Klaus-Dietrich Wolff; David A. Mitchell; Andreas M. Fichter; Martin Scholz
Intraoperative near‐infrared indocyanine‐green (ICG) angiography enables the visualization of microvascular perfusion and may help in the early detection of complications. The purpose of the present study was to examine whether the effect of microvascular stenoses can be quantitatively assessed by analysis of ICG‐angiography in a microvascular model. Graded stenoses and total vessel occlusion of the carotid, aorta, and femoral arteries were created in 25 Wistar rats. Stenoses were graded to reduce arterial flow by 25%, 50%, 75%, and 100% of baseline flow as measured by transit‐time flowmeter analyzing the emission signal of the ICG detected and investigated by the mathematical software tool (FLOW 800). ICG angiography was performed to assess vessel perfusion and flow curves were analyzed and correlated with the stenosis rate. A total of 576 investigations were performed. The area under the curve (P < 0.001), first and second maximum (P < 0.001), and the maximum slope to the first maximum (P < 0.001) were found to be of high prognostic value in evaluating the different flow patterns. Differences were displayed in comparisons by the maximum intensity of the ICG‐concentrations. The maximum slope to the second maximum was found to be predictive in selected vessel types, and specific changes of the flow curve were found to indicate compromised vascular flow. The FLOW 800 tool applied for ICG angiography has shown to be a quick and reliable method for assessing blood flow in vessels in this study. The dynamic assessment of the ICG signal allows reliable identification of microanastomotic complications with the described parameters.
Clinical Oral Investigations | 2015
Herbert Deppe; Thomas Mücke; Stefan Wagenpfeil; Marco R. Kesting; Eva Linsenmeyer; Thomas R. Tölle
BackgroundIn general, trigeminal nerve injury is known as a potential risk of many surgical procedures in the oral cavity. Recent literature demonstrated that the risk of nerve injury is correlated with the experience of the surgeon. Therefore, the purpose of this study was to evaluate retrospectively the incidence of trigeminal nerve injuries in a teaching university setting.Material and methodsFrom January 2000 to December 2009, a total of 1,559 patients underwent one intervention in the postcanine region of the mandible. Interventions included extractions, osteotomies, periradicular surgery, and implant surgery. In 2010, all 1,559 patient charts were screened. A record was made if trigeminal nerve injury was documented within the first month following surgery. These patients were re-evaluated.ResultsDocumentation in the charts revealed that sensorial disturbance following surgery was seen in 42 patients (2.69xa0%). Among them, nine patients were clinically re-evaluated by the authors and 12 were interviewed by phone and observed by their dentist without any problems. Persistence of sensory disturbance was found in 5 of the 21 patients (0.32xa0%), and four of these five lesions were in the lingual nerve (0.25xa0%). Related to the type of surgery, most sensory disturbances were seen following periradicular surgery.DiscussionWithin the limitations of this study, it may be stated that oral surgery in an outpatient setting of a teaching university hospital resulted in very low rates of trigeminal nerve injuries. It may be concluded that adequately surveyed trainees can perform mandibular surgery without an increased risk of trigeminal sensorial disturbance.