Wolfgang Koenen

Removal of the Outer Table of the Skull for Reconstruction of Full-Thickness Scalp Defects with a Dermal Regeneration Template

BACKGROUND The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches. OBJECTIVE The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects. METHODS Full-thickness scalp defects of up to 126 cm2 in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a dermal regeneration template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis. RESULTS Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (± 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed. CONCLUSION This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.

One-stage reconstruction of deep facial defects with a single layer dermal regeneration template.

Background  The reconstruction of deep facial wounds in oncological surgery is challenging. Especially for elderly multimorbid patients, a rapid procedure with acceptable aesthetic and reliable functional outcome is required. Recently, a new single layer skin substitute was developed. Integra® dermal regeneration template single layer (IDRT‐SL) allows one‐stage surgery in combination with split thickness skin grafting. However, no study has yet analysed the efficiency of IDRT‐SL treatment.

Functional and Aesthetic Reconstruction of Full-Thickness Defects of the Lower Lip After Tumor Resection: Analysis of 59 Cases and Discussion of a Surgical Approach

BACKGROUND Carcinoma of the lower lip is a common cancer of the head and neck region. The accepted standard of care is surgical resection and reconstruction. The delicate location poses a challenge to surgeons because they have to aim for conflicting goals: complete oncological resection and functional and aesthetic restoration. For over a century, this challenge led to the development of more than 100 different reconstructive procedures. OBJECTIVE To develop a standardized surgical approach to simplify selection of an adequate reconstructive procedure. MATERIALS AND METHODS We performed a review of the literature and a retrospective analysis of 59 patients treated according to a standardized surgical approach over the past 5 years. RESULTS By taking into account the anatomic location, the width of the defect, and the amount of tissue loss, three flowcharts have been developed to guide the physician to a selection of suitable reconstructive procedures for each case. CONCLUSION This surgical approach facilitated the successful reconstruction of all encountered defects, and over a mean period of 31 months, no recurrences or major complications were seen. The authors have indicated no significant interest with commercial supporters.

S3-Leitlinie zum Umgang mit Antikoagulation bei Operationen an der Haut.

Hintergrund: Immer häufiger sind Patienten aufgrund verschiedener Erkrankungen auf die Einnahme von Antikoagulanzien und Thrombozytenaggregationshemmern angewiesen. Besteht bei diesen Patienten die Notwendigkeit einer Operation an der Haut, stellt sich die Frage des perioperativen Umgangs mit Antikoagulation.

Long‐term results after reconstruction of full thickness scalp defects with a dermal regeneration template

Objective  Large scalp defects in which the pericranium has to be resected can be reliably reconstructed using Integra®. In the present study, we retrospectively analysed the long‐term outcome of our patients.

Angioma serpiginosum following the lines of Blaschko – an effective treatment with the IPL technology

Angioma serpiginosum, first described by Hutchinson in 1889, is a rare benign vascular nevus with dilatation and proliferation of the capillaries in the upper dermis. A 15‐year‐old boy presented with an angioma serpiginosum on the right side of the body following the lines of Blaschko. Both the clinical pattern and the appearance in a male are unusual.Treatment with IPL technology (intense pulsed light), which emits polychromatic light from a high‐intensity flashlamp, proved to be an effective approach.

Promising Results from a Pilot Study on Compression Treatment of Ear Keloids

Background: Ear keloids continue to be a therapeutic challenge. Objective: To evaluate the clinical success of a modified “oyster splint technique.” Methods: Ten patients with an ear keloid agreed to receive the compression therapy. After surgical removal, a compressive device made of acrylic resin was applied on top of a silicone gel sheet and patients were asked to wear the splint 23 hours a day for at least 8 months. If the scar showed a tendency to grow, corticosteroids were injected intralesionally. In addition to recurrence rate, other parameters and wearing times were obtained by an interview. Results: Two of 10 patients experienced a recurrence in a mean follow-up period of 18.2 months (range 4–44 months). The daily wearing time of the compression splint was critical for the success of the treatment (p = .022). The splint had to be worn at least 10 hours a day for a minimum of 8 months to prevent recurrence. However, the need for additional intralesional steroid injections was significantly lower in patients wearing the splint for more than 20 hours per day (p = .048). The splint treatment was painless for 80% of patients. The therapeutic result was given a median mark of 1.75 (1 = best, 6 = worst). Conclusion: Although it requires considerable time and effort, the technique seems to be a promising therapy.

Analysis of treatment costs for complex scalp wounds.

Background: Two stage reconstructions of deep scalp wounds with exposed calvarial bone require a vital granulation tissue. By evaluating different surgical approaches functional and cosmetic results as well as economic aspects have to be taken into account.

Medicinal leeches for the treatment of venous congestion and hematoma after plastic reconstructive surgery.

Background: Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery.

Ex vivo expanded haematopoietic progenitor cells improve dermal wound healing by paracrine mechanisms

Background:  Although dermal wounds are common, treatment remains limited and largely ineffective. Recent studies suggest that therapeutic application of progenitor cells is useful for tissue regeneration.