Zielsetzung: Die onkoplastische Reduktion mit superior oder inferior gestieltem Pedikel zählt zu den Standardtechniken onkoplastisch brusterhaltender Operationen. In einer Modifikation beider Techniken wird eine superior gestielte Reduktionsplastik durchgeführt, gleichzeitig der inferiore Pedikel zur Deckung des Quadrantektomiedefektes verwendet.

AllergyVolume 65, Issue 6 p. 798-799 Extensive allergic reaction to a new wound closure device (Prineo™) K. M. Dunst, Corresponding Author K. M. Dunst Department of DermatologyGeneral Hospital LinzKrankenhausstrasse 94020 LinzAustriaTel.: ++43 732 7806 73035Fax: ++43 732 7806 3738E-mail: karin.dunst@gmx.atSearch for more papers by this authorJ. Auboeck, J. AuboeckSearch for more papers by this authorB. Zahel, B. ZahelSearch for more papers by this authorB. Raffier, B. RaffierSearch for more papers by this authorG. M. Huemer, G. M. HuemerSearch for more papers by this author K. M. Dunst, Corresponding Author K. M. Dunst Department of DermatologyGeneral Hospital LinzKrankenhausstrasse 94020 LinzAustriaTel.: ++43 732 7806 73035Fax: ++43 732 7806 3738E-mail: karin.dunst@gmx.atSearch for more papers by this authorJ. Auboeck, J. AuboeckSearch for more papers by this authorB. Zahel, B. ZahelSearch for more papers by this authorB. Raffier, B. RaffierSearch for more papers by this authorG. M. Huemer, G. M. HuemerSearch for more papers by this author First published: 04 May 2010 https://doi.org/10.1111/j.1398-9995.2009.02243.xCitations: 21 An extensive allergic skin reaction is reported after use of a newly introduced surgical adhesive (Prineo™). Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume65, Issue6June 2010Pages 798-799 RelatedInformation

In this study, we evaluated and compared the effectivity of two modalities, gene therapy with adenovirus-mediated transforming growth factor-β and extracorporal shock waves (ESW) therapy, to treat ischemically challenged epigastric skin flaps in a rat model. Thirty male Sprague-Dawley rats were divided into three groups of ten rats each. An epigastric skin flap model, based solely on the right inferior epigastric vessels, was used as the model in this study. Rats received either subdermal injections of adenovirus encoding TGF-β(Ad-TGF-β) or ESW treatment with 750 impulses at 0.15 mJ/mm . The third group received no treatment and served as a control group. A flap measuring 8 × 8 cm was outlined on the abdominal skin. The TGF-β injections were given subdermally in the left upper corner of the flap just prior to flap elevation, whereas the ESW treatment was immediately after the flap was sutured back to its bed. Flap viability was evaluated seven days after the initial operation. Digital images of the epigastric flaps were taken and areas of necrotic zones relative to total flap surface area were measured and expressed as percentages by using a software program. Overall, there was a significant increase in mean percent surviving area in the Ad-TGF-β group and the ESW-group compared to the control group (ESW-group: 97.7 ± 1.8% vs. Ad-TGF-β: 90.3 ± 4.0% and control group: 82.6 ± 4.3%; p < 0.05). Furthermore, in the ESW group mean percent surviving areas were significantly larger than in the Ad-TGF-β group (ESW-group: 97.7 ± 1.8% vs. Ad-TGF-β: 90.3 ± 4.0%; p < 0.05). We conclude that treatment with ESW enhances epigastric skin flap survival significantly more than Ad-TGF-β treatment and, thus, represents a modality that is more feasible, cost effective and less invasive compared to gene therapy with growth factors to improve blood supply to ischemic tissue.

BACKGROUND: Tumor quadrantectomy combined with reduction mammaplasty allows resection of breast cancer with wider free margins and an improved cosmetic result. METHODS: 121 women with 125 breast cancers (114 invasive cancers, 11 high grade DCIS) underwent tumor quadrantectomy combined with a reduction mammaplasty. The oncological and cosmetic outcome is evaluated. RESULTS: Reduction mammaplasties were performed unilaterally (n = 4/121) or bilaterally (n = 117/121). Mean free surgical margins were 11.8 mm in patients with invasive cancer and 18.6 mm in patients with high grade DCIS. 3 of 125 resection specimen revealed positive margins (all were DCIS), in 2 of 125 specimens multicentric invasive cancer was found and the 5 patients underwent secondary mastectomy with immediate reconstruction. In 4 of 117 patients an occult invasive cancer was found in the histological specimen of the contralateral breast. After a median follow-up of 32 months (range 11–106 months) there were no local recurrences in the breast or axilla, three patients developed distant metastases. The postoperative cosmetic result evaluated by the patients was rated as excellent in 97 of 121 patients (80%) and good in 24 of 121 patients (20%) with no poor result. CONCLUSIONS: Tumor quadrantectomy combined with reduction mammaplasty allows wide tumor resection with adequate cosmetic result.

The effect of gene therapy with adenovirus-mediated (Ad) vascular endothetial. growth factor (VEGF) was compared to that of shock wave (SW) therapy on skin flap survival in a rat model, using the epigastric skin flap, based solely on the right inferior epigastric vessels.Thirty mate Sprague-Dawley rats were randomly divided into three groups (SW-group, Ad-VEGF-group, and Control-group) of 10 rats each. Immediately after surgery, the SW-group was administered 2500 impulses at 0.15 mJ/mm(2), in the Ad-VEGF-group injections were made to the subdermal space whereas the Control-group received no treatment. Flap viability was evaluated on day 7 after the operation. Standardised digital pictures of the flaps were taken and transferred to the computer, and necrotic zones relative to total flap surface area were measured and expressed as percentages.Overall, significantly smaller areas of necrotic zones were noted in the SW-group and the Ad-VEGF-group compared with the Control-group (SW-group: median 2.23% (range: 0-5.1) versus Control-group: median 17.4% (range: 11.8-22.8) (p < 0.05); Ad-VEGF-group: median 9.25% (range: 7.6-11.9) versus Control-group: median 17.4% (range: 11.8-22.8) (p < 0.05)). Furthermore, in the SW-group, areas of necrotic zones were significantly smaller than in Ad-VEGF-group (SW-group: median 2.23% (range: 0-5.1) versus Ad-VEGF-group: median 9.25% (range: 7.6-11.9) (p < 0.05)).We conclude that treatment with SW enhances epigastric skin flap survival significantly more than Ad-VEGF treatment and also represents a feasible and cost effective technique to improve blood supply in ischaemic tissue. (c) 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.

Endovenous laser treatment (EVLT) has become a valuable and safe option in the treatment of varicose veins. Although long-term results are lacking, most patients seem to benefit in the short-term from EVLT. Reported postoperative complications are limited, consisting usually of pain, ecchymosis, induration, phlebitis, or spot skin burn injuries. The most feared complication is an extension of the saphenous thrombus into the femoral vein, with possible pulmonary embolism. Here we report a septic thrombophlebitis after EVLT resulting in a phlegmonous infection of the whole leg that was treated by surgical drainage. Aggressive local therapy and antibiotic treatment resulted in complete resolution of symptoms and eventual satisfactory healing.

Zielsetzung:Die onkologische Sicherheit brusterhaltender Operationen bei retroareolären Mammakarzinomen konnte in Studien gezeigt werden. Dennoch wird von vielen Operateuren bei zentralen Karzinomen die Mastektomie bevorzugt, was in dem unsicheren kosmetischen Ergebnis nach zentraler Quadrantektomie begründet ist. In einer prospektiven, nicht randomisierten Studie wurden onkologische und kosmetische Ergebnisse brusterhaltender Operationen mit Mastektomie verglichen.

Microsurgical tissue transfer has constantly improved the therapeutic options for reconstruction in the head and neck region, but the ideal flap has yet to be found. The purpose of this study is to discuss the aesthetic potential of the free gracilis muscle flap in difficult head and neck reconstruction. We report our experience with the free gracilis muscle flap in seven patients who underwent reconstruction in the head and neck region for a variety of indications. In all seven patients, the transplanted muscle flaps healed well, with no flap loss. Postoperative complications consisted of skin‐graft loss in one patient requiring a second split‐thickness skin graft. Donor‐site morbidity was minimal in all patients. For difficult reconstruction in the head and neck region, the free gracilis muscle flap offers a number of advantages, including reliable vascular anatomy, relatively great plasticity, and a concealed donor area. Thus this type of flap offers a valuable option whenever an aesthetically pleasing result is sought. © 2005 Wiley‐Liss, Inc. Microsurgery 25:00–00, 2005.

A 17-year-old boy jumped over a fence and sustained an avulsion injury. The fifth finger was amputated, and the tendon of the flexor digitorum profundus muscle was completely pulled out. The finger was replanted microsurgically.

We investigated the feasibility in rats of enhancing skin-flap prefabrication with subdermal injections of adenovirus-encoding vascular endothelial growth factor (Ad-VEGF). The left saphenous vascular pedicle was used as a source for vascular induction. A peninsular abdominal flap (8 x 8 cm) was elevated as distally based, keeping the epigastric vessels intact on both sides. After the vascular pedicle was tacked underneath the abdominal flap, 34 rats were randomly divided into three groups according to treatment protocol. The implantation site around the pedicle was injected with Ad-VEGF in group I (n = 10), with adenovirus-encoding green fluorescent protein (Ad-GFP) in control group I (n = 14), and with saline in control group II (n = 10). All injections were given subdermally at four points around the implanted vessel by an individual blinded to the treatment protocol. The peninsular flap was sutured in its place, and 4 weeks later, an abdominal island flap based solely on the implanted vessels was elevated. The prefabricated island flap was sutured back, and flap viability was evaluated on day 7. Skin specimens were stained with hematoxylin and eosin for histological evaluation. In two rats from each group, microangiography was performed to visualize the vascularity of the prefabricated flaps. There was a significant increase in survival of prefabricated flaps in the Ad-VEGF group compared to the control groups: Ad-VEGF, 88.9 +/- 6.1% vs. Ad-GFP, 65.6 +/- 9.4% (P < 0.05) and saline, 56.0 +/- 3.4% (P < 0.05). Sections from four prefabricated flaps treated with Ad-GFP revealed multiple sites of shiny deposits of green fluorescent protein around the area of local administration 1 day and 3 weeks after gene therapy. Histological examination done under high-power magnification (x400) with a light microscope revealed increased vascularity and mild inflammation surrounding the implanted vessel in all groups. However, we were unable to demonstrate any significant quantitative difference with respect to vascularity and inflammatory infiltrates in prefabricated flaps treated with Ad-VEGF compared with controls. Microangiographic studies showed increased vascularity around the implanted pedicle, which was similar in all groups. However, vascularization was distributed in a larger area in the prefabricated flaps treated with Ad-VEGF. In this study, the authors demonstrated that adenovirus-mediated VEGF gene therapy increased the survival of prefabricated flaps, suggesting that it may allow prefabrication of larger flaps and have the potential to reduce the time required for flap maturation.

Cutaneous mastocytosis (CM) or urticaria pigmentosa is characterized by abnormal proliferation and accumulation of mast cells. Clinically, CM usually presents as symmetrically distributed red-brown macules or papules that develop weals, erythema and often pruritus on stroking (Darier's sign). The histological hallmark of the disease is an increase in oval to spindle-shaped mast cells in the dermis located around blood vessels and skin appendages. We describe three patients with a new clinicopathological type of CM, which clinically mimics a histiocytic disorder and histologically mimics leucocytoclastic vasculitis (LV). Three infants (two boys and one girl) developed generalized reddish-yellow-brown macules of 3-10 cm with occasional scaling and crusting on the trunk and extremities without further symptoms or organ involvement except variable itching. Histology revealed diffuse and dense dermal infiltrates of eosinophils, neutrophils and nuclear debris with perivascular accentuation, imitating LV. This infiltrate masked large epithelioid cells, positive for macrophage markers, which by special histochemical stains for metachromatic granules turned out to be mast cells. This is the first report of this new variant of CM, which may cause considerable diagnostic difficulties both clinically and histopathologically.

The induction of neoangiogenesis by exogenous growth factors in failing skin flaps has recently yielded promising results. Gene transfer with virus vectors has been introduced as a highly capable route of administration for growth factors, such as vascular endothelial growth factor or fibroblast growth factor. Extracorporal shock waves (ESW) deliver energy by means of high amplitudes of sound to the target tissue and have been shown to induce angiogenesis. We compared the effectiveness of gene therapy with adenovirus-mediated transforming growth factor-beta (TGF-beta) and ESW therapy to treat ischemically challenged epigastric skin flaps in a rat model. Thirty male Sprague-Dawley rats were divided into three groups of 10 each with an 8 x 8 cm epigastric skin flap. Rats received either subdermal injections of adenovirus (Ad) encoding TGF-beta (10(8) pfu) or ESW treatment with 750 impulses at 0.15 mJ/mm2. The third group received no treatment and served as a control group. Flap viability was evaluated after 7 days and digital images of the epigastric flaps were taken and areas of necrotic zones relative to total flap surface area calculated. Histologic evaluation and increased angiogenesis were confirmed by CD31 immunohistochemistry. Overall, there was a significant increase in mean percent surviving area in the Ad-TGF-beta group and the ESW group compared to the control group (ESW group: 97.7 +/- 1.8% vs. Ad-TGF-beta: 90.3 +/- 4.0% and control group: 82.6 +/- 4.3%; p < 0.05). Furthermore, in the ESW group mean percent surviving areas were significantly larger than in the Ad-TGF-beta group (ESW group: 97.7 +/- 1.8% vs. Ad-TGF-beta: 90.3 +/- 4.0%; p < 0.05). Flap vascularization was increased by Ad-TGF-beta and ESW with numerous vessels, however, there was no significant difference between the two treatment groups. We conclude that treatment with ESW enhances epigastric skin flap survival significantly more than Ad-TGF-beta treatment and thus represents a modality that is feasible, cost-effective, and less invasive compared to gene therapy with growth factors to improve blood supply to ischemic tissue.

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.

Schoeller, Thomas M.D.; Huemer, Georg M. M.D.; Kolehmainen, Maija M.D.; Otto-Schoeller, Angela M.D.; Wechselberger, Gottfried M.D. Author Information

Several methods have been used in an attempt to increase blood supply and tissue perfusion in ischemic tissues. The authors investigated the effect of extracorporal shock wave (ESW) treatment on compromised skin flaps. For this purpose, the epigastric skin flap model in rats, based solely on the right inferior epigastric vessels was used.Twenty mate Sprague-Dawley rats were divided into two groups (ESW-group, Control group) of 10 rats each. The ESW-group was administered 2500 impulses at 0.15 mJ/mm(2) immediately after surgery, whereas, the control group received no treatment. Flap viability was evaluated on day 7 after the operation. Standardised digital pictures of the flaps were taken and transferred to the computer, and necrotic zones relative to total flap surface area were measured and expressed as percentages. Overall, there was a significant reduction in the surface area of the necrotic zones of the flaps in the ESW group compared to the control. group (ESW group: 2.2 +/- 1.9% versus control: 17.4 +/- 4.4% (p < 0.01)).In this study, the authors demonstrated that treatment with ESW enhanced epigastric skin flap survival, as confirmed by the significant reduction of necrotic flap zones. ESW treatment seems to represent a feasible and cost effective method to improve blood supply in ischemic tissue. (C) 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.

Department of Plastic and Reconstructive Surgery, Leopold-Franzens University, Anichstrasse 35, 6020 Innsbruck, Austria, [email protected]

Large skull defects lead to progressive depression deformities, with resulting neurological deficits. Thus, cranioplasty with various materials is considered the first choice in therapy to restore cerebral function. A 31‐year‐old female presented with a massive left‐sided hemispheric substance defect involving bone and brain tissue. Computed tomography showed a substantial convex defect involving the absence of calvarial bone as well as more than half of the left hemisphere of the brain, with a profound midline shift and a compression of the ventricular system. There was a severe problem due to multiple deep‐skin ulcerations at the depression margin, prone to skin perforation with a probability of intracranial infection. In a first step, a free myocutaneous latissimus dorsi flap was transplanted for volume replacement of the hemispheric brain defect, and 4 months later, artificial bone substitute was implanted in order to prevent progressive vault depression deformity. Healing was uneventful, and the patient showed definite neurological improvement postoperatively. Free tissue transfer can be a valuable option in addition to cranioplasty in the treatment of large bony defects of the skull. Besides providing stable coverage for the reconstructed bone or its substitute, it can also serve as a volume replacement. © 2005 Wiley‐Liss, Inc. Microsurgery 25:325–328, 2005.