The technique of lymphangioplasty or capillary thread drainage was historically performed with subcutaneously implanted surgical threads. It has recently been revived by introducing a thread-like aligned nanofibrillar collagen matrix (BioBridge™). These collagen threads constitute subcutaneous neocollectors along which guided lymphangiogenesis is said to occur secondarily. We present for the first time a tissue examination of a 10-month implanted BioBridge™ sample with surrounding tissue from a human subject by histology, scanning and transmission electron microscopy.

Data are available from the corresponding author on reasonable request.

Background Although complete mesocolic excision has been performed for 10 years there remains no published prospective data. The lack of a classification which includes completeness of mesocolic tissue removal as well as plane of surgery contributes to the problem of comparing studies. The aim of the present study was to develop such a classification for right hemicolectomy. Methods In a prospective, non-randomized trial we collected specimens of right hemicolectomies from 38 German hospitals between February 2012 and October 2016. The degree of radicality of resection was reported. Photographs were taken of the specimens. After screening the images it became apparent that the specimens could be divided into four main groups according to the degree of missing mesocolic tissue, and three subgroups reflecting the plane of surgery. Results Of 1373 patients 1097 images were available. Grading was possible in 1077 (98.2%). Distribution was Type 0 (best) 38.6%, Type I 43.3%, Type II 8.5%, Type III (poorest) 7.8%. Surgery was considered to be in a suboptimal plane of surgery in 15.2% overall, highest in Type III (37%) and lowest in Type 0 (7.8%, p < 0.001). Conclusions The proposed classification may be a relevant tool for the further investigation of CME for right colon cancer because it allows us to differentiate the aspects of lymphadenectomy and the preservation of the integrity of the mesocolon.

One of the big controversies in colorectal cancer research is whether complete mesocolic excision (CME) offers a benefit for patients with carcinoma of the right colon or whether it might even harm these patients. A randomized trial to clarify this question has often been advocated. However, setting up such a trial is hampered by a major problem, which is mainly related to the difficulty of defining a standardized control group. First, there is no consensus of a standard non-CME hemicolectomy. Second, a surgeon who has been trained for CME will perform a “standard” right hemicolectomy differently than before. It won’t be the traditional hemicolectomy but a 5/6 CME-hemicolectomy, thus making it very difficult to detect a difference. Our approach to answering the question was a multicenter, non-randomized, registry-based trial with centralized assessment of the entire specimen. This trial has just closed recruitment after enrolling more than 1000 patients, so that long-term results can be expected in a few years.

Zusammenfassung Einleitung Strahlen-induzierte Angiosarkome der Brust sind seltene Sekundärmalignome, die nach adjuvanter Bestrahlung eines Mammakarzinoms mit einer Latenz von Jahren auftreten. Sie wachsen multifokal und neigen häufig zu Lokalrezidiven und stellen somit eine chirurgische Herausforderung dar. Aufgrund ihrer Seltenheit ist es weiterhin ungeklärt, ob ein radikales chirurgisches Vorgehen mit einer verbesserten Prognose einhergeht. Das Ziel der Arbeit war es den prognostischen Wert der chirurgischen Radikalität zu bestimmen. Patienten und Methoden Es erfolgte eine retrospektive Analyse an 18 Patientinnen, die chirurgisch in unserer Klinik behandelt wurden. Der mediane Nachbeobachtungszeit betrug 4,4 Jahre. Die zu untersuchenden Faktoren inklusive Bewertung der chirurgischen Resektionsränder wurden mittels univariater Analysen hinsichtlich ihres Einflusses auf das lokale rezidivfreie Überleben und das Gesamtüberleben untersucht. Ergebnisse Das mediane Erkrankungsalter lag bei 66,3 Jahren. Die mediane Latenz zwischen der Bestrahlung und der Erstdiagnose des Angiosarkoms betrug 6,9 Jahre. Die 5-Jahresraten für das rezidivfreie Überleben und das Gesamtüberleben betrugen 25,0% (95%-Konfidenzintervall [KI]: 7,8–47,2) und 53,8% (95%-KI: 26,8–74,8). Die R0-Resektion der Primärläsion war mit einem signifikant besseren rezidivfreien Überleben (P=0,017) als auch Gesamtüberleben (P=0,013) assoziiert. Das gleiche galt für die R0-Resektion der letzten Rezidivläsion (P=0,040) hinsichtlich des Gesamtüberlebens. Diskussion Das aggressive Wachstum und die ausgeprägte Rezidivneigung strahleninduzierter Angiosarkome erfordern und rechtfertigen ein radikales chirurgisches Vorgehen. Wenn immer möglich, sollte eine R0-Resektion angestrebt werden, um die lokale Kontrolle und das Gesamtüberleben zu verbessern.

Sarcomas of the hand and wrist are rare malignancies, which should be referred to high-volume comprehensive cancer centres providing multidisciplinary treatment options. The tumour board should propose patient-oriented oncological pathways as well as sophisticated hand and plastic reconstructive procedures. In Addition, isolated limb perfusion with TNF-alpha and melphalan is likely to lead to preoperative tumour shrinkage allowing for R0 resection in sano. Our clinical results in long-term survivors demonstrate reduced amputation rates and salvage of basic hand function when a risk-adapted treatment rationale is applied.

Clinical history, physical examination, evolution and imaging findings (Colour Doppler sonography, MRI if available) are of pivotal importance in the diagnostic pathway of an infantile vascular anomaly. Histopathology with specific stains and markers is contributive in difficult cases. Differentiation between vascular tumors (hemangioma) and vascular malformations is now well known and integrated into the ISSVA classification. We report here a 6-months-old boy, who presented with a localized cutaneous and expansive vascular birthmark in the left cheek and developed bleedings at the age of 18 months. Diagnostic features of a hemangioma were not evident, and the final diagnosis of a venous malformation was confirmed by histopathology.

BACKGROUNDComplete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer may be superior to standard hemicolectomy in terms of oncological results. This hypothesis is currently being investigated in a large multicentre trial conducted by the authors of this paper (Resektatstudie). Because CVL in right-sided hemicolectomy is technically rather demanding the incidence of central node involvement is of special interest. Therefore, during the single centre pilot phase of our multicentre trial we have analysed the incidence of central lymph node metastasis in CME specimens.PATIENTSIn 51 patients with right-sided colon adenocarcinoma (cT1-3, cM0) an open CME with CVL was performed. In the fresh specimen the central four centimetres of the ileocolic vessels that would have been presumably left in place during a standard hemicolectomy were marked with a suture. The lymph nodes in this segment were separately analysed.RESULTSIn the CME specimen the mean lymph node count was 52.6 (range: 27-171). 35.0 % (range: 13.1-65.6 %) of the nodes were located in the central 4 cm segment. The proportion of patients with positive nodes was 25.5 % (13/51). Of all nodes 1.97 % (53/2686) were metastatic. In 3/51 (5.8 %) patients the central nodes were involved. In one patient the central nodes were the only metastatic site. UICC stage was influenced in two of the three patients who had central involvement (stage migration: UICC IIB to IIIB, UICC IIIB to IIIC).CONCLUSIONCME with CVL in right-sided colon adenocarcinoma increases the probability of complete removal of the local lymph node drainage and thus local metastatic lymph nodes. Considering this result an improvement of long-term survival by the CME procedure seems conceivable but needs to be confirmed by the current multicentre trial.

Soft tissue sarcomas (STS) are heterogeneous malignant tumors of mesenchymal origin. Due to low incidence and high number of different histological subtypes, their pathogenesis and thus potential targets for their therapy remain barely investigated. Several studies revealed significant higher EPHB4 expression in malignancies such as prostate and colorectal cancer showing survival advantages for these tumor cells. Therefore we studied the expression of EPHB4 in a total of 46 clinical human specimens of different STS and human fibroblasts. EPHB4 mRNA and protein expression were significantly increased in synovial sarcoma. After targeting EPHB4 in fibrosarcoma, synovial sarcoma, liposarcoma and MFH sarcoma cell lines by siRNA or by inhibition of autophosphorylation using the specific EPHB4 kinase inhibitor NVP-BHG712 a decreased proliferation rate/vitality of synovial- and fibrosarcoma cells was observed. Silencing of EPHB4 significantly reduced the transmigration of synovial sarcoma cells towards fibroblasts and endothelial cells. In addition, we assessed the anti-metastatic effect of EPHB4 inhibition in vivo by intraperitoneal administration of the EPHB4 inhibitor in an appropriate sarcoma lung metastasis xenograft model. As result 43% of NVP-BHG712 treated mice (n=3/7) developed pulmonary metastases whereas all control mice (n=5) revealed lung metastases. The residual 57% of mice (n=4/7) showed only small local tumor cell spots. Size measurements of the Vimentin positive area explained significant decrease in lung metastasis formation (p<0.05) after EPHB4 kinase inhibition. In summary, these data provide first evidence of the importance of EPHB4 in the tumorigenesis of synovial sarcoma and present EPHB4 as a potential target in the therapy of this malignancy.

AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK

We report the case of a 29-year-old female patient with a relapse of a Nora lesion in an atypic location. The literature for this rare benign lesion is reviewed and etiology, diagnostics and therapy are discussed.

Objective: The gold standard in the treatment of soft tissue sarcomas (STS) remains the surgical resection with clear margins and radiation therapy. It is still questionable whether a systemic therapy with chemotherapeutics has a positive impact on the overall survival. Doxorubicin is currently one of the most commonly used chemotherapeutic agents, but options are limited both in number and ef cacy for patients with advanced disease. The aim of this study was to establish a syngeneic immunocompetent murine  brosarcoma (BFS1) model that would allow study of host defense-like lytic peptide ([D]-K3H3L9) and Doxorubicin combination therapy.

Die operative Entfernung mit einem Sicherheitsabstand von 1–2 cm stellt die Basis der multidisziplinären Versorgung von Weichgewebssarkomen des Rumpfes und der Extremitäten dar. Bei Tumoren mit hoher biologischer Aktivität (Grading 2/3) ist die perioperative Radiatio/Chemotherapie unter Studienbedingungen indiziert. Für periphere Lokalisationen oder Komplikationen werden im Tumorboard zusätzliche Möglichkeiten wie die hypertherme Perfusion mit Tumornekrosefaktor α oder das gesamte Spektrum der plastischen Wiederherstellung einbezogen. Grundsätzlich sollten Patienten mit Weichgewebssarkomen in „high volume“-Zentren versorgt werden.

Adequate surgical removal of soft tissue sarcomas of the trunk and extremities employing safety margins of 1-2 cm is the accepted basis of multidisciplinary treatment. In cases of high risk tumors (grades G2/G3) the tumor board decision should include radiochemotherapy under study conditions. Difficult peripheral locations or perioperative complications require additional techniques, such as hyperthermic perfusion with tumor necrosis factor alpha or the complete spectrum of reconstructive plastic procedures. Patients with soft tissue sarcoma of the trunk or of the extremities should always be referred to high volume centers.

Negative surgical margins (R0 resection) play a key role in the prevention of local recurrences of soft tissue sarcoma of the extremities in the multimodal therapy concept. The prognostic relevance for long-term survival is still under dispute. Despite the fact that numerous recommendations and guidelines have existed for over 100 years, strong evidence-based data from prospective randomized studies are still not available today. These studies should include parameters like tumor localization, subtype and biological aggressiveness. Recommendations as to surgical therapy diverge considerably. They range from amputation and compartment resection to centimetre and millimetre surgical margins. The present article analyses currently available data and definitions and discusses the impact on functional restriction, lymph drainage, local recurrence and the perioperative irradiation field. In the absence of surgical standards, it is doubtful whether existing studies and multicenter trials currently underway are valid. Close co-operation between surgeon and pathologist is imperative to further substantiate the significance of histological examinations and resection margins.

ABSTRACTWound infection is a common risk for patients with chronic nonhealing wounds, causing high morbidity and mortality. Currently, systemic antibiotic treatment is the therapy of choice, despite often leading to several side effects and the risk of an insufficient tissue penetration due to impaired blood supply. If systemically delivered, moxifloxacin penetrates well into inflammatory blister fluid, muscle, and subcutaneous adipose tissues and might therefore be a possible option for the topical treatment of skin and infected skin wounds. In this study, topical application of moxifloxacin was investigated in comparison to mupirocin, linezolid, and gentamicin using a porcine wound infection and a rat burn infection model. Both animal models were performed either by an inoculation with methicillin-resistantStaphylococcus aureus(MRSA) orPseudomonas aeruginosa. Wound fluid, tissue, and blood samples were taken, and bacterial counts as well as the moxifloxacin concentration were determined for a 14-day follow-up. A histological comparison of the rat burn wound tissues was performed. Both strains were susceptible to moxifloxacin and gentamicin, whereas mupirocin and linezolid were effective only against MRSA. All antibiotics showed efficient reduction of bacterial counts, and except with MRSA, infected burn wounds reached bacterial counts below 105CFU/g tissue. Additionally, moxifloxacin was observed to promote wound healing as determined by histologic analysis, while no induction of bacterial resistance was observed during the treatment period. The use of topical antibiotics for the treatment of infected wounds confers many benefits. Moxifloxacin is therefore an ideal candidate, due to its broad antibacterial spectrum, its high efficiency, and its potential to promote wound healing.

Tsoukas, R.L.1*; Becerikli, M.1; Jacobsen, F.1; Mikhail, B.D.1; Schulte, M.1; Stricker, I.2; Rittig, A.1; Steinau, H.-U.1; Steinstraesser, L.1 Author Information