BACKGROUND:Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications. METHODS:Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications. RESULTS:Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes. CONCLUSION:Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient's outcome.

Postoperative complications such as seroma formation and wound-site infection occur following completion axillary lymph node dissection (ALND) for melanoma. We analyzed the impact of time-to-drain removal and drainage volume on seroma formation after ALND. We retrospectively analyzed data from 118 patients after completion ALND for melanoma. Primary endpoints were daily amount of drainage volume, seroma formation and time-to-drain removal. Secondary endpoints included patient-related, disease-specific and perioperative parameters as well as the number of histologically analyzed lymph nodes and surgical complications graded by the Clavien–Dindo classification (CDCL). Statistical analyses were performed using logistic regression models. Drain removal around the 8th postoperative day was statistically associated with a lower risk for the occurrence of seroma formation (p < 0.001). Patients with an increased drainage volume during the early postoperative days were more prone to develop seroma after drain removal. With 49% (CDCL I and II), most complications were managed conservatively, while only 5.9% (CDCL III) required revision surgery (CDCL overall: 55.9%). ALND is a safe procedure with a low rate of severe CDCL III type of complications. To decrease seroma evacuation, our results imply that drains should be removed around the 8th postoperative day to reduce the risk of infection, readmission or prolonged hospitalization.

Introduction Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM. Materials and methods Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC). Results Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 ( p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 ( p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure. Conclusions Our findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation. Trial registration The data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.

Im multimodalen Therapiekonzept des frühen Mammakarzinoms hat die onkoplastische Mammachirurgie ihren festen Platz. Bei 30% ist ein Brusterhalt nicht möglich und eine Mastektomie mit Rekonstruktion ist nötig. Eine zusätzliche Verbesserung des operativ-kosmetischen Outcomes kann mittels Lipofilling erzielt werden, doch die onkologische Sicherheit und die Patientenzufriedenheit sind entsprechend geltender Daten unklar.

Abstract Background: Breast cancer (BC) is with 30% among all cancers the most common cancer among women in Austria. Regarding therapy and management of BC, surgical treatments with resection and reconstruction play a crucial role. Breast-conserving therapy (BCT) represents a common procedure. However, mastectomy is still needed in about 30% of the patients with the diagnosis BC and as prophylactic surgery in indicated cases. Recently, autologous fat transfer (AFT, lipofilling) has been used to improve cosmesis in oncoplastic and reconstructive breast surgery. There is a gap of evidence for the oncological safety as well as the benefit for quality of life (QoL) in patients who had an AFT after the BC or prophylactic surgery. Material and methods: We assessed peri-and postoperative results, oncological outcomes and QoL in 55 patients undergoing AFT after BCT or mastectomy at our department between 2013 and 2018. QoL was assessed with the EORTC QLQ C30 and QLQ-BRECON23 questionnaires. Results: Overall, 55 patients (73 breasts) underwent AFT after BCT or mastectomy. 39 patients had a diagnosis of invasive BC (four bilateral) and six patients a diagnosis of DCIS. 24 mastectomies were done as prophylactic surgery. AFT was done in 22 cases with nipple sparing mastectomy (NSM), in 30 cases with skin sparing mastectomy (SSM), in 9 cases with simple mastectomy ± reconstruction and in 12 cases with BCT. The number of AFT sessions was 1-8 (mean 1.8). The injected fat volume per session was 30-390 ml. There were 10 (14%) complications: 3 hematomas (none needed reintervention), local inflammation requiring antibiotic therapy (n=3), formation of an oil cyst (n=1), and fat necrosis (n=3). In two cases of fat necrosis biopsy was performed to confirm the diagnosis. After a median follow-up of 34 months there was one recurrence (Paget´s disease after BC). QoL data will be presented at the meeting. Conclusion: Lipofilling after mastectomy for cancer appears to be oncologically safe. Our complication rate is relatively high, although additional surgical intervention (biopsy) was only necessary in two cases. Patients considering AFT should be informed about additional risk for biopsy, as well as other common complications. Citation Format: Bjelic-Radisic V, Oberfichtner K, Wurzer P, Trapp E, Rappl T, Reisniger J, Kamolz L-P, Tamussino K. Short-term outcomes and QoL following autologous fat transfer in oncoplastic and reconstructive breast surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-07.

We aimed to evaluate the interaction between individual risk factors and institutional complication rates after reduction mammaplasties to develop a chart for a personalized written patient informed consent. We retrospectively reviewed charts of 804 patients who underwent bilateral breast reduction between 2005 and 2015. The Clavien-Dindo classification was used to classify postoperative complications. Relevant predictors were found by applying a stepwise variable selection procedure. Multilevel predictors were assessed through chi-square tests on the respective deviance reductions. 486 patients were included. The most common complications were wound healing problems (n = 270/56%), foreign body reactions (n = 58/12%), wound infections (n =45/9, 3%) and fat tissue necrosis (n = 41/8%). The risk factors for the personalized patient chart for the most common complications influencing the preoperative informed consent were: smoking, operative technique, resection weight for wound healing problems; body mass index and allergies for wound infections; and patients' age, resection weight for fat tissue necrosis. The resultant chart of institutionally encountered most common complications based on individual risk factors is a graphical template for obtaining patient informed consent in the future. Whether this approach influences patient information retainment, incidence of filed lawsuits or behavioral change needs to be prospectively tested in future studies.

Objective Over several decades, numerous national and international registries on breast implants went online, aiming to collect prospective data to provide increased safety for patients and surgeons. We performed a review of all published data on breast implant registries to assess availability and quality of data and determine its usefulness and impact. Materials and Methods PubMed, Ovid, and Web of Science were searched to identify all articles containing breast implant registries in English language. The review was registered at PROSPERO (CRD42016041255) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There was no limitation by publication date. Results Eight hundred ninety-five articles were identified; after removal of duplicates, 536 abstracts were screened on breast implant registries in plastic and reconstructive surgery. Unrelated articles, non-English articles, and not breast implant-related studies were excluded. Twenty breast implant registry-related articles met the inclusion criteria; 7 articles contained actual data on breast implants. Compared with international trends, only a minimal percentage of performed surgical breast augmentations is documented in registries, and the overall data quality and availability were low. Conclusions Only a fraction of performed breast augmentations is documented properly in a registry. Currently, there are no published data based on a clinical quality registry. Sustained funding and reliable administrative governmental structures remain crucial to establish an adequate clinical quality registry for breast implants as currently launched in Australia to analyze outcomes and risk factors for an increased patient safety.

Introduction: Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. Methods: Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Results: We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8 +/- 5years with burns covering 52 +/- 20% of the total body surface area and a hospitalization lasting 33 +/- 31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, -6.4 (-7.0, -5.7) mmHg for DBP, and -5.8 (-6.4, -5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (-22.5, 25.1) mmHg for SBP, 9.9 (-25.8, 13.0) mmHg for DBP, and 8.7 (-22.8,11.1) mmHg for MAP. Conclusions: Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.

OBJECTIVE:Mesenchymal stem/stromal cells derived from human term placentas (PMSCs) are novel therapeutic agents and more topical than ever. Here we evaluated the effects of three types of PMSCs on wound healing in an in vivo mouse model: Amnion-derived MSCs (AMSCs), blood vessel-derived MSCs (BV-MSCs) from the chorionic plate and Wharton's jelly-derived MSCs (WJ-MSCs) from the umbilical cord.METHODS:We topically applied PMSCs onto skin wounds in mice using the dermal substitute Matriderm® as carrier and evaluated wound healing parameters. In addition, we investigated the effects of all PMSC types under co-application with placental endothelial cells (PLECs). After 8 days, we compared the percent of wound closure and the angiogenic potential between all groups.RESULTS:AMSCs, BV-MSCs and WJ-MSCs significantly induced a faster healing and a higher number of blood vessels in the wound when compared to controls (Matriderm®-alone). PLECs did not further improve the advantageous effects of PMSC-treatment. Quantitative data and 3D analysis by high resolution episcopic microscopy confirmed a lower density of vessels in Matriderm®/PMSCs/PLECs co-application compared to Matriderm®/PMSCs treatment.CONCLUSION:Results indicate that all three PMSC types exert similar beneficial effects on wound closure and neovascularization in our mouse model.PRACTICE:Using Matriderm® as carrier for PMSCs propagates rapid cell migration towards the wound area that allows a fast and clinically practicable method for stem cell application.IMPLICATIONS:These promising effects warrant further investigation in clinical trials.

The use of injectable solutions for aesthetic purposes has increased tremendously, but lacks objective support. We aimed at assessing static and dynamic effects of botulinum toxin A (BoNTA) on glabellar lines by use of an objective three-dimensional methodology.

Reconstruction of bodily deformities due to burns is exceptionally difficult. The difficulty arises largely from a lack of understanding of the pathomechanism underlying scar tissue formation. Also, technical limitations in replacing body parts further fuel the psychological frustrations of reconstructive surgeons. The use of a musculocutaneous flap and/or fasciocutaneous flap, particularly as modified to follow the principles of z-plasty or three-quarter z-plasty, has been found to be effective in restoring functions lost because of scarring and scar contracture. It is conceivable that refinements in microsurgical tissue transfer techniques, together with advances in tissue engineering and facial transplantation, will render the task of reconstructing burn deformities much easier.

Background: Scars, skin pigmentation mismatch, contour deformities are often negatively affecting good reconstructive outcomes in reconstructed patients.In cases when surgery is reaching its limits, it is important to provide another treatment option like using medical tattooing.This may help to improve the postoperative outcome and patient´s satisfaction.We analyzed the beneficial effects of medical tattooing, an advanced form of cosmetic tattooing, in reconstructed patients. Methods:We analyzed the outcome of surgical NAC (nipple-areola complex) reconstructions in comparison with tattooed NACs in breast-reconstructed patients (after skin-sparing mastectomy and implant reconstruction).20patients underwent post-reconstruction medical tattooing by a tattoo-artist to improve colour mismatch and contour deformities using colors like carbon black, titanium dioxide, glycerine, isopropyl alcohol.All colors were applied using an electric tattoo machine; 20patients underwent nipple-reconstruction using different type of local flaps and skin-grafting (groin-skin).GAIS?Results: Compared to reconstructive NAC procedures, medical tattooing showed more improved aesthetic outcome.Patient satisfaction was significantly higher in the posttattooed patients.Further, no adverse events were noticed in the medical tattoo group.In the reconstructed group the aesthetic outcome was not as perfect because of colour mismatch and contour-irregularities. 1 loss of implant following skin penetration and infection after flap-elevation for nipple reconstruction was noted. Conclusion:A cross-over combination of reconstructive surgery and medical tattooing is a promising and much safer approach to provide high patient satisfaction in reconstructive surgery.

Modern treatment of partial-thickness burns follows the paradigm of less frequent dressing changes to allow for undisturbed reepithelialization of the burn wound. We compared Mepilex Ag (M), a silver-impregnated foam dressing, and Suprathel (S), a DL-lactid acid polymer, in the outpatient treatment of partial-thickness burns in pediatric and adult patients. Patients were enrolled in a randomized, controlled, prospective clinical trial. We monitored time to reepithelialization, wound pain, discomfort during dressing changes, and treatment cost. Objective scar characteristics (elasticity, transepidermal water loss, hydration, and pigmentation) and subjective assessments (Patient and Observer Scar Assessment Scale) were measured at 1 month post burn. Data are presented as mean ± SEM, and significance was accepted at P < 0.05. Sixty-two patients (S n = 32; M n = 30) were enrolled; age, sex, and burn size were comparable between the groups. Time to reepithelialization was not different between the groups (12 days; P = 0.75). Pain ratings were significantly reduced during the first 5 days after burn in the Suprathel group in all patients (P = 0.03) and a pediatric subgroup (P < 0.001). Viscolelasticity of burned skin was elevated compared with unburned skin in the Mepilex Ag group at 1 month post burn. Patients treated with Suprathel reported better overall scar quality (S: 2; M: 4.5; P < 0.001). The cost of treatment per square centimeter for Mepilex Ag was considerably lower than that of Suprathel. Both dressings are feasible and efficacious for the outpatient treatment of minor and selected moderate partial-thickness burns. Reduced pain, especially in a pediatric patient population, may be advantageous, despite increased treatment cost.

Introduction: Websites serve as information and communication platforms; hence, they are important tools for the self-promotion of hospitals. In 2010, Selig et al. evaluated the online presence of burn centers in Germany, Austria, and Switzerland based on 37 quality criteria. This study aimed to re-evaluate these websites to assess their development over the past 6.5 years. Materials and methods: Websites of the German-speaking burn centers were re-evaluated according to criteria previously described by Selig et al. Particular attention was paid to specific information on burns. Additionally, the implementation of social media platforms was investigated. Results: There was an overall increase in the quality of information published on websites. There was a considerable improvement recorded, especially in the categories of "teaching" and "patient care." However, burn-specific information was found to be still sparse. Over 50% of the hospitals were present on social media. Conclusions: Although the quality of information published on German-speaking burn center websites increased, they must be further developed, especially regarding burn-related information. Moreover, a clear structure and design could prevent long searches and facilitate an easier flow of information. The interface from websites and social media platforms appear to be an important tool for up-to-date self-promotion. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.

Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting-notably in the case of recurrences-additional strain on the constantly reduced resources in public healthcare. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center. In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence. The hospital patient database search included all patients with a diagnosis of pressure ulcers of the torso and lower extremity. One hundred sixty-three patients were diagnosed with pressure ulcers and 55 patients with 63 pressure ulcers met our inclusion criteria. The 17 recurrences (27%) had an average follow-up of 728 days. Most presented with lesions of the ischial tuberosity (n=24). Recurrence was statistically associated with defect size (p=0.013, Cox regression analysis), and serum albumin levels (p=0.045, Spearman correlation), but no association was found for body mass index, bacterial profile, comorbidities, localization, previous surgery, or time-to-admission for reconstruction (all p>0.05). Supported by the recent literature we identified factors like defect size to be associated with pressure ulcer recurrence, but not with time-to admission for reconstruction or number of previous debridements. Whether laboratory values like serum albumin levels were the cause, the result or associated with pressure ulcer recurrence warrants further investigation.

Mass casualty events and disasters are marked by a mismatch (disproportion) between the number of victims and the resources available for care. It is crucial that in such events, a central incident command post be rapidly established to (1) determine the number and severity of injured people, (2) identify and contact the centers available for care, (3) perform burn triage, and (4) distribute the burn victims according to the severity of their injuries to available burn centers. Triage is an ongoing process that must be repeated at several key junctures. It is common to retriage burn patients from a nonburn center to a burn center, but it may also be necessary to retriage patients from one burn center to another when surge capacity is reached. Distribution of burn victims across international boundaries may be needed to avoid overloading local burn centers. Burn mass casualty events are complex situations that require cooperation among rescue teams, security agencies, medical providers and hospitals, technical relief teams, burn centers, rehabilitation centers, transport resources, and many more who are involved in acute care. Thus, it is of utmost importance to provide administrative support and funding to enable comprehensive training and preparation for these events.