Introduction:Wide Awake Local Anesthesia No Tourniquet (WALANT) is an established method of local anesthesia in hand surgery. In rare cases, ischemic complications may occur due to the adrenaline contained in the tumescent solution. The vasoconstrictive effect of adrenaline can be antagonized by the local injection of phentolamine. To date, little is known in Germany about the incidence and treatment of ischemic complications, as well as the state of knowledge regarding phentolamine. Material and Methods:An online survey of hand surgeons in Germany was used to evaluate their knowledge of the management and incidence of ischemic complications associated with the use of the WALANT technique in the hand. Among other things, the survey was designed to assess knowledge of and access to phentolamine as an antidote to the adrenaline contained in the WALANT solution. Results:A total of 124 surgeons participated in the study. 8.3% of the surgeons had experience with ischemic complications when using the WALANT technique. Ischemic complications were observed mainly after surgical annular ligament release, but also after Dupuytren's contracture surgery and carpal tunnel release. In none of the cases was the antidote phentolamine used. 47.7% of the users had no knowledge of the antidote phentolamine, and accordingly, phentolamine was only available in 53.2% of the hospitals. There was an interest in training in the form of continuing education, specialist literature and workshops to improve the use of phentolamine. Conclusion:Although WALANT is recognized as a very safe procedure, ischemic complications can occur in hand surgery in rare cases. The present study shows an insufficient level of knowledge regarding the antidote phentolamine in the treatment of ischemic complications associated with the WALANT technique. Users of the WALANT technique must be familiar with the procedure and its potential risks in order to be able to respond appropriately in an emergency. Even rare complications may, in case of doubt, lead to functional impairment and medikolegal consequences, particularly when phentolamine is not available. We therefore recommend always maintaining a stock of phentolamine and providing regular training sessions to ensure optimal patient safety.

Hand lacerations carry a significant risk of overlooked involvement of deep-lying functional structures. Flexor and extensor tendons, digital nerves and blood vessels run immediately subcutaneously and can be completely or partially injured even with minor skin lesions. Inadequate medical history, incomplete clinical examination or failure to perform a systematic wound exploration are among the most common causes of a delayed diagnosis. This results in poorer functional outcomes, more complex secondary reconstructions and increased medico-legal risks. This CME article provides a practice-oriented overview of the structured diagnostics and management of lacerations of the hand. A particular focus is placed on wound exploration as a central diagnostic step for the reliable identification of tendon, nerve and vascular injuries. In addition, evidence-based principles of acute care, surgical treatment and early functional follow-up treatment are summarized.

BACKGROUND:Red cell distribution width (RDW), serum protein levels, platelet count (PLT), and RDW/protein and RDW/PLT ratios have been associated with adverse outcomes in various medical conditions such as sepsis and critical illness. This study aimed to investigate the association between these parameters and in-hospital mortality following severe burn injury. METHODS:Intensive care burn patients admitted between March 2007 and December 2020 with a total body surface area (TBSA) burned ≥ 20 % were analyzed. Multivariate analysis was conducted to examine variables associated with mortality. RDW/protein and RDW/PLT ratios on post-burn days 1, 3 and 7 were analyzed by receiver operating characteristic curves. RESULTS:A total of 288 patients were included. Mortality was 26 %, with non-survivors being significantly older, more frequently male, and presenting with an average of 49 % of TBSA burned. RDW, serum protein levels and PLT were not independent predictive values. The RDW/protein ratios on post-burn days 3 and 7 were significantly associated with in-hospital mortality. The respective AUC value exceeded 0.8 on post-burn day 7, indicating good predictive ability. CONCLUSION:Post-burn evaluation of the RDW/protein ratio may provide a simple, cost-effective, and valuable predictor for mortality risk assessment following burn injury.

Introduction Wide Awake Local Anesthesia No Tourniquet (WALANT) is an established method of local anesthesia in hand surgery. In rare cases, ischemic complications may occur due to the adrenaline contained in the tumescent solution. The vasoconstrictive effect of adrenaline can be antagonized by the local injection of phentolamine. To date, little is known in Germany about the incidence and treatment of ischemic complications, as well as the state of knowledge regarding phentolamine.Material and Methods An online survey of hand surgeons in Germany was used to evaluate their knowledge of the management and incidence of ischemic complications associated with the use of the WALANT technique in the hand. Among other things, the survey was designed to assess knowledge of and access to phentolamine as an antidote to the adrenaline contained in the WALANT solution.Results A total of 124 surgeons participated in the study. 8.3% of the surgeons had experience with ischemic complications when using the WALANT technique. Ischemic complications were observed mainly after surgical annular ligament release, but also after Dupuytren's contracture surgery and carpal tunnel release. In none of the cases was the antidote phentolamine used. 47.7% of the users had no knowledge of the antidote phentolamine, and accordingly, phentolamine was only available in 53.2% of the hospitals. There was an interest in training in the form of continuing education, specialist literature and workshops to improve the use of phentolamine.Conclusion Although WALANT is recognized as a very safe procedure, ischemic complications can occur in hand surgery in rare cases. The present study shows an insufficient level of knowledge regarding the antidote phentolamine in the treatment of ischemic complications associated with the WALANT technique. Users of the WALANT technique must be familiar with the procedure and its potential risks in order to be able to respond appropriately in an emergency. Even rare complications may, in case of doubt, lead to functional impairment and medikolegal consequences, particularly when phentolamine is not available. We therefore recommend always maintaining a stock of phentolamine and providing regular training sessions to ensure optimal patient safety.

Complex full-thickness skin defects remain challenging to reconstruct due to the loss of regenerative dermal structures. Dermal regeneration templates such as the NovoSorbⓇ Biodegradable Temporising Matrix (BTM) have been introduced to facilitate dermal regeneration prior to definitive skin grafting. We hereby describe the outcome following its use in the context of wound treatment. A retrospective analysis was conducted including all patients treated with BTM at a single plastic surgery center between March 2020 and February 2026. Demographic, clinical, microbiological, and surgical data were extracted from electronic health records. Outcomes of interest included BTM infection, BTM loss prior to skin grafting and skin graft take. Univariate and multivariable analyses were performed to identify factors associated with BTM loss. A total of 104 wounds in 86 patients were included. Burns were the most common etiology (40.7%), followed by chronic wounds (19.8%), infections (17.4%), trauma (15.1%), and tumors (9.3%). The mean wound area treated with BTM was 725 cm² (± 937.6). Complete BTM integration occurred in 74.1% of wounds, partial integration in 9.6%, and BTM loss in 16.3%. Infectious complications occurred in 15.4% and skin graft failure following successful BTM integration in 6.9%. Peripheral arterial disease and exposed tendons were significantly more frequent in cases of BTM loss in univariate analysis but were not independent predictors in multivariable analysis. BTM represents a reliable reconstructive option for complex full-thickness wounds across diverse etiologies, demonstrating high integration and graft success rates. Peripheral arterial disease and exposed tendons may increase the risk of BTM loss, although independent predictive value was not confirmed.

Schnittverletzungen der Hand bergen ein erhebliches Risiko für eine übersehene Beteiligung tief liegender funktioneller Strukturen. Beuge- und Strecksehnen, digitale Nerven und Gefäße können bereits bei kleinen Hautläsionen verletzt sein. Unzureichende Anamnese, unvollständige klinische Untersuchung oder Verzicht auf eine systematische Wundexploration zählen zu den häufigsten Ursachen verzögerter Diagnosen. Folgen sind schlechtere funktionelle Ergebnisse, komplexere sekundäre Rekonstruktionen und erhöhte medikolegale Risiken. Der vorliegende CME-Beitrag gibt einen praxisorientierten Überblick über die strukturierte Diagnostik und das Management von Schnittverletzungen der Hand. Ein besonderer Fokus liegt auf der Wundexploration als zentralem diagnostischem Schritt zur sicheren Identifikation von Sehnen‑, Nerven- und Gefäßverletzungen. Darüber hinaus werden evidenzbasierte Prinzipien der Akutversorgung, der operativen Therapie und der frühfunktionellen Nachbehandlung zusammengefasst.

Breast hypertrophy, characterized by abnormal breast enlargement, often leads to chronic neck and back pain. Breast-reduction mammoplasty is commonly performed to alleviate these symptoms and improve breast appearance. Proper preoperative measurements are crucial for satisfactory long-term results. This study aimed to investigate long-term postoperative changes in breast morphology following breast reduction mammoplasty. We retrospectively analyzed 122 patients who underwent breast reduction mammoplasty at Hannover Medical School between 2011 and 2021. Various pedicle techniques were used, and changes in breast shape and contour were measured from pre- and postoperative photographs using Image J software. A total of 122 female patients (244 breasts) were included. The average postoperative nipple to inframammary fold (N-IF) distance on the right side changed from 142 mm to 72 mm (P<0.0001) at >3 months, 72 mm to 80 mm at 3-6 months, and 80 mm to 85 mm at >1 year. Statistically significant changes in breast shape were observed when comparing preoperative measurements with all postoperative time points (P<0.0001). No significant differences were found between the individual postoperative time points (>3 months vs. 3-6 months; 3-6 months vs. >1 year), indicating that breast shape stabilizes within the first 3 months after surgery and remains relatively stable thereafter. The mean increase in N-IF distance at >1 year follow-up was 16 mm on the right and 14 mm on the left. The sulcus jugularis to nipple (SN-N) distance increased by 12 mm on the right and 6 mm on the left. The clavicle to nipple (C-NL) distance increased by 16 mm on the right and 14 mm on the left. This study demonstrates satisfactory and stable long-term changes in breast shape post-mammoplasty, aiding surgeons in planning and advising patients on expected outcomes. Level of Evidence: Level III, risk / prognostic study.

Serum creatinine and protein levels have been proposed as potential biomarkers for predicting adverse outcomes in patients with burn injuries. This study aimed to investigate the prognostic utility of these markers and the serum creatinine-to-protein ratio in relation to in-hospital mortality following severe burn injuries. This retrospective cohort study included patients with burn injuries admitted within a 13-year period, with a TBSA affected of ≥ 20%. Creatinine, serum protein levels, and the creatinine-to-protein ratio were assessed on postburn days (PBD) 1, 3, and 7. Multivariate analysis identified independent mortality predictors, and receiver operating characteristic (ROC) curves assessed predictive accuracy. Among 283 patients, an overall mortality rate of 24.7% was noted. Neither creatinine nor protein levels independently predicted mortality. However, the creatinine-to-protein ratio was significantly elevated in non-survivors on all measured days, with the PBD 7 value emerging as an independent predictor of in-hospital mortality. Ratios measured on PBD 3 and 7 yielded an area under the ROC curve of 0.75, indicating robust predictive capability. The postburn creatinine-to-protein ratio, particularly on PBD 7, is a reliable, accessible, and cost-effective biomarker for mortality risk in patients with severe burn injuries. Its use could enhance early prognostic evaluation in burn care.

Background: Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection. Procalcitonin (PCT) has emerged as a promising biomarker for early diagnosis and prognosis in severe infections. Methods: We performed a retrospective analysis of 62 patients with confirmed NF treated at a high-volume Department of Plastic Surgery between January 2005 and May 2024. Clinical parameters, laboratory values, and surgical outcomes were evaluated. Patients were stratified into survivors and non-survivors. Results: Elevated PCT levels at admission were significantly associated with in-hospital mortality (p = 0.0329), whereas other parameters showed no statistical significance. Skin grafting was the most common reconstructive procedure. No significant association was found between the type of reconstructive surgery and survival. Conclusion: Serum PCT levels at admission may serve as a valuable prognostic marker in NF. Once infection control is achieved, reconstructive surgical interventions appear to be safe and do not influence survival.

Introduction: The success of modern chemotherapy in overall survival of patients with advanced stages of osteosarcoma and soft tissue sarcoma has reached a plateau. Therefore, a deeper understanding of molecular mechanisms behind deregulated apoptosis in sarcoma is essential for the cure of patients with advanced stages of osteosarcoma and soft tissue sarcoma. Lifeguard (LFG) is a member of the Bax inhibitor-1 (BI-1) protein family and has anti-apoptotic effects by inhibiting Fas-mediated cell death signaling. Although LFG has been proven to be expressed in several breast cancer tissues, the expression and function of LFG regarding apoptosis in different subtypes of sarcoma remains unclear. METHODS:In the present study, the expression of LFG in osteosarcoma (50 samples), chondrosarcoma (28 samples), and soft tissue sarcoma (total 55 samples) with different tumor stages for each sarcoma subtype was analyzed. For each subtype, clinical TNM classification (tumor, node, metastasis) and pathological grading were determined and compared to healthy tissues. Soft tissue sarcoma subtypes included liposarcoma, dermatofibrosarcoma, angiosarcoma, leiomyosarcoma, malignant schwannoma, and synovial cell sarcoma. RESULTS:In this study, significantly higher expressions of anti-apoptotic LFG protein in osteosarcoma, chondrosarcoma, and many different subtypes of soft tissue sarcoma were found, compared to healthy tissues. More importantly, a positive correlation between LFG expression and tumor stage for osteosarcoma was found. CONCLUSION:LFG protein might play an important role in inhibition of Fas-mediated apoptosis in osteosarcoma cells, with possible potential for targeted tumor therapy in osteosarcoma. .

Hand injuries are a leading cause of emergency department visits. Recent trends in hand trauma management reflect a shift toward outpatient care, driven by factors such as a shortage of skilled personnel or increasing cost pressures. This study analyzed these trends to propose updated management strategies for hand injuries. This retrospective cohort study included 14,414 patients treated at a certified major hand surgical trauma center between 2007 and 2022. Patients were divided into two groups: the earlier cohort (EC, 2007–2014) and the current cohort (CC, 2015–2022). Trends in inpatient and outpatient care, as well as hospitalization durations, were analyzed. During the study period, approximately one-third of all patients required inpatient treatment, with one-third of hospitalized patients staying at least one week, one-fifth staying two weeks, and one-tenth staying three or more weeks. Inpatient treatment rates decreased annually by 7

Introduction: Hand burns are common, affecting 80 % of burn cases and 40 % of hospitalized patients. Although the palmar surface constitutes only 1.2 % of total body surface area, burns in this region can severely impair hand function. Currently, no standardized treatment guidelines exist. This study analyzes functional and aesthetic outcomes in adult patients with conservatively treated partial-thickness palmar burns. Methods: A retrospective, single-center cohort study was conducted on adult patients with second-degree palmar burns treated between 2012 and 2022. Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and aesthetic outcomes were evaluated based on skin discoloration, scarring, and patient-reported concerns. Results: Of 316 cases, 57 (18.0 %) met inclusion criteria. Deep burns were more often treated inpatient (60.0 % vs. 24.4 %, p = 0.033) and healed significantly slower (23.87 ± 5.44 vs. 8.41 ± 3.57 days, p < 0.001). Functional impairments were comparable between groups (p > 0.195), though QuickDASH scores were slightly worse in deep burns (p = 0.312). Aesthetic outcomes did not differ significantly. Non-isolated burns were linked to longer healing (p < 0.001), worse QuickDASH scores (p = 0.015), and more frequent inpatient care (p = 0.012). Conclusions: Deep burns showed significantly longer healing times but no major differences in functional or aesthetic outcomes compared to superficial burns. Non-isolated burns were associated with poorer functional outcomes and longer recovery, suggesting that burn extent impacts healing and rehabilitation needs. These findings support structured follow-up and rehabilitation strategies, emphasizing the need for further research to refine treatment protocols.

Acute and chronic alcohol abuse are common among burn patients and may be associated with chronic liver injury, a potential factor influencing outcomes. This study evaluates the predictive power of the blood alcohol concentration (BAC) and non-invasive liver fibrosis scores and their applicability in burn patients. A retrospective analysis was conducted on patients admitted to a high-volume supraregional burn center in Northern Germany between 2007 and 2024. Patients were categorized based on their BAC at admission: low (< 100 mg/dL) vs. high (≥ 100 mg/dL). Data collected included demographics, comorbidities, and outcomes. Non-invasive liver fibrosis markers such as the Fibrosis-4 (FIB-4) score, aspartate transaminase-to-platelet ratio index (APRI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score were applied to both groups. Among 121 large-surface burn patients (mean total body surface area: 16.4%), no significant differences were observed between BAC groups in demographics, comorbidities, or ICU admission rates. The serum ethanol concentration showed no significant predictive value for mortality (AUC = 0.515). In contrast, the FIB-4 score (AUC = 0.781) and APRI (AUC = 0.736) demonstrated strong prognostic accuracy. In multivariate analysis, the Abbreviated Burn Severity Index (OR = 2.42; p = 0.001), serum albumin (OR = 0.29; p = 0.016), and FIB-4 score (OR = 1.50; p = 0.033) emerged as independent predictors of mortality. Propensity score matching analysis confirmed that BAC was not associated with increased mortality after adjustment for burn depth and extent. Non-invasive liver fibrosis markers, such as FIB-4 score, provide valuable prognostic insights in burn patients, independent of acute alcohol intoxication and should be considered a routine screening tool for large surface burn patients. Incorporating chronic liver dysfunction into existing burn severity models may enhance risk stratification and outcome prediction.

Tendinopathy of the flexor carpi ulnaris tendon is a rare entity. We present a 35-year old tennis player suffering tremendous pain (visual analogue scale (VAS) rating of 9/10) at the flexor carpi ulnaris tendon with adjacent calcification in close proximity to the pisiform bone. Sclerosing therapy using polidocanol under power and laser Doppler guidance was initiated, with immediate decrease of capillary blood flow by 25% with resolution of the neovascularisation in power Doppler. Immediately following sclerosing, the patient’s reported pain level on the VAS was reduced from 9/10 to 4/10. Following a short period of rest, eccentric training of the forearm muscle was initiated over 12 weeks with functional complete recovery and complete resolution of wrist pain.

AIMS:Several methods for calculating the extent of large surface burns have been described in the literature. However, the commonly used methods have several limitations and an overall tendency to overestimate the burn area. This study aimed to use ImageJ for high-precision computer-assisted estimation of large surface burns. METHODS:A retrospective analysis of the burn registry of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of Hannover Medical School was performed from 1st January 2018 to 1st July 2024. Photo documentation of large surface burn patients was used to estimate the total body surface area (TBSA) using ImageJ and compared it to the estimations made by the referring emergency doctor, consultant plastic surgeon and a smartphone application (E-burn 1.0.0). RESULTS:A total of 37 patients were included in this study. The mean TBSA evaluated by ImageJ was 36.81 %, which was statistically significantly lower than estimations made by a consultant plastic surgeon with 41 % mean TBSA (p = 0.008) and referring emergency doctors with 50.97 % mean TBSA (p < 0.0001). There was no statistically significant correlation between the estimation made by ImageJ and that made by the smartphone application which estimated a mean TBSA of 37.84 % (p = 0.1225). CONCLUSIONS:ImageJ may be used for high-precision computer-assisted volume estimation of large surface burns by counting pixel by pixel to provide highly accurate TBSA estimations.

Background: Lipedema, a chronic condition affecting mostly women, involves painful bilateral increase of subcutaneous adipose tissue. The societal impact of this disease is still poorly understood. This study aimed to validate the Lymphedema Quality-of-Life Questionnaire (LYMQOL) for lipedema patients in Germany, assessing its feasibility, reliability, and validity. Methods and Results: A total of 81 German-speaking stage II lipedema patients were asked to complete both the LYMQOL (arm and leg versions) and the Short Form Health Survey (SF-36) questionnaires twice, and this was 2 weeks apart. Feasibility was evaluated through response rates, scale structure via factor analysis, validity through SF-36 correlations, and reliability through internal consistency and test-retest reliability analysis. A valid 68% response rate was achieved. Both arm and leg versions demonstrated construct validity with significant correlations to SF-36 subscales. Internal consistency for the leg version was acceptable to excellent, and good to excellent for the arm version. Test-retest reliability was very good for both versions. Conclusions: This study validates the LYMQOL as a robust tool for assessing lipedema patients' quality of life, and also validates the German translation contained in this article. We hope to fill a critical research gap and support future clinical studies aiming at enhancing patient care.

This case report presents a 24-year-old patient with severe mental and physical disabilities who sustained deep partial-thickness burns to the perianal and gluteal region. Conventional surgical interventions, such as skin grafting, were deemed unsuitable due to the high risk of infection and the patient’s non-compliance with specialized positioning. Instead, the innovative use of platelet-rich plasma (PRP) therapy was implemented, involving subdermal PRP injections and daily dressing changes. PRP, derived from the patient’s own blood, offers low immunogenicity and promotes wound healing by enhancing angiogenesis, modulating inflammation, and reducing oxidative stress. The patient showed significant wound healing and reepithelialization, avoiding the need for any surgery. This case highlights the efficacy of PRP in managing complex burn wounds and underscores the necessity for personalized treatment strategies, particularly for patients with significant comorbidities, where conventional methods may pose additional risks.