BACKGROUND:Apart from surgical procedures for breast and buttock augmentation, copolyamide fillers can be locally injected for an increase in volume. This method is especially popular in Asia. PATIENT:A 39-year-old female patient had received a buttock augmentation by injection of a copolyamide filler. She presented with multiple abscesses six years after the augmentation. She had developed multiple fistulas and the filler had migrated down to the thigh muscles. RESULTS:In the presented case, the patient experienced multiple complications such as abscess formation, filler migration and chronic infection, with a significant time delay. Complete removal of the filler is only possible by removing surrounding tissue as well. Surgical treatment with repeated debridements and administration of an intravenous broad-spectrum antibiotic are the current standard of care. In contrast, the SWOP technique presented here appears to be less invasive and less likely for local recurrence. CONCLUSION:A breast or buttock augmentation with copolyamide fillers is associated with a high risk of abscess and fistula formation leading to a permanent disfigurement of the patient.

Zusammenfassung Hintergrund Neben operativen Verfahren zur Brust- und Gesäßaugmentation besteht die Möglichkeit, mittels einer Injektion von Copolyamidfillern eine Volumenzunahme des gewünschten Areals zu erreichen. Dieses Verfahren erfreut sich insbesondere im asiatischen Raum großer Beliebtheit. Patientin Eine 39-jährige Patientin hatte eine Gesäßaugmentation mit einem Copolyamidfiller (Aquafilling) erhalten. Mit einer Zeitverzögerung von sechs Jahren zeigten sich multiple Abszedierungen und eine Migration des Fillers, mit furchsbauartiger Fistelgangbildung bis in die Oberschenkelmuskulatur. Es bestand die Notwendigkeit einer wiederholten operativen Therapie. Ergebnisse In dem demonstrierten Fall zeigen sich bei diesem Produkt vorbekannte Komplikationen wie eine Fillermigration, eine Abszedierung und eine chronische Infektion. Diese traten erst mit einer deutlichen Zeitverzögerung auf. Eine vollstände Entfernung des Fillers ist nur mit dem umliegenden Gewebe möglich. Eine operative Therapie mittels wiederholten Débridements und Gabe eines intravenösen Breitspektrumantibiotikums sind aktueller Therapiestandard. Die hier vorgestellte SWOP-Technik erscheint demgegenüber weniger invasiv und weniger lokalrezidivträchtig. Schlussfolgerung Die Gesäß- oder Brustaugmentation mit Copolyamidfillern ist mit dem erheblichen Risiko einer chronischen Eiterung und Fistelbildung verbunden, das bis zu einer Entstellung des Patienten führen kann.

The aim of the study appears to focus on identifying and analyzing errors or inadequacies within the organization of specialized care for patients who have experienced traumatic amputation of hand segments. The specific goals might include understanding the flaws in the existing care structures, improving patient outcomes, and developing recommendations to enhance the quality of specialized care provided to patients who have suffered hand segment amputations.Methods. 2020 to 2022 to the clinic of the National Scientific Center for Surgery named after Syzganov, 165 patients with acute injuries of limb segments were urgently hospitalized to provide specialized surgical care, leading to decompensation of blood circulation in the hand or fingers. Results. Due to incorrect actions in 24 patients, it was not possible to replant the delivered segments (33 segments). These patients underwent stump formation.At the same time, 50-75% still allow diagnostic, technical and tactical errors in the treatment of this category of patients. The possibility of replantation and revascularization, as well as their outcome, largely depended on the timeliness and quality of first aid, compliance with the conditions for preserving the cut-off segment, the speed of transportation and other organizational factors. Conclusions. The use of modern methods of microsurgical restorative interventions with the reconstruction of injured vessels can significantly expand the possibilities of preserving and restoring completely and partially torn segments of the hand and fingers. The improvement of the results of treatment of patients with traumatic amputations and injuries of the neurovascular bundles of limb segments was significantly affected by the provision of timely specialized microsurgical care

Background Free fascial flaps from the anterolateral thigh (ALT) were used to reconstruct soft tissue defects after trauma to the ankle. This modification was compared to the conventional fasciocutaneous method. Material and methods The defect size, the thickness of the subcutaneous fat layer on the thigh and the extent of the soft tissue covering the ankle were determined retrospectively. The evaluations were compared between fascial (Fo) and fasciocutaneous flaps (Fc). The foot and ankle outcome score (FAOS) was used. Esthetic outcome surveys were carried out. Results A total of 18 isolated fractures of the ankle were evaluated. In 94% of the cases a closed soft tissue damage predominated. After fracture fixation using a plate, soft tissue defects with a mean area of 40.4 +/- 13.1 cm(2) (28-76 cm(2)) developed. The thickness of the soft tissue covering over the affected malleoli increased significantly in both groups as a result of the flap surgery (4.5 +/- 0.7 vs. 21.1 +/- 6.4 mm, p < 0.05). A significant difference was found when comparing the body mass index (BMI) between the groups (Fc 26.3 +/- 3.4 kg/m(2) vs. Fo 30.1 +/- 4.2 kg/m(2), p < 0.05). For both groups there was a positive correlation (r = 0.843) between the BMI and the thickness of the epifascial fat layer of the thigh. The FOAS survey revealed 75.9 +/- 28.9 and 47.9 +/- 32.4 points, respectively, for "function in daily life" and "foot and ankle-related quality of life". The esthetic reconstruction result was rated as "acceptable" by 55% and as "good" by 45%. Discussion The modified method of a free fascial flap from the ALT can be useful in situations where a bulky flap makes it difficult to fit it into the defect.

A method for the reconstruction of an extensive soft tissue defect after a complicating olecranon fracture is presented. A perforator-based retrograde pedicled propeller flap was used from the lateral upper arm with additive microvascular "turbo"-anastomosis to the radial artery and vein. The turbo-flap was performed under regional anesthesia.

BACKGROUND:The classic type of epithelioid sarcoma (ES) is a rare, aggressive soft tissue neoplasm that most commonly affects the distal upper extremities of young patients. This study aimed to assess clinical features and provide a long-term report of the oncological outcome.METHODS:We retrospectively analyzed our clinical database for patients with ES of the distal upper extremities.RESULTS:Twenty-three patients with ES of the distal upper extremity were treated surgically between January 1990 and August 2018. ES affected most commonly the palmar side of young patients. The most common site affected by a sarcoma was the wrist in 47.8% of cases, followed by metacarpals and fingers with 34.8% and 17.4%, respectively. Most of the patients were treated according to the protocols of interdisciplinary tumor boards with multimodal therapy. A local recurrence was observed in 7 patients (30.4%). The 5 - and 10-year recurrence-free survival was 80.4% (95% confidence interval [CI]: 68.6-76.8) and 60.9% (95% CI: 53.5-68.3), respectively. The 5- and 10-years disease-specific survival was 89.9% (95% CI: 87-92.8) and 61.9% (95% CI: 56.5-67.3), respectively. Five patients (21.7%) had metastasis in regional lymph nodes.CONCLUSION:The classic type of ES represents a group of high-grade sarcomas, which affect the dominantly distal upper extremity. Specific clinical, diagnostic, and oncological characteristics make it difficult to diagnose and therapy. Wide tumor resection as a part of multimodal therapy remains a more viable and common treatment option for patients with ES on distal extremities. High rates of lymph node metastasis are typical for ES.

Background:The modern multimodal treatment of malignant tumors has increased disease-specific survival and decreased the burden of tumor-associated complications. The main focus of palliative surgery is not based primarily on quantitative success parameters of tumor response but is instead mainly on the question of quality of life.Aim:The current study was conducted to analyze the clinical and oncological outcomes of palliative patients with soft tissue sarcoma.Design:Of 309 patients with extra-abdominal high-grade soft tissue sarcoma treated between August 2012 and December 2014, our retrospective analysis revealed 33 palliative patients for this study. All patients were evaluated and managed by a multidisciplinary team with expertise and experience in sarcoma treatment. The survival analysis was made using the Kaplan-Meier method.Results:The main sarcoma symptoms were pain (27.3%) and ulcerated tumors or shortly before ulceration (24.2%). Thirteen patients (39.4%) were operated on with negative margins, 15 (45.5%) with positive margins, 2 with tumor debulking (6.1%), and 3 patients (9.1%) were treated only with palliative hyperthermic isolated limb perfusion. Ten pedicle flaps were performed after sarcoma resection. The median operation time was 85 minutes (range, 37-216 minutes). The median hospitalization stay was 9.5 days (range, 3-27 days). No patients died during hospitalization. Twelve-month disease-free survival was 48.5% (95% confidence interval: 45.4-51.6).Conclusions:Palliative surgery of metastatic or advanced soft tissue sarcoma can improve the wound care and quality of life. Closed noninfected wounds enable further treatment options, such as chemotherapy, immunotherapy, and radiotherapy. This surgery should be considered during the discussion on interdisciplinary tumor boards.

Prolongierte Wundheilungsstörungen nach dorsalen Spondylodesen können zur Ausbildung von Gewebedefekten mit Exposition des Implantats führen und das klinische Outcome beeinträchtigen. Diese Arbeit zielt darauf ab, die Anwendung der Keystone-Perforator-Lappenplastik in der Rekonstruktion von lumbosakralen Gewebedefekten vorzustellen. In die retrospektive Studie wurden 11 konsekutive Patienten mit einer über 2 Wochen persistierenden Wunddehiszenz von über 6 × 6 cm Defektfläche nach dorsalen Spondylodesen eingeschlossen. Zur plastischen Rekonstruktion kam die Keystone-Perforator-Lappenplastik zum Einsatz, deren arterielle Blutversorgung auf intra- und intermuskulär perforierenden Ästen der Rr. dorsales der Aa. lumbales basierte. Das mediane Alter der Patienten betrug 58 Jahre (54,7 ± 8,3). Der durchschnittliche Body-Mass-Index (BMI) und Charlson Comorbidity Index (CCI) waren 29,9 bzw. 3,4. In 8 Fällen wurde eine lumbosakrale, sonst eine lumbale Fusion durchgeführt. Im Rahmen von Wundrevisionen wurden bei den Patienten durchschnittlich 4 Anwendungen von Vakuum-Saug-Systemen bei einer medianen Defektausdehnung von 7,5 cm in der Breite und 16,5 cm in der Länge eingesetzt. Die mikrobiologische Analyse der intraoperativ gewonnenen Gewebeproben nach wiederholten Vakuumbehandlungen erbrachte in allen Fällen einen positiven Keimnachweis. Die Dauer der stationären Behandlung nach einer Lappenplastik betrug im Durchschnitt 15 Tage und war signifikant kürzer als die Dauer des Managements der offenen Defektwunden (15,5 ± 2,5 vs. 37 ± 16,5, p < 0,05). Die Keystone-Perforator-Lappenplastik bietet eine suffiziente und revisionsstabile Defektabdeckung im Zuge der Infektsanierung nach dorsaler Spondylodese.

Zusammenfassung Eine alternative Methode zur plastischen Defektdeckung am Ellenbogen wird vorgestellt. Verwendet wurde ein perforatorbasierter, retrograd gestielter Propellerlappen vom lateralen Oberarm mit additiver mikrovaskulärer „Turbo“-Anastomosierung an die A. und V. radialis. Die Turbolappenplastik wurde in Regionalanästhesie durchgeführt.

Artificial tissue substitutes are of great interest for the reconstruction of destroyed and non-functional skin or bone tissue due to its scarcity. Biomaterials used as scaffolds for tissue regeneration are non-vascularized synthetic tissues and often based on polymers, which need ingrowth of new blood vessels to ensure nutrition and metabolism. This review summarizes previous approaches and highlights advances in vascularization strategies after implantation of surface-modified biomaterials for skin and bone tissue regeneration. The efficient integration of biomaterial, bioactive coating with endogenous degradable matrix proteins, physiochemical modifications, or surface geometry changes represents promising approaches. The results show that the induction of angiogenesis in the implant site as well as the vascularization of biomaterials can be influenced by specific surface modifications. The neovascularization of a biomaterial can be supported by the application of pro-angiogenic substances as well as by biomimetic surface coatings and physical or chemical surface activations. Furthermore, it was confirmed that the geometric properties of the three-dimensional biomaterial matrix play a central role, as they guide or even enable the ingrowth of blood vessels into a biomaterial.

BACKGROUND:Prolonged surgical site infections after spinal fusion surgery may lead to exposure of the implant due to the formation of extensive tissue defects and endanger the clinical outcome. OBJECTIVE:This study aims to enlighten the role of the keystone perforator flap method in the reconstruction of lumbar soft tissue defects. MATERIAL AND METHODS:The retrospective study included 11 consecutive patients with a wound dehiscence of over 6 × 6 cm defect area persisting for 2 weeks after spinal fusion. The keystone perforator flap was applied for the reconstruction of tissue defects, whereas the arterial blood supply of the flaps was based on the intramuscular and intermuscular perforating branches of the dorsal branches of the lumbar arteries. RESULTS:The median age of our cohort was 58 years. The median body mass index (BMI) and Charlson comorbidity index (CCI) were 29.9 and 3.4, respectively. In eight cases a lumbosacral was carried out whereas in the remaining series a lumbar fusion was performed. In the course of the subsequent wound revision, on average 4 applications of negative pressure wound therapy (NPWT) were performed. The average defect size was 7.5 cm in width and 16.5 cm in length. The microbiological analysis of the tissue samples obtained intraoperatively after repeated NPWT revealed positive evidence of pathogenic bacteria in all cases. The average duration of inpatient treatment after flap surgery was 15 days, which was significantly shorter than the NPWT management of the open defect wounds (15.5 ± 2.5 vs. 37 ± 16.5, p < 0.05). CONCLUSION:The keystone perforator flap offers a stable coverage for soft tissue defects and supports infection control after spinal fusion.

Verletzungen von Lymphgefäßen können nach Trauma oder infolge einer Operation entstehen und für die Patienten eine nicht unwesentliche Problematik darstellen. Sie können zur Ausbildung von schwerwiegenden Wundheilungsstörungen mit komplexer Therapiebedürftigkeit führen. Wir berichten über eine Lymphkollektorläsion nach Entfernung eines Hauttumors in der Axillarregion und die mikrochirurgische Versorgung mittels lymphovenöser Anastomosierung

Bei der klinischen Untersuchung zeigt sich eine 2cm große Narbe prätibial am Übergang vom mittleren zum distalen Drittel des Unterschenkels mit klarer Sekretion aus einer Fistel (. Abb. 1a). Lokale oder fortgeleitete Zeichen einerWundinfektion fehlten. Die periphere Durchblutung, Motorik und Sensibilität distal der Verletzung waren intakt. Es bestanden keine Nebenerkrankungen. Der bakteriologische Befund des Wundabstriches blieb ohne Keimnachweis.

Introduction: Extracorporeal shock waves (ESWs) have been shown to have a positive effect on skin wound healing; however, little is known on the regeneration of the microcirculation and angiogenesis as well as the different application modes. Methods: A total of 40 BALB/c mice were provided with dorsal skin fold chambers and were divided into 3 therapy groups (n = 30) and one control group (n = 10). The 3 therapy groups were treated with shock waves at different pulse rates (500–1,000 pulses/min) and application frequencies (day 0 and day 6 or day 0 only). Photographic documentation and intravital microscopy were carried out on day 1, 2, 4, and 6 after wounding. Results: Using the newly developed Diver Box, shock waves could be applied in vivo without mechanical tissue damage. Shock wave therapy to skin wounds demonstrated to induce faster wound closure rates in the beginning than controls in groups with higher pulse rates and frequencies of the shock waves. Furthermore, the regeneration of microcirculation and perfusion in the healing skin was significantly improved after the application of, in particular, higher pulse rates as given by increased numbers of perfused capillaries and functional vessel density. The study of inflammation showed, especially in high-pulse ESW groups, higher leukocyte counts, and rolling leukocytes over time until day 6 as a response to the induction of inflammatory reaction after ESW application. Angiogenesis showed a marked increase in positive areas as given by sprouts, coils, and recruitments in all ESW groups, especially between days 4 and 6. Conclusion: The major findings of this trial demonstrate that ESW therapy to skin wounds is effective and safe. This is demonstrated by the initially faster wound closure rate, but later the same wound closure rate in the treatment groups than in controls. Furthermore, during the regeneration of microcirculation and perfusion in the healing skin, a significant improvement was observed after the application of, in particular, higher ESW pulse rates, suggesting an ESW-related increase in nutrient and oxygen supply in the wound tissue.

BACKGROUND:Secondary lymphedema is a leading sequela of cancer surgery and radiotherapy. The microsurgical transfer of lymph node flaps (LNFs) to affected limbs can improve the symptoms. The intra-abdominal cavity contains an abundant heterogenic source. The aim of this study is to aid selection among intra-abdominal LNFs. METHODS:Eight LNFs were harvested in a microsurgical fashion at five sites in 16 cadavers: gastroepiploic, jejunal, ileal, ileocolic, and appendicular. These flaps were compared regarding size, weight, arterial diameter, and lymph node (LN) count after histologic verification. RESULTS:One hundred and sixteen flaps were harvested. The exposed area correlated with the flap weight and volume (r2  = 0.86, r = 0.9). While gastroepiploic LNFs (geLNFs) showed the highest median weight of 99 ml, the jejunal LNFs (jLNFs) had the highest density with 3.8 LNs per 10 ml. The most reliable jLNF was 60 cm from the ligament of Treitz. Three or more LNs were contained in 94% of the jejunal, 88% of the ileal/ileocolic, and 63% of the omental LNs. The ileocolic LNF had the largest arterial diameter of 3 mm, yet the smallest volume. CONCLUSIONS:jLNF and ileal LNF provide a reliable, high LN density for simultaneous, smaller recipient sites. geLNFs are more suitable for larger recipient sites.

BACKGROUND:We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery. METHODS:A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery. OUTCOME:To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus. CONCLUSION:In certain extreme situations, the free "Chinese" radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.