Hyperspectral imaging (HSI) has shown significant diagnostic potential for both intra- and postoperative perfusion assessment. The purpose of this study was to combine machine learning and neural networks with HSI to develop a method for detecting flap malperfusion after microsurgical tissue reconstruction. Data records were analysed to assess the occurrence of flap loss after microsurgical procedures. A total of 59 free flaps were recorded, ten of which demonstrated postoperative malperfusion, leading to necrosis. Several supervised classification algorithms were evaluated to differentiate impaired perfusion from healthy tissue via HSI recordings. The best flap classification performance was observed using a convolutional neural network using HSI based perfusion parameters within 72 h after surgery, with an area under the curve of 0.82 ± 0.05, a sensitivity of 70% ± 33%, a specificity of 76% ± 26%, and an F1 score of 68% ± 28%. HSI combined with artificial intelligence approaches in diagnostic tools could significantly improve the detection of postoperative malperfusion and potentially increase flap salvage rates.

Background: This is the first exploratory investigation of the Essen Transidentity Quality of Life Inventory (ETLI) questionnaire administered to transgender men before and after mastectomy. Methods: Eighty-two transgender men were enrolled in a cross-sectional study. Depending on whether a mastectomy had been performed, 42 patients were assigned to the preoperative and 40 to the postoperative group. Data collection included epidemiologic data, screening questions for comorbidities or mental disorders and three questionnaires (Short-Form Health Survey [SF-36], BODY-Q Chest Module and ETLI). The trial was registered at the German Clinical Trial Register under the number: DRKS00035156. Qualitative data were compared using the chi-squared test, and quantitative scores were analysed using the t-test. Effect sizes were determined using ANOVA. A p-value < 0.05 was considered significant. Results: The average age of the participants was 26.9 years, with an average duration of hormone intake of 31.4 months and a BMI of 23.8 kg/m². The subscales mental quality of life (QoL) (p < 0.001), physical QoL (p < 0.001), social QoL (p < 0.001) and the global sum score (p < 0.001) of the ETLI showed significantly different scores in the postoperative group compared to the preoperative group. Similarly, the mental component scale of the SF-36 (<0.001) and the Body-Q Chest Module ‘chest’ (< 0.001) and ‘nipples’ (< 0.001) were significantly increased in the group after mastectomy. Conclusion: The ETLI questionnaire is a viable tool to measure effects on the QoL and satisfaction with body image in transgender men, correlating with well-established scores.

Background:Postoperative necrosis of the umbilicus is a rare yet serious complication in abdominoplasty. Fixation of the umbilicus to the fascia (umbilicopexy) is commonly used to enhance aesthetic outcomes, but concerns regarding potential compromise to perfusion remain unaddressed. This study investigates the impact of umbilicopexy on umbilical perfusion using hyperspectral imaging (HSI), a non-invasive method for assessing tissue oxygenation and perfusion. Methods:In this prospective study, 28 patients (25 female; mean age 42 years, range 24 to 60 years) undergoing abdominoplasty were assessed: 11 underwent umbilicopexy, while 17 served as controls. HSI parameters, including tissue oxygenation (StO2), near-infrared perfusion index (NIR PI), tissue hemoglobin index (THI), and tissue water index (TWI), were recorded intraoperatively and on postoperative days (POD) 1 and 2. Clinical outcomes, including marginal wound necrosis and revision surgeries, were also documented. Results:StO2 values were higher intraoperatively in the umbilicopexy group (80 ± 7 %) compared to the control group (68 ± 16 %; p = 0.025). By POD 1, StO2 decreased in both groups (umbilicopexy: 66 ± 11 %, control: 56 ± 15 %, p = 0.067). Marginal wound necrosis occurred in 9 % of the umbilicopexy group and 18 % of controls (p = 1.0), while revision surgery related to perfusion deficits was required in none of the patients in both groups. No significant differences were found in NIR PI, THI, or TWI across groups or time points. Conclusion:HSI proved valuable for real-time perfusion monitoring suggesting that Umbilicopexy is not adversely affecting umbilical perfusion or wound healing in abdominoplasty. Larger cohort studies with additional confounders are recommended to confirm these findings.

This study aims to determine key demographic and behavioural risk factors contributing to firework-related injuries and their outcomes. A retrospective study was conducted on pediatric and adult patients treated for firework-related injuries at the University Hospital Leipzig from December 28th to January 3rd over 10 years (2013–2023). Data were collected on demographics, injury details, weather conditions and classification of fireworks. A total of 155 patients (mean age 24 years, 80

Background: This study aimed to validate the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator for predicting outcomes in patients undergoing abdominoplasty after massive weight loss. Methods: Patients’ characteristics, pre-existing comorbidities and adverse outcomes in our department from 2013 to 2023 were collected retrospectively. Adverse events were defined according to ACS-NSQIP standards and predicted risks were calculated manually using the ACS-NSQIP risk calculator. Binary logistic regression and the Brier score were used to assess the diagnostic accuracy of the model. Results: Among the 337 individuals who underwent abdominoplasty, 251 had achieved significant weight loss before surgery. After excluding 46 cases due to incomplete data, 205 cases remained for analysis. There were 20% cases of serious complications, 26.3% of some complications, 10.2% of readmissions, 18.8% returned to the operating theatre, 15.6% of surgical site infections and 0.5% each of pneumonia and venous thromboembolism. Although the calculator predicted a 1.5% discharge rate to nursing or rehabilitation facilities and a 0.1% rate of sepsis, neither outcome was observed. Elevated American Society of Anesthesiologists (ASA) status was significantly associated with a higher complication rate, except for surgical site infections (SSI) (p = 0.06). Additionally, an elevated Body Mass Index (BMI) before post-bariatric surgery and a higher resection weight were both associated with increased rates of return to the operating theatre (p = 0.01) and serious complications (p = 0.01). Predicted complication rates (0.1%-8.6%) underestimated actual complication rates (0.5%-26.3%). The Brier scores did not differ significantly from the null model for any outcomes except for general complications (p = 0.001) and logistic regression models demonstrated low sensitivity (0.0-9.8%) and weak odds ratios (1.28-1.46), indicating limited reliability. Conclusion: The ACS-NSQIP risk calculator does not reliably predict adverse outcomes in this patient cohort.

Background: Due to a lack of validated methodologies, this study aimed to evaluate the quality of life (QoL) among individuals affected by lymphedema and to compare them with the general population and common diseases. Patients and methods: Patients were recruited from October 2023 till March 2024. The SF-36 and LYMQOL questionnaires were administered. The Robert Koch Institute provided data from the survey for secondary evaluations of the DEGS1 study. Descriptive analysis of the patient's data was conducted, followed by an analysis of risk factors, a comparison with common diseases and a pairs matched analyses with the general population based on the parameters sex, age and Body Mass Index (BMI). A p-value below 0.05 was considered significant. Results: Among the 273 patients, 18 had primary lymphedema and 255 had secondary lymphedema due to cancer history. Staging revealed 28 patients in stage I, 137 in stage II, and 75 in stage III. The majority of patients (83%) were female and mostly the lower extremity was affected. Age, International Society of Lymphology (ISL)-stage, and BMI were significantly correlated with reduced QoL in seven, six, and eleven out of thirteen subscales of the respective scores. The LYMQOL analysis revealed, that patients with upper limb lymphedema (ULL) demonstrated higher QoL compared to those with lower limb lymphedema (LLL). When compared to the general population, individuals with ULL exhibited reduced QoL in five out of eight SF-36 domains (p<0.05). Conversely, LLL patients showed decreased QoL across all eight SF-36 subscales (p<0.01). In comparison to diseases like myocardial infarction or malignant diseases, patients with lymphedema experience a significant, diminished QoL. Conclusions: By 2024, lymphedema patients continue to experience significantly lower QoL compared to the general population or common diseases in Germany. LLL patients exhibit a reduced QoL compared to individuals with ULL.

The LYMQOL Leg questionnaire is the most widely used, evidence-based tool for the assessment of health-related quality of life (HRQoL) in patients with lower limb lymphedema (LLL). It has been translated into several languages, but a German version is currently lacking. The aim of our study was to validate a German translation of LYMQOL Leg. Translation and cross-cultural adaptation were performed in accordance with ISPOR principles. A total of 103 patients with LLL from Germany, Austria, and Switzerland were interviewed twice. The content and face validity assessments indicated that the German LYMQOL Leg questionnaire was acceptable for interviewing patients with lymphedema. Comparing the LYMQOL Leg with the SF-36 demonstrated good construct validity. Reliability determined by the test–retest procedure was good (intra-class-correlation coefficients 0.68–0.92). Cronbach’s alpha values ranged from 0.76 to 0.90 in both interviews, showing an acceptable internal consistency. The four domains of the questionnaire reached a cumulative variance of 52.7% in the factor analysis. The association between the lymphedema stages and the LYMQOL Leg domain scores was not significant. In conclusion, the validity of the German version of LYMQOL Leg, called LYMQOL Bein, was confirmed and thus represents a suitable tool for measuring HRQoL in German-speaking patients with LLL.

The aim of this study was to assess the efficacy of hyperspectral imaging (HSI) as an intraoperative perfusion imaging modality during gender affirmation surgery (GAS). The hypothesis posited that HSI could quantify perfusion to the clitoral complex, thereby enabling the prediction of either uneventful wound healing or the occurrence of necrosis. In this non-randomised prospective clinical study, we enrolled 30 patients who underwent GAS in the form of vaginoplasty with the preparation of a clitoral complex from 2020 to 2024 and compared patients' characteristics as well as HSI data regarding clitoris necrosis. Individuals demonstrating uneventful wound healing pertaining to the clitoral complex were designated as Group A. Patients with complete necrosis of the neo-clitoris were assigned to Group B. Patient characteristics were collected and subsequently a comparative analysis carried out. No significant difference in patient characteristics was observed between the two groups. Necrosis occurred when both StO2 and NIR PI parameters fell below 40%. For the simultaneous occurrence of StO2 and NIR PI of 40% or less, a sensitivity of 92% and specificity of 72% was calculated. Intraoperatively, the onset of necrosis in the clitoral complex can be reliably predicted with the assistance of HSI.

Background: The effectiveness of closed incision negative pressure wound therapy (ciNPWT) has been shown across various studies. However, studies with large patient cohorts comprising post-bariatric patient populations are missing. The objective of this research was to assess the influence of ciNPWT on post-operative wound complications in this demanding patient collective. Methods: We conducted a retrospective case-control study. Between 1 January 2013 and 31 December 2023, a total of 251 abdominoplasty procedures following massive weight loss were identified. Patients were matched based on resection weights. We matched 118 patients separated into two groups depending on post-surgical wound management (conventional wound dressings vs ciNPWT). The primary outcomes were wound-related disorders and secondary outcomes were the number of readmissions or reoperations within 30 days after the initial surgery. Results: The study revealed equal incidence of seroma formation (15 vs 15, p = 1.0), rates of wound dehiscence (23 vs 20, p = 0.56), surgical site infection (11 vs 6, p = 0.18), hematoma (17 vs 9, p = 0.07), complete removal of all drainages (6.7 vs 6.1 days, p = 0.34) and total number of readmission (12 vs 11, p = 0.77) or reoperations (12 vs 10, p = 0.63) within 30 days. The second hospital stay caused by revision was significantly shorter in the ciNPWT group (5.8 days vs 12.0 days, p = 0.02). Conclusion: Consequently, we did not find evidence to support the hypothesis that ciNPWT reduces complications after abdominoplasty in patients with massive weight loss.

Background: Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice. Objective: The aim of this study was to describe the demographic and economic indicators of a university hospital and to examine the development of inpatient and outpatient case numbers over the past decade. Material and methods: A retrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate a correlation, a linear regression model was calculated and a p-value <0.05 was considered significant. Results: In total, 2918 cases were included over a decade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 +/- 0.6 and with a patient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 per inpatient case and 300.77 per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period. Conclusion: The increasing case numbers in the outpatient and inpatient sectors indicate a centralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.

Handchirurgische Abteilungen stehen heute vor der Herausforderung, rentabel zu arbeiten, Nachwuchs auszubilden, steigende Fallzahlen zu bewältigen und die geforderte Ambulantisierung in der klinischen Praxis umzusetzen. Ziel dieser Studie war es, die demografischen und ökonomischen Kennzahlen einer Universitätsklinik zu beschreiben und die Entwicklung der stationären und ambulanten Fallzahlen der letzten Dekade zu untersuchen. Durchgeführt wurde eine monozentrische, retrospektive Datenauswertung von Patienten, welche aufgrund einer Handverletzung im Zeitraum von 2013 bis 2023 behandelt wurden. Die Fälle wurden mittels der Hauptdiagnosen der International Classification of Diseases (ICD) identifiziert und deskriptiv analysiert. Um einen Zusammenhang nachzuweisen, wurde ein lineares Regressionsmodell gerechnet und ein p-wert <0,05 als signifikant angenommen. Insgesamt wurden 2918 Fälle über eine Dekade ab dem Jahr 2013 eingeschlossen. Davon waren 776 Fälle ambulant. Zwei Drittel der Patienten waren männlich. Die Patienten waren insgesamt gesund mit einem Status von 1,6 ± 0,6 in der Klassifikation der American Society of Anesthesiologists (ASA) und einem Patient Clinical Complexity Level (PCCL) von 0 in 79

Abkürzungen A. Arteria LVA lymphovenöse Anastomosen M. Musculus s. Siehe STS Stewart-Treves-Syndrom VLKT vaskularisierte Lymphknotentransplantation

BACKGROUND:Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice. OBJECTIVE:The aim of this study was to describe the demographic and economic indicators of a university hospital and to examine the development of inpatient and outpatient case numbers over the past decade. MATERIAL AND METHODS:A retrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate a correlation, a linear regression model was calculated and a p-value <0.05 was considered significant. RESULTS:In total, 2918 cases were included over a decade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with a patient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period. CONCLUSION:The increasing case numbers in the outpatient and inpatient sectors indicate a centralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.

Biocompatibility testing of materials is carried out in 2D cell cultures or animal models despite serious limitations. 3D skin equivalents are advanced in vitro models for human skin. Silicone has been shown to be noncytotoxic but capable of eliciting an immune response. Our aim was to (1) establish a 3D skin equivalent to (2) assess the proinflammatory properties of silicone. We developed a coculture of keratinocytes and fibroblasts resulting in a 3D skin equivalent with an implant using samples from a breast implant. Samples with and without the silicone implant were studied histologically and immunohistochemically in comparison to native human skin samples. Cytotoxicity was assessed via LDH-assay, and cytokine response was assessed via ELISA. Histologically, our 3D skin equivalents had a four-layered epidermal and a dermal component. The presence of tight junctions was demonstrated in immunofluorescence. The only difference in 3D skin equivalents with implants was an epidermal thinning. Implanting the silicone samples did not cause more cell death, however, an inflammatory cytokine response was triggered. We were able to establish an organotypical 3D skin equivalent with an implant, which can be utilised for studies on biocompatibility of materials. This first integration of silicone into a 3D skin equivalent confirmed previous findings on silicone being non-cell-toxic but capable of exerting a proinflammatory effect.

Microsurgical free-tissue transfer has been a safe option for tissue reconstruction. This study aimed to analyze the diagnostic accuracy of hyperspectral imaging (HSI) after free-tissue transfer surgery. From January 2017 to October 2019, 42 consecutive free-flap surgeries were performed, and their outcomes were analyzed via HSI. Clinical examination of free-flap perfusion was initially performed. Clinical examination findings were subsequently compared with those of HSI. Potential venous congestion with subsequent necrosis was defined as a tissue hemoglobin index of ≥53%. Student's t-test was used to compare the results of the analysis. The evaluation of sensitivity and specificity for flap failure detection was time dependent using the Fisher's exact test. A p-value of ≤0.05 was considered statistically significant. Microsurgical tissue transfer success rate was 84%. Seven patients presented with venous congestion that caused total flap necrosis. Overall, 124 assessments were made. HSI accurately identified 12 out of 19 pathological images: four as false positive and seven as false negative. The sensitivity and specificity of HSI were 57 and 94%, respectively, compared to those of clinical examination that were 28 and 100%, respectively, within 24 h following tissue transfer. The sensitivity and specificity of HSI were 63 and 96%, respectively, compared to those of clinical examination that were 63 and 100%, respectively, within the first 72 h. A tissue hemoglobin index of ≥53% could predict venous congestion after free-flap surgery. HSI demonstrated higher sensitivity than clinical examination within the first 24 h; however, it was not superior compared to clinical findings within 72 h.

Abkürzungen A. Arteria LVA lymphovenöse Anastomosen M. Musculus s. Siehe STS Stewart-Treves-Syndrom VLKT vaskularisierte Lymphknotentransplantation

Cutaneous melanoma is the deadliest skin cancer and shows an increasing incidence. Survival rates of melanomas without metastases are high, but once metastases develop, mortality rates rise significantly. The Wnt/β catenin signaling plays an important role in tumorigenesis and critically regulates melanoma progression. In this review, we describe the underlying mechanisms of Wnt signaling and outline how Wnt signaling controls cellular processes involved in the development, homeostasis, and progression of malignant melanoma. Level of Evidence: Not gradable.

Basal cell carcinoma (BCC) is the most common skin cancer worldwide, and its incidence is increasing due to the aging population and the cumulative effects of widespread sun exposure. The Wnt gene family is involved in cell growth regulation, differentiation, and organogenesis, and not surprisingly, Wnt genes have been linked to oncogenesis. Specifically, β-catenin, a key signaling regulator of the Wnt pathway, is involved in the genesis of numerous human cancers including BCCs. Dysregulation of the patched/hedgehog intracellular signaling pathway, other important pathways regulating cell growth and regulation, has also been linked to BCCs. In this review, we outline the key mechanisms of the Wnt and patched/hedgehog intracellular signaling pathways and their involvement in the development, homeostasis, and progression of BCCs. Level of Evidence: Not gradable.

Hyperspectral imaging (HSI) is a new device for monitoring microcirculation. The aim of this study is to describe hyperspectral imaging after free tissue. We assessed 22 patients from our department who underwent hyperspectral imaging monitoring. Four parameters were measured: tissue oxygenation, tissue hemoglobin index, deep tissue near-infrared perfusion index, and water distribution. Measurements were taken from normally perfused flaps, areas of locally impaired perfusion, and complete flap malperfusion daily within the first 7 days. Statistical differences were determined using Student’s t tests. Receiver operating characteristic curves were illustrating the reliability of each parameter. Ten free anterolateral thigh flaps and eight free latissimus dorsi flaps were included. One flap was subsequently lost. Of 184 total measurements, 119 were taken in normally perfused flap areas, 63 in areas of locally impaired perfusion due to partial flap necrosis, and 2 were taken of a flap without perfusion due to arterial occlusion. In the latter case, tissue oximetry and tissue hemoglobin index were 3% (normally perfused flaps 37.5±12.6% (p<0.05) and 23.7±19.4% (p<0.05), respectively), whereas for locally impaired perfusion tissue, hemoglobin index was raised to 76.8±19.9% (p<0.05) and tissue oximetry and deep tissue near-infrared perfusion index were reduced to 28.8±15.8% (p<0.05) and 24.0±16.9% (p<0.05), respectively. A tissue hemoglobin index of ≥ 53% had a sensitivity of 92% and a specificity of 93% for the detection of locally impaired perfusion. Other parameters were less reliable. HSI is a useful tool for flap monitoring after microsurgical tissue transfer. It provided accurate information which correlated with clinical assessments and guided decision-making regarding revision because it can easily detect impaired flap perfusion dueto arterial occlusion or venous stasis. It also defined locally impaired perfused tissue at theflapborder. Level of evidence: Level IV, diagnostic study.