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Thorough knowledge of perforator anatomy can facilitate anterolateral thigh (ALT) free flap harvest. The selection of the right or left thigh as donor area may be supported by preoperative perforator imaging and practical considerations. The study aims to determine if the leg dominance should be taken into account, when choosing the donor thigh for ALT free flap harvest, as muscle mass and perfusion might influence perforator quantity.ALT perforators were localized by color-coded duplex sonography and dynamic infrared thermography on both thighs within a defined 250 × 80 mm area in 24 subjects. Perforator number and thickness of subcutaneous tissue and muscle layer were compared in dominant and nondominant legs.We found no statistically significant difference comparing sonographically identified ALT perforator numbers and hot spot numbers in dominant and nondominant legs. Yet, we found high interindividual differences. The comparison of subcutaneous tissue and muscle thickness yielded no significant difference.Our study yielded no evidence for preference of the dominant or nondominant leg in ALT free flap harvesting. As we found high interindividual differences in perforator number, we suggest to rely on preoperative perforator imaging when choosing the ALT free flap donor thigh.

Background The anterolateral thigh flap is a versatile and dependable perforator flap and is a popular choice in the reconstruction of various body sites. The variable perforator anatomy suggests preoperative perforator imaging to improve safety and speed of dissection. An innovative perforator imaging technique is thermography, which lately gained attention in plastic surgery. Methods Thirty-two healthy participants were included in this randomized study. One thigh was examined with dynamic infrared thermography and consecutively with ultrasound, while the contralateral thigh was examined with ultrasound as standalone technology. Results The application of dynamic infrared thermography prior to ultrasound perforator identification significantly accelerated the ultrasound examination duration by 90 to 130 seconds. The mean duplex ultrasound examination duration correlated positively with the hotspot and perforator quantity per thigh. Conclusion The addition of thermographic perforator mapping can accelerate color duplex ultrasound anterolateral thigh perforator imaging. Furthermore, thermography supplements color duplex ultrasound with crucial information on angiosome location.

Introduction Scaphoid nonunion after failed primary treatment remains challenging particularly when entailed by bone loss, avascular necrosis or deformity. We describe a scaphoid augmentation and fixation technique for cases of recalcitrant nonunion after screw placement by autologous press fit corticocancellous dowel. This study aims to provide reliable data on clinical and radiological outcomes and to contextualize in the face of other treatment options. Material and methods The study included 16 patients with recalcitrant nonunion of the scaphoid. All patients received screw removal and scaphoid reconstruction by a dowel shaped non-vascularized corticocancellous bone graft from the iliac crest facilitating packing of the screw channel. Bone union, the scapholunate, radiolunate and intrascaphoidal angles were evaluated on X-ray and CT images, range of motion noted. Additionally grip strength, DASH and Green O’Brien scores were obtained from eight patients. Results A union rate of 73% was noted after mean follow-up of 54 months. After revisional reconstruction of the scaphoid an extension–flexion rate of 84% of the healthy side was noted while pronation-supination reached 101%. DASH score averaged at 2.9, rest pain on a numeric rating scale was 0.43 with 99% peak grip force of the healthy side. Conclusion In complex cases of revisional scaphoid nonunion after screw placement, the corticocancellous iliac crest pressfit dowel is an option for augmentation and stabilization of the scaphoid by preserving the articular surface. Level of evidence IV, retrospective case series.

Introduction Fluctuations in the numbers of patient consultations in hand trauma emergency units are challenging in terms of both scheduling and the provision of sufficient resources. Trauma consultations in general are affected by both temporal and meteorological variables. As the genesis and epidemiology of hand trauma have their own characteristics, this study aimed to identify the influence of temporal and meteorological factors on hand trauma consultations. Materials and methods All patients treated for hand trauma in our level one trauma center in 2019 were included in the study population and the data were analyzed in retrospect. The daily weather data, including temperature, sunshine duration, precipitation, humidity and wind speed, as well as temporal factors such as time of day, weekday and public holidays were considered and correlated with patient consultations. Gender differences were studied as well. Results We included 4787 hand trauma patients (66.4% male, mean age 38.4 ± 19.3 years, 31.7% occupational injuries). Significantly more consultations occurred on Saturdays as compared to weekdays (14.8 ± 0.6, n = 52 vs. 13.0 ± 0.2, n = 261; p = 0.028), and fewer occurred on official holidays (11.8 ± 0.5, n = 63 vs. 13.4 ± 0.2, n = 302; p = 0.0047). We found a significant positive correlation between daily consultations, sunshine duration (r = 0.14, p = 0.0056) and the mean temperature (r = 0.20, p r = − 0.17, p = 0.001) was observed. Furthermore, fewer consultations were seen on days with precipitation (12.7 ± 0.3, n = 219 vs. 13.8 ± 0.3, n = 146; p = 0.009). The variation was considerably stronger in men. Conclusions Hand trauma consultations increased with increasing temperatures, duration of sunshine, and decreasing humidity. Peak admissions were seen on Fridays and Saturdays. These findings can assist in predicting days with peak admissions to allocate resources appropriately.

ZusammenfassungMikrochirurgische Präparations- und Nahttechniken erfordern hartnäckiges Üben, eine gewisse Frustrationstoleranz und Ausdauer. Gerade Neulinge üben oftmals am „trockenen Modell“ um einen fließenderen Übergang bezüglich der späteren Anwendung am Patienten im Operationssaal zu erreichen. Ob am OP-Handschuh, Schweineherz, als Virtual Reality Tool, Rattenmodell mit Lupenbrille oder Mikroskop – viele verschiedene mikrochirurgische Übungsmodelle sind bekannt. Seit einigen Jahren sind auch Eigenbauten mit Smartphone-Kamera als Vergrößerungshilfe beschrieben. Neuerdings gibt es nun ein kommerzielles System aus den USA, welches es dem Trainee relativ einfach und kostengünstig erlaubt, zu jeder Zeit und fast an jedem Ort mikrochirurgische Basistechniken und das Handling von Faden und Instrumenten zu erlernen oder fortgeschrittene Knotentechniken wie den „Through-the-loop“-Knoten am Modell zu perfektionieren. Hierzu wird ein herkömmliches Smartphone als Mikroskopersatz in einen 3D-Schwenkarm eingespannt und mikrochirurgische Techniken können über das Display des Gerätes geübt werden. Passend zum Übungssystem gibt es vorgefertigte „Übungskarten“ mit eingebauten kleinen Plastikröhrchen verschiedener Stärke (1–3 mm), an denen unterschiedliche Anastomosetechniken geübt werden können.Wir glauben, dass zukünftig derartige Modelle in allen mikrochirurgischen Kliniken zum Standardrepertoire in der mikrochirurgischen Ausbildung für junge Assistenzärzte und Studierende gehören könnten. Sie sind preiswert, praktikabel und jederzeit an jedem Ort anwendbar.

Background The anterolateral thigh (ALT) flap is commonly utilized in reconstructive surgery. Preoperative perforator mapping facilitates dissection. Dynamic infrared thermography can be applied to identify ALT perforators. However, its accuracy has not been evaluated in detail before. Therefore, this study aimed to assess the precision of dynamic infrared thermography in ALT perforator localization. Methods The survey site was defined as a 25 × 8 cm rectangle on the anterolateral thigh and a coordinate system was established. The area was examined consecutively by dynamic infrared thermography with a FLIR ONE camera after 2-minute fan precooling. Two surgeons then independently performed color duplex ultrasound on the basis of the identified hotpots. Results Twenty-four healthy subjects were examined. About 74.8% of perforators were musculocutaneous or musculoseptocutaneous. The mean distance between study area center and perforator or hotspot center was 51.8 ± 27.3 and 46.5 ± 26.2 mm, respectively. The mean distance from hotspot center to sonographic perforator fascia passage was 15.9 ± 9.9 mm with a maximum of 48.4 mm. The positive predictive value of thermographic ALT perforator identification was 93%. Conclusion Thermographic hotspot and perforator location diverge widely in ALT flaps. Dynamic infrared thermography can therefore not be used as standalone technique for preoperative ALT perforator identification. However, the application before color duplex ultrasound examination is a reasonable upgrade and can visualize angiosomes and facilitate the examination.

Corona hat vieles auf den Kopf gestellt und erforderte eine enorme Anpassungsleistung von Einrichtungen der Erwachsenenbildung. Doch was bleibt davon dauerhaft bestehen? Welche Veränderungen waren überraschend und welche sind wider Erwarten nicht eingetreten? Darüber spricht Redakteur Jan Rohwerder mit Anne Becke vom Verein Leben mit Behinderung Hamburg, mit Andreas Grünewald von der Deutschen Angestellten-Akademie Kiel, mit Dr. Christine Schäfer von der Kreisvolkshochschule Barnim sowie mit Dr. Beate Schmidtgen von der Evangelischen Erwachsenenbildung Hochrhein-Markgräflerland.

Microsurgical dissection and suturing techniques require persistent practice and perseverance. Rookies in particular often practice on the "dry model" in order to achieve a smooth transition to the application on the patient in the surgical theatre. Whether surgical glove, pig heart, with magnifying glasses, as a virtual reality tool, rat model with or without a training microscope - many different exercise models are described. For a number of years, self-made devices with smartphone cameras as a magnifying aid have also been known and are sometimes used. There is now a new commercial system from the US which allows the trainee to learn basic microsurgical techniques at any time and almost anywhere, or to perfect advanced knotting techniques such as the "through-the-loop" knot relatively easily and inexpensively. For this purpose, a conventional smartphone can be clamped in a 3 D swivel arm and anastomoses can be practiced on various vessel lumens. The smartphone therefor mimics a surgical microscope. There are prefabricated "cards" with built-in small plastic tubes of various diameters (1-3 mm) that can be used for practice.We believe that in the future such training kits can be part of the standard reporting in microsurgical training for interns and students in microsurgical centers.Mikrochirurgische Präparations- und Nahttechniken erfordern hartnäckiges Üben, eine gewisse Frustrationstoleranz und Ausdauer. Gerade Neulinge üben oftmals am „trockenen Modell“ um einen fließenderen Übergang bezüglich der späteren Anwendung am Patienten im Operationssaal zu erreichen. Ob am OP-Handschuh, Schweineherz, als Virtual Reality Tool, Rattenmodell mit Lupenbrille oder Mikroskop – viele verschiedene mikrochirurgische Übungsmodelle sind bekannt. Seit einigen Jahren sind auch Eigenbauten mit Smartphone-Kamera als Vergrößerungshilfe beschrieben. Neuerdings gibt es nun ein kommerzielles System aus den USA, welches es dem Trainee relativ einfach und kostengünstig erlaubt, zu jeder Zeit und fast an jedem Ort mikrochirurgische Basistechniken und das Handling von Faden und Instrumenten zu erlernen oder fortgeschrittene Knotentechniken wie den „Through-the-loop“-Knoten am Modell zu perfektionieren. Hierzu wird ein herkömmliches Smartphone als Mikroskopersatz in einen 3D-Schwenkarm eingespannt und mikrochirurgische Techniken können über das Display des Gerätes geübt werden. Passend zum Übungssystem gibt es vorgefertigte „Übungskarten“ mit eingebauten kleinen Plastikröhrchen verschiedener Stärke (1–3 mm), an denen unterschiedliche Anastomosetechniken geübt werden können.Wir glauben, dass zukünftig derartige Modelle in allen mikrochirurgischen Kliniken zum Standardrepertoire in der mikrochirurgischen Ausbildung für junge Assistenzärzte und Studierende gehören könnten. Sie sind preiswert, praktikabel und jederzeit an jedem Ort anwendbar.