Search

Copyright of Langenbeck's Archives of Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundPentoxifylline (PTX), a methylxanthine derivate with immunomodulating properties, has been used as adjunctive treatment in severe neonatal sepsis. The aim of the study was to investigate the anti-inflammatory effects of PTX on Lipopolysaccharides (LPS)-stimulated monocytes of preterm neonates in vitro compared with monocytes of term infants and adult controls.MethodsWhole cord blood samples and control adult blood samples were incubated with LPS and PTX. The expression of surface markers, phagocytosis, cytokine secretion, and Toll-like receptor (TLR)4 signaling of monocytes were assessed by flow cytometry. Changes of TLR4-messenger RNA (mRNA) levels were confirmed by reverse-transcriptase PCR.ResultsThe expression of CD14, CD11b, CD64, CD71, and CD80 was downregulated by PTX in a dose-dependent manner; the greatest effect was observed on CD14 and CD11b in preterm infants. PTX markedly downregulated LPS-induced tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 levels in all age groups. Early IL-10 production was significantly downregulated by PTX in term and preterm neonates, while remaining unchanged in adults. Moreover, PTX downregulated TLR4 expression of monocytes on cellular and mRNA level, decreased signaling, and suppressed phagocytosis.ConclusionPTX downregulated TLR4 expression and signaling, thereby leading to strong anti-inflammatory properties in monocytes. Age-dependent differences were identified for CD14 and CD11b expression and IL-10 production.

Premature infants are highly susceptible to severe bacterial infections. The impaired infection control related to the functional immaturity of the neonatal innate immune system is an important cause of infection. Different monocyte subpopulations have been described and functionally characterized. However, data from preterm infants are scarce. We analyzed constitutive monocyte TLR2, TLR4, CD163, and HLA-DR expression in preterm cord blood. We further investigated activation of the signaling proteins ERK1/2 and NF-κB in monocyte subpopulations after ex vivo stimulation with the bacterial TLR agonists LPS and lipoteichoic acid. The functional outcome of the stimulation was determined by the intracellular production of TNF. Furthermore, the phagocytic activity was measured via flow cytometry. TLR4 and HLA-DR showed a gestational age-dependent increase. However, activation of ERK1/2 and NF-κB was impaired in neonatal monocyte subpopulations after stimulation with TLR agonists. Accordingly, intracellular TNF was diminished in preterm monocytes, especially in nonclassic monocytes. Premature monocytes showed high phagocytic activity, with significantly lower acidification of the phagosome. The reduced functional response of nonclassic monocytes of preterm neonates appears to be part of the diminished early immune response to bacterial cell wall components and is likely to contribute to their susceptibility to bacterial infection., (© Society for Leukocyte Biology.)

The length of the vascular pedicle is critically important in the use and safety of a free flap. A lengthening of the artery and vein, until now, has been achieved through the use of either an autologous vein interposition graft or an arteriovenous loop. In such patients, the risk is nevertheless increased and does so proportionally to the increasing length of the venous interposition. We present a 30-year-old male electrician who had lost his left forearm and most of his right ulna after high-voltage electrical trauma. Lengthening of the vascular pedicle of a free fibula flap was achieved by anastomosis to the thoracodorsal vessels for 4 weeks. After this time, the flap was raised again together with the pedicle of the latissimus dorsi and used safely for reconstruction of the ulnar defect. Postoperative recovery after both operations was uneventful and the aim of reconstruction fully realized. In our opinion, this procedure provides an interesting alternative in patients in whom the length of the vascular pedicle is crucial but the designated flap has only a short pedicle.

The etiology, symptomatology, clinical findings, course and staging of Dupuytren's contracture are discussed. Surgery is indicated from the second stage onwards; since pain very rarely occurs, it plays no role in establishing the indication for operation. The surgical techniques available are described. Conservative therapy has no influence on the course of the condition, while radiotherapy is inadmissible on account of its side effects. Physical therapy and physiotherapeutic pre-operative measures can improve the results of surgery.

Fasciocutaneous flaps demonstrate, in comparison to subcutaneous transposition flaps, far better local hemodynamic circulation and the length to width ratio can be increased to 3:1 or 5:1 so that they provide a simple method of closure in soft tissue defects. Fasciocutaneous flaps can be prepared rapidly and simply, due to the subfascial dissection, so that traumatic soft tissue defects can be closed directly. The donor site is closed with a split skin graft. Free musculocutaneous flaps and regional musculocutaneous island flaps are far more useful in large muscular defects, degloving injuries and osteomyelitis.

One of the disadvantages of the radial forearm flap is the donor defect covered by split skin grafts. The use of a tissue expander allows direct closure of smaller donor defects resulting in a cosmetically more acceptable linear scar. The skin expander must be implanted adjacent to the planned radial forearm flap in the epifascial plane for at least six weeks, preferably for two to three months. The operative technique is demonstrated at a typical clinical case and experiences with six further patients reported.

Of 550 patients treated in our burn unit 5.1% had electrical injuries. Injuries of the skull and scalp were caused by entry of electrical current. The classic reconstruction of the scalp and skull is performed after sequestration of the necrotic bone, a time-consuming process which frequently has complications. An alternative is to induce regeneration of the vitalized bone by covering it early with a vascular tissue flap. Skeletal scintigraphy has the advantage of allowing early and safe assessment of the vitality of the injured bone and helps to control vitalization.

12 cases of finger transposition during replantation using microvascular techniques are reported, all of which were performed in the Department of Plastic and Reconstructive Surgery, Klinikum Rechts der Isar der Technischen Universität München (Head of Department: Prof. Dr. med. Ursula Schmidt-Tintemann). In multiple injuries of the hand, it is sometimes necessary to reconstruct fingers depending on their functional importance, when it is not possible to make a precise anatomical reconstruction owing to the destruction of the various amputated parts. The functional results following finger transposition are comparable to the results following 500 finger replantations in our hospital.

We present our experimental and clinical experiences with the free neurovascular forearm flap. The flap is based on the radial artery, one of the great veins of the forearm (cephalic, basilic, or interconnecting vein), and one or two cutaneous forearm nerves (ulnar, median, or lateral). Because of the standard anatomy, the large caliber of blood vessels, the good sensory supply, the quality and quantity of the forearm skin, and the thin layer of subcutaneous fat, the free forearm flap is a technically easy and safe flap for reconstruction of soft-tissue defects, especially those in the head and neck and those areas of the extremities where sensitive skin is desired.

The coverage of extensive defects of the scalp is sometimes a problem. In some clinical cases the methods of definitive coverage are shown. Microsurgery permits the replantation of a scalp or the coverage of a defect with a free flap. A new technique consists in the use of a tissue expander to stretch the remaining scalp.

The possibility of replantation is discussed for children's amputation injuries. The use of this technique is also indicated for multiple amputations and severe crush injuries. More than half of the replanted fingers healed successfully. Since the existence of the Replantation centre of the Klinikum Rechts der Isar, over 600 operations of separated limbs were performed. The healing rate of totally and subtotally separated limbs of adults was 87%. The attempt was made to replant separated digits of 14 children, aged from 1 to 8 years, with microvascular anastomoses. The grade of injuries and the minimal size of anatomic structures demand a particularly high standard of the operative standard. Replantation was also indicated for badly squashed and contaminated limbs.

Large soft tissue defects on the upper arm and the forearm of a 14-year-old boy caused by electrical trauma were repaired with a free latissimus dorsi flap on the left forearm and a neurovascular lat. dorsi island flap to the right upper arm. Both extremities were saved, the defects covered and good functional repair was achieved. The latissimus dorsi flap is a save and easy procedure with a high variability. It is especially suitable for primary repair of large soft tissue defects.

One hundred late results of augmentation mammaplasty for the following conditions are reported: aplasia, hypoplasia, asymmetry and deformities after total and partial mastectomy. Our criteria for assessment were shape, consistency and quality of scars. The objective assessments were compared with the patients subjective assessments. The most unsatisfactory results were in augmentation after subcutaneous mastectomy and the best were in hypoplasias when small implants were used. Two types of implant were compared: gel filled and inflatable. Results were slightly better with gel filled implants. Better results were obtained if the implant was placed subpectorally and postoperative massage was carried out. Special note is made of the high rate of fibrous capsule contraction.