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Background: The radial forearm flap remains the gold standard in phalloplasty in gender-affirming surgery due to its versatility and functional outcome, but the significant donor site morbidity and its impact on daily functioning and aesthetic perception remains understudied. This study provides valuable insights into the mid-term functional and aesthetic outcomes of the forearm in transgender individuals following radial forearm flap phalloplasty using widespread instruments for assessment scoring systems and for the evaluation of postoperative wound healing of surgical interventions in general. Methods: Between January 2013 and March 2018, a total of 47 patients underwent radial phalloplasty at AGAPLESION Markus Hospital, and 20 consented to participate in this cross-sectional, retrospective study evaluating functional and aesthetic outcomes post-radial forearm flap phalloplasty using standardized questionnaires (DASH, POSAS, and SBSES). A univariate median regression of each score was performed to determine the associations with selected variables, and correlation analyses between scores was performed using a nonparametric Spearman rank correlation. Results: Among the 20 participants, the median Quick DASH, DASH functionality, DASH sport and music, and DASH work scores indicated minimal to no functional impairment. Scar evaluations using the PSAS, OSAS, and SBSES scales showed overall patient satisfaction with minimal concerns regarding pigmentation and scar texture. Notably, an increase of 0.27 cm2 in wound surface area added one point to the DASH sport and music score (p = 0.037). Statistical analysis also demonstrated a significant correlation between functional and aesthetic assessment scores. Conclusions: The radial forearm phalloplasty donor site, evaluated by the PSAS, OSAS, and SBSES scales, leads to minimal or no functional impairment; however, the worsening of the DASH sport and music score with increasing wound surface reflects a direct relation between wound size and functional impairment. [ABSTRACT FROM AUTHOR]

Objective: This study investigates whether psychological well‐being in post‐bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods: An anonymous, nonrandomized, cross‐sectional survey study was designed. Psychological well‐being of four groups of post‐bariatric‐patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results: A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self‐esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p < 0.001) and less insecure (p = 0.030) than patients who had not yet undergone body contouring procedures but sought it. Satisfaction with the result of the body contouring procedures was associated with lower depression levels (p < 0.001), higher self‐esteem (p < 0.001) and a more positive body‐image (p < 0.001). Conclusions: Depressive symptoms or low self‐esteem are not motivational factors for post‐bariatric patients to seek body contouring procedures. Body contouring procedures are associated with improvement in psychological well‐being in post‐bariatric patients. Patients' satisfaction with the result of the body contouring procedures is significantly associated with positive psychological well‐being. [ABSTRACT FROM AUTHOR]

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Background: With the introduction of novel surgical robots and surgical microscopes for the special needs of open microsurgery, the concept of robotic-assisted microsurgery is gaining popularity. While initial preclinical studies indicate a steep learning curve, favourable ergonomics and improved precision, albeit with an increased operating time, data on the clinical application of the new systems is still limited. This study describes our first clinical experience with robotic-assisted autologous breast reconstruction and outlines the opportunities and limitations of the approach., Patients and Methods: Our retrospective data analysis included a total of 28 patients who underwent unilateral robotic-assisted autologous breast reconstruction between July 2022 and August 2023. We applied a combined approach using the Symani Surgical System together with the RoboticScope. Descriptive evaluation of patient characteristics, surgical data and complications was performed., Results: Average patient age was 54.3±11.1 years and average BMI was 26.5±3.5 kg/m 2 . Twenty-six patients received a DIEP flap and 2 patients received a PAP flap, the flaps being connected to the internal mammary artery in 22 cases, to a perforator of the internal mammary artery in 5 cases, and to a branch of the thoracodorsal artery in one case. The average incision-suture time was 267±89 min, with an average ischaemia time of 86±20 min and duration of the arterial anastomosis of 29±12 min. In two cases, immediate intraoperative anastomosis revision was performed, but no flap loss occurred., Conclusion: The results of this study demonstrate the safe feasibility of robot-assisted autologous breast reconstruction using a combination of Symani and RoboticScope. In the future, special attention should be paid to minimally invasive techniques of flap harvest and connecting vessel preparation., Competing Interests: Maximilian Kückelhaus ist klinischer Berater der Firma MMI., (Thieme. All rights reserved.)

Background: In recent years, the PAP (profunda artery perforator) flap has gained popularity in reconstructive breast surgery. However, the tissue available for flap harvest is usually limited. Therefore, grafting two PAP flaps to form a stacked PAP flap for unilateral reconstruction of large breasts is a safe and reliable option. Patient We present the case of a 59-year-old patient arriving at our unit with prior bilateral nipple-sparing mastectomy and implant-based reconstruction after diagnosis of BRCA-2 mutation and breast cancer. Autologous reconstruction with a DIEP flap was the initial treatment suggested to our patient. Preoperative CT scans showed subpar perforators not suitable for anastomosis, ultimately resulting in unilateral DIEP flap reconstruction on the left side. After an uneventful postoperative period, the patient requested autologous conversion of the right side due to persistent symptomatic capsular contracture. To achieve symmetry with the contralateral breast, we decided to perform a stacked PAP flap for unilateral breast reconstruction., Results: The combined flaps provided enough tissue to achieve a satisfactory aesthetic result and symmetry and weighed 600 g in total, while the single DIEP flap on the left side weighed 716 g. There were no complications during the surgical procedure. Postoperative recovery was uneventful, and the patient was discharged after seven days. There were no signs of adipose tissue necrosis at the most recent check-up. On the left donor side, there was a small wound healing defect, which healed well non-surgically. The patient was satisfied with the results., Conclusion: The PAP flap has become an established alternative to standard breast reconstruction procedures. The stacked PAP flap can provide a safe and efficient method for unilateral reconstruction of large breasts. Perfusion and drainage through the inferiorly anastomosed flap showed sufficient outflow and did not lead to increased adipose tissue necrosis. In our case, the total surgery time was not substantially longer than in single PAP flap surgery. Furthermore, the possibility of unilateral placement of two flaps may avoid follow-up operations such as multiple lipotransfers to equalise both breasts., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Lipedema is a common chronic fat distribution disorder often aligned with pain and reduced quality of life affecting 6-10% of the female population. Although lipedema has acquired more scientific attention in the last decade, validated diagnosis and treatment still remain challenging for specialists., Patients and Methods: In this article we evaluate the effect of liposuction on appearance, pain and coexisting diseases of 860 patients with lipedema. Comparison among stages of lipedema pre- and post-liposuction was performed by using t-Tests for independent samples and Kruskal-Wallis-Tests., Results: Our study demonstrates the positive effect on pain reduction in patients with lipedema after liposuction (NRS 2.24) compared with pre-liposuction pain perception (NRS 6.99) and pain perception of patients with conservative treatment (NRS 6.26). Significant differences were shown in the perception between the stages of lipedema and in the reduction of pain perception by liposuction. Furthermore we examined co-diseases in patients with lipedema, primarily menstruation complaints (43%), sleeplessness (36%) and migraine (35%)., Conclusions: A progress of lipedema disease leads not only to a change of appearance and proportion but also to a progressive increase of pain. Liposuction shows a significant effect on pain reduction -independent of the patients' stage of lipedema., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Background: In 2017, we reported the first life-saving regeneration of virtually an entire epidermis by combined gene and stem cell therapy. Recently, we demonstrated excellent long-term stability of this transgenic epidermis. Skin quality in this experimental approach and its potential application in other conditions were elucidated here regarding long-term outcomes of biomechanical properties., Patients and Methods: Analysis of biomechanical properties including skin elasticity, anisotropy and friction was performed on multiple body sites 24, 36 and 60 months following transplantation. Firstly, the sites were matched against and compared to remaining stable non-transgenic areas as well as to a control group of 13 healthy subjects. Parameters for skin elasticity, deformation and friction were assessed non-invasively., Results: Biomechanical properties of the transgenic epidermis showed encouraging results in comparison to both the remaining stable non-transgenic skin as well as healthy controls. Skin elasticity was comparable to the controls. Skin friction showed some decrease in both transgenic and non-transgenic areas as compared to the controls., Conclusions: The excellent functional outcomes of the transgenic epidermis demonstrate stable long-term results of this novel combined gene and stem cell therapy for epidermal regeneration. Thus, other applications for this technology, such as treatment of specific burns, should be explored., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

The autologous lipotransfer represents an established method in the field of Plastic Surgery. As a reliable and safe method for breast reconstruction and breast augmentation it offers an alternative to established methods such as implants and flap surgery.Survival rate of adipose derived stromal cells limits success or failure of fat grafting. Slight changes in the fat grafting process can lead to huge changes in ADSC-survival rate.This review wants to optimize the fat-grafting process to ensure best outcomes., Competing Interests: Es bestehen keine Interessenkonflikte., (Thieme. All rights reserved.)