Extensive Convexity Flattening of a Synthetic Skull Implant the Overcome Major Scalp Deficiency After Multiple Craniotomies.

Multiple craniofacial surgeries and postoperative recalcitrant infections frequently can lead to secondary scalp tissue scarring and skin retraction. Although there are different methods of reducing and optimizing scalp skin tension, the authors describe a last resort treatment method of cranioplastic procedure, which despite of its unfavorable cosmetic outcome, relieves the skin tension through extensive flattening of the polyetheretherketone curvature. Thereby, a custom-made cranioplastic bone flap was extensively flattened in the curvature of the fronto-parietal area with consideration of the related brain hemisphere extension.

Infection of the Hand.

is an opportunistic, low-virulence pathogen occasionally associated with human infections and found largely in immunocompromised patients and those with intravascular devices. We report the case of a healthy 70-year-old man who presented with an infection of the hand, who had no history of trauma but had been gardening for 4 months. Despite surgical debridement and empirical antibiotics, the infection could not be controlled.

Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia.

Purpose: We report on patient and surgeon experience after single-port endoscopic carpal tunnel release (CTR) using wide-awake local anesthesia no tourniquet (WALANT) technique.

Methods: From July to November 2018, patients undergoing endoscopic CTR with WALANT were prospectively included. Follow-up was 3 months.

Diffuse Dermal Angiomatosis of the Breast: A Distinct Entity in the Spectrum of Cutaneous Reactive Angiomatoses - Clinicopathologic Study of Two Cases and Comprehensive Review of the Literature.

Diffuse dermal angiomatosis (DDA) is a rare reactive angioproliferation in the skin and considered to be a subtype in the group of cutaneous reactive angiomatoses. DDA is clinically characterized by livedoid patches and plaques with tender ulceration. Its histologic features are a reactive diffuse proliferation of bland endothelial cells and pericytes within the dermis, forming small capillary vessels.

In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair.

Background: One of the intraoperative challenges of fetal spina bifida repair is skin closure when there is an extended skin defect. Thus, we examined whether distally pedicled random pattern transposition flaps (TFs) are a valid option to overcome this problem.

Subjects And Methods: All patients undergoing in utero repair of spina bifida with application of a TF for back skin closure were analyzed focusing on intraoperative flap characteristics and postoperative flap performance.

Human Adipose Mesenchymal Cells Inhibit Melanocyte Differentiation and the Pigmentation of Human Skin via Increased Expression of TGF-β1.

There is accumulating evidence that interactions between epidermal melanocytes and stromal cells play an important role in the regulation of skin pigmentation. In this study we established a pigmented dermo-epidermal skin model, melDESS, of human origin to investigate the effects of distinct stromal cells on melanogenesis. melDESS is a complex, clinically relevant skin equivalent composed of an epidermis containing both melanocytes and keratinocytes.

Characterization of vasculogenic potential of human adipose-derived endothelial cells in a three-dimensional vascularized skin substitute.

Purpose: The need for clinically applicable skin substitutes continues to be a matter of fact. Hypothetically, a laboratory grown autologous skin analog with near normal architecture might be a suitable approach to yield both satisfactory functional and cosmetic long-term results. In this study, we explored the use of human endothelial cells derived from freshly isolated adipose stromal vascular fraction (SVF) in a three-dimensional (3D) co-culture model of vascularized bio-engineered skin substitute.

The Frontal View of the Nose: Lighting Effects and Photographic Bias.

Background: Most aesthetic rhinosurgeons rely on proper photographic documentation of the nose using several different views. The frontal view is probably the most important, but it is also the most demanding.

Objectives: In the frontal view, delicate, 3-dimensional (3D) anatomic structures require special photographic skills.

Simultaneous proximal interphalangeal joint arthroplasty and extensor tendon reconstruction in adjacent fingers: case report.

We present a case of a young man with heavily injured proximal interphalangeal joints and deficits of the extensor mechanism in 2 fingers treated by silicone proximal interphalangeal joint arthroplasty and 2-stage reconstruction of the extensor mechanism. The postoperative result was satisfactory with a painless, if limited, active arc of motion of the proximal interphalangeal joints of 50° in the middle finger and 35° in the ring finger.

Tissue-engineered dermo-epidermal skin grafts prevascularized with adipose-derived cells.

The major problem in skin grafting is that tissue-engineered skin grafts after their transplantation are initially entirely dependent on diffusion. Since this process is slow and inefficient, nutrients, growth factors, and oxygen will insufficiently be supplied and the regenerating graft will undergo a physiological crisis, resulting in scar-like dermal structures and shrinkage. The tissue-engineering of a vascular network in human dermo-epidermal skin substitutes (DESS) is a promising approach to overcome this limitation.

De novo epidermal regeneration using human eccrine sweat gland cells: higher competence of secretory over absorptive cells.

In our previous work, we showed that human sweat gland-derived epithelial cells represent an alternative source of keratinocytes to grow a near normal autologous epidermis. The role of subtypes of sweat gland cells in epidermal regeneration and maintenance remained unclear. In this study, we compare the regenerative potential of both secretory and absorptive sweat gland cell subpopulations.

Premiere use of Integra™ artificial skin to close an extensive fetal skin defect during open in utero repair of myelomeningocele.

Background: There are fetuses demonstrating very large myelomeningocele lesion which can not be covered with autochothonous skin.

Material And Methods: We use Integra™ artificial skin for intrauterine coverage of the back lesion. A reverse latissimus dorsi flap was used postnatally to reinforce the repair site.

"Trooping the color": restoring the original donor skin color by addition of melanocytes to bioengineered skin analogs.

Purpose: Autologous skin substitutes to cover large skin defects are used since several years. Melanocytes, although essential for solar protection and pigmentation of skin, are not yet systematically added to such substitutes. In this experimental study, we reconstructed melanocyte-containing dermo-epidermal skin substitutes from donor skins of different skin pigmentation types and studied them in an animal model.

Rebuild, restore, reinnervate: do human tissue engineered dermo-epidermal skin analogs attract host nerve fibers for innervation?

Purpose: Tissue engineered skin substitutes are a promising tool to cover large skin defects, but little is known about reinnervation of transplants. In this experimental study, we analyzed the ingrowth of host peripheral nerve fibers into human tissue engineered dermo-epidermal skin substitutes in a rat model. Using varying cell types in the epidermal compartment, we wanted to assess the influence of epidermal cell types on reinnervation of the substitute.

Human eccrine sweat gland cells turn into melanin-uptaking keratinocytes in dermo-epidermal skin substitutes.

Recently, Biedermann et al. (2010) have demonstrated that human eccrine sweat gland cells can develop a multilayered epidermis. The question still remains whether these cells can fulfill exclusive and very specific functional properties of epidermal keratinocytes, such as the incorporation of melanin, a feature absent in sweat gland cells.

Subdivision of the sural nerve: step towards individual facial reanimation.

Long term facial paralysis is a serious affliction and upsetting for the patient. Dynamic facial reanimation has become the treatment of choice. Various techniques that use different donor muscles have been developed since the first functional muscle transplant for facial paralysis more than 30 years ago.

The value of ultrasonography in hand surgery.

The quality of ultrasound imaging to examine anatomical structures in the wrist and hand has improved highly over the last years. The value of ultrasonography (US) performed by hand surgeons on treatment decisions was investigated in this study. One hundred and ninety-five patients with an unclear clinical hand problem were evaluated by high-definition ultrasonography from January 2005 until June 2007.

Markers to evaluate the quality and self-renewing potential of engineered human skin substitutes in vitro and after transplantation.

We screened a series of antibodies for their exclusive binding to the human hair follicle bulge. In a second step these antibodies were to be used to identify basal keratinocytes and potential epithelial stem cells in the human epidermis and in engineered skin substitutes. Of all the antibodies screened, we identified only one, designated C8/144B, that exclusively recognized the hair follicle bulge.

Frequency and conduction velocity analysis of the abductor pollicis brevis muscle during early fatigue.

The physiological behavior of the abductor pollicis brevis (APB) muscle during early stage of fatigue is important as a reference for future clinical assessment of a pathologically altered muscle, as e.g. in carpal tunnel syndrome.

Injury to the upper extremity caused by extravasation of contrast medium: a true emergency.

This retrospective clinical study, over a period of four years, includes 16 patients who had extravasation of iopromidum 623 mg (Ultravist 300) in the upper extremity during computed tomography (CT). Although conservative management is sufficient in most cases, seven patients were operated on. The mean time between extravasation and operation was 155 minutes.

Long-term follow-up evaluation of denervation of the wrist.

Purpose: To evaluate the indications and results of complete wrist denervation and to focus on the correlation between results and length of follow-up evaluation.

Methods: A retrospective review was performed of 71 complete denervations of the wrist joint in 70 patients with an average follow-up period of 9.6 years (range, 1-23 y) using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

Smoke in the operating theater: an unregarded source of danger.

Monopolar electrocautery devices are being used in operating theaters worldwide and have become a "sine qua non" in modern surgery. Despite being widespread, the use of electrocautery is not harmless, because by burning the tissue with rather low temperatures as compared with usual combustion, toxic gases evolve and particles are dispersed and are inhaled by the staff in the operating theater. Samples of this smoke, which evolves particularly densely during reduction mammaplasty, were analyzed using a carbon dioxide laser photoacoustic spectrometer.

Fetal surgery for myelomeningocele: panacea or peril?

Myelomeningocele affects thousands of children worldwide with devastating consequences. In an effort to improve neurologic outcome, fetal surgery has been performed for myelomeningocele for the past 5 years. Sensorimotor function is not appreciably improved, although there may be a reduction in hindbrain herniation and a decreased need for ventriculoperitoneal shunting.