[Prospects of tissue transfer and tissue culture].

Posttraumatic lesions of joints and extremities create a major challenge for an anatomic plastic reconstruction. The experimental and clinical progress in the field of tissue engineering, immunosuppression of allografts and xenografting including methods of genetic engineering provides a potential basis for the reconstruction of whole limbs or anatomical segments with living tissue.

Adhesion receptors and cytokine profiles in controlled tourniquet ischaemia in the upper extremity.

Adhesion mechanisms mediated by cytokines have been recognized to play a crucial role in ischaemia-reperfusion mechanisms. Although this phenomenon has been well investigated in organ transplantation, little data is available from upper extremity surgery. Profiles of adhesion molecules (CD11/CD18), key cytokines (TNF-alpha and IL-1), CD4+ and CD8+ lymphocytes, and polymorphonuclear neutrophils were investigated following controlled tourniquet ischaemia of the upper extremity for elective hand surgery.

[Reconstructive plastic surgery of thoracic wall defects].

Full-thickness defects of the thoracic wall following tumor resection, irradiation damage or secondary wound healing in thoracic surgery require early interdisciplinary cooperation to achieve patient-specific treatment modalities. Plastic surgical differential therapy allowing for sufficient soft tissue coverage, stabilisation of the thoracic wall and space filling in intrathoracic cavities, is presented and critically discussed.

Effect of low dose aspirin on thrombus formation at arterial and venous microanastomoses and on the tissue microcirculation.

In free flap/replantation surgery, failure is usually associated with thrombotic occlusion of a microvascular anastomosis (risk zone I) or, on occasion, flow impairment in the microcirculation of the transferred or replanted tissue (risk zone II). The objective of this study is to describe the effect of low dose aspirin on blood flow at both risk zones in microvascular surgery. Risk zone I: In rat femoral arteries and veins, thrombus formation was measured at the anastomoses using transillumination and videomicroscopy.

[Monitoring growth factors during wound healing as the basic principle of effective clinical growth factor therapy?].

The microenvironment of healing human skin wounds is continuously monitored by a cutaneous chamber model. In recent studies in patients, baseline data for barrier function, temporal profiles of growth factors, and other mediators of healing were established. This model may be useful in clinical research of modulators of healing and wound pharmacology.

[Diagnosis and therapy of calcifying intramuscular hemangiomas of the lower extremity].

During a 6 year interval from 1990 to 1996 13 patients suffering from calcifying cavernous hemangioma of the lower extremity were treated by surgical resection of the tumor and were followed-up postoperatively for remaining functional loss and recurrence rate. The resection of the medial head of the gastrocnemius muscle was performed seven times, the resection of the lateral head was done in 5 patients. In one patient the soleus muscle was partially resected.

[Thrombosis and tissue protection in microvascular surgery--an overview].

Although microvascular surgery has become a safer procedure in recent years, failure still occurs. The main cause of failure is thrombosis of the anastomosed vessels. Thrombosis involves the vascular wall, platelets and the coagulation system.

[Physiologic and pathologic patterns of reaction to silicone breast implants].

Local morphological reaction patterns on breast implants can be of high significance as possible starting point for controversely discussed systemic immune response triggered by silicon or silicone. Therefore, the collagenous capsules of 149 explanted mammoplasty prostheses were examined macroscopically, under a scanning electron microscope and light-microscopically using antibodies to the macrophage antigen CD68, vimentin, muscle actin, and the proliferation antigen MIB1, and were then correlated with anamnestic data (implanted type of prosthesis, indication for im- or explantation). According to our examinations, the in-vivo durability of the prostheses' shells is considerably decreasing with the expansion of their surfaces.

[Plastic soft tissue coverage in defect fractures of the tibia].

Sequential radical debridement and early soft-tissue reconstruction have considerably decreased the amputation rate, length of hospital stay, chronic osteitis, the rehabilitation period and secondary reconstructive procedures in lower leg injuries. The introduction of distraction osteotomy and "biologic osteosynthesis procedures" have led to shorter and safer osteoplastic methods. The indication, tactics and technical pitfalls of current interdisciplinary treatment options requiring modifications in soft-tissue coverage are presented.

Breast reconstruction with the extended latissimus dorsi flap.

Autologous breast reconstruction started with the use of a myocutaneous latissimus dorsi flap. The need for an additional silicone implant to obtain sufficient breast volume intensified the search for new flaps, resulting in the microvascular TRAM flap, which is currently considered the "gold standard" in autologous breast reconstruction. For patients who are not suited for this procedure or reject this treatment option, a modified extended latissimus dorsi flap was designed and used in 47 patients.

[Indications for arterialization of tissue].

Data from 69 arterialized venous flaps and transplants were reviewed and showed on overall complication rate of 18.6%. Possible hemodynamic mechanisms include, among others, the opening of macro- and microvenous interconnecting pathways with in the perivenous areolar tissue and pressure-induced insufficiency of venouf valves.

The clinical reliability of vein grafts in free-flap transfer.

The use of interposition vein grafts has been associated in the literature with a high complication and flap failure rate. Ninety-three vein grafts in 55 patients over a 46-month period were analyzed to evaluate the clinical reliability of vein grafts in a predominantly trauma patient population (37/55). Fifty-two arterioarterial grafts and 41 veno-venous grafts were performed.

Functional soft-tissue coverage in skeletonizing injuries of the upper extremity using the ipsilateral latissimus dorsi myocutaneous flap.

The concept of early "functional" soft-tissue coverage is demonstrated in three cases of severe skeletonizing avulsion/contusion injuries of the upper extremity, including the replantation of a "frozen" arm. According to the MESS score, all extremities would have been allocated to the amputation group. Therapeutic strategy consisted of primary repair of all neurovascular structures, serial debridements, and early definitive coverage with simultaneous restoration of the elbow flexor or extensor muscles.

[Biological and molecular biology aspects of burn therapy].

Early wound closure, permanent skin replacement and management of postburn deformities are still unsolved problems in the treatment of burns. However, recent developments in biology and molecular biology provide new possibilities for improved therapy. This includes the enhancement of burn wound healing by growth factors and growth hormone, modulation of immunogenicity of skin allografts by gene transfer, cytokine treatment of burn sepsis and the use of cell membrane stabilizers in electrical injuries.

Soft-tissue calcifications: differential diagnosis and therapeutic approaches.

Calcification of soft tissue may be an unspecific local response or present as only a symptom of a complex underlying disease. Patient approach and treatment vary greatly depending on the cause of soft-tissue calcifications. The review of literature reveals multiple causes but also confusing nomenclature for similar clinical entities.

[Preventing blood transfusion in a severely burned Jehovah's witness].

The treatment rationale of a burn victim (35% TBSA) who was child of Jehova's witnesses is described. Following a combined approach including erythropoetin and blood saving surgical techniques we were able to excise and graft the burn areas without blood transfusion. An extremely low hemoglobin of 3.

[Muscle power and shoulder joint function after removal of the latissimus dorsi muscle].

Free transplantation of the latissimus dorsi muscle has become the treatment of choice in extensive soft-tissue defects of the lower leg after trauma. However, neither the ability of the remaining muscles of the shoulder to compensate for the lost function nor the long-term effects of latissimus dorsi removal on the function of the shoulder have been objectively measured. Therefore, the postoperative shoulder function in 23 patients was compared after removal of the latissimus dorsi muscle with 23 control subjects.

Appropriate techniques for musculoskeletal tumor biopsy.

Despite the crucial nature of a biopsy for the diagnosis and treatment of a musculoskeletal tumor, the basic tenets of biopsy technique are frequently not respected. Unfortunately, catastrophic errors in biopsy technique occur frequently. Examples of the more common errors and the correct surgical techniques are discussed.

Use of glycerolized human allografts as temporary (and permanent) cover in adults and children.

Multiple efforts to achieve immediate and complete burn wound closure following early debridement have been attempted to prevent septic complications, and to decrease the morbidity and mortality associated with major burns. The BG University Hospital Bergmannsheil Bochum (BGUBB) Burn Centre admitted 157 patients with deep partial thickness and full thickness skin burns during 1991 and 1992. Twenty-eight of these patients (18 per cent) were treated with glycerolized human allografts.

Application of the pinless external fixator in severely burned patients.

In the treatment of patients with full thickness burns of the limbs adequate positioning is known as a critical condition for a favourable outcome after debridement and skin grafting. Up to now prevention of wound compression, prevention of shear forces and daily wound inspection were facilitated by using halofixators (HF) for the skull and AO external fixation (AO-EF) systems for the limbs. For the skull the HF is still the method of choice.

[Indications for vein interposition in microsurgical reconstruction of complex defects of the lower extremity after tumor and trauma].

Reconstructive microsurgery has become a routine procedure in plastic surgery. Success rates in major centers range between 95 and 98%. In selected "high risk" cases, vein grafts are required to facilitate microsurgical anastomoses, as in complex defects of the lower leg, post ischemic syndrome (PIS) or following major tumor resections.

[Reconstructive secondary interventions in scalp defects].

Scalp defects in combination with exposure of the skull require early debridements and immediate soft tissue coverage by local flaps or free tissue transfer. Tactical and technical treatment rationale options are discussed, which are necessary to achieve patient specific reconstructive procedures.