Denis Ehrl - Academia.edu (original) (raw)

Papers by Denis Ehrl

Research paper thumbnail of Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Journal of Reconstructive Microsurgery

Background Several patient-related factors have been identified with regard to the safety and eff... more Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models. Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p

Research paper thumbnail of The Layered Anatomy of the Nose: An Ultrasound-Based Investigation

Aesthetic Surgery Journal

Background An increasing number of soft tissue filler procedures in the nasal region has been rep... more Background An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. Objectives To describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. Methods A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose using ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. Results In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n= 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% - 67.5% in relation to nasal len...

Research paper thumbnail of Die COVID-19 Pandemie und ihre Folgen für die Plastische Chirurgie und Handchirurgie

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

ZusammenfassungIn Deutschland wurde der erste Patient mit SARS-Cov-2 Virus Infektion am 27. Janua... more ZusammenfassungIn Deutschland wurde der erste Patient mit SARS-Cov-2 Virus Infektion am 27. Januar 2020 in München bestätigt. Für uns als Plastische Chirurgen und Handchirurgen ist es von zentralerBedeutung, dass wir uns als verantwortungsbewusste Menschen und Ärzte dafür einsetzen, die Übertragung von Viren zu verringern und die Ressourcen zur Behandlung von Patienten, die an der Krankheit schwer erkrankt sind, frei geben. Die vorliegende Arbeit gibt einer Übersicht zu aktuellen Entwicklungen und Erkenntnissen für das Fachgebiet Plastische Chirurgie und für die Handchirurgie.Gleichzeitig müssen wir über unsere Fachgesellschaften aktiv Kriterien und Regularien zur Versorgung von an COVID-19 erkrankten Patienten mitgestalten, den Erhalt unserer Notfallversorgung sichern und sinnvolle Exit-Strategien erarbeiten. Naturgemäß kann dabei gerade bei der rasanten Entwicklung der Erkenntnisse in der aktuellen Pandemie nur eine Momentaufnahme gegeben werden.

Research paper thumbnail of Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study

Clinical Hemorheology and Microcirculation

BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of... more BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening c...

Research paper thumbnail of Impact of Two Attendings on the Outcomes of Microvascular Limb Reconstruction

Journal of Reconstructive Microsurgery

Background Free tissue transfers are routinely performed for extremity reconstruction. In an era ... more Background Free tissue transfers are routinely performed for extremity reconstruction. In an era of increasing economic pressure in many healthcare systems, efficiency needs to be optimized for any kind of operative procedure. This study is examining the possible benefit of a two-attending approach to microsurgical reconstruction of the limbs using antero-lateral thigh- (ALT) or gracilis-muscle flaps at a major academic microsurgical center. Methods 309 patients underwent 392 free ALT- (206) or gracilis-muscle (186) flaps for limb defect reconstruction at our institution (2009–2015). All available data was retrospectively screened for patients' demographics, perioperative details, surgical complications, and overall flap survival. The cases were divided into two groups according to the number of operating microsurgeons: one versus two attendings. Results No significant differences existed between the two groups (341 “one attending” versus 51 “two attendings”) regarding preoperat...

Research paper thumbnail of Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions

Journal of Reconstructive Microsurgery

Background Patients requiring microsurgical defect reconstruction are highly susceptible to intra... more Background Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions. Methods Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p

Research paper thumbnail of Ökonomische Aspekte der interdisziplinären Plastischen Chirurgie – Veränderung der diagnosebezogenen Fallgruppen (DRG) durch Eingriffe der rekonstruktiven Mikrochirurgie

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Zusammenfassung Hintergrund Die Etablierung der Mikrochirurgie hat in den letzten Jahrzehnten ein... more Zusammenfassung Hintergrund Die Etablierung der Mikrochirurgie hat in den letzten Jahrzehnten eine enorme Verbesserung der operativen Versorgung von interdisziplinären Fällen ermöglicht. Gleichzeitig steigt hierdurch aber auch der Ressourcenaufwand der mitbehandelnden plastischen Chirurgie. Ziel der vorliegenden Arbeit war es daher, den Zusammenhang zwischen Erlössteigerung und Ressourcenaufwand der rekonstruktiven Mikrochirurgie an einem Universitätsklinikum der Maximalversorgung in der interdisziplinären Zusammenarbeit darzustellen. Methoden An einem Standort einer plastisch-chirurgischen Abteilung einer Universitätsklinik wurden in den Jahren 2018 und 2019 alle Fälle der interdisziplinären Zusammenarbeit fallbegleitend verfolgt. Aus dem Gesamtkollektiv wurden die interdisziplinären chirurgischen Fälle identifiziert und prospektiv mit Hinblick auf die stationären Behandlungstage, operativen Ressourcenaufwand und die ökonomische Entwicklung (DRG-Erlöse vor und nach mikrochirurgisch...

Research paper thumbnail of Treatment Options for Pilonidal Disease

The American Surgeon

Pilonidal disease can be treated medically; however, surgical excision remains the gold standard.... more Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38–101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was ...

Research paper thumbnail of Skrotales Lymphödem

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

ZusammenfassungDer Fallbericht beschreibt das seltene Krankheitsbild des skrotalen Lymphödems (El... more ZusammenfassungDer Fallbericht beschreibt das seltene Krankheitsbild des skrotalen Lymphödems (Elephantiasis) bei einem Kaukasier. Es handelt sich dabei um die ausgeprägteste Form der skrotalen Elephantiasis, die nach unseren Informationen bisher in Deutschland beschrieben wurde. Es soll ein Vorschlag für eine operative Therapie und Rekonstruktion des Genitales unter Erhalt der Hoden mit einem funktionell und ästhetisch akzeptablen Ergebnis gegeben werden.

Research paper thumbnail of Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn’s disease—a unique case report

International Journal of Colorectal Disease

Research paper thumbnail of One-year outcomes of intraarticular fat transplantation for thumb carpometacarpal joint osteoarthritis – case review of 99 joints

Plastic and Reconstructive Surgery

Research paper thumbnail of Interdisziplinäre Plastische Chirurgie – Chancen, Voraussetzungen und Hemmnisse der Rekonstruktiven Mikrochirurgie an Kliniken der Maximalversorgung

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Zusammenfassung Hintergrund Für eine zeitgemäße sowie bestmögliche interdisziplinäre Behandlung v... more Zusammenfassung Hintergrund Für eine zeitgemäße sowie bestmögliche interdisziplinäre Behandlung von komplexen Weichteildefekten nach ausgedehnten Traumata, tiefgreifenden Infektionen sowie Tumorentfernungen ist eine eigenständige Infrastruktur für Plastische Chirurgie heutzutage essentiell. Diese Arbeit soll den Stellenwert der rekonstruktiven Mikrochirurgie an einem Universitätsklinikum in der interdisziplinären Zusammenarbeit aufzeigen. Methoden 2018 wurden bei 47 Patienten an einem Standort 50 freie mikrochirurgische Defektrekonstruktionen durchgeführt. Die Daten der Patienten wurden retrospektiv nach Demographie, Komorbiditäten, perioperativen und postoperativen Details, interdisziplinärer Zusammenhang, Hospitalisierung, Komplikationen sowie Endergebnissen untersucht. Ergebnisse Es wurden 50 freie Lappenplastiken nach komplexen Traumata (23,4 %), Infektionen (25,5 %), Tumorresektionen (42,6 %), pAVK (4,2 %) sowie sekundären Lymphödemen (4,2 %) durchgeführt. Bei 76,6 % der Patien...

Research paper thumbnail of Impact of Duration of Perioperative Ischemia on Outcomes of Microsurgical Reconstructions

Journal of Reconstructive Microsurgery

Background Free tissue transfers have become routine for a variety of reconstructive purposes. Du... more Background Free tissue transfers have become routine for a variety of reconstructive purposes. During the time of transfer, some period of ischemia time is unavoidable, causing structural and metabolic changes. This study aimed to evaluate whether length of intraoperative ischemia affects the outcomes of microsurgical reconstructions. Methods Within a 7-year period, 638 patients having undergone 690 microvascular free flap reconstructions fulfilled inclusion criteria for this study. The data were retrospectively screened for patients' demographics, intra- and perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups according to the length of intraoperative ischemia time, “< 60” versus “≥ 60 minutes.” Results Both groups were comparable regarding the patient constellation, comorbidities, smoking status, and perioperative characteristics. Operative times were significantly longer in patients which had ischemia times of ≥...

Research paper thumbnail of Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients

Journal of Burn Care & Research

Research paper thumbnail of Does Cigarette Smoking Harm Microsurgical Free Flap Reconstruction?

Journal of Reconstructive Microsurgery

Background Free tissue transfers can successfully address a wide range of reconstructive requirem... more Background Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions. Methods Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center. The cases were divided into “smoker” (S) and “nonsmoker” (NS) groups according to their cigarette smoking status. The data were retrospectively screened for patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and overall outcomes. Results Both groups were comparable regarding comorbidities including hypertension, peripheral artery disease, diabetes, American Society of Anesthesiologists scores, types of performed free flaps, and recipient sites. Whil...

Research paper thumbnail of Total Endoprosthesis Versus Lundborg´s Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis

Plastic and Reconstructive Surgery - Global Open

Background: There exist various operative approaches for the treatment of trapeziometacarpal join... more Background: There exist various operative approaches for the treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundsborg's resection arthroplasty (RA) with implantation of a total endoprosthesis. Patients and Methods: In this 2-center study, we retrospectively analyzed 71 patients with symptomatic osteoarthritis of the carpometacarpal I joint stage III according to the Eaton-Littler classification. Thirty-two patients underwent a Lundsborg's RA group, and 39 patients received a total endoprosthesis of the carpometacarpal I joint (TEP group). We evaluated operative time, DASH score, postoperative time until resolution of symptoms, pain level, pinch force, and satisfaction with the treatment. Results: Both groups had a similar mean length of follow-up of 42 months (TEP group) and 36 months (RA group). The final DASH score was significantly better in the TEP-group (10.1 versus 21.5 in the RA group; P ≤ 0.05). Also, the time interval from surgery till absence of any pain (1.5 versus 5.9 months) and the time of inability to work (6 versus 21 weeks) were significantly shorter for the TEP group compared with the RA group (P ≤ 0.05). The pinch force, pain intensity, and the satisfaction with the treatment were comparable (P > 0.05). The duration of the operation was significantly shorter in the RA group (31 min versus 65 min in the TEP group; P ≤ 0.05). Conclusion: Both techniques resulted in improved function of the operated hand and a clear reduction of symptoms. However, the implantation of a total endoprosthesis seems to have advantages, given a significantly better DASH score and a significantly shorter time until resolution of symptoms.

Research paper thumbnail of The ALT-flap for Achilles tendon reconstruction

Plastic and Reconstructive Surgery

Research paper thumbnail of Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

Journal of Neurological Surgery Part B: Skull Base

Background An oncologic tumor resection of the scalp can result in complex wounds that result in ... more Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2...

Research paper thumbnail of Ist „fix and flap“ auch im hohen Alter sinnvoll anwendbar?

Research paper thumbnail of Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

Journal of Reconstructive Microsurgery

Background Free tissue transfers have become standard for a wide variety of reconstructive purpos... more Background Free tissue transfers have become standard for a wide variety of reconstructive purposes. In an era of increasing economic pressure, it is important to precisely define appropriate candidates and indications for a complex surgery to optimize efficiency and patient outcomes. This study evaluates the feasibility to perform microsurgical procedures in a medically compromised patient cohort at a major academic microsurgical center. Methods Within 7 years, 897 patients underwent 969 microvascular free flap reconstructions. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups in “low-risk” (American Society of Anesthesiologists [ASA] I and II) or “high-risk” (ASA III and IV) as per the preoperative medical status classified according to the ASA score of physical status. Results Despite the significantly high prevalence of hypertension, peripheral ...

Research paper thumbnail of Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Journal of Reconstructive Microsurgery

Background Several patient-related factors have been identified with regard to the safety and eff... more Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models. Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p

Research paper thumbnail of The Layered Anatomy of the Nose: An Ultrasound-Based Investigation

Aesthetic Surgery Journal

Background An increasing number of soft tissue filler procedures in the nasal region has been rep... more Background An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. Objectives To describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. Methods A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose using ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. Results In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n= 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% - 67.5% in relation to nasal len...

Research paper thumbnail of Die COVID-19 Pandemie und ihre Folgen für die Plastische Chirurgie und Handchirurgie

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

ZusammenfassungIn Deutschland wurde der erste Patient mit SARS-Cov-2 Virus Infektion am 27. Janua... more ZusammenfassungIn Deutschland wurde der erste Patient mit SARS-Cov-2 Virus Infektion am 27. Januar 2020 in München bestätigt. Für uns als Plastische Chirurgen und Handchirurgen ist es von zentralerBedeutung, dass wir uns als verantwortungsbewusste Menschen und Ärzte dafür einsetzen, die Übertragung von Viren zu verringern und die Ressourcen zur Behandlung von Patienten, die an der Krankheit schwer erkrankt sind, frei geben. Die vorliegende Arbeit gibt einer Übersicht zu aktuellen Entwicklungen und Erkenntnissen für das Fachgebiet Plastische Chirurgie und für die Handchirurgie.Gleichzeitig müssen wir über unsere Fachgesellschaften aktiv Kriterien und Regularien zur Versorgung von an COVID-19 erkrankten Patienten mitgestalten, den Erhalt unserer Notfallversorgung sichern und sinnvolle Exit-Strategien erarbeiten. Naturgemäß kann dabei gerade bei der rasanten Entwicklung der Erkenntnisse in der aktuellen Pandemie nur eine Momentaufnahme gegeben werden.

Research paper thumbnail of Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study

Clinical Hemorheology and Microcirculation

BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of... more BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening c...

Research paper thumbnail of Impact of Two Attendings on the Outcomes of Microvascular Limb Reconstruction

Journal of Reconstructive Microsurgery

Background Free tissue transfers are routinely performed for extremity reconstruction. In an era ... more Background Free tissue transfers are routinely performed for extremity reconstruction. In an era of increasing economic pressure in many healthcare systems, efficiency needs to be optimized for any kind of operative procedure. This study is examining the possible benefit of a two-attending approach to microsurgical reconstruction of the limbs using antero-lateral thigh- (ALT) or gracilis-muscle flaps at a major academic microsurgical center. Methods 309 patients underwent 392 free ALT- (206) or gracilis-muscle (186) flaps for limb defect reconstruction at our institution (2009–2015). All available data was retrospectively screened for patients' demographics, perioperative details, surgical complications, and overall flap survival. The cases were divided into two groups according to the number of operating microsurgeons: one versus two attendings. Results No significant differences existed between the two groups (341 “one attending” versus 51 “two attendings”) regarding preoperat...

Research paper thumbnail of Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions

Journal of Reconstructive Microsurgery

Background Patients requiring microsurgical defect reconstruction are highly susceptible to intra... more Background Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions. Methods Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p

Research paper thumbnail of Ökonomische Aspekte der interdisziplinären Plastischen Chirurgie – Veränderung der diagnosebezogenen Fallgruppen (DRG) durch Eingriffe der rekonstruktiven Mikrochirurgie

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Zusammenfassung Hintergrund Die Etablierung der Mikrochirurgie hat in den letzten Jahrzehnten ein... more Zusammenfassung Hintergrund Die Etablierung der Mikrochirurgie hat in den letzten Jahrzehnten eine enorme Verbesserung der operativen Versorgung von interdisziplinären Fällen ermöglicht. Gleichzeitig steigt hierdurch aber auch der Ressourcenaufwand der mitbehandelnden plastischen Chirurgie. Ziel der vorliegenden Arbeit war es daher, den Zusammenhang zwischen Erlössteigerung und Ressourcenaufwand der rekonstruktiven Mikrochirurgie an einem Universitätsklinikum der Maximalversorgung in der interdisziplinären Zusammenarbeit darzustellen. Methoden An einem Standort einer plastisch-chirurgischen Abteilung einer Universitätsklinik wurden in den Jahren 2018 und 2019 alle Fälle der interdisziplinären Zusammenarbeit fallbegleitend verfolgt. Aus dem Gesamtkollektiv wurden die interdisziplinären chirurgischen Fälle identifiziert und prospektiv mit Hinblick auf die stationären Behandlungstage, operativen Ressourcenaufwand und die ökonomische Entwicklung (DRG-Erlöse vor und nach mikrochirurgisch...

Research paper thumbnail of Treatment Options for Pilonidal Disease

The American Surgeon

Pilonidal disease can be treated medically; however, surgical excision remains the gold standard.... more Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38–101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was ...

Research paper thumbnail of Skrotales Lymphödem

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

ZusammenfassungDer Fallbericht beschreibt das seltene Krankheitsbild des skrotalen Lymphödems (El... more ZusammenfassungDer Fallbericht beschreibt das seltene Krankheitsbild des skrotalen Lymphödems (Elephantiasis) bei einem Kaukasier. Es handelt sich dabei um die ausgeprägteste Form der skrotalen Elephantiasis, die nach unseren Informationen bisher in Deutschland beschrieben wurde. Es soll ein Vorschlag für eine operative Therapie und Rekonstruktion des Genitales unter Erhalt der Hoden mit einem funktionell und ästhetisch akzeptablen Ergebnis gegeben werden.

Research paper thumbnail of Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn’s disease—a unique case report

International Journal of Colorectal Disease

Research paper thumbnail of One-year outcomes of intraarticular fat transplantation for thumb carpometacarpal joint osteoarthritis – case review of 99 joints

Plastic and Reconstructive Surgery

Research paper thumbnail of Interdisziplinäre Plastische Chirurgie – Chancen, Voraussetzungen und Hemmnisse der Rekonstruktiven Mikrochirurgie an Kliniken der Maximalversorgung

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Zusammenfassung Hintergrund Für eine zeitgemäße sowie bestmögliche interdisziplinäre Behandlung v... more Zusammenfassung Hintergrund Für eine zeitgemäße sowie bestmögliche interdisziplinäre Behandlung von komplexen Weichteildefekten nach ausgedehnten Traumata, tiefgreifenden Infektionen sowie Tumorentfernungen ist eine eigenständige Infrastruktur für Plastische Chirurgie heutzutage essentiell. Diese Arbeit soll den Stellenwert der rekonstruktiven Mikrochirurgie an einem Universitätsklinikum in der interdisziplinären Zusammenarbeit aufzeigen. Methoden 2018 wurden bei 47 Patienten an einem Standort 50 freie mikrochirurgische Defektrekonstruktionen durchgeführt. Die Daten der Patienten wurden retrospektiv nach Demographie, Komorbiditäten, perioperativen und postoperativen Details, interdisziplinärer Zusammenhang, Hospitalisierung, Komplikationen sowie Endergebnissen untersucht. Ergebnisse Es wurden 50 freie Lappenplastiken nach komplexen Traumata (23,4 %), Infektionen (25,5 %), Tumorresektionen (42,6 %), pAVK (4,2 %) sowie sekundären Lymphödemen (4,2 %) durchgeführt. Bei 76,6 % der Patien...

Research paper thumbnail of Impact of Duration of Perioperative Ischemia on Outcomes of Microsurgical Reconstructions

Journal of Reconstructive Microsurgery

Background Free tissue transfers have become routine for a variety of reconstructive purposes. Du... more Background Free tissue transfers have become routine for a variety of reconstructive purposes. During the time of transfer, some period of ischemia time is unavoidable, causing structural and metabolic changes. This study aimed to evaluate whether length of intraoperative ischemia affects the outcomes of microsurgical reconstructions. Methods Within a 7-year period, 638 patients having undergone 690 microvascular free flap reconstructions fulfilled inclusion criteria for this study. The data were retrospectively screened for patients' demographics, intra- and perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups according to the length of intraoperative ischemia time, “< 60” versus “≥ 60 minutes.” Results Both groups were comparable regarding the patient constellation, comorbidities, smoking status, and perioperative characteristics. Operative times were significantly longer in patients which had ischemia times of ≥...

Research paper thumbnail of Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients

Journal of Burn Care & Research

Research paper thumbnail of Does Cigarette Smoking Harm Microsurgical Free Flap Reconstruction?

Journal of Reconstructive Microsurgery

Background Free tissue transfers can successfully address a wide range of reconstructive requirem... more Background Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions. Methods Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center. The cases were divided into “smoker” (S) and “nonsmoker” (NS) groups according to their cigarette smoking status. The data were retrospectively screened for patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and overall outcomes. Results Both groups were comparable regarding comorbidities including hypertension, peripheral artery disease, diabetes, American Society of Anesthesiologists scores, types of performed free flaps, and recipient sites. Whil...

Research paper thumbnail of Total Endoprosthesis Versus Lundborg´s Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis

Plastic and Reconstructive Surgery - Global Open

Background: There exist various operative approaches for the treatment of trapeziometacarpal join... more Background: There exist various operative approaches for the treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundsborg's resection arthroplasty (RA) with implantation of a total endoprosthesis. Patients and Methods: In this 2-center study, we retrospectively analyzed 71 patients with symptomatic osteoarthritis of the carpometacarpal I joint stage III according to the Eaton-Littler classification. Thirty-two patients underwent a Lundsborg's RA group, and 39 patients received a total endoprosthesis of the carpometacarpal I joint (TEP group). We evaluated operative time, DASH score, postoperative time until resolution of symptoms, pain level, pinch force, and satisfaction with the treatment. Results: Both groups had a similar mean length of follow-up of 42 months (TEP group) and 36 months (RA group). The final DASH score was significantly better in the TEP-group (10.1 versus 21.5 in the RA group; P ≤ 0.05). Also, the time interval from surgery till absence of any pain (1.5 versus 5.9 months) and the time of inability to work (6 versus 21 weeks) were significantly shorter for the TEP group compared with the RA group (P ≤ 0.05). The pinch force, pain intensity, and the satisfaction with the treatment were comparable (P > 0.05). The duration of the operation was significantly shorter in the RA group (31 min versus 65 min in the TEP group; P ≤ 0.05). Conclusion: Both techniques resulted in improved function of the operated hand and a clear reduction of symptoms. However, the implantation of a total endoprosthesis seems to have advantages, given a significantly better DASH score and a significantly shorter time until resolution of symptoms.

Research paper thumbnail of The ALT-flap for Achilles tendon reconstruction

Plastic and Reconstructive Surgery

Research paper thumbnail of Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

Journal of Neurological Surgery Part B: Skull Base

Background An oncologic tumor resection of the scalp can result in complex wounds that result in ... more Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2...

Research paper thumbnail of Ist „fix and flap“ auch im hohen Alter sinnvoll anwendbar?

Research paper thumbnail of Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

Journal of Reconstructive Microsurgery

Background Free tissue transfers have become standard for a wide variety of reconstructive purpos... more Background Free tissue transfers have become standard for a wide variety of reconstructive purposes. In an era of increasing economic pressure, it is important to precisely define appropriate candidates and indications for a complex surgery to optimize efficiency and patient outcomes. This study evaluates the feasibility to perform microsurgical procedures in a medically compromised patient cohort at a major academic microsurgical center. Methods Within 7 years, 897 patients underwent 969 microvascular free flap reconstructions. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups in “low-risk” (American Society of Anesthesiologists [ASA] I and II) or “high-risk” (ASA III and IV) as per the preoperative medical status classified according to the ASA score of physical status. Results Despite the significantly high prevalence of hypertension, peripheral ...