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Lucius J, Jensen JO, Tasar RR, Schleusser S, Stang FH, Mailänder P, Kisch T. Acute Microcirculatory Effects of Remote Ischemic Conditioning in Superficial Partial Thickness Burn Wounds. J Burn Care Res 2023; 44:912-917. [PMID: 36326797 DOI: 10.1093/jbcr/irac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Microcirculation is a critical factor in burn wound healing. Remote ischemic conditioning (RIC) has been shown to improve microcirculation in healthy skin and demonstrated ischemic protective effects on heart, kidney, and liver cells. Therefore, we examined microcirculatory effects of RIC in partial thickness burn wounds. The hypothesis of this study is that RIC improves cutaneous microcirculation in partial thickness burn wounds. Twenty patients with partial thickness burn wounds within 48 hours after trauma were included in this study. RIC was performed with an upper arm blood pressure cuff on a healthy upper arm using three ischemia cycles (5 min inflation to 200 mm Hg) followed by 10-minute reperfusion phases. The third and final reperfusion phase lasted 20 minutes. Microcirculation of the remote (lower/upper extremities or torso) burn wound was continuously quantified, using a combined Laser Doppler and white light spectrometry. The capillary blood flow in the burn wounds increased by a maximum of 9.6% after RIC (percentage change from baseline; P < .01). Relative hemoglobin was increased by a maximum of 2.8% (vs. baseline; P < .01), while cutaneous tissue oxygen saturation remained constant (P > .05). RIC improves microcirculation in partial thickness burn wounds by improving blood flow and elevating relative hemoglobin.
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Affiliation(s)
- Julia Lucius
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Jan-Oluf Jensen
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Raphael R Tasar
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Felix H Stang
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Mailänder
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Matzkeit N, Kisch T, Waldmann A, Schweiger U, Mailänder P, Westermair AL. Deep wrist injuries from suicide attempts vs. accidents do not differ regarding sensorimotor outcome, but regarding patient-reported outcome measures. J Plast Surg Hand Surg 2023; 57:95-102. [PMID: 34730072 DOI: 10.1080/2000656x.2021.1993868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite the clinical importance of deep wrist injuries (DWIs), data comparing the outcome of suicide attempt survivors vs. accident survivors are lacking. Patients admitted to our Clinic for acute treatment of a DWI from 2008 to 2016 were contacted for a follow-up assessment of sensory, motor and functional outcomes. Patients also completed the Disability of the Arm, Shoulder and Hand Questionnaire, the Modified Mayo Wrist Score, the Boston Carpal Tunnel Questionnaire, and the WHOQOL-BREF questionnaires. 51 patients could be followed up, on average 4.3 ± 2.9 years after their injury. Suicide attempt survivors did not differ from accidents survivors concerning two-point discrimination, grip and pinch strength, but showed poorer outcomes in self-reported disability, symptom severity, and quality of life. Patients with DWIs from suicide attempts vs. accidents do not differ in sensorimotor outcomes but patient-reported outcome measures. Level of Evidence: II.
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Affiliation(s)
- Nico Matzkeit
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.,Hamburg Cancer Registry, Ministry for Health and Consumer Protection, Hamburg, Germany
| | - Ulrich Schweiger
- Hamburg Cancer Registry, Ministry for Health and Consumer Protection, Hamburg, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Schleusser S, Schulz L, Song J, Deichmann H, Griesmann AC, Stang FH, Mailaender P, Kraemer R, Kleemann M, Kisch T. A Single Application of Cold Atmospheric Plasma (CAP) Improves Blood Flow Parameters in Chronic Wounds. Microcirculation 2022; 29:e12754. [PMID: 35218286 DOI: 10.1111/micc.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To find out if application of cold atmospheric plasma (CAP) affects microcirculation in chronic wounds. METHODS We treated 20 patients with chronic wounds on the lower extremity with CAP. Blood flow parameters of wounds were assessed with combined Laser-Doppler-Flowmetry and spectrophotometry in tissue depth of 2 and 6-8 millimeters. Parameters were assessed under standardized conditions before and over the course of 30 minutes after application of CAP. RESULTS Deep capillary blood flow increased significantly by up to 24.33% (percentage change) after treatment with CAP and remained significantly elevated until the end of measuring period at 30 minutes. Superficial oxygen tissue saturation was significantly elevated by 14.05% for the first 5 minutes after treatment. Postcapillary venous filling pressure was significantly elevated by 10.23% 19 minutes after CAP and stayed significantly elevated starting from minute 24 until the end of measuring. CONCLUSION CAP increases microcirculation parameters in chronic wounds significantly. Since CAP is known for its benefits in wound healing the effects observed may explain the improved healing of chronic wounds after its use. Whether CAP application can increase blood flow in chronic wounds for longer periods of time or boosts blood flow when applied more than once should be subject to further research.
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Affiliation(s)
- Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Lysann Schulz
- Department of Interdisciplinary Intensive Care, University Hospital Leipzig, Germany
| | - Jungin Song
- Department of Plastic Surgery, Helios University Hospital Wuppertal, Germany
| | - Henriette Deichmann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Felix H Stang
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Robert Kraemer
- Department of Plastic-, Reconstructive and Aesthetic Surgery, Klinikum Westfalen, Germany
| | | | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Liodaki E, Kisch T, Mailänder P, Stang F. [Use of acellular allogeneic nerve transplants for nerve defects of the hand : Experience from a German hand surgery center]. Unfallchirurg 2022; 125:892-896. [PMID: 35166880 DOI: 10.1007/s00113-022-01143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
Peripheral nerve injuries are often encountered in traumatological care. The aim of this manuscript is to provide initial data, experiences and performance reports from Germany in the implantation of acellular human nerve transplants in peripheral sensory nerve defects of the hand and to put these data in the context of a comprehensive review of the literature. Of the patients 4 (7 digital nerves) were examined 6 months postoperatively and 5 patients (6 digital nerves) were examined 1 year after the operation (3 were also at the 6‑month examination). All patients had a clinical improvement after nerve reconstruction (≥ S3 according to the classification of sensory recovery of the Medical Research Council modified by Mackinnon and Dellon). Disadvantages of our clinical study are the small number of patients, the inhomogeneity (primary and secondary nerve reconstruction) and the lack of comparison with other nerve reconstruction methods.
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Affiliation(s)
- Eirini Liodaki
- Klinik für Plastische Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| | - Tobias Kisch
- Klinik für Plastische Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Peter Mailänder
- Klinik für Plastische Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Felix Stang
- Klinik für Plastische Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
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Schleußer S, Kalousis K, Kisch T, Mailänder P, Stang F. [The Emergency Classification of Hand Injuries: Analyzing Urgency Assessment among German Hand Surgeons]. HANDCHIR MIKROCHIR P 2022; 54:21-27. [PMID: 35026857 DOI: 10.1055/a-1655-9187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Emergency capacities in the operating theatre are limited and often need to be split among surgical departments. Hand injuries often have to compete with other surgical disciplines for the availability of operating capacity. For this reason, an emergency classification was introduced to define a timespan in which the injury should be taken care of in the OR in order to enable the prioritizing of emergency cases in an interdisciplinary approach when capacities are scarce. However, neither valid data nor specific recommendations concerning the medical urgency of treatment or the forensic background of different hand injuries exist to this date. PURPOSE This work describes how emergency classifications in Germany are applied to hand surgical cases and how certain hand injuries are prioritized among different hand surgeons. MATERIAL AND METHODS An online survey was sent to all members of the German Society for Hand Surgery twice during a time span of several months. The survey featured questions on size and type of clinic or practice and requested an assessment of urgency levels for various hand injuries (immediately - within 2 h - within 6 h - within 12 h - within 24 h or elective care). The analysis of the questionnaire and graphic presentation was carried out using Excel. RESULTS 172 (25 %) out of 700 active members filled in the survey. Among the participants were members of university clinics, hospitals run by the German Statutory Accident Insurance, specialized clinics and primary care clinics. 15 % of participants work in a practice that offers hand-surgical treatment. First and foremost, maximum care hospitals with a hand surgical department participate in the treatment of hand injuries. 64 % of the hospitals use an emergency classification to enable the interdisciplinary prioritizing of surgical emergencies. The categorization of limb-threatening hand injuries appears to be very homogenous among participants whereas non-threatening injuries are assessed rather inconsistently. CONCLUSION Emergency treatment of hand injuries primarily depends on available resources and surgical capacities. The assessment of urgency and severity of injuries additionally depends on experience and education. In order to maintain the ability to compete with other surgical disciplines for surgical capacities, a standard classification of hand surgical urgencies needs to be established. As valid data on the treatment of hand injuries are still missing, further studies need to evaluate possible outcomes in order to define the timespan in which surgery should take place.
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Affiliation(s)
- Sophie Schleußer
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck Klinik für Plastische Chirurgie
| | - Konstantinos Kalousis
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck Klinik für Plastische Chirurgie
| | - Tobias Kisch
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck Klinik für Plastische Chirurgie
| | - Peter Mailänder
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck Klinik für Plastische Chirurgie
| | - Felix Stang
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck Klinik für Plastische Chirurgie
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Klee G, Kisch T, Kümpers C, Perner S, Schinke S, Zillikens D, Langan EA, Terheyden P. The treatment of Merkel cell carcinoma with immune checkpoint inhibitors: implications for patients with rheumatoid arthritis. Rheumatol Adv Pract 2021; 5:rkab037. [PMID: 34622124 PMCID: PMC8493100 DOI: 10.1093/rap/rkab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine skin cancer, which typically affects elderly and immunocompromised and/or immunosuppressed patients. The checkpoint inhibitor avelumab, a mAb targeting the anti-programmed cell death ligand 1 (anti-PD-L1), has revolutionized the treatment of metastatic MCC, achieving dramatic improvements in disease control and overall survival. However, checkpoint inhibitors are associated with the development of immune-related adverse events, such as exacerbation of pre-existing RA. Although most immune-related adverse events can be managed successfully with CSs, their frequent and/or long-term use runs the risk of undermining the efficacy of immune checkpoint inhibition. Methods We report two cases of MCC, in which immunosuppressive therapy for the management of RA was administered. Results Immunosuppression for (i) pre-existing and (ii) immune checkpoint inhibitor-exacerbated RA was associated with progression of metastatic MCC. Conclusion Any decision to initiate immunosuppressive treatment for RA in patients receiving immune checkpoint inhibitor therapy should include careful consideration of the risk of potentially fatal cancer progression and be taken after consultation with the patient’s oncologist and rheumatologist. When the immunosuppressive treatment is required, it should be administered for as short a time as possible and under strict clinical and radiological surveillance.
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Affiliation(s)
| | - Tobias Kisch
- Department of Plastic Surgery, University of Luebeck
| | | | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck.,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel
| | - Susanne Schinke
- Department of Rheumatology, University of Luebeck, Luebeck, Germany
| | | | - Ewan A Langan
- Department of Dermatology.,Dermatological Science, University of Manchester, Manchester, UK
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Buck T, Kisch T, Kruse C, Brandenburger M. 332 New Methods for the Functional In Vitro Characterization of Isolated Human Eccrine Sweat Glands. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Galati V, Vonthein R, Stang F, Mailaender P, Kisch T. Split thickness skin graft versus application of the temporary skin substitute suprathel in the treatment of deep dermal hand burns: a retrospective cohort study of scar elasticity and perfusion. Int J Burns Trauma 2021; 11:312-320. [PMID: 34557334 PMCID: PMC8449150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Two therapeutic options for deep dermal hand burns are autologous split-thickness skin graft (STSG) following tangential excision and the application of the temporary wound dressing Suprathel following removal of burn blisters. We compared elasticity and perfusion of burn scars after both types of therapy at least one year after completion of treatment. A case series of 80 patients of our department with deep dermal hand burns between 2013 and 2018 was examined in the year 2019 at least one year after completion of treatment (24 females and 56 males with a median age of 47.6 years). The clinical assessment of the scar was performed with the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and the objective assessment with suction cutometry (MPA 580) and an O2C device on both hands. Our statistical analysis showed no statistically significant differences for the R2 and R5 elasticity values between the two types of therapy. The 95% confidence intervals for the ratios of elasticity, and microcirculatory perfusion parameters and scar scale scores of burn scars to respective healthy areas of skin after STSG and Suprathel-therapy mostly covered 1. Subgroup analysis of R2 viscoelasticity and analyses with adjustments for scar compression therapy, nicotine consumption, age, palmar or dorsal localization of the burn scar and interactions of age with smoking and localization gave similar results. The adjusted analysis of SO2 showed statistically significant lower SO2 values, 9% less, after STSG compared to Suprathel treatment. Split-thickness skin graft following tangential excision and the application of Suprathel following removal of burn blisters may be equivalent options for treatment of deep dermal hand burns. To detect possible small differences, further studies with larger samples are required.
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Affiliation(s)
- Virginia Galati
- Department of Plastic Surgery, Hand Surgery, Burn Care Unit, University Hospital Schleswig-Holstein, University of LuebeckLuebeck, Germany
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of LuebeckLuebeck, Germany
| | - Felix Stang
- Department of Plastic Surgery, Hand Surgery, Burn Care Unit, University Hospital Schleswig-Holstein, University of LuebeckLuebeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery, Burn Care Unit, University Hospital Schleswig-Holstein, University of LuebeckLuebeck, Germany
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery, Burn Care Unit, University Hospital Schleswig-Holstein, University of LuebeckLuebeck, Germany
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Jensen JO, Schulz L, Schleusser S, Matzkeit N, Stang FH, Mailaender P, Kraemer R, Kleemann M, Deichmann H, Kisch T. The repetitive application of cold atmospheric plasma (CAP) improves microcirculation parameters in chronic wounds. Microvasc Res 2021; 138:104220. [PMID: 34216601 DOI: 10.1016/j.mvr.2021.104220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic wounds, such as venous leg ulcers, diabetic foot ulcers, and pressure ulcers, impose a significant burden on patients and health care systems worldwide. Cold atmospheric plasma (CAP) accelerates wound healing and decreases bacterial load in chronic wounds in both in vitro and in vivo experiments. For the first time, we examined the effects of a repetitive application of CAP on the microcirculation in chronic wounds. HYPOTHESIS The repetitive application of cold atmospheric plasma application further improves microcirculation in chronic wounds. METHODS Twenty patients with chronic wounds were treated repetitively with CAP. The repetitive application consisted of three CAP sessions, each lasting 90 s and separated by a 10-minute microcirculation measuring period. Microcirculation parameters were assessed with combined Laser-Doppler-Flowmetry and spectrophotometry in a tissue depth of 2 mm. RESULTS Tissue oxygen saturation was significantly increased after the first CAP application. The effect amplitude and duration were further increased after the second and third CAP application with a maximum increase by 16,7% (percent change; p = 0,004 vs. baseline) after the third application. There was no significant increase in capillary blood flow until the third CAP application. After the third CAP application, an increase by 22,6% (p = 0,014) was observed. Postcapillary filling pressure was not significantly increased over the measuring period. The repetitive application of CAP further enhances the microcirculation in chronic wounds compared to a single application. CONCLUSION The repetitive application of CAP boosts and prolongs tissue oxygen saturation and capillary blood flow in chronic wounds compared to a single application. This insight could provide an impetus for new treatment protocols.
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Affiliation(s)
- Jan-Oluf Jensen
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany.
| | - Lysann Schulz
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Nico Matzkeit
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Felix H Stang
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Robert Kraemer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Westfalen, Dortmund, Germany
| | - Markus Kleemann
- Department of Surgery, Dr. Erler Kliniken, Nuernberg, Germany
| | - Henriette Deichmann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Matzkeit N, Schulz L, Schleusser S, Jensen JO, Stang FH, Mailaender P, Krämer R, Kisch T. Cold atmospheric plasma improves cutaneous microcirculation in standardized acute wounds: Results of a controlled, prospective cohort study. Microvasc Res 2021; 138:104211. [PMID: 34144075 DOI: 10.1016/j.mvr.2021.104211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Given the high prevalence of wounds and their challenging treatment, the research of therapies to improve wound healing is of great clinical interest. In addition, the general consequences of developing chronic wounds constitute a large health economic aspect, which underscores the interest in the development of efficient treatment strategies. Direct cold atmospheric plasma (di_CAP) has been shown to have beneficial effects on microcirculation of human tissue (Kisch et al., 2016a). It also affects microbial settlements, which may have supportive effects on wound healing processes (Balzer et al., 2015). To treat these adequately, in our view, the positive effects on wound healing should be objectified by application on standardized wounds. However, wound healing is a complex process, depending on nutrient and oxygen supply by cutaneous blood circulation. In spite of microcirculation has been shown to improve in healthy skin by CAP, a quantification of the effect in a standardized wound model has never been evaluated (Kisch et al., 2016a). Based on this, we hypothesize that CAP also influences the microcirculation in standardized acute wounds in a prospective cohort study. METHODS Microcirculatory data of 20 healthy subjects (14 males, 6 females; mean age 40.85 ± 15.84 years; BMI 26.83 ± 7.27 kg/m2) were recorded continuously at a standardized acute wound after skin transplantation (donor site) at the thigh. Under standardized conditions, microcirculatory measurements were performed using a combined laser Doppler and photospectrometry system. After baseline measurement, CAP was applied by a dielectric barrier discharge (DBD) plasma device for 90 s to the acute wound area. Immediately after the application, cutaneous microcirculation was assessed for 30 min (min) at the same site. RESULTS After CAP application, tissue oxygen saturation immediately increased by 5% (92,66 ± 4,76% vs. Baseline 88,21 ± 6,52%, p < 0,01) in the first 60 s and remained significantly elevated for 4 min. Capillary blood flow increased by 19.3% within the first minute of CAP therapy (220.14 ± 65.91 AU vs. Baseline 184.52 ± 56.77 AU, p < 0.001). The statistically highly significant increase in blood flow continued over the entire measurement time. A maximum value was shown in the blood flow in the 15th minute (232.15 ± 58.90 AU, p < 0.001) according to CAP application. With regard to the output measurement, it represents a percentage increase of 25.8%. The measurement of post-capillary venous filling pressure at a tissue depth of 6-8 mm was 59.39 ± AU 12.94 at baseline measurement. After application, there were no significant changes. CONCLUSION CAP increases cutaneous tissue oxygen saturation and capillary blood flow at the standardized acute wound healing model. These results support recently published data on wound healing after CAP treatment. However, further studies are needed to determine if this treatment can improve the reduced microcirculation in chronic wounds. Moreover, repetitive application protocols have to be compared with a single session treatment approach.
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Affiliation(s)
- Nico Matzkeit
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
| | - Lysann Schulz
- Division of Interdisciplinary internal ICU, Medical Department I, University Hospital Leipzig, Germany
| | - Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Jan-Oluf Jensen
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Felix Hagen Stang
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Robert Krämer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Westfalen, Dortmund, Germany
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
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Kisch T, Matzkeit N, Waldmann A, Schweiger U, Stang F, Mailänder P, Westermair AL. Time heals all wounds - Outcomes of deep palmar wrist injuries may improve long after reinnervation. Hand Surg Rehabil 2021; 40:331-337. [PMID: 33640517 DOI: 10.1016/j.hansur.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/18/2022]
Abstract
Despite the clinical importance of deep wrist injuries (DWIs), data on the timeframe of possible improvements in hand function are scarce. We tested the hypotheses that a) the length of follow-up is positively correlated with the outcome, and b) this correlation is tempered by nerve involvement. All patients admitted to the Clinic of Plastic Surgery with an acute DWI between 2008 and 2016 were contacted for a follow-up examination including two-point discrimination, range of motion, grip, and pinch strength, as well as DASH and MMWS questionnaires and employment status. Possible confounders such as age, handedness, and intentionality of the injury (accidental or suicidal) were assessed and controlled for statistically. Fifty-three patients were reviewed (74% male and 26% female, 86% right-handed, 70% accidental injuries, mean age at injury 42.0 ± 17.1 years), an average of 4.3 ± 2.9 years after their injury. In patients with a nerve injury, length of follow-up had significant effects on two-point discrimination, grip and pinch strength, self-reported symptom severity and impairment. Contrary to conventional knowledge, the clinical outcome of DWIs may improve beyond 3 years when there is nerve involvement. This important prognostic finding has far-reaching implications for both clinicians (e.g., asked to give their medical opinion) and patients (e.g., considering re-training after a DWI).
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Affiliation(s)
- T Kisch
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - N Matzkeit
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - A Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Hamburg Cancer Registry, Ministry for Health and Consumer Protection, Billstraße 80, 20539 Hamburg, Germany
| | - U Schweiger
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - F Stang
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - P Mailänder
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - A L Westermair
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Stang F, Schleußer S, Liodaki ME, Kisch T, Mailaender P, Jahnke I. [10 years of hand traumatology - an epidemiological, structural and economic analysis at a maximum care provider]. HANDCHIR MIKROCHIR P 2021; 53:7-18. [PMID: 33588487 DOI: 10.1055/a-1349-4660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Hand surgery in Germany has been subject to structural changes that strongly affect the balance between medicine and economics. On the one hand there is a shift of elective hand surgery from the inpatient to the outpatient sector. On the other hand - so our observations - emergency hand trauma cases are more concentrated in bigger hospitals. Given this background there is a lack of statistical data on the management of hand trauma care and treatment of patients with hand injuries. This article discusses a 10-year-analysis of hand traumatological cases treated at a maximum care hospital regarding epidemiological, structural and economic aspects. MATERIAL AND METHODS Using a database query using ICD codes, inpatient hand trauma cases were identified between 2009-2018 and analyzed with regard to epidemiological and economic indicators (age, gender, comorbidities, case-mix-index (CMI), revenue, length of stay, length of surgery) using PIVOT tables. Patients under the age of 16 years, forearm fractures and intensive care patients were excluded. RESULTS In the study period the typical hand surgical trauma patient was male with an average age of 44 years. The Patient-Clinical-Complexity-Level (PCCL) was 0 in 80 % of all cases. The proportion of work-related injuries averaged around 25 %. The three top diagnose related groups (DRG) were the I32F (18.5 %), X01B (11.3 %) and the I32A (7.2 %). A striking point was the massive increase in the overall number of trauma cases over the years from approx. 300 cases in 2009 to over 1000 cases per year in 2018 with a shift of the main workload to on-call and night-shift hours away from core working times. In the study period 4 of 5 others hospitals located in a distance of 100 km reduced and stopped treatment of emergency hand cases. The average length of a hospital stay was approx. 4-5 days, the average cut/suture time less than 60 minutes and the average CMI 1.23. Those cases generate an average proceed of € 4370 in 2018, whereby the cases generated by the work-related injuries averaged € 387 less. DISCUSSION On the assumption that the number of emergency hand trauma cases did not really increase in the study period we think that there was a concentration of such cases in a few centres still providing extensive treatment for hand injuries while in smaller hospitals care for emergency hand trauma cases is progressively reduced. However, hand injuries may be worth a second thought for economic reasons because they can create reasonable revenues with rather little effort.If a critical number of patients is exceeded, costs of service provisions can be significantly amortized by the proceed generated by treatment. In those hospitals still taking care for acute hand injuries the workload especially in standby duty increased. What may have a negative input on the numbers of treated elective hand surgery cases.
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Affiliation(s)
- Felix Stang
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
| | - Sophie Schleußer
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
| | - Maria Eirini Liodaki
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
| | - Tobias Kisch
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
| | - Peter Mailaender
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
| | - Iris Jahnke
- Universitätsklinik Schleswig-Holstein, Campus Lübeck Klinik für Plastische Chirurgie
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Westermair AL, Matzkeit N, Waldmann A, Stang F, Mailänder P, Schweiger U, Kisch T. Traumatizing Oneself-Deep Wrist Injuries Self-Inflicted with Suicidal Intention are Associated with More Severe PTSD Symptomatology than Similar Injuries from Accidents. Suicide Life Threat Behav 2020; 50:856-866. [PMID: 32147883 DOI: 10.1111/sltb.12630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As suicide attempts by definition entail at least some threat to physical integrity and life, they theoretically qualify as an A1 criterion for posttraumatic stress disorder (PTSD). This study uses the unique opportunity of deep wrist injuries to quantify the effect of intentionality on PTSD rates by comparing suicide attempt survivors with patients who sustained accidental injuries similar in mechanism, localization, and extent. METHOD Patients who had been admitted with an acute deep wrist injury from 2008 to 2016 filled out the revised Impact of Event Scale and reported other known PTSD risk factors. Mental morbidity and intentionality of the injury were determined by psychiatric consultation during the index hospitalization. RESULTS Fifty-one patients were followed up (72.5% male, 92.2% Caucasian, mean age at injury 42.3 ± 17.5 years, 72.5% accidental injuries), on average 4.2 ± 2.9 years after their injury. The intentionality of the injury alone predicted the severity of intrusions, avoidance, hyperarousal, and probable PTSD (aOR = 14.0). CONCLUSIONS Traumatization in the context of a suicide attempt may be a hitherto unknown PTSD risk factor. Patients after suicide attempts, especially medically serious attempts, should be monitored for PTSD symptoms.
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Affiliation(s)
| | - Nico Matzkeit
- Clinic of Plastic Surgery, University of Lubeck, Lubeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, Lubeck, Germany.,Hamburg Cancer Registry, Hamburg, Germany
| | - Felix Stang
- Clinic of Plastic Surgery, University of Lubeck, Lubeck, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University of Lubeck, Lubeck, Germany
| | - Ulrich Schweiger
- Psychosomatic Medicine and Psychotherapy, University of Lubeck, Lubeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University of Lubeck, Lubeck, Germany
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14
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Neis JP, Cordesmeyer S, Kempa S, Kisch T, Stang F, Kalousis K, Wenzel E, Mailānder P. Think big - Plastic surgical treatment of complicated large sacral ulcerations: A case comparison. Hell J Nucl Med 2019; 22 Suppl 2:27. [PMID: 31802040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Large pressure ulcers are a well know problem occurring frequently on immobilized patients. They can develop rapidly especially over bony prominences on the elderly, ICU patients and on patients after spinal cord injury. Plastic surgical treatment can be challenging if the defects are large and complications occur like affection of anal region or development of a Marjolin's scar ulcer. Large defects of the sacral region are well known in our university hospital. Common local flaps like gluteal rotation or (double) V-Y advancement flap are often used for the treatment of smaller defects. In special cases these therapies are not sufficient. Rarely we use fillet flap of the lower extremity to cover large sacral defects on patients who were unable to walk before. SUBJECTS AND METHOD In this case report we demonstrate two relatively young paraplegic patients (49 and 57years old) with large sacral defect wounds. One case occurred in 2017, the other in 2019. After spinal cord injury many years ago both of them developed chronic pressure ulcers of the sacral region. In the case of 2017 a Marjolin's scar ulcer developed as a complication. Both patients had previously lost a leg during the surgical treatment. We used the other remaining leg as a fillet flap in combination with interdisciplinary rectum extirpation for sufficient surgical treatment. RESULTS In both cases adequate coverage of the sacral defect was achieved after interdisciplinary surgical treatment including rectum extirpation. Fillet flaps were safe, even after necessary surgical revisions. In one of the cases a vacuum wound therapy and several debridements were needed. After rehabilitation the patient of the earlier case is able to fully mobilize himself in everyday life and is even able to use public transport. CONCLUSION Using a fillet flap of the lower extremity to cover large sacral ulcers is often the last possibility of surgical treatment. Though many complications can occur, full rehabilitation and social participation is possible after fillet flap surgery even with loss of both legs. Depending on patient's motivation and availability of orthopedic technology like special electric wheel chairs and other tools full mobility can be achieved.
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Affiliation(s)
- Jan Philipp Neis
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Lindert J, Tafazzoli-Lari K, Tüshaus L, Larsen B, Bacia A, Bouteleux M, Adler T, Dalicho V, Vasileiadis V, Kisch T, Stang F, Welzel J, Wünsch L. Optical coherence tomography provides an optical biopsy of burn wounds in children-a pilot study (Erratum). J Biomed Opt 2019; 24:1. [PMID: 30746921 PMCID: PMC6988179 DOI: 10.1117/1.jbo.24.2.029801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This erratum corrects a misspelling of an author's name.
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Affiliation(s)
| | | | | | - Beke Larsen
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | - Anna Bacia
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | | | - Tina Adler
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | | | - Vasileios Vasileiadis
- University Lübeck, Pediatric Surgery, Lübeck, Germany
- University Marbug, Pediatric Surgery, Marburg, Germany
| | - Tobias Kisch
- University Lübeck, Plastic Surgery, Lübeck, Germany
| | - Felix Stang
- University Lübeck, Plastic Surgery, Lübeck, Germany
| | - Julia Welzel
- General Hospital Augsburg, Dermatology, Augsburg, Germany
| | - Lutz Wünsch
- University Lübeck, Pediatric Surgery, Lübeck, Germany
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Olbrisch K, Kisch T, Thern J, Kramme E, Rupp J, Graf T, Wicha SG, Mailänder P, Raasch W. After standard dosage of piperacillin plasma concentrations of drug are subtherapeutic in burn patients. Naunyn Schmiedebergs Arch Pharmacol 2018; 392:229-241. [PMID: 30368548 DOI: 10.1007/s00210-018-1573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022]
Abstract
Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5 g, tid) was administered over 0.5 h. Blood samples were taken at 1, 4, and 7.5 h after the end of the infusion. Free piperacillin plasma concentrations were determined. Pharmacokinetic parameters and in silico analysis results were calculated using the freeware TDMx. The primary target was defined as percentage of the day (fT>1xMIC; fT>4xMIC) when piperacillin concentrations exceeded 1xMIC/4xMIC (minimum inhibitory concentration), considering a MIC breakpoint of 16 mg/L for Pseudomonas aeruginosa. In an off-label approach, two burn patients were treated with 8/1 g piperacillin/tazobactam, 3 h qid. fT>1xMIC (55 ± 22% vs. 77 ± 24%) and fT>4xMIC (17 ± 11% vs. 30 ± 11%) were lower in burn than in ICU patients after 4/0.5 g, 0.5 h, tid. In silico analyses indicated that fT>1xMIC (93 ± 12% burn, 97 ± 4% ICU) and fT>4xMIC (62 ± 23% burn, 84 ± 19% ICU) values increase by raising the piperacillin dosage to 8/1 g qid and prolonging the infusion time to 3 h. Off-label treatment results were similar to in silico data for burn patients (84%fT>1xMIC and 47%fT>4xMIC). Standard dosage regimens for piperacillin/tazobactam resulted in subtherapeutic piperacillin concentrations in burn and ICU patients. Dose adjustments via in silico analyses can help to optimize antibiotic therapy and to predict respective concentrations in vivo. Trial registration: NCT03335137, registered 07.11.2017, retrospectively.
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Affiliation(s)
- Katharina Olbrisch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Julia Thern
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Evelyn Kramme
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Centre Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sebastian G Wicha
- Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Walter Raasch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
- CBBM (Center of Brain, Behavior and Metabolism), University of Lübeck, Lübeck, Germany.
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Lindert J, Tafazzoli-Lari K, Tüshaus L, Larsen B, Bacia A, Bouteleux M, Adler T, Dalicho V, Vasileidos V, Kisch T, Stang F, Welzel J, Wünsch L. Optical coherence tomography provides an optical biopsy of burn wounds in children-a pilot study. J Biomed Opt 2018; 23:1-6. [PMID: 30324791 DOI: 10.1117/1.jbo.23.10.106005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
Thermic injuries are among the most severe injuries in childhood. Burn depth is the most relevant prognostic factor, and still its assessment is both difficult and controversial. This diagnostic uncertainty results in repeated wound assessments over a 10-day period and carries a relevant risk for over- and undertreatment. Precise wound assessment would thus be a significant step toward improved care. Optical coherence tomography (OCT) is a noninvasive laser-based technique with a penetration depth of ∼2 mm. It provides structural images of the skin while dynamic OCT (D-OCT) shows blood vessels. In this study, we investigated burns and scalds in 130 children with OCT and D-OCT to identify patterns of injury related to the depth of the burn wound. OCT and D-OCT images from burned skin differed consistently from normal skin. We observed several not formerly described morphologic patterns associated with burn injuries. Superficial wounds are characterized by a loss of the epidermal layer and a smooth surface. With deeper wounds, surface irregularity, loss of the dermal papillary pattern, disappearance of skin lines, and characteristic changes in the microvascular architecture were observed. This is the first systematic study of D-OCT in the assessment of burn wounds in children. A number of burn-associated patterns of injury were identified. Thus, D-OCT provided an "optical biopsy" of burn wounds that adds significant information about the severity of a burn wound.
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Affiliation(s)
| | | | | | - Beke Larsen
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | - Anna Bacia
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | | | - Tina Adler
- University Lübeck, Pediatric Surgery, Lübeck, Germany
| | | | - Vasileiadis Vasileidos
- University Lübeck, Pediatric Surgery, Lübeck, Germany
- University Marbug, Pediatric Surgery, Marburg, Germany
| | - Tobias Kisch
- University Lübeck, Plastic Surgery, Lübeck, Germany
| | - Felix Stang
- University Lübeck, Plastic Surgery, Lübeck, Germany
| | - Julia Welzel
- General Hospital Augsburg, Dermatology, Augsburg, Germany
| | - Lutz Wünsch
- University Lübeck, Pediatric Surgery, Lübeck, Germany
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Galati V, Wortmann F, Stang FH, Thorns C, Mailänder P, Kisch T. A Rare Manifestation of Primary Bone Lymphoma: Solitary Diffuse Large B-Cell Lymphoma of the Little Finger. J Hand Surg Am 2018; 43:779.e1-779.e4. [PMID: 29398333 DOI: 10.1016/j.jhsa.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/29/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Abstract
Solitary primary non-Hodgkin bone lymphoma of the hand is a rare entity with only 3 cases reported in the literature. We report the case of a 77-year-old patient with isolated large B-cell bone lymphoma of the proximal phalanx of the little finger without rheumatoid arthritis or methotrexate treatment. The patient was treated with digital amputation and at 6 months' follow-up showed no relapse or dissemination of the disease.
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Affiliation(s)
- Virginia Galati
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Friederike Wortmann
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Felix H Stang
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Christoph Thorns
- Department of Pathology, Section of Hematopathology and Endocrine Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Peter Mailänder
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
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Volz S, Kalousis K, Song JI, Kisch T, Wenzel E, Mailänder P. Brachytherapy in soft tissue tumours: an interdisciplinary challenge! Hell J Nucl Med 2017; 20 Suppl:163. [PMID: 29324933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Interdisciplinary work including surgery and additive radiotherapy is often needed for the therapy of tumours. Beneath this, brachytherapy is an important part of the radiotherapy. It was first used over 100 years ago and is in regular use after the development of afterload technology in the early 1970s. Today it is often used in different tumour therapies, for example in soft tissue sarcoma or breast tumours, in order to decrease the risk of local recurrence. Concerning its benefits, higher doses could be used because of the localized effect with equivalent local control rate and less toxicity of treatment. Moreover, brachytherapy can also shorten the treatment time from 5-7 weeks to some days and is better reconcilable due to its localized effects, thus reducing side effects, as radiation-induced reactions, teleangiectasia and brosis. Precondition for application of brachytherapy is the need of a good soft tissue coverage and wound healing. Therefore, good interdisciplinary cooperation between plastic surgery and radiotherapy is important. After wide surgical resection reconstruction with different kind of flaps are often required, for achieving early wound healing and fast start of radiotherapy. PATIENTS AND METHOD Between 2011 and 2017 we applied brachytherapy to 13 patients with soft tissue sarcomas and other tumours like merkel-cell-carcinoma, schwannoma, and breast cancer. The treatment consisted of tumour resection, intraoperative insertion of brachytherapy catheters and after that brachytherapy alone or in combination with external beam radiotherapy. In half of the patients a reconstruction with different flaps was required, including pedicled trapezius flap, musculus latissimus dorsi flap and radial forearm flap; in some cases nerve and tendon reconstruction for better function and faster wound healing and so faster start of postoperative brachytherapy was also needed. The mean age of the patients was 55 years (±19) and we could start brachytherapy after 3-21 days after the operation, with a mean start on day 8±5 postoperatively. Three patients received additional percutaneous radiotherapy. The patients who received only brachytherapy got a dose of 2, 5 or 3Gy twice daily, with a mean total dose of 31±3Gy. CONCLUSION Multidisciplinary work, including surgery as the main procedure and radiotherapy additionally, is needed for a successful treatment of soft tissue tumours. Depending on the type and the stadium of tumour plastic and reconstructive surgery provides soft tissue coverage, faster wound healing and the chance for limb salvage; on the other hand, additive brachytherapy contributes to a good tumour control. Therefore, a close collaboration between the two specialties is of particular importance, in order to improve the effectiveness of the therapy and the postoperative quality of life of the patient.
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Affiliation(s)
- Silvanie Volz
- Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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20
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Liodaki E, Kisch T, Wenzel E, Mailänder P, Stang F. Percutaneous Cannulated Compression Screw Osteosynthesis in Phalanx Fractures: The Surgical Technique, the Indications, and the Results. Eplasty 2017; 17:e8. [PMID: 28293333 PMCID: PMC5329938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. Methods: We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Results: Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. Conclusions: The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures.
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Affiliation(s)
- Eirini Liodaki
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany,Correspondence:
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Eike Wenzel
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Mailänder
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Felix Stang
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Kraemer R, Sorg H, Forstmeier V, Knobloch K, Liodaki E, Stang FH, Mailaender P, Kisch T. Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation. Ultrasound Med Biol 2016; 42:2975-2982. [PMID: 27662701 DOI: 10.1016/j.ultrasmedbio.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: -22.1% vs. group C: -5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: -4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen saturation, albeit to a lower extent, and decreases both blood velocity and venous filling pressure. Low-energy ESWT reduced tissue perfusion, but improved oxygen saturation immediately after the application.
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Affiliation(s)
- Robert Kraemer
- Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Heiko Sorg
- Department for Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Alfried Krupp Krankenhaus, Essen, Germany
| | - Vinzent Forstmeier
- Department of Visceral and Thoracic Surgery, German Armed Forces Hospital Ulm, Ulm, Germany
| | | | - Eirini Liodaki
- Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Felix Hagen Stang
- Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Mailaender
- Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Açil Y, Ghoniem AA, Gülses A, Kisch T, Stang F, Wiltfang J, Gierloff M. Suppression of osteoblast-related genes during osteogenic differentiation of adipose tissue derived stromal cells. J Craniomaxillofac Surg 2016; 45:33-38. [PMID: 27842921 DOI: 10.1016/j.jcms.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/31/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Recent studies indicated a lower osteogenic differentiation potential of adipose tissue-derived stromal cells (ASCs) compared to bone marrow derived mesenchymal stromal cells. The aim of this study was to evaluate the effects of potent combinations of highly osteogenic bone morphogenetic proteins (BMPs) in order to enhance the osteogenic differentiation potential of ASCs. Human ASCs were cultured for 10 days in the presence of osteogenic medium consisting of dexamethasone, ß-glycerophosphate and ascorbat-2-phosphate (OM) supplemented with BMP-2, BMP-6, BMP-9+IGF-2 and BMP-2,-6,-9 (day 1+2: 50 ng/ml, days 3-6: 100 ng/ml, days 7-10: 200 ng/ml). The formation of the osteoblast phenotype was evaluated by quantification of osteoblast-related marker genes using real-time polymerase chain reaction (RT-PCR). Matrix mineralization was assessed by Alizarin Red S staining. Statistical analysis was carried out using the one-way analysis of variance (ANOVA) followed by the Scheffe's post hoc procedure. Osteogenic medium (OM) significantly increased the expression of alkaline phosphatase (ALP) and osteocalcin (p < 0.05) and led to a stable matrix mineralization. Under the influence of BMP-9+IGF-2 and BMP-2,-6,-9 the ALP expression further increased compared to ASCs cultured with OM only (p < 0.01). However, multiple osteogenic markers showed no change or decreased under the influence of OM and BMP combinations (p < 0.05). The current results indicate a restricted osteogenic differentiation potential of ASCs and suggest careful reconsideration of their use in bone tissue engineering applications.
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Affiliation(s)
- Yahya Açil
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Amir Alexander Ghoniem
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Aydin Gülses
- Center for Oral and Dental Health, Kars, Turkey.
| | - Tobias Kisch
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Felix Stang
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Jörg Wiltfang
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Matthias Gierloff
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
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Kisch T, Wuerfel W, Forstmeier V, Liodaki E, Stang FH, Knobloch K, Mailaender P, Kraemer R. Repetitive shock wave therapy improves muscular microcirculation. J Surg Res 2016; 201:440-5. [DOI: 10.1016/j.jss.2015.11.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/30/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023]
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Kisch T, Helmke A, Schleusser S, Song J, Liodaki E, Stang FH, Mailaender P, Kraemer R. Improvement of cutaneous microcirculation by cold atmospheric plasma (CAP): Results of a controlled, prospective cohort study. Microvasc Res 2015; 104:55-62. [PMID: 26655582 DOI: 10.1016/j.mvr.2015.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cold atmospheric plasma (CAP) has proven its benefits in the reduction of various bacteria and fungi in both in vitro and in vivo studies. Moreover, CAP generated by dielectric barrier discharge (DBD) promoted wound healing in vivo. Charged particles, chemically reactive species (such as O3, OH, H2O2, O, NxOy), ultraviolet radiation (UV-A and UV-B), strong oscillating electric fields as well as weak electric currents are produced by DBD operated in air. However, wound healing is a complex process, depending on nutrient and oxygen supply via cutaneous blood circulation. Therefore, this study examined the effects of CAP on cutaneous microcirculation in a prospective cohort setting. HYPOTHESIS Cold atmospheric plasma application enhances cutaneous microcirculation. METHODS Microcirculatory data of 20 healthy subjects (11 males, 9 females; mean age 35.2 ± 13.8 years; BMI 24.3 ± 3.1 kg/m(2)) were recorded continuously at a defined skin area at the radial forearm. Under standardized conditions, microcirculatory measurements were performed using a combined laser Doppler and photospectrometry system. After baseline measurement, CAP was applied by a DBD plasma device for 90 s to the same defined skin area of 22.5 cm(2). Immediately after the application cutaneous microcirculation was assessed for 30 min at the same site. RESULTS After CAP application, tissue oxygen saturation immediately increased by 24% (63.8 ± 13.8% from 51.4 ± 13.2% at baseline, p<0.001) and stayed significantly elevated for 8 min. Cutaneous blood flow increased by 73% (41.0 ± 31.2 AU from 23.7 ± 20.8 AU at baseline, p<0.001) and remained upregulated for 11 min. Furthermore, cutaneous blood flow showed two peaks at 14 (29.8 ± 25.0 AU, p=0.049) and 19 min (29.8 ± 22.6 AU, p=0.048) after treatment. Postcapillary venous filling pressure continuously increased, but showed no significant change vs. baseline in the non-specific BMI group. Subgroup analysis revealed that tissue oxygen saturation, postcapillary venous filling pressure and blood flow increased more in case of a lower BMI. CONCLUSION CAP increases cutaneous tissue oxygen saturation and capillary blood flow at the radial forearm of healthy volunteers. These results support recently published data on wound healing after CAP treatment. However, further studies are needed to determine if this treatment can improve the reduced microcirculation in diabetic foot ulcers. Moreover, repetitive application protocols have to be compared with a single session treatment approach.
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Affiliation(s)
- Tobias Kisch
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
| | - Andreas Helmke
- Application Center for Plasma and Photonic APP, Fraunhofer Institute for Surface Engineering and Thin Films IST, Göttingen, Germany
| | - Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Jungin Song
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Eirini Liodaki
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Felix Hagen Stang
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Robert Kraemer
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
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Kisch T, Sorg H, Forstmeier V, Knobloch K, Liodaki E, Stang F, Mailänder P, Krämer R. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation. J Tissue Viability 2015; 24:140-5. [DOI: 10.1016/j.jtv.2015.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/07/2015] [Accepted: 07/29/2015] [Indexed: 01/13/2023]
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Kisch T, Klemens JM, Hofmann K, Liodaki E, Gierloff M, Moellmeier D, Stang F, Mailaender P, Habermann J, Brandenburger M. Collection of Wound Exudate From Human Digit Tip Amputations Does Not Impair Regenerative Healing: A Randomized Trial. Medicine (Baltimore) 2015; 94:e1764. [PMID: 26469916 PMCID: PMC4616794 DOI: 10.1097/md.0000000000001764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The regrowth of amputated digit tips represents a unique regenerative healing in mammals with subcutaneous volume regrowth, restoration of dactylogram, and suppression of scar formation. Although factor analysis in amphibians and even in mice is easy to obtain, safety of harvesting biomaterial from human digit tip amputations for analysis has not yet been described.The aim of this study was to evaluate if recovering wound exudate does hamper clinical outcome or influence microbiologic or inflammation status.A predefined cohort of 18 patients with fresh digit tip amputations was randomly assigned to receive standard therapy (debridement, occlusive dressing) with (n = 9) or without (n = 9) collection of the whole wound exudate in every dressing change. Primary endpoint (lengthening) and secondary endpoints (regeneration of dactylogram, nail bed and bone healing, time to complete wound closure, scar formation, 2-point discrimination, microbiologic analysis, inflammatory factors interleukin (IL)-1α, tumor necrosis factor-α, IL-4, and IL-6) were determined by an independent, blinded observer.Patients' characteristics showed no significant differences between the groups. All patients completed the study to the end of 3 months follow-up. Exudate collection did not influence primary and secondary endpoints. Furthermore, positive microbiologic findings as well as pus- and necrosis-like appearance neither impaired tissue restoration nor influenced inflammatory factor release.Here, the authors developed an easy and safe protocol for harvesting wound exudate from human digit tip amputations. For the first time, it was shown that harvesting does not impair regenerative healing. Using this method, further studies can be conducted to analyze regeneration associated factors in the human digit tip.DRKS.de Identifier: DRKS00006882 (UTN: U1111-1166-5723).
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Affiliation(s)
- Tobias Kisch
- From the Department of Plastic Surgery and Hand Surgery, University Hospital Schleswig-Holstein Campus Lübeck, University of Lübeck (TK, EL, MG, DM, FS, PM); Fraunhofer Research Institution for Marine Biotechnology EMB (JMK, KH, MB); and Department of Surgery, Section for Translational Surgical Oncology and Biobanking, University Hospital Schleswig-Holstein Campus Lübeck, University of Lübeck, Lübeck, Germany (JH)
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Kisch T, Liodaki E, Kraemer R, Mailaender P, Brandenburger M, Hellwig V, Stang FH. Electrocautery Devices With Feedback Mode and Teflon-Coated Blades Create Less Surgical Smoke for a Quality Improvement in the Operating Theater. Medicine (Baltimore) 2015; 94:e1104. [PMID: 26166102 PMCID: PMC4504583 DOI: 10.1097/md.0000000000001104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Monopolar electrocautery is a fast and elegant cutting option. However, as it creates surgical smoke containing polycyclic aromatic hydrocarbons (PAHs), it may be hazardous to the health of the surgical team. Although new technologies, such as feedback mode (FM) and Teflon-coated blades (TBs), reduce tissue damage, their impact on surgical smoke creation has not yet been elucidated. Therefore, we analyzed the plume at its source.The aim of this study was to evaluate if electrocautery FM and TBs create less surgical smoke.Porcine tissue containing skin was cut in a standardized manner using sharp-edged Teflon-coated blades (SETBs), normal-shaped TBs, or stainless steel blades (SSBs). Experiments were performed using FM and pure-cut mode. Surgical smoke was sucked through filters or adsorption tubes. Subsequently, filters were scanned and analyzed using a spectrophotometer. A high-performance liquid chromatography (HPLC-UV) was performed to detect benzo[a]pyrene (BaP) and phenanthrene as 2 of the most critical PAHs. Temperature changes at the cutting site were measured by an infrared thermometer.In FM, more surgical smoke was created using SSB compared with TBs (P < 0.001). Furthermore, differences between FM and pure-cut mode were found for SSB and TB (P < 0.001), but not for SETB (P = 0.911). Photometric analysis revealed differences in the peak heights of the PAH spectrum. In HLPC-UV, the amount of BaP and phenanthrene detected was lower for TB compared with SSB. Tissue temperature variations increased when SSB was used in FM and pure-cut mode. Furthermore, different modes revealed higher temperature variations with the use of SETB (P = 0.004) and TB (P = 0.005) during cutting, but not SSB (P = 0.789).We found that the use of both TBs and FM was associated with reduced amounts of surgical smoke created during cutting. Thus, the surgical team may benefit from the adoption of such new technologies, which could contribute to the primary prevention of smoke-related diseases.
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Affiliation(s)
- Tobias Kisch
- From the Department of Plastic Surgery and Hand Surgery (TK, EL, RK, PM, FHS), University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck; Fraunhofer Research Institution for Marine Biotechnology EMB (MB); and Analytical Chemistry and Instrumental Analysis (VH), University of Applied Sciences, Lübeck, Germany
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Liodaki E, Kalousis K, Mauss K, Kisch T, Mailaender P, Stang F. Epidemiology of pneumonia in a burn care unit: the influence of inhalation trauma on pneumonia and of pneumonia on burn mortality. Ann Burns Fire Disasters 2015; 28:128-133. [PMID: 27252611 PMCID: PMC4837489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 03/04/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study is to determine the epidemiological characteristics of burn patients developing pneumonia, as well as the predisposing factors and the mortality of these patients. Infectious complications present serious problems in severely burned patients. Pneumonia, in particular, is a major cause of morbidity and mortality in burn patients. Patients with inhalation injuries are exposed to a greater risk due to the possible development of infectious complications in the lower respiratory tract. During their stay in our Burn Care Unit, 22.9% of our burn patients developed pneumonia and 10.9 % of these patients died. Risk factors for the development of pneumonia in burn patients were found to be inhalation trauma, high ABSI score, the Baux and modified Baux index, and high ASA score (p<0.01). Age and gender showed no significant correlation to the incidence of pneumonia. In this study we were able to determine the incidence of pneumonia in burn patients, their mortality and the strong correlation of the presence of inhalation injury with the development of pneumonia.
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Affiliation(s)
- E. Liodaki
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - K. Kalousis
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - K.L. Mauss
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - T. Kisch
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - P. Mailaender
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - F. Stang
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Mehnert JM, Kisch T, Brandenburger M. Co-Culture Systems of Human Sweat Gland Derived Stem Cells and Peripheral Nerve Cells: Anin VitroApproach for Peripheral Nerve Regeneration. Cell Physiol Biochem 2014; 34:1027-37. [DOI: 10.1159/000366318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
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