JournalTOCs

European Surgery

[3 followers] Follow
Full-text available via subscription

Subscription journal
ISSN (Print) 1682-4016 - ISSN (Online) 1682-8631
Published by Springer-Verlag

[2216 journals]

First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer
- Abstract: Summary Background Deep excision down to the muscle fascia and split-thickness skin grafting is a necessary part in modern surgical care of adult burn patients presenting with full-thickness wounds. We evaluated a new surgical approach combining a dermal matrix, autologous fat-transfer, and split-thickness skin grafting. Methods Full thickness burn wounds of five consecutive patients were excised down to the muscle fascia. Parts of the excised adipose tissues were harvested for in vitro analysis of preadipocyte viability and its potential for proliferation and differentiation. The excised fatty tissue was manually harvested by use of a Coleman Liposuction needle mounted on 10 ml syringes, and spread onto a bovine collagen-elastin scaffold (Matriderm®). The sheet was put upside down onto the wound and covered with split-thickness grafts during the same operation. Skin biopsies for histological evaluation were taken on days 30 and 90 postoperatively. Results Preadipocytes from excised burn wounds showed cell behavior comparable to healthy fat tissue. FACS Analysis showed 75 % viable cells in the samples which is comparable to healthy fat tissue. Three patients showed more than 90 % vital split thickness skin grafts 10 days after surgery. All skin biopsies confirmed the presence of adipose tissue. Conclusions Autologous fat-transfer in combination with a dermal substitute and split-thickness skin grafts seems to be a possible reconstructive procedure for covering defects after deep excision down to the fascia in a single step approach.
  PubDate: 2013-05-08
54th Annual Meeting Of the Austrian Society of Surgery
- PubDate: 2013-05-01
Applications of tissue engineering in modern laryngology 
- Abstract: Summary Background Tissue Engineering is a multidimensional approach that aims to produce a structure similar to target tissue. Main targets in laryngeal tissue engineering (TE) are chronic vocal fold scars and vocal fold atrophy which occurs in elderly patients. The main obstacle for restoration is the highly complex architecture of the human vocal fold. Deterioration of its micro-architecture leads to altered vibration characteristics that have deleterious effects on voice quality, causing hoarseness (dysphonia). The aim of this study is to give an actual clinical and experimental overview of this field as well as to further elucidate promising new findings and trends. Methods We performed a PubMed survey on articles relevant to this field. Results Fifty relevant articles were included that reflect the latest advances with growth factors, cell therapy and scaffold engineering, as well the first applications in humans. Cell therapy, using somatic or stem cells, remains highly promising; however, there is a lack of applications in humans due to safety concerns. Different types of scaffolds have been investigated and atelocollagen sheets were already implanted in human vocal folds. Many trials used a combined approach of cell therapy, scaffolds, and different growth factors. Conclusions Experiments and trials in laryngeal tissue engineering have emerged over the last decades and clinical use is near. Within this review, we discuss the latest developments to encourage further research on this fascinating topic. Similar to other fields, a close cooperation between different professions such as physicians, bioengineers, as well as industrial partners is required to succeed in laryngeal TE.
  PubDate: 2013-05-01
Minimally invasive right pneumonectomy: case report
- Abstract: Summary Background Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early-stage lung cancer (Scott et al. Chest 132:234–42, 2007). Since 2009, we have used a VATS approach for all early-stage lung tumors as well as benign indications for lung lobectomy. (Bodner et al. Eur Surg 43:224–8, 2011) As experience with the technique is growing, indications are expanded. Here, we report our first right-sided minimally invasive pneumonectomy. Patient and methods A 60-year-old man was diagnosed with a centrally located tumor in the right lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Written informed consent was given. Results The operation was completed using three incisions. A complete mediastinal lymph node dissection was performed. The azygos vein was used for securing of the bronchial stump. For specimen removal, the inferior incision was enlarged to 8 cm. Total operative time was 199 min. Estimated blood loss was less than 100 ml. The patient was extubated in the operating room. The postoperative course was uneventful: chest drain was removed on postoperative day 3; the patient was off pain medication on postoperative day 5, and was discharged on postoperative day 7. Pathologic work-up showed a squamous cell lung cancer invading all lobes with invasion of the right main bronchus. No infiltration was found in the lymph nodes removed (39 lymph nodes in total). Conclusion Parenchyma sparing procedures are the preferred type of procedure whenever possible. However, VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive lung lobectomy with less pain and fast rehabilitation. To facilitate specimen retrieval, the inferior incision should be enlarged because of larger intercostal spaces in this area.
  PubDate: 2013-04-19
Approach to the upper body after massive weight loss
- Abstract: Summary Background Upper and lower body lifts are key concepts in re-shaping the body after massive weight loss. Because of their mutual interaction, the whole body should be examined and evaluated before any contouring operation. Upper body contouring covers the arms, thoracic flanks, male or female breast and back. Method Before the operation, the excess tissue is determined by pinching and then marking the skin. These lines are supplemented by perpendicular orientation lines to help the surgeon to recognise corresponding wound edges and join them after resection of the skin. As the skin excess on the upper arms is often overestimated, the actual resection line is usually well within the line determined by the pinch test. After the fatty tissue is suctioned off, the deep subcutaneous layer is left undisturbed to protect lymphatic vessels and the nerves, and the excess skin is removed from the superficial subcutaneous layer. On the lateral thoracic wall, the skin is firmed up from the back and upper abdomen to the breast fold. The latter must be secured topographically in its typical position with sutures to the ribs, rib periosteum or fascia so that the breast is not skewed. Contouring operations on the breast always require pre-operative imaging studies. Besides breast lift and reduction, breast enlargement to correct involution is not uncommon. Pedicled, de-epithelialized subcutaneous flaps from the thoracic flank and upper abdomen are more suitable than implants. If needed, breast volume may be further enhanced with secondary lipofilling. Result The combination of a thoracic flank and lower body lift usually avoids separate lifts and scars on the back. If necessary, however, any folds or bulges are removed from their base after liposuction. Conclusion The optical result correlates directly with the body mass index at the time of surgery. As almost all the patients are above the BMI norms, there are limits to what can be expected. The majority of the patients under consideration here considered the optical result of the upper body lift to be good to very good and were well satisfied.
  PubDate: 2013-04-19
Concentrated sugar belongs to the museum
- PubDate: 2013-04-18
Tissue engineering in thoracic surgery
- Abstract: Summary Background Adequate reconstruction after extensive resection of the trachea, the chest wall, or the diaphragm represents a considerable challenge for the confronted thoracic surgeon. Therefore, different materials and surgical techniques have been tested; the results were not always satisfying. Increasing evidence exists that tissue engineering can be used to replace damaged tissues and organs such as the trachea, the lungs, the chest wall, and the diaphragm. Methods This review focuses on the current progress in tissue engineering in general thoracic surgery, illustrating the existing options in particular for tracheal reconstruction. Furthermore, a detailed overview concerning the different options of tissue engineering in the replacement of the lung, the chest cavity, the diaphragm, and the chest wall is given. Results Considerable progress could be yielded in the development of a tissue-engineered tracheal graft, where the step from the animal model into the clinical application in the human patient was feasible. Regarding tissue engineering of the chest wall, the diaphragm, and the chest cavity encouraging preliminary results were obtained in the preclinical testing. However, the step into the clinical application could not be reached up till now. Conclusions Tissue engineering seems to represent an appropriate future option for reconstruction after extensive resection of the trachea, the chest wall, or the diaphragm. Although tissue engineering is still not reality and therefore far away from daily clinical routine, further studies are definitely warranted enabling continuous improvements as soon as possible, particularly in thoracic surgery.
  PubDate: 2013-04-18
The epidemiology of obesity
- Abstract: Summary Background Worldwide, the prevalence of obesity has tripled since 1980. This article gives an overview on the current status of the prevalence of obesity and overweight as well as on the impact of obesity on bariatric surgery and body-contouring surgery. Methods Review of the latest data on obesity from different health organizations and international governments. Results By 2015, approximately 2.3 billion adults will be overweight including more than 700 million obese. There are wide variations in the prevalence of obesity throughout the world. Obesity already accounts for up to 7 % of health care costs. The demand for bariatric surgery and body-contouring surgery after massive weight loss is expected to rise. Conclusions Obesity is a problem of epidemic proportions and is also rising in low- and middle-income countries.
  PubDate: 2013-04-16
When to repair ischemic mitral valve regurgitation' An algorithmic approach
- Abstract: Summary Background Despite huge progress in the surgical management of ischemic mitral regurgitation, there is still controversy regarding the ideal treatment option. Aims Our study aimed to define an algorithmic approach in order to select those patients who will benefit the most from concomitant mitral valve procedure. Methods Patients with mitral regurgitation (MR) who met the inclusion criteria were included in our study. Patients with structural MR including ruptured chordae or papillary muscle, abnormal leaflet thickening, annular calcification, or other valvular or congenital heart diseases, ventricular aneurysms and those who were candidates for other surgical procedures were excluded. A total of 350 patients (about 12 %) were classified as having ischemic mitral regurgitation (IMR) and were enrolled in our analysis. All the patients underwent coronary artery bypass grafting and by the designed algorithmic approach were also decided to have additive procedures for their concomitant IMR. Results Six months survival was 91.5 % among all the patients in this study. During the follow-ups 86.9 % of the patients survived . Overall mortality rate was 13.1 % (n = 46), of which 7.1 % (n = 25) occurred due to cardiac and 6 % (n = 21) as a result of a non-cardiac cause. Conclusion Individualising methods to select patients suffering from IMR for concomitant mitral valve procedure and coronary artery bypass grafting (CABG) seems to serves more effectively by reducing unnecessary surgeries and at the same time not missing absolute indications for concomitant valve repairs. Our algorithm showed a promising efficacy to effectively select patients for CABG and concomitant mitral valve procedures.
  PubDate: 2013-04-16
Surgery spring sounds: topic justifies
- PubDate: 2013-04-13
Selected commentary to “Esophageal sphincter device for gastroesophageal reflux disease”
- PubDate: 2013-04-09
Examining and choosing patients for body contouring after massive weight loss
- Abstract: Summary Background In the past decade, overweight and morbid obesity in Europe have come to be nearly as common as in the United States. Fifty percent of the Austrian population is overweight, and nearly a quarter of that number is morbidly obese. In Germany and Austria, 8 % of children are morbidly obese. The costs for the treatment of this new epidemic and its consequences put considerable strain on health budgets that are already stretched to the limit. Hence, the main emphasis is on the treatment of those who are already ill, and on prevention. Treatment of obesity is a long-term proposition. The many comorbidities can be improved by weight reduction, whereby plastic surgery also plays a role. Bariatric surgery is the surgical option of treatment. But when that works, deformity due to obesity is replaced by disfiguring flaccid skin after weight loss. Body contouring with plastic surgery is the only way to correct this problem. Methods Plastic surgery after massive weight loss must be planned on an individual basis. Preferably, even before a weight-reduction regime has begun, is the best time to discuss with the patient the corrections and total body concept. This will improve emotional stability, patient satisfaction, and has a positive effect on social reintegration at the end of treatment. Results Full-body contouring will usually require two or more very time consuming operations. The result correlates directly with initial body mass index. Complications are frequent but can often be managed with conservative measures. Many of them are a matter of shape. Patients should be made aware of possible corrections in advance. Complications after surgery are much more frequent with a BMI above 35. Conclusions The plastic surgeon concludes the weight-reduction program by removing the last traces of the original obesity.
  PubDate: 2013-04-09
For how many times can a partially absorbable monofilament mesh be sterilized' In vitro experimental study
- Abstract: Summary Background We investigated the effects of hydrogen peroxide gas plasma resterilization (HPS) on partially absorbable monofilament meshes in terms of their mechanical properties and risk of infection. Methods A mesh was divided into small pieces which were categorized as HPS-1, HPS-2 and HPS-3 according to the number of HPS. To assess the strength of specimens, maximum load, elongation at maximum load and quantity of energy required for complete failure of the specimens were measured. Microbiological and ultrastructural analyses were also performed. Results There was not a significant relationship between control and HPS-1, HPS-2 groups in terms of maximum load and quantity of energy required for complete failure of the specimens. However, those parameters were statistically different between HPS-3 and control groups. We observed minor morphological changes in the HPS-3 group when compared to those of the control group. No risk of infection was detected by microbiological tests. Conclusion It is advisable to apply HPS to partially absorbable monofilament meshes no more than twice since sterilization for three times leads to degeneration in mesh structure and strength.
  PubDate: 2013-04-01
Clinico-pathological findings in stage-I primary spontaneous pneumothorax: analysis of 19 cases and literature review
- Abstract: Summary Background Some patients suffering from spontaneous primary pneumothorax have a normal appearing lung during video-assisted thoracic surgery (VATS; stage I). There is a paucity of data on microscopic appearances of lung biopsies in patients with stage I pneumothorax. Objectives This prospective study aims to test the hypothesis that there is no histologically normal lung tissue in patients suffering from stage-I primary spontaneous pneumothorax. Methods Apical VATS lung wedge resection was prospectively performed in patients with stage-I primary spontaneous pneumothorax. All specimens were sent for pathologic examination. The data recorded included age, sex, smoking history, tension pneumothorax, indications for surgery and hospital stay. A thorough literature review was also performed. Results Nineteen patients were operated on. Thirteen male and six female, mean age of 30 years. Twelve (63 %) patients were current smokers. Eleven patients had recurrent pneumothorax. Wedge lung biopsies were taken from the apex of the right upper lobe in 13 and the left upper lobe in six. One patient had a recurrent pneumothorax within 1 month. Pathologic examination demonstrated in all patients’ dilatation and destruction of the alveolar walls distal to the terminal bronchiole; fibrosis of the parenchymal septae; cystic dilatation of the airspaces and thickening of the visceral pleura. Literature review showed alteration of lung parenchyma with a striking variability. Conclusions This study confirms that no normal apical lung parenchyma exists in patients with stage-I primary spontaneous pneumothorax. In the era of evidence-based medicine, wedge apical lung biopsy is, therefore, desirable to obtain a histological cause in patients with stage-I primary spontaneous pneumothorax.
  PubDate: 2013-04-01
Complications in body-contouring procedures with special regard to massive weight loss patients: personal observations
- Abstract: Summary Background With the increasing rate of obese people, the number of patients who again loose massive weight correlates. These patients suffer from their extensive excess of skin and seek for body-contouring surgery. The most common plastic surgical procedures after massive weight loss are abdominoplasties and lower body lifts. Methods In our retrospective review from 2000 to 2010, we present data on patient demographics, operative procedures, early-somatic and late-formal complications, and revision surgeries. Results Somatic complications occurred in 45 abdominoplasty patients (18 %), surgical revision was necessary in 16 of these patients (7 %). In the lower body lift group, 14 patients (29 %) suffered from somatic complications and 8 (16 %) of them needed revision surgery. Deforming late complications were seen in 25 (10 %) of the abdominoplasty patients and in 1 (2 %) of the lower body lift patients. Revision surgery for formal complications was performed in 21 of the abdominoplasty patients (9 %) and in the 1 lower body lift patient. Sixty-eight additional body-contouring procedures were performed in the abdominoplasty group, 13 in the lower body lift group. Conclusions With the increasing number of massive weight loss patients, the need for body-contouring surgeries ascends. The larger amount of excess skin in these patients requires adapted operation methods. Therefore, lower body lift procedures are nowadays performed more often in relation to abdominoplasties alone. With the expansion of surgical treatment the rate of complications rise.
  PubDate: 2013-04-01
Long-term survival after hand-assisted laparoscopic approach of primary retroperitoneal mucinous cystadenocarcinoma in male: case report and review of literature
- Abstract: Summary Background Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is a rare disease and mostly occurs in females, and there are only three male cases described in the literatures without long-term follow-up. Case report A 59-year-old male presented with a left retroperitoneal cystic mass (7.5 ´ 7 ´ 3 cm) that upwardly displaced the left kidney and caused abdominal discomfort. The tumor was totally excised by the hand-assisted laparoscopic method without complications or recurrence in a follow-up period of 79 months. The etiology from coelomic metaplasia of peritoneal epithelium was proved by a spectrum of diverse cells (benign, borderline malignant, and malignant cells) during pathological examination. Results This is the fourth male case of PRMC in the world with a favorable outcome after hand-assisted laparoscopic excision, and this is also distinct by the longest follow-up period in this disease entity. Conclusions Because of its low-malignant potential and recurrence rate, surgical excision is still the best choice of treatment, but the least invasion method should be adopted in front.
  PubDate: 2013-04-01
8th International Congress of the European Federation for Colorectal Cancer (EFR)
- PubDate: 2013-04-01
Impact of resection techniques on postoperative lung function parameters in pulmonary metastasectomy
- Abstract: Summary Background Pulmonary metastasectomy with curative intent is nowadays a common practice in thoracic surgery. The impact of metastasectomy on respiratory function has become a relevant factor in the treatment algorithm of these patients. However, no sufficient data on the loss of lung function following pulmonary metastasectomy is available to date. Methods A prospective single center study was designed to determine changes in lung function parameters in patients undergoing metastasectomy. Forty-five consecutive patients were included in the study. In 19 patients, metastases were removed by enucleation (laser = 10; electrocautery = 9), in 19 patients by wedge resection, and 7 patients received a lobectomy in order to achieve clear resection margins. Lung function testing was obtained from all patients preoperatively and 3 months after hospital discharge. Results A significant decrease in FEV1 and VC was found when comparing enucleation/wedge/lobectomy patients (FEV1: 3.4 ± 0.7, 7.6 ± 1.5, 14.2 ± 3.0; VC: 2.4 ± 1.6, 4.7 ± 1.6, 16.9 ± 2.9; respectively). However, no differences were found regarding the loss of FEV1 per resected nodule between laser and electrocautery enucleations. These findings were confirmed by a volumetric analysis of the resected tissue and did not correlate with size of metastases as determined by preoperative CT evaluations. Conclusions The surgical resection of pulmonary metastases is associated with a detectable but mild loss of lung function. Lung parenchyma sparing resection methods—e.g. electrocautery or laser enucleations—should be preferred over less tissue-sparing techniques.
  PubDate: 2013-03-28
Editorial
- PubDate: 2013-03-19
Approach to the lower body after massive weight loss: the Innsbruck experience with abdomino-torso and thigh-contouring after massive weight loss
- Abstract: Summary Background The number of patients requiring post-bariatric body-contouring after massive weight loss (MWL) is steadily increasing. The management of this demanding clientele of patients is challenging and requires a structured approach. The aim of this article is to provide a detailed overview of the contouring approach to the lower body after MWL practiced at Innsbruck Medical University, Department of Plastic, Reconstructive and Aesthetic Surgery, along with an analysis of the procedures over a 10-year period. Special attention is given to the surgical challenges, such as patients presenting with pre-existing scars in the upper abdomen. Methods A detailed overview of the patient selection as well as the patient evaluation process requiring abdominal, trunk, and thigh-contouring is outlined. The anatomic basis for abdominal and thigh-contouring is depicted along with a detailed depiction of the relevant procedures for abdominal and thigh-contouring, both in presence and without pre-existing scars. Furthermore, an analysis of the patients treated at Innsbruck Medical University for lower body-contouring between January 2002 and June 2012 with respect to selected patient demographics and epidemiology of procedures is performed. Results The key to satisfactory results is a thorough analysis of the horizontal and vertical skin and fat excess of the abdomino-torso, buttock and flank areas as well as the thigh areas and choosing an adequate and safe procedure addressing the respective areas of skin and fat excess. Special attention must be given to the distribution and position of pre-existing scars. Within the 10.5-year period, a total of 624 abdominal-contouring and 46 medial thigh-contouring procedures were performed. In 41 cases, tailored techniques were applied paying attention to pre-existing scars. The majority of patients were female (91 %). The average patient age equaled 40.6 years. Conclusions A structured approach, analyzing the distribution and composition fat and skin excess in the respective body areas allows for functional, aesthetic and safe and lower body-contouring.
  PubDate: 2013-02-01