Zentralblatt fur Chirurgie最新文献

{"title":"[Reconstruction of Perineal and Pelvic Defects: the Inferior Epigastric Artery (DIEA) as a Recipient Vessel for Free Flap Reconstruction].","authors":"Wolfram Demmer, Nicholas Möllhoff, Felix Hubertus Vollbach, Nikolaus Wachtel, Tim Nürnberger, Sinan Mert, Benedikt Fuchs, Constanze Kuhlmann, Denis Ehrl, Riccardo Giunta","doi":"10.1055/a-2684-3365","DOIUrl":"https://doi.org/10.1055/a-2684-3365","url":null,"abstract":"<p><p>Extensive defects in the perineal or anterior/lateral pelvic region can occur as a result of tumour-related resections, infections, or postoperative complications. In cases where local or pedicled flap reconstructions are insufficient, microsurgical reconstruction using free flaps becomes necessary. Due to its location and calibre, the inferior epigastric artery (DIEA) is a suitable recipient vessel for microsurgical tissue transfer.In a retrospective case study conducted between June 2024 and March 2025, patients with perineal or pelvic defects underwent microsurgical reconstruction. Defect coverage was achieved using free flap techniques (musculocutaneous vastus lateralis [MVL], musculocutaneous latissimus dorsi [LD] and parascapular flaps) with end-to-end anastomosis to the DIEA. Preoperative planning included CT angiography to assess the vascular situation. Microsurgical anastomoses were performed in a standardised manner, with arterial anastomoses hand-sewn and venous anastomoses carried out using venous couplers. The perfusion of the anastomoses and the flap was assessed using ICG fluorescence. Postoperative care included structured offloading and mobilisation.During the study period, five patients (average age 64.6 years, ASA score 2.8) with perineal or pelvic defects averaging 413.4 cm² were treated. The underlying causes were tumours (3) and extensive infections (2). The DIEA was successfully used as a reliable recipient vessel in all cases. Venous anastomoses were performed using venous couplers with an average diameter of 2.5 mm (range: 2-3 mm). No flap losses or necroses occurred.The results confirm the suitability of the DIEA as a consistent, superficial, and easily dissectible recipient vessel with stable calibre and sufficient flow, even for large flaps. It enables safe microsurgical reconstructions in the anterior and lateral pelvic region and represents a valid alternative to the femoral artery, without compromising extremity perfusion. The study highlights the significant role of the DIEA in plastic and reconstructive surgery of complex pelvic and perineal defects.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Free Microvascular Lymph Node Transplantation from the Omentum for the Treatment of Lymphoedema].","authors":"Benedikt Fuchs, Sinan Mert, Tim Nürnberger, Petra Zimmermann, Irene Mesas Aranda, Riccardo Giunta, Paul S Wiggenhauser","doi":"10.1055/a-2690-6258","DOIUrl":"https://doi.org/10.1055/a-2690-6258","url":null,"abstract":"<p><p>Lymphoedema is a chronic, progressive condition that may occur as a primary disorder or secondarily following lymphatic damage, such as after lymphadenectomy or radiotherapy. Conservative therapies often provide only limited relief, so that surgical approaches like vascularised omental lymph node transfer (VOLT) are increasingly relevant.We present two cases of advanced secondary lower-limb lymphoedema following lymphadenectomy. Both patients demonstrated severe lymphatic transport dysfunction on lymphoscintigraphy and MRI. A double microsurgical lymph node transfer using VOLT was performed in each case. The omentum, selected for its high lymph node density and lymphangiogenic potential, was divided intraoperatively to reconstruct both the groin and lower leg regions. In addition, a systematic literature review on omental lymph node transfer for lymphoedema was conducted using PubMed.In both cases, postoperative assessment confirmed adequate perfusion of the grafts and clinical improvement of lymphoedema symptoms. The literature review revealed consistent evidence of significant limb volume reduction, improved lymphatic drainage, and a marked decrease in the incidence of cellulitis following VOLT.VOLT is an effective surgical option for therapy-refractory lymphoedema and may substantially improve patient quality of life. Despite promising results, further standardised prospective long-term studies are required to validate its efficacy and safety.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Notice: Kolloidhaltige hypertone Lösungen in der Kardiochirurgie.","authors":"","doi":"10.1055/a-2663-2262","DOIUrl":"https://doi.org/10.1055/a-2663-2262","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 5","pages":"405"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bundesgerichtshof zur adäquaten Patientenaufklärung: Ohne Aufklärungsgespräch geht es nicht – Aufklärungsbögen richtig einsetzen.","authors":"Silke Peetz, Albrecht Wienke, Rolf-Werner Bock","doi":"10.1055/a-2661-8789","DOIUrl":"https://doi.org/10.1055/a-2661-8789","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 5","pages":"397-398"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lesion Preparation in Peripheral Arteries - Fact or Fashion?]","authors":"Grigorios Korosoglou, Michael Lichtenberg, Christian A Behrendt, Andrej Schmidt, Ralf Langhoff, Christos Rammos, Erwin Blessing, Dittmar Böckler, Thomas Zeller","doi":"10.1055/a-2540-3349","DOIUrl":"10.1055/a-2540-3349","url":null,"abstract":"<p><p>Peripheral arterial disease (PAD) is mostly caused by stenotic atherosclerotic lesions of lower limb arteries. Intermittent claudication is the most common manifestation, while, in more advanced stages of the disease, chronic limb-threatening ischemia (CLTI) occurs. Optimal medical therapy is an essential cornerstone in all stages of PAD, while endovascular and open surgical revascularisation are of great importance - depending on the patient and lesion characteristics and can be used in a complementary manner. In patients with claudication, the improvement in the pain-free walking distance is the primary therapeutic goal, while, in patients with CLTI, amputation-free survival is most important. In both patient groups, there is a need for strict control of cardiovascular risk factors, including blood pressure and diabetes control, nicotine abstinence and reduction in cholesterol levels using intensive statin therapy, in accordance with national and international guidelines. Endovascular treatment of PAD is used widely and by various specialist disciplines. However, conventional endovascular therapy procedures have limitations in complex and heavily calcified lesions, so that, for example, classic balloon angioplasty in such lesions is associated with \"recoil\" and/or severe dissections, which usually require the placement of permanent metallic implants. Lesion preparation procedures, such as atherectomy and intravascular lithotripsy (IVL) can improve compliance of calcified arteries, by either creating microfractures at calcified sites or removing calcified material. In this way, balloon angioplasty can be performed with less barotrauma and the need for stent implantation can be reduced, while subsequent treatment with drug-coated balloons (DCB) is associated with potentially improved penetration of the drug into the vessel wall, and thus increases the effectiveness of the procedure by enhancing anti-restenotic effects. In this manuscript, the potential - but also the limitations - of different lesion preparation strategies are presented and discussed.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"408-419"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pancreatic Surgery in Childhood and Adolescence].","authors":"Maximilian Brunner, Sonja Diez, Julia Syed, Christian Krautz, Robert Grützmann","doi":"10.1055/a-2673-6274","DOIUrl":"https://doi.org/10.1055/a-2673-6274","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 5","pages":"401-405"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethische Herausforderungen durch KI in der Chirurgie.","authors":"André Schulze, Johanna Brandenburg, Rayan Younis, Marius Distler, Stefanie Speidel, Jürgen Weitz, Martin Wagner","doi":"10.1055/a-2652-7696","DOIUrl":"https://doi.org/10.1055/a-2652-7696","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 5","pages":"389-392"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[3D-Printed Templates for Physician Modified Endografts - Current Concepts and New Workflows].","authors":"Sabrina Frenzel, Jan Stana, Christian Hagl, Linda Grefen, Nikolaos Tsilimparis, Maximilian Grab","doi":"10.1055/a-2577-5181","DOIUrl":"10.1055/a-2577-5181","url":null,"abstract":"<p><p>Fenestrated or branded prostheses are used to treat complex abdominal aortic aneurysms. In urgent cases, \"Physician-modified endografts\" (PMEG) are used when delivery times for customised prostheses are long. In this technique, the distances between the fenestrations are measured on the patient's computer tomography data set, manually transferred to the three-dimensional surface of the prosthesis by the surgeon and the fenestrations are cut into the endoprosthesis accordingly. This process is highly dependent on the surgeon's experience. This paper provides an overview of current modification processes and presents a new, simplified workflow to produce a template for modification within 12 hours of receiving the CT data set.Preoperative CT data sets served as the basis for the development of the patient-specific templates. The three-dimensional, individualised templates were to be additively manufactured using a transparent material and placed over the standard tubular prostheses. Due to the transparency of the material and the possibility of rotating the prosthesis within the template, the optimal position of the fenestrations on the prosthesis was to be found independently of experience.Patient-specific templates for modifying prostheses were developed and additively manufactured using CT data (n = 22). For each template design, the segmentation, design and additive manufacturing process could be completed within 12 hours in a standardised manufacturing process. Material transparency, template design and easy handling of the templates permitted the positioning of the fenestrations regardless of experience. Low-resolution CT data sets, extreme curvatures or angles of the aorta were considered exclusion criteria.The patient-specific templates could be created within 12 hours using a standardised procedure with a simple development process. The transparent templates are a further step towards patient-specific medicine.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"437-445"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Malignant Tumours of the Aorta].","authors":"Steffen Wolk, Christian Reeps","doi":"10.1055/a-2590-1736","DOIUrl":"10.1055/a-2590-1736","url":null,"abstract":"<p><p>Aortic malignancies are rare diseases, of which only about 200 cases have been described in the literature. Most common forms are high-grade sarcomas, in over 80% of patients, which predominantly grow intimately and which can occur at any location in the aorta. In addition to non-specific symptoms, such as fever, hypertension and general weakness, aortic sarcomas in one third of patients manifest as peripheral embolism or, in the case of mural sarcoma, as an aneurysm or aortic rupture. In diagnostic testing, MRI is considered the gold standard, as CT angiography or PET CT can only show non-specific signs. Since aortic malignancies often manifest themselves as other diseases, diagnosis and therapy are often delayed. In therapy, the focus is on radial tumour resection with aortic replacement, possibly followed by adjuvant medical therapy. The 1-, 3- and 5-year survival rates are 26%, 7.6% and 3.5%, respectively.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"432-436"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"Ralph Ingo Rückert","doi":"10.1055/a-2536-6712","DOIUrl":"https://doi.org/10.1055/a-2536-6712","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 5","pages":"406-407"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}