Zentralblatt fur Chirurgie最新文献

{"title":"[Free Flap Reconstruction of Gluteal Defects].","authors":"Denis Ehrl, Konrad Karcz, Moritz Billner, Maximilian Stumpfe, Celena Soergel, Philipp von Imhoff, Vadym Burchak","doi":"10.1055/a-2615-6463","DOIUrl":"https://doi.org/10.1055/a-2615-6463","url":null,"abstract":"<p><p>Large and bulky soft tissue defects in the gluteal, perineal and sacral regions are a reconstructive challenge, especially if suitable local flaps are not available. In such cases, a free flap may be necessary, the choice of which depends on the size and depth of the defect and the available recipient vessels.In this study, different options for defect coverage in this area are analysed and evaluated. Particular attention is paid to the choice of recipient vessel, flap and surgical planning.Free flap is an effective and safe method for the reconstruction of large soft tissue defects in the gluteal, perineal and sacral regions. The superior and inferior gluteal arteries are the preferred recipient vessels, but arteriovenous (AV) loops can serve as alternatives when primary vessels are not available. While the latissimus dorsi flap is particularly suitable for flat defects, the vastus lateralis flap offers advantages for deep or voluminous defects, due to its volume.Microsurgical reconstruction of these defects requires individual planning, depending on patient factors, defect morphology and vascular conditions. The choice of the appropriate flap and careful selection of the recipient vessel are decisive for the reconstructive success of this complex procedure.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699707","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":"[Plastic Surgical Management and Clinical Practice-based Algorithm for Coverage of Inguinal Defects after Vascular Prosthesis Infection].","authors":"Irene Mesas Aranda, Konstantin Koban, Sinan Mert, Benedikt Fuchs, Riccardo Giunta, Severin Wiggenhauser","doi":"10.1055/a-2636-2641","DOIUrl":"https://doi.org/10.1055/a-2636-2641","url":null,"abstract":"<p><p>Infections involving vascular prostheses in the groin region are a major surgical challenge, associated with substantial morbidity and mortality rates. The complex anatomical structures and high density of bacterial colonisation considerably complicate their surgical management. Consequently, reconstructive therapy demands individualised and interdisciplinary strategies to achieve optimal outcomes.A systematic search was conducted using PubMed and the Cochrane Library to collect and evaluate current evidence and recommendations regarding the reconstructive management of infected vascular prostheses. The developed algorithm incorporated essential factors, such as defect size, infection severity, and patient-specific characteristics to guide therapeutic decision making.Pedicled flap techniques, particularly those employing the M. sartorius or M. gracilis, are rapid and reliable reconstructive solutions - due to their robust vascular supply. In cases of larger defects, the transverse myocutaneous gracilis (TMG), Rectus femoris, and anterolateral thigh (ALT) flaps proved to be suitable alternatives. Prophylactic use of pedicled flaps was associated with a reduction in postoperative complications, particularly in high-risk patientsThe surgical management of deep groin infection requires meticulous individualised and interdisciplinary planning and plastic reconstructive experience. The proposed algorithm provides a structured and evidence-based framework to improve healing rates and minimise the risk of complications.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683250","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":"[The Reconstruction of Complex Thoracic Defects with Free Flaps and the Choice of the Appropriate Recipient Vessel].","authors":"Florian Falkner, Rebecca Luisa Schäfer, Simon Mayer, Nicolas Ewerbeck, Riccardo Giunta, Denis Ehrl, Nicholas Möllhoff, Wolfram Demmer, Vanessa Masalov, Emre Gazyakan, Julian Vogelpohl, Ulrich Kneser, Felix Hubertus Vollbach","doi":"10.1055/a-2637-5118","DOIUrl":"10.1055/a-2637-5118","url":null,"abstract":"<p><p>Extensive thoracic wall defects can arise from the resection of malignant tumours or from sternal osteomyelitis following cardiac surgery. The aim of this study is to analyse the feasibility of reconstruction with free flaps, and considers recipient vessel conditions, surgical complications, and reconstructive outcomes.In this bicentric retrospective clinical study, all patients who underwent free flap transplantation for the reconstruction of an extensive thoracic wall defect between January 2013 and September 2024 were included. The objective was to evaluate surgical details and outcomes as well as surgical and medical complication rates. In a subgroup analysis, complications and outcomes of free flaps requiring the creation of suitable recipient vessels using an arteriovenous loop (AVL) were compared with those of free flaps that did not require additional vascular surgical procedures.A total of 107 patients (n = 66, 62% after cardiac surgery; n = 41, 38% after oncological surgery) underwent thoracic wall reconstruction with free myocutaneous tensor fasciae latae (TFL) flaps (n = 47; 44%), vastus lateralis (VL) flaps (n = 37; 35%), combined VL-anterior lateral thigh flaps (cVL-ALT) (n = 17; 16%) or cVL-TFL flaps (n = 2; 2%), anterior lateral thigh flaps (ALT, n = 2, 2%), and transverse rectus abdominis flaps (TRAM, n = 2, 2%). Of these reconstructions, 39 (36%) required simultaneous AVL creation. Postoperatively, six cases (6%) of pedicle thrombosis occurred. Complete flap necrosis occurred in three cases (3%) (VL flap, n = 2; cVL-ALT flap, n = 1), while partial flap necroses were observed in eight cases (8%) (TFL, n = 3; kVL-ALT, n = 2; VL, n = 2; TRAM, n = 1). Postoperative surgical complications showed no significant difference between reconstructions with or without the need for simultaneous AVL creation with respect to venous thrombosis (n = 0 vs. n = 3), arterial thrombosis (n = 2 vs. n = 1), partial flap necrosis (n = 3 vs. n = 5), and total flap necrosis (n = 0 vs. n = 3).This study demonstrates that reconstruction of extensive thoracic wall defects with free VL or TFL flaps is feasible with low complication rates, even when simultaneous AVL creation is required.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683251","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":"[Student Training in Surgical Wound Care: Development and Curricular Implementation of a Course for the Improvement of Practical Skills and Expertise].","authors":"Pernilla Virginia Conrad, Gudrun Karsten, Regine Gläser, Charlotte Hauser, Katrin Hertrampf","doi":"10.1055/a-2615-5997","DOIUrl":"https://doi.org/10.1055/a-2615-5997","url":null,"abstract":"<p><p>Wound care is an important medical skill that is not an important part of medical training. National and international studies show that the teaching of wounds is inadequate in medical curricula and that there is a desire for further training among students. Therefore the aim of this project was to improve students' expertise in surgical wound care.Following a survey of students in their 2nd clinical and practical year (n = 169) at the Faculty of Medicine in Kiel that addressed their level of knowledge of wound care, an innovative teaching concept was designed, including a practical section using real-life models. The pilot course was held in the summer semester of 2023 and the learning success was determined by a pre-post survey of the entire semester. The course was then implemented into the curriculum.The assessment of the level of knowledge revealed important uncertainties. In the practical year, 39.7% were confident in aseptic wound care. Training in wound care was rated as inadequate. Completion of our course resulted in an increase in the assessment of their own skills. The identified uncertainties were reduced by the training: 75% of students were confident in wound care.This course improves medical education, can be easily implemented in any faculty and could lead to improved patient care.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217036","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":"34. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie (D-A-CH-Tagung): Einladung nach Bregenz.","authors":"Robert Scheubel","doi":"10.1055/a-2580-1327","DOIUrl":"https://doi.org/10.1055/a-2580-1327","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 3","pages":"251-253"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217040","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":"Perspektiven der Transplantationschirurgie – zwischen technologischem Fortschritt und strukturellen Herausforderungen.","authors":"Jörg C Kalff, Tim Oliver Vilz","doi":"10.1055/a-2502-3538","DOIUrl":"https://doi.org/10.1055/a-2502-3538","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 3","pages":"207-208"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217043","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":"[Centralisation of Liver Transplantation: Implications for Training Transplant Surgeons].","authors":"Simon Moosburner, Nathanael Raschzok, Wenzel Schoening, Brigitta Globke, Johann Pratschke, Robert Öllinger, Felix Krenzien","doi":"10.1055/a-2587-2394","DOIUrl":"10.1055/a-2587-2394","url":null,"abstract":"<p><p>The centralisation of liver transplantation in Germany is seen as a promising approach to improve care quality through higher case volumes and specialised structures. However, it poses significant challenges for surgical training. Reduced availability of training positions, limited diversity of clinical experience, and the risk of capacity bottlenecks could impact the education of young transplant surgeons in the long term. This article explores the opportunities and risks of centralisation, particularly regarding surgical education. While higher case volumes are associated with better outcomes, it is argued that complementary measures such as regional support structures, rotation programs, and, where applicable, the use of practical training models are essential to ensure comprehensive education. The implementation of regulations of minimum case volume is also discussed as a potential regulatory tool. Finally, the article highlights the need for future studies to systematically evaluate the impact of centralisation on surgical education and to provide an evidence-based foundation for decision making.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"223-229"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036833","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":"Bedeutung von KI und Robotik für die Viszeralchirurgie.","authors":"Tobias Keck","doi":"10.1055/a-2498-0445","DOIUrl":"https://doi.org/10.1055/a-2498-0445","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 3","pages":"191-193"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217041","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":"[Extracorporeal Life Support in Lung Transplantation and Beyond].","authors":"Alexander Hermann, Thomas Schweiger","doi":"10.1055/a-2563-8383","DOIUrl":"10.1055/a-2563-8383","url":null,"abstract":"<p><p>Lung transplantation is often the sole and final therapeutic option for patients with end-stage lung disease. In recent years, clinical outcomes have steadily improved, driven in part by advancements in extracorporeal mechanical support. These techniques have become an integral component of routine clinical practice, particularly in lung transplantation centres. Extracorporeal lung support systems range from relatively simple pumpless devices to complex cannulation techniques and device configurations. In particular, extracorporeal membrane oxygenation (ECMO) encompasses various configurations widely utilised in thoracic surgery, especially in lung transplantation. A distinction can be made between preoperative ECMO, referred to as bridge-to-transplant, and intraoperative ECMO support, which is employed during the transplantation procedure. In recent years, intraoperative ECMO has largely replaced the traditional heart-lung machine. Additionally, ECMO plays a critical role in the immediate postoperative period, both in preventing and managing primary graft dysfunction. Beyond lung transplantation, extracorporeal life support systems are also applied in complex thoracic surgical resections and procedures involving the central airways. In the future, technical advancements and improvements in treatment protocols are expected to further enhance the role of extracorporeal mechanical support in the management of thoracic surgical patients.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"286-294"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Status of Robotics in Living Donor Liver and Kidney Transplantation - Review of the Literature and Results of a Survey among German Transplant Centres].","authors":"Cornelius J van Beekum, Ulrich Zwirner, Dennis Kleine-Döpke, Gerrit Grannas, Jessica Singh, Nicolas Richter, Moritz Schmelzle, Philipp Felgendreff, Markus Quante","doi":"10.1055/a-2538-8802","DOIUrl":"10.1055/a-2538-8802","url":null,"abstract":"<p><p>The advantages of minimally invasive surgical techniques are undisputed. With the introduction of robotic assistance systems, classic laparoscopy has been further developed and is now also being utilized in transplant surgery, which was previously mainly characterised by open surgical procedures, particularly in living donor liver and kidney donations. In order to assess the current implementation status of robotic assistance systems in transplant surgery, international studies in this field were summarized and correlated with a national survey on the use of robotic assistance systems in living donation.First, a narrative summary of the MEDLINE-listed publications on robotic living kidney and liver donation was carried out. In addition, an online survey was conducted among German transplant centres with ten questions on the utilization of robotic techniques in Germany.Retrospective cohort studies at a small number of transplant centres worldwide report particular advantages of robotics, especially regarding blood loss, patient comfort and length of hospital stay. One-third of German transplant centres already perform living kidney donations with robotic assistance, and one-fifth of centres even use this technique in over 90% of cases. In contrast, living liver donations are only performed in one German transplant centre using robotic assistance for left lateral liver resection of the donor.In the context of living donation, advocates of robotics emphasise technical advantages, greater patient comfort and a steeper learning curve. A persistent and significant point of criticism regarding robotic surgical techniques remains the prolonged warm ischemia time, especially during learning curves. The survey results presented here demonstrate that there is still a substantial need for discussion on this current topic. However, there is a lack of prospective randomised controlled studies.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"230-242"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671185","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}