Zentralblatt fur Chirurgie最新文献

{"title":"[Microvascular Reconstruction of the Laryngotracheal Junction].","authors":"Miguel Goncalves, Stephan Hackenberg, Agmal Scherzad","doi":"10.1055/a-2866-2106","DOIUrl":"https://doi.org/10.1055/a-2866-2106","url":null,"abstract":"<p><strong>Background: </strong>The laryngotracheal junction (LTJ) is a functionally critical zone, due to its narrow anatomy, complex airflow dynamics, and proximity to the glottis and cricoid cartilage. Extensive stenoses, cricoid defects, and stomal anterior wall loss frequently exceed the possibilities of conventional resection and reconstruction.</p><p><strong>Objective: </strong>To outline the current role of microvascular reconstruction at the LTJ, with a focus on indications, techniques, and limitations from the perspective of otolaryngology and thoracic surgery.</p><p><strong>Methods: </strong>Narrative literature review of clinically established flap reconstruction techniques at the LTJ, including recent case series and key publications.</p><p><strong>Results: </strong>For short, non-pretreated defects, cricotracheal resection and segmental tracheal resection with end-to-end anastomosis remain the standard of care. Microvascular reconstructions are mainly used for long, circumferential LTJ defects, extensive cricoid loss, previously irradiated or multiply operated regions, and complex treatment interventions. The radial forearm free flap is currently the best-established option for long tracheal and laryngotracheal defects and can be combined with cartilage reinforcement or a mucosal lining. Osseous flaps such as the medial femoral condyle flap and the thoracodorsal artery scapular tip flap allow larynx-preserving reconstruction, with restoration of a stable ring or posterior framework in selected cases. Prefabricated constructs, ALT-based flaps, jejunal grafts, and pedicled flaps play an adjunctive role in borderline and salvage situations.</p><p><strong>Conclusion: </strong>Microvascular reconstruction extends the therapeutic spectrum for LTJ surgery beyond conventional resection techniques and can provide a functional airway in highly complex situations and with acceptable morbidity. Given the limited evidence base from case series, interdisciplinary planning and centralisation of these procedures in experienced centres are essential.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219840","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":"Subspezialisierung und Weiterbildung.","authors":"Andreas Kirschniak","doi":"10.1055/a-2858-9354","DOIUrl":"https://doi.org/10.1055/a-2858-9354","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 3","pages":"217"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206352","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":"[Interdisciplinarity, Evidence and Relevance of Classification for Care in Thoracic Outlet Syndrome].","authors":"Nora Franziska Dengler, Nadja Gruebel, Maria T Pedro, Sami Ridwan","doi":"10.1055/a-2734-3580","DOIUrl":"10.1055/a-2734-3580","url":null,"abstract":"<p><strong>Abstract: </strong>Thoracic Outlet Syndrome (TOS) refers to the compression of the neurovascular structures at the thoracic outlet. Its incidence is estimated at 2-3 cases per 100000 individuals per year. Patients are frequently affected by pain and/or functional impairment. The diagnostic and therapeutic process typically involves multiple medical specialties. Diagnosis is primarily clinical and requires the exclusion of differential diagnoses. Additional diagnostic modalities, such as ultrasound, MRI, angiography, or electroneurography, may provide supportive information. Depending on the treating discipline, different classifications and therapeutic strategies are applied. The availability of high-quality studies on treatment remains limited, although evidence has improved in recent years. To date, no standardised, interdisciplinary guidelines for the diagnosis and management of Thoracic Outlet Syndrome have been established.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"312-315"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783026","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":"[Surgical Practice During the Study of Human Medicine - From \"To be in a Physician's Company\" to a Structured Use of Various Teaching Modes and Coordinated Teaching Contents (a Conceptual Suggestion)].","authors":"Gerald Pliske, Katrin Werwick, Inken Häusler-Pliske, Sara Al-Madhi, Udo Barth, Frank Meyer","doi":"10.1055/a-2738-2769","DOIUrl":"10.1055/a-2738-2769","url":null,"abstract":"<p><strong>Background: </strong>Surgery can be considered to be one of the major medical disciplines in the study of human medicine. In this context, surgical education is a great challenge, in particular, due to the necessary training of technical skills. The aim of the manuscript was based on i) selective references out of the medical scientific literature and ii) own teaching-associated experiences to reflect an innovative systematic and structured use of diverse teaching modi and coordinated teaching contents as conceptual idea for the surgical practice as part of the study of human medicine.</p><p><strong>Results (foci): </strong>Surgical practice has been i) established as obligatory practice-oriented part of surgical teaching during the study of human medicine and ii) approved as indispensable teaching tool. Successive implementation of the SkillsLab was a milestone in the study of human medicine medical education, in particular, with regard to the practical focus and issues. Since 2009, facultative teaching sessions have been available for the medical students at the Otto-von-Guericke University Medical School of Magdeburg (Germany) - in other words, University Medicine at Magdeburg [UMMD]), which are designed and provided by the various surgical disciplines. Since 2011, parts of curricular surgical teaching have been specified: Within 9 modules, medical students are taught theoretical basics using oral presentations and exercises as well as practical surgical activities during the 1st part of the obligatory surgical practice time-period of 2 weeks, corresponding to 56 hours overall. During the 2nd more bed-side-oriented (and, thus, conventional) surgical practice, the skills acquired during the 1st part of surgical practice can be further trained and solidified and further systematisised, with structured teaching contents using innovative teaching approaches. The \"Logbook - Surgical Practice\" which needs to be conducted by the students themselves, summarises the teaching contents, gives instructions and allows the semiquantitative acquisition of teaching results/effects (\"Observed - Under Instructions Performed - Independently Executed\").</p><p><strong>Conclusion: </strong>Teaching in the SkillsLab allows far better integration of the medical students in surgical activities during surgical practice and sustainably increases the practically focused and, thus, desirable teaching effect.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"218-228"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655937","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":"10.1055/a-2615-5997","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Patients/materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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":"229-239"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","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":"Einladung zur 35. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie nach Mainz vom 09. bis 11. September 2026.","authors":"","doi":"10.1055/a-2851-2785","DOIUrl":"https://doi.org/10.1055/a-2851-2785","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 3","pages":"280-281"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206357","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":"[Thoracic Spine Metastases: Interdisciplinary Surgical Strategies Between Thoracic and Neurosurgery].","authors":"Sami Ridwan, Mihail-Lucian Stefan, Sandra Schulte, Jan Reichelt, Stefan Fischer, Franz-Josef Hans","doi":"10.1055/a-2715-5182","DOIUrl":"10.1055/a-2715-5182","url":null,"abstract":"<p><strong>Abstract: </strong>Thoracic spine metastases are a common manifestation of advanced malignancies and may in some cases require interdisciplinary management. Due to the complex anatomy of the thoracic region, particularly the proximity to mediastinal organs, major vessels, and the spinal cord, precise preoperative planning and surgical execution are essential. Thoracic surgical expertise is crucial for mobilising intrathoracic structures, securing vascular control, and establishing a safe anterior surgical corridor, especially in diseases involving thoracic organs and the spine. Neurosurgery focuses on decompression of neural elements, tumour resection, and biomechanical stabilisation of the spine. Different disciplines must work closely together, often simultaneously in the operating theatre, in order to achieve surgical, functional, and oncological goals. Advances in intraoperative imaging, navigation, robotics, and minimally invasive techniques have led to more individualised, safer, and more effective procedures than previously possible. Furthermore, the modern treatment of spinal metastases requires integration of oncology, radiation therapy and pain medicine. Studies demonstrate that structured, interdisciplinary care improves neurological outcomes, enhances quality of life, and facilitates timely continuation of systemic therapies. This article highlights the surgical intersection between thoracic and neurosurgery in the management of thoracic spine metastases, analyses established and emerging techniques, and illustrates how technological and organisational innovations enable high-quality, patient-centred treatment strategies.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"282-293"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145347836","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":"[Endoscopic Approaches to the Thoracic Spine].","authors":"Vincent Hagel, Gregor Gaudin","doi":"10.1055/a-2773-1913","DOIUrl":"10.1055/a-2773-1913","url":null,"abstract":"<p><strong>Purpose: </strong>In spinal surgery, endoscopic surgical techniques have been gaining increasing importance in recent years. Although the technique itself has existed for decades, it has only begun to spread more widely in recent years due to technological advancements and increasingly structured training concepts. Nowadays, endoscopic procedures can be performed on all regions of the spine, including the thoracic spine.</p><p><strong>Materials/methods: </strong>The two standardised endoscopic techniques for the thoracic spine are the interlaminar and the transforaminal approaches. Additionally, there are individual case reports describing an endoscopic transthoracic or retropleural approach. These approaches are primarily used to treat degenerative pathologies such as spinal canal stenosis and herniated discs, but also ossifications of the ligamentum flavum or the posterior longitudinal ligament. In individual cases, the endoscopic approach can also be utilised for the treatment of rarer conditions such as infections, tumours, and spontaneously occurring dural injuries.</p><p><strong>Results: </strong>As in other areas of the spine, endoscopic techniques for the thoracic spine are believed to offer potential advantages over traditional methods, such as reduced postoperative pain and a shorter hospital stay or overall quicker recovery time.</p><p><strong>Conclusion: </strong>Endoscopic approaches to the thoracic spine presumably offer advantages over conventional surgical techniques. However, the currently available literature is insufficient to make well-founded statements about clinical outcomes and about future developments. Since these approaches consistently pose a challenge, they should only be performed by surgeons experienced in endoscopic techniques.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"307-311"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985806","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":"Patienten mit Herzinsuffizienz in der Chirurgie: PeriOP-CARE HF.","authors":"Götz Schmidt, Marit Habicher, Manuel Kenz, Melanie Markmann, Birgit Aßmus, Michael Sander","doi":"10.1055/a-2723-0591","DOIUrl":"https://doi.org/10.1055/a-2723-0591","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 3","pages":"203-207"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206322","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":"[Perioperative Molecular Testing in Non-small Cell Lung Cancer].","authors":"Uyen-Thao Le, Anne Maria Schultheis, Severin Schmid","doi":"10.1055/a-2507-2643","DOIUrl":"10.1055/a-2507-2643","url":null,"abstract":"<p><strong>Abstract: </strong>Non-small cell lung cancer (NSCLC) is known to exhibit high tumor heterogeneity, and molecular alterations can be detected in a relevant proportion of patients. These alterations may permit the use of targeted therapy but also have important implications for the use of other therapies particularly immune checkpoint inhibitors. Therefore, comprehensive characterization of the molecular profile is crucial for achieving optimal therapeutic outcomes in the perioperative setting even in early stages. A wide range of diagnostic techniques with specific advantages and limitations are currently available for molecular testing of NSCLC. The choice of method depends on the clinical setting and the available tissue. Modern next-generation sequencing panels currently represent the diagnostic gold standard in this regard. Numerous studies are currently investigating the use of various targeted therapies for molecularly altered NSCLC in adjuvant, neoadjuvant, and perioperative settings, and have in some cases yielded spectacular improvements of disease-free- as well as overall survival. The results of the ADAURA trial led to the approval of osimertinib for adjuvant treatment of completely resected, EGFR-mutated NSCLC, while the ALINA trial provided the basis for the approval of alectinib in the adjuvant treatment of ALK-positive, completely resected NSCLC. This article discusses the current evidence regarding the perioperative use of targeted therapies, the recommendations for molecular testing in non-small cell lung cancer, and the resulting therapeutic implications, as well as ongoing research efforts in this evolving field.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 3","pages":"316-327"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206307","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}