Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[Optimisation of the efficiency and cost structure of LVA operations at a university hospital].","authors":"Felix Reinkemeier, Christoph Wallner, Marius Drysch, Marcus Lehnhardt, Oliver Schoeffski, Sonja Schmidt","doi":"10.1055/a-2560-1467","DOIUrl":"https://doi.org/10.1055/a-2560-1467","url":null,"abstract":"<p><p>The increasing number of lymphatic surgery procedures in recent years has led to an increased economic relevance of plastic surgery departments. The high time variance associated with microsurgical LVA procedures makes surgical planning more challenging and hampers optimal capacity utilisation. In addition, there is currently no data on the adequate representation of the surgical costs in the InEK (Institute for the Hospital Remuneration System) matrices of the DRGs to be billed.By analysing a total of 69 patient cases with LVA surgery, the influence of patient-specific and independent parameters as well as the choice of anaesthesia on the incision-suture time was investigated. After breaking down the surgical costs using cost object accounting, the revenue generated was calculated depending on the DRG. A cost-effectiveness analysis of LVA surgeries and benchmarking with other clinics was then performed.Patient-independent parameters such as the surgeon's experience and the number of anastomoses have a significant influence on the duration of the surgery, whereas patient-specific factors such as comorbidities are of minor importance. Regarding the surgical costs incurred in relation to the amounts calculated by InEK, there was a large discrepancy in the reimbursement amounts depending on the DRG billed, with some of the costs found to be inadequately covered. The training costs for LVA operations exceeded €200.The choice of the DRG to be billed has a decisive influence on the economic viability of LVA operations in the German healthcare system. In addition, inclusion or modulation of patient-independent parameters can optimise surgical planning, resulting in a more efficient use of operating room capacity and improved cost-effectiveness. Training costs are not adequately reflected in LVA surgeries.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035949","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":"[Strategies for Preventing Fires and Thermal Injuries in the Operating Room].","authors":"Maximilian C Stumpfe, Raymund E Horch","doi":"10.1055/a-2513-0574","DOIUrl":"10.1055/a-2513-0574","url":null,"abstract":"<p><p>Thermal injuries and operating room fires pose significant risks to patients, especially when energy-based devices like monopolar diathermy are used. A study conducted by the FDA over 20 years reported over 3,500 injuries and 178 deaths, mostly caused by burns. The main causes of operating room fires can be explained by the \"fire triangle\": ignition sources, fuels, and oxidizers. Monopolar diathermy and lasers act as ignition sources, while alcohol-based disinfectants provide fuel. As oxidizers, oxygen and nitrous oxide further increase the risk of fire.This review is based on a literature analysis and case vignettes of patients with thermal injuries. It aims to highlight the severe consequences of such injuries and outline preventive measures.The findings underscore the need for a multidisciplinary approach. Key strategies include reducing oxygen concentration and using alternative disinfectants. Targeted training for the surgical team, along with the use of \"Fire Risk Assessment Tools\", can substantially improve patient safety.In conclusion, comprehensive risk management, the development of specific protocols, and team training are essential to prevent thermal injuries and sustainably reduce patient risk in the operating room.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"130-138"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494953","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":"[Generation Z in Surgery and 'Work-Life Balance': Challenge or Opportunity?]","authors":"Riccardo E Giunta","doi":"10.1055/a-2524-0253","DOIUrl":"10.1055/a-2524-0253","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"90-91"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568964","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":"[Tubular Breast Deformity: Presentation of an Established Treatment Algorithm and Results of a Retrospective Study Over 7 Years].","authors":"Sophia-Theresa Diesch, Vanessa Brébant, Vivien Noisser, Andree Faridi, Lukas Prantl","doi":"10.1055/a-2549-6795","DOIUrl":"10.1055/a-2549-6795","url":null,"abstract":"<p><p>Congenital deformities of the female breast pose a unique surgical challenge, requiring an individualized approach, particularly for young patients. In this article, we describe a surgical treatment algorithm evaluated over a 7-year period through a retrospective study, focusing on complication rates and breast anthropometric data.A retrospective cohort study was conducted, including 36 patients followed up for 7±3.2 years. All patients underwent surgery based on the proposed therapeutic algorithm. Postoperative assessments were performed at 1 and 6 weeks and 6 months to 10 years. Clinical data, including complications, Baker grade, ptosis degree, and anthropometric measurements, were collected. Additionally, 3D breast images were taken, and a validated patient-reported quality of life outcome measure (Breast-Q™) was administered.Alloplastic augmentation exhibited a significantly higher complication rate (42%) compared with autologous fat transplantation (7.69%). We observed a mean side-to-side difference in areolar diameter of 0.37 cm for autologous reconstruction and 0.78 cm for alloplastic augmentation. The calculated symmetry index revealed 93% symmetry for both therapeutic approaches. All objective measurement methods demonstrated a lasting, symmetrical therapeutic success in correcting congenital deformities. Long-term patient-reported result satisfaction (Breast-Q™) was 74%. Patients undergoing autologous reconstruction required an average of 2.9 procedures to achieve the desired outcome, compared with 1.3 procedures for alloplastic augmentation.The therapeutic algorithm proved to be valid in terms of complication rates, breast symmetry, nipple-areolar complex (NAC) symmetry, and patient satisfaction. It can be considered for patients with congenital breast deformities. Alloplastic reconstruction should be critically discussed due to its increased complication rate.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"102-111"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756060","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":"On occasion of the \"ESPRAS - A Day in Paris\" meeting at the 68th SOFCPRE Congress November 21st 2024.","authors":"R E Giunta, J Saboye","doi":"10.1055/a-2534-7628","DOIUrl":"10.1055/a-2534-7628","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"152-154"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544573","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":"Generation Z in Plastic Surgery: Challenges, Solutions and New Horizons - A European and transatlantic overview.","authors":"Riccardo E Giunta, Franco Bassetto, Cenk Demirdöver, Gregory R D Evans, Mark Henley, Ilkka Kaartinen, Marcus Lehnhardt, Jaume Masia, Paul McArthur, Jacques Saboye, Yonca Steubing, Irene Mesas Aranda","doi":"10.1055/a-2502-1684","DOIUrl":"10.1055/a-2502-1684","url":null,"abstract":"<p><strong>Introduction: </strong>  The entrance of Generation Z (born 1997-2012) into professional life, including the practice of medicine, marks a transformational shift in priorities and values. This generation, shaped by digital immersion and a strong focus on work-life balance, is redefining the landscape of Plastic Surgery. Their preferences for inclusivity, innovation, and structured working hours challenge traditional models of mentorship, patient care, and surgical training. The aim of this survey was to explore the impact of Generation Z on the field of Plastic Surgery through insights offered by leaders of major Plastic Surgery societies in Europe and the United States, who together provide a comprehensive perspective on generational change and its implications for clinical practice, education, and healthcare systems in Plastic Surgery.</p><p><strong>Methods: </strong>  In October 2024 eight leaders of national Plastic Surgery societies and associations were invited to complete a structured questionnaire with five open-ended questions. They provided detailed responses on challenges, opportunities, and structural changes needed to address Generation Z's influence.</p><p><strong>Results: </strong>  Key findings highlight a generational shift in the approach to professional life, with an emphasis on digital innovation, work-life balance, and the interaction with social media. Respondents noted an increased interest in aesthetic over reconstructive surgery and a preference for private practice among younger surgeons, raising concerns about workforce shortages in public healthcare. Advances in digital learning and simulation-based training were identified as opportunities to facilitate medical education. However, the ethical challenges of misinformation on social media and a decline in hierarchical mentorship were emphasized as critical concerns. Despite generational tensions, the integration of Generation Z's strengths in technology and advocacy for systemic reform holds promise for addressing burnout and enhancing healthcare delivery.</p><p><strong>Conclusion: </strong>  The arrival of Generation Z in Plastic Surgery represents a possible pivotal moment to reimagine traditional models of surgical education, patient care, and professional priorities. Collaboration between generations and proactive adaptation to these changes is an imperative to ensure a dynamic, inclusive, and sustainable future for the specialty.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"139-151"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016697","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":"Correction: Incidental Findings of Internal Mammary Lymph Node Recurrence after Breast Cancer during Microsurgical Breast Reconstruction: Discussion of Treatment Options and Review of the Literature.","authors":"Roland Hoffmeister, Therese Pross, Lutz Moser, Alba Fricke, Uwe von Fritschen","doi":"10.1055/a-2598-3554","DOIUrl":"https://doi.org/10.1055/a-2598-3554","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"57 2","pages":"e1"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082201","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":"Incidental Findings of Internal Mammary Lymph Node Recurrence after Breast Cancer during Microsurgical Breast Reconstruction: Discussion of Treatment Options and Review of the Literature.","authors":"Roland Hoffmeister, Therese Pross, Lutz Moser, Alba Fricke, Uwe von Fritschen","doi":"10.1055/a-2560-1560","DOIUrl":"10.1055/a-2560-1560","url":null,"abstract":"<p><p>Lymphatic drainage through the internal mammary lymph nodes (IMLN) is a key pathway for breast cancer metastasis, although IMLN metastasis is rare following primary treatment. In earlier years, treatment protocols primarily addressed axillary lymph node metastasis.We present five cases where IMLN metastases were discovered incidentally during autologous free-flap breast reconstruction. These cases highlight implications for both the reconstructive plastic surgeon and subsequent adjuvant therapy.From a plastic-reconstructive perspective, we recommend performing routine biopsies on any incidentally identified IMLN during autologous breast reconstruction. Positive findings may upstage the patient's disease and influence further treatment planning. However, we do not recommend actively searching for or extending dissections to harvest IMLN specimens. Only in the presence of a suspicious perinodal tumour mass do we perform an intraoperative frozen-section analysis, with reconstruction paused if malignancy is confirmed. After complete staging and discussion in a multidisciplinary conference, we proceed with tumour resection according to oncological standards if curative resection is deemed feasible. Reconstruction can then be performed during the same procedure. For locoregional recurrence of breast cancer, treatment continues to be a multimodal approach involving surgery, radiation, and systemic therapy to ensure local control and optimise long-term survival. In primary treatment, current national and international guidelines now recommend locoregional irradiation of the internal mammary chain for high-risk cases, which may further reduce the incidence of incidental IMLN metastasis findings in the future.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"57 2","pages":"112-121"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046524","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":"[Objectification of Skin Quality in Flap Reconstructions using the Cuto-, Mexa-, and Tewameter: A Comparative Analysis of Sural and ALT Flap Techniques].","authors":"Yonca Steubing, Maxi von Glinski, Marcus Lehnhardt, Christine Seelmann, Heinz Herbert Homann, Arne Beierlorzer","doi":"10.1055/a-2545-0399","DOIUrl":"10.1055/a-2545-0399","url":null,"abstract":"<p><p>The reconstruction of full-thickness soft tissue injuries on the distal lower extremity depends on the defect size, the patient's risk profile and comorbidities. A pedicled sural flap or a free ALT flap are standard procedures for restoring the tissue. To compare the skin and scar quality of the two reconstructive options, subjective patient perception and satisfaction as well as the objective skin properties were examined using the Patient and Observer Scar Assessment Scale (POSAS), Cuto-, Mexa-, and Tewameter.This retrospective study included 40 patients who received a pedicled sural flap or a free ALT flap for tissue reconstruction on the distal lower extremity between 2013 and 2018. A subjective assessment of skin quality was conducted using the POSAS and a visual analogue scale to determine patients' perception and satisfaction with the surgical results. Skin quality was analysed using a Cuto-, Mexa-, and Tewameter in the flap area, the area surrounding the flap, the healthy contralateral side, the donor site, and the corresponding contralateral side of the donor site.The examination of the subjectively perceived skin and scar quality showed a significantly higher level of satisfaction among patients with ALT flaps than among patients with sural flaps. The POSAS evaluation showed better skin quality at the ALT donor site compared with the sural donor site. The melanin and erythema values recorded by the Mexameter revealed a positive correlation with the POSAS data. In an intra-individual skin comparison, the objective measurements demonstrated that both flaps exhibit reduced elasticity, while both donor sites show increased elasticity compared with the healthy contralateral side. In addition, an increased erythema value was found at the flaps and donor sites compared with the healthy opposite side.The instrument-based measurement methods exhibited objective differences in the skin properties of the examined skin areas. A correlation analysis between subjective perception and objective measurement data demonstrated that visual properties, such as melanin content and erythema, showed a stronger correlation with subjective perception than mechanical properties. Overall, patients with an ALT flap were more satisfied than patients with a sural flap, which can be attributed to a lower morbidity of the donor site.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"122-129"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712204","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 Assessment and Management of Hypercoagulability and Thrombophilia in Microsurgery: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)].","authors":"Benjamin Thomas, Thorsten Steinfeldt, Ulrich Seyfert, Kai Megerle, Rolf-Dieter Bader, Christine Radtke, Christoph Hirche, Amir K Bigdeli, Ulrich Kneser, Emre Gazyakan, Jurij Kiefer, Björn Behr","doi":"10.1055/a-2535-2467","DOIUrl":"10.1055/a-2535-2467","url":null,"abstract":"<p><p>Uninterrupted blood flow through microsurgically anastomosed vessels is crucial for the postoperative success of reconstructive microsurgery. Contrary to the highly standardized anastomosis techniques, the pivotal partner discipline of evidence-based microsurgical haemostaseology and haemorrheology is still in its infancy. Prospective clinical studies yielding evidence-based recommendations are notably lacking. Currently, perioperative management in microsurgery is based solely on site-specific empirical experience. The collective aim of these diverse efforts is the preoperative identification of increased coagulation (hypercoagulability) or clotting activities (thrombophilia) and the development of relevant anticoagulation strategies. During the 43rd Annual Meeting of the German-Speaking Working Group for Microsurgery (DAM) in November 2022 in Frankfurt, experts in microsurgery, haemostaseology, and anaesthesia deliberated on the fundamentals of coagulation and physiology. Also, alongside a literature review, consensus recommendations for the perioperative management of hypercoagulopathies were established. Subsequently, methodologies were assessed within the panel, criteria for decision-making were gathered, and, ultimately, a consensus recommendation by DAM regarding a perioperative algorithm was devised, which is detailed in this position paper.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"92-101"},"PeriodicalIF":0.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781944","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}