Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[Optimising Processes in a Severe Burn Intensive Care Unit through the Implementation of a Digital Management System].","authors":"Sonja Verena Schmidt, Marius Drysch, Yonca Steubing, Christoph Wallner, Marcus Lehnhardt, Oliver Schoeffski, Felix Reinkemeier","doi":"10.1055/a-2360-9549","DOIUrl":"10.1055/a-2360-9549","url":null,"abstract":"<p><strong>Background: </strong>The treatment of severely burned patients is demanding and necessitates specialised centres capable of providing adequate therapy over several months. The establishment of digital management systems in intensive care units signifies a substantial advancement in modern healthcare. Introducing such a system in a specialised intensive care unit for severe burn patients presents opportunities for optimisation but also potential obstacles. This study aims to provide insights into the perception of change from the perspective of staff and discuss the implementation of digital systems in the field of intensive care medicine.</p><p><strong>Methods: </strong>After a selective sample was established, the impacts of the digital management system were examined across various categories. The data collected through a questionnaire and brief interviews were evaluated in terms of average values within each category, with interpretations taking into account characteristics such as professional group and work experience.</p><p><strong>Results: </strong>Overall, the digital management system is considered suitable for use in the intensive care unit for severe burn patients by both medical and nursing staff. The continuous monitoring of vital parameters and the reduction of errors in medication administration are highlighted as positive aspects. However, negative points include the inferior documentation of burn wounds and specialised documentation for burn patients.</p><p><strong>Conclusion: </strong>In due consideration of various factors such as experience, team size, and patient clientele, which impact the usability of the program, some aspects in need of improvement were identified. In summary, however, it can be said that there was a positive and favourable consensus regarding the introduction of such a system in the intensive care unit. Additionally, it can be concluded that the system is described as significantly more effective for a general surgical intensive care unit than for a specialised intensive care unit, e. g. an intensive care unit for severe burn patients.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"438-447"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301405","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 Cost of Lipoedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs of Lipoedema (Stage III) at a German University Clinic].","authors":"Philipp Moog, Edith Gawlik, Stefan Eisenreich, Oliver Schoeffski, Hans-Günther Machens, Jun Jiang, Haydar Kükrek","doi":"10.1055/a-2362-1185","DOIUrl":"10.1055/a-2362-1185","url":null,"abstract":"<p><strong>Background: </strong>Liposuction for stage III lipoedema is a guideline-based but also time-consuming treatment, which can be carried out under specific conditions at the expense of the German statutory health insurance companies (SHI) based on a decision made by the German Federal Joint Committee (\"Gemeinsamer Bundesausschuss\", G-BA), the highest decision-making body in the German healthcare system, in 09/2019. We postulate that the treatment is not reflected in a cost-covering manner in the university cost system.</p><p><strong>Methods: </strong>This monocentric, retrospective study examined the economic aspects of 92 cases in 48 lipoedema patients treated during the period from 09/2019 to 08/2023 at the expense of the SHI. These cases were filtered out using DRG coding and the Operation and Procedure Classification system (\"Operationen- und Prozedurenschlüssel\", OPS), and the costs and revenues per patient were calculated using the data from our internal service accounting.</p><p><strong>Results: </strong>After an inpatient stay of 2.64±1.33 days, the total revenue was € 4,726.79±680.98. This included € 1,532.92±856.99 inpatient costs, € 2,686.02±1,174.70 in operating costs, € 940.76±189.18 in anaesthesia costs and € 63.19±125.38 in other costs that had to be paid within the clinic. On average across all treatments, this resulted in a loss of -€ 875.22 /case. In 54 cases (59%), the costs exceeded the revenue. In total, the calculation of all cases resulted in a loss of € -80,520.63. If medical personnel costs are included, this amount rises to over € 100,000.</p><p><strong>Conclusion: </strong>The results show that the surgical treatment of lipoedema in the German DRG and university cost systems is not cost-covering. This could be relevant in the final economic assessment of the G-BA, which may result in an adjustment of the DRG revenue.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"427-435"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301406","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":"[Hairiness and Skin Colouration after Breast Reconstruction with a Deep Inferior Epigastric Perforator Flap and Reconstruction of the Nipple-Areolar Complex].","authors":"Yi Bräuer, Jan Langer, Jörn Andreas Lohmeyer, Philipp Deindl, Maike Keck","doi":"10.1055/a-2372-1848","DOIUrl":"10.1055/a-2372-1848","url":null,"abstract":"<p><strong>Introduction: </strong>Although DIEP (deep inferior epigastric perforator) is the gold standard for breast reconstruction, long-term results with a view to postoperative hairiness and flap skin colouration have rarely been described in the literature.</p><p><strong>Methods: </strong>Patients who underwent DIEP flap breast reconstruction followed by NAC reconstruction between 2010 and 2019 were invited to our clinic for a survey and a clinical examination. A total of 781 patients were invited. The survey included the BREAST-Q and a study-specific questionnaire. The clinical examination contained specific measurements regarding postoperative hairiness and skin colouration.</p><p><strong>Results: </strong>A total of 179 patients were examined, with 203 breasts having been reconstructed. Only breasts with a visible flap skin island were taken into further evaluation. A total of 109 DIEP flap and 77 NAC reconstructions were evaluated. In the patient-reported survey, 27.5% (30 of 109) reported additional flap hairiness and 62.4% (68 of 109) reported differences in flap skin colouration compared with the surrounding skin. The clinical examination revealed a significant difference between the skin colouration of the flap compared with the surrounding skin and the skin colouration of the reconstructed NAC compared with the existing original NAC. In both cases, the reconstructions appeared significantly \"lighter\" (p<0.05). No significant difference was found between patients with and without hair in terms of overall satisfaction evaluated by using the BREAST-Q. Neither did the colour difference have a significant influence on patients' satisfaction.</p><p><strong>Conclusion: </strong>Additional breast hairiness and different skin colouration is relevant and should be communicated preoperatively.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"420-426"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141857","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":"[Subcutaneous Washout Procedure (SWOP) for Treating Severe Complications of an Aesthetic Gluteal Augmentation with a Copolyamide Filler].","authors":"Katharina Oster, Andrej Ring, Niklas Dellmann, Rosmaria Thomas, Dimitrij Zilakov, Mathias Witt","doi":"10.1055/a-2288-5002","DOIUrl":"10.1055/a-2288-5002","url":null,"abstract":"<p><strong>Background: </strong>Apart from surgical procedures for breast and buttock augmentation, copolyamide fillers can be locally injected for an increase in volume. This method is especially popular in Asia.</p><p><strong>Patient: </strong>A 39-year-old female patient had received a buttock augmentation by injection of a copolyamide filler. She presented with multiple abscesses six years after the augmentation. She had developed multiple fistulas and the filler had migrated down to the thigh muscles.</p><p><strong>Results: </strong>In the presented case, the patient experienced multiple complications such as abscess formation, filler migration and chronic infection, with a significant time delay. Complete removal of the filler is only possible by removing surrounding tissue as well. Surgical treatment with repeated debridements and administration of an intravenous broad-spectrum antibiotic are the current standard of care. In contrast, the SWOP technique presented here appears to be less invasive and less likely for local recurrence.</p><p><strong>Conclusion: </strong>A breast or buttock augmentation with copolyamide fillers is associated with a high risk of abscess and fistula formation leading to a permanent disfigurement of the patient.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"463-467"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447618","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":"[Current Requirements and Qualification Criteria for Habilitation and Extraordinary Professorship at German University Hospitals].","authors":"Michele Rudari, Vlad Stefan, Sophia Finkbeiner, Adrian Dragu, Bernd Janetzky, Seyed Arash Alawi","doi":"10.1055/a-2407-4414","DOIUrl":"https://doi.org/10.1055/a-2407-4414","url":null,"abstract":"<p><strong>Background: </strong>Achieving a medical professorship marks a significant step in a doctor's academic career, associated with a significant level of responsibility and obligations. The requirements to obtain a medical professorship in Germany vary significantly.</p><p><strong>Material and methods: </strong>Based on an online search, we studied the statutes and regulations of medical faculties in Germany to determine the requirements for habilitation and an extraordinary professorship within Germany. All 38 German medical faculties were included. The evaluation was carried out for performance requirements in the areas of teaching and research.</p><p><strong>Results: </strong>The general requirement for a habilitation application is the completion of the medical specialist certification examination. On average, 2.3 years of teaching activity are expected. The minimum number of teaching hours averages 2.6 weekly semester hours. An average of at least 11 publications are required. Of these, an average of 7 must be written as first or last author. For an extraordinary professorship, an average of 4.4 years (min. 2, max. 6) of teaching activity after habilitation is required. The minimum number of teaching hours in semester hours averages 1.9 hours (min. 1, max. 2). The minimum number of publications averages 9 publications (min. 4, max. 24), of which an average of 6.3 must be written as first or last author.</p><p><strong>Conclusion: </strong>The requirements for habilitation and extraordinary professorship in Germany vary, especially with a view to publications and teaching. Depending on the faculty, lower publication numbers can be compensated by higher \"impact factors\". Furthermore, there is no national standardisation and comparability in the field of medical academic graduations.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 6","pages":"454-462"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787825","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":"[Commentary on the Article of Philipp Moog, Edith Gawlik, Stefan Eisenreich et al. The Cost of Lipedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs Of Lipedema (Stage III) at a German University Clinic].","authors":"Sixtus Allert","doi":"10.1055/a-2357-9973","DOIUrl":"10.1055/a-2357-9973","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"436-437"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367549","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 Sarajevo\" meeting at the 13th BAFPRAS Congress.","authors":"Riccardo E Giunta","doi":"10.1055/a-2457-6885","DOIUrl":"10.1055/a-2457-6885","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"468-469"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669727","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":"[Is networking in international societies dispensable in Plastic Surgery? Clear vote in favour of ESPRAS and ICOPLAST at the 54th Annual Conference of the DGPRÄC in Düsseldorf].","authors":"Riccardo E Giunta","doi":"10.1055/a-2418-4345","DOIUrl":"10.1055/a-2418-4345","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"406-408"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669723","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":"HaMiPla Best Paper Award – Ihre Favoriten in 2023.","authors":"Dr Anika-Maria Obry","doi":"10.1055/a-2440-6606","DOIUrl":"https://doi.org/10.1055/a-2440-6606","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 6","pages":"470-471"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787826","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":"[Long-Term Outcome of Digital Defect Reconstruction using Cross-Finger Flaps].","authors":"Markus Mulica, Mohamed Yasmin, Aijia Cai, Andreas Arkudas, Wibke Müller-Seubert, Raymund E Horch","doi":"10.1055/a-2351-6697","DOIUrl":"10.1055/a-2351-6697","url":null,"abstract":"<p><strong>Introduction: </strong>Although multiple advances have been made in finger defect reconstruction, cross-finger flaps remain an important reconstructive tool. However, data on long-term results are scarce in the literature. This study aimed to assess the clinical and subjective long-term outcomes of patients who underwent cross-finger flap reconstruction for palmar digital and fingertip defects.</p><p><strong>Patients and methods: </strong>Between January 2003 and July 2022, 35 patients (31 male, 4 female, mean age: 59.0 years±20.1) were screened and included in the study. The data were obtained through a clinical examination, a Quick-DASH score and a self-designed questionnaire. Clinical outcomes were assessed by evaluating the range of motion (ROM) of the reconstructed finger and the donor finger compared with the contralateral uninjured hand. In addition to ROM, a static two-point separation test was performed to assess the sensory function of the reconstructed finger. The follow-up period was between 1 year and 19 years (mean: 12.6 years±6.1).</p><p><strong>Results: </strong>There was no significant difference in terms of ROM between the reconstructed finger and the donor finger compared with the contralateral uninjured hand. All patients reported normal discrimination between sharp and blunt objects. However, there was a significant difference in two-point discrimination between the reconstructed finger and the healthy contralateral finger (p<0.05). The average Quick-DASH score was 5.1 points. Satisfaction with the functional outcome in terms of mobility and load-bearing capacity of the cross-finger flap averaged 8.1 out of 10 points. Satisfaction with the aesthetic outcome of the reconstructed finger averaged 7.7 out of 10 points. In 4 cases, persistent pain was reported when the reconstructed finger was under stress. No cases of pain at rest were reported.</p><p><strong>Conclusion: </strong>In the long run, cross-finger flaps are a safe and effective reconstructive procedure for covering defects in palmar injuries of the finger and fingertip amputation. They represent a simple, reliable, long-lasting reconstructive technique. The necessary temporary iatrogenic syndactyly does not lead to long-term limitations in the range of motion.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"448-453"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621842","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}