Background
Bioprinting is one of the most rapidly developing fields in medicine. Plastic and reconstructive surgery will be affected enormously by bioprinting, due to its original purpose of ...restoring injured or lost tissue. This article in particular has the purpose to analyze the current state of bioprinted tissues as well as research engagement for its application in plastic and reconstructive surgery.
Material and methods
A systematic search for the time span between 2000 and 2022 was performed on EMBASE, PubMed, Scopus, and Web of Science databases according to the PRISMA Guidelines. Criteria for the selection of publications were in vitro, animal in vivo, and human in vivo studies where three-dimensional bioprinting of tissue was performed. We extracted data such as (a) author’s country of origin, (b) in vitro study, (c) animal in vivo study, and (d) human in vivo study and categorized the publications by topics such as (1) neural tissue, (2) vascularization, (3) skin, (4) cartilage, (5) bone, and (6) muscle. Additionally, recent discoveries of in vivo animal trials were summarized.
Results
Out of a pool of 1.629 articles, only 29 publications met our criteria. Of these publications, 97% were published by university institutions. Publications from China (28%,
n
=8), the USA (28%,
n
=8), and Germany (10%,
n
=3) led the publication list on 3D bioprinting. Concerning the publications, 45% (
n
=13) were in vitro studies, 52% (
n
=15) in vivo studies on animal models, and 3% (
n
=1) pilot clinical studies on humans as reported by Zhou et al. (
EBioMedicine
28: 287–302, 2018). Regarding the classification of topics, our study revealed that publications were mainly in the field of 3D printing of cartilage (
n
=13, 39%), skin (
n
=7, 21%), bone (
n
=6, 18%), and vascularization (
n
=5, 15%).
Conclusions
To this date, it has not been yet possible to bioprint whole tissue systems. However, the progress in three-dimensional bioprinting is rapid. There are still some challenges, which need to be overcome regarding cell survival before and during the printing process, continuation of architecture of bioprinted multilinear cells, and long-term stabilization and survival of complex tissues.
Level of evidence
: Not ratable.
In the clinical setting, optical coherence tomography (OCT) is applicable for the non‐invasive diagnosis of skin cancer and may in particular be used for margin definition prior to excision. In this ...regard, OCT may improve the success rate of removing tumor lesions more effectively, preventing repetitive excision, which may subsequently result in smaller excisions. In this study, we have aimed to evaluate the applicability of OCT for in vivo presurgical margin assessment of non‐melanocytic skin tumors (NMSC) and to describe the feasibility of different scanning techniques. A total number of 18 patients planned for excision of lesions suspicious of NMSC were included in this study. Based on OCT, we defined the specific tumor margins on 19 lesions preoperatively using different scanning modalities. Sixty‐one margin points and five complete tumor margins were analysed on 18 patients with a total of 19 lesions including 63% basal cell carcinoma (BCC) (n = 12), 16% (n = 3) squamous cell carcinoma (SCC) and 21% of other types of skin tumors (n = 4) were classified. In 84% of the cases (n = 16), the OCT‐defined lateral margins correctly indicated complete removal of the tumor. The surgical margins chosen by the surgeon never fell below the OCT‐defined margin. Regarding the techniques of marginal definition, punctual tumor border scan in the perpendicular direction, with an extension of free‐run scans for unsure cases can hardly be recommended. This study shows that suspected NMSC can effectively be confirmed, and furthermore, resection margin can be minimized under OCT control without reducing the rate of complete removal.
Partial and full thickness burns require surgical treatment, such as early débridement and skin transplantation in MEEK/MESH technique or further reconstructive surgery. Infections of burns or ...transplanted areas limit surgical success and increase patient mortality. For split-thickness grafts in MEEK technique a superficial silk is applied as a protective on-top dressing, whereas in MESH technique fatty gauze and foam are used as standard protective covers over five to seven days. However, wound occlusion by both materials provides the soil for growth of microorganisms. The timely identification of impending infections is necessary to initiate early removal in order to safe and preserve skin grafts. Early identification of infections and removal of foreign material should therefore be attempted.
Burn wounds treated with split-thickness skin grafts processed by MEEK/MESH technique and covered with silk or foam overlayers were analyzed for signs of bacterial infection using the MolecuLight i:X™ device. In addition, swaps for microbiological analysis where taken from fluorescent areas and correlated with florescent image results.
We examined burn wounds (n = 14) of three different intensive care patients. The MolecuLight i:X™ camera showed a strong colonization of the transplanted areas and foreign materials, that were in line with microbiological analysis findings. The representation of the excitation load showed high values in the foreign materials. The take rate of MEEK-transplants was 90 % compared to MESH-transplanted with about 60 %. The positive predictive value was 81.8 % for detection of a wound infection with autofluorescence. The negative predictive value was 90.3 % with a sensitivity of 86.7 % and a specificity of 87.5 %.
The representation of the fluorescence exciter load shows high concentrations of pathogens both in the MEEK silk layer as well as in foam linkers. Overall split-thickness grafts according to the MEEK technique showed a higher healing rate compared to MESH technique. Screening of burns wounds with autofluorescence imaging can be helpful for an additive wound assessment. Split-thickness graft covers should be applied only for a minimum time period required to ensure stable grafting.
Interdisciplinary emergency departments in Germany are seeing an increasing inflow of patients for several reasons. Since the number of patients in the emergency room cannot be planned, there may be ...a lack of capacity with prolonged waiting periods and delays. In particular, a significant amount of capacities is consumed by hand injuries. Also it is suspected for the discipline of plastic surgery that the majority of emergency presentations are unjustified. We provide a collection of data followed by an analysis of emergencies to better understand the increased number of patients with the aim of identifying possible solutions for the relief of emergency care.
We performed a retrospective analysis of documented patient cases seen in the interdisciplinary emergency room of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of a university hospital. Over the span of one year, we evaluated the diagnosis, waiting time and distribution of patients over 24 hours at 7 weekdays. Furthermore, we evaluated the justification of emergency presentation and the necessity of inpatient admission.
We assessed a total of 2768 patients with an average age of 40 years (median = 37 years, male 59 %/ female 41 %) within one year (2016-2017). Of 2450 patients, 69 % were legitimate emergencies, defined by severity of trauma or disease. Proportionally, the most common cause of presentation for 2768 cases was upper extremity injury with cut and saw injuries amounting to 25 % (n = 697), followed by lacerations/bite injuries with 22 % (n = 611) and burns with 17 % (n = 477). Most services were performed between 09:00 a.m. and 01:00 p.m. There were no significant differences regarding the distribution over different weekdays. In 24 % (n = 583) of these cases, the patient was hospitalised for inpatient treatment. In 45 % of cases, there was no indication for hospitalisation after treatment. The waiting time for 2450 patients averaged 2:23 h (median = 01:43 h) until treatment.
In face of these results it may be argued, that a majority of emergency cases could be selected through filter structures to be distributed to suitable facilities. This could cover a large proportion of the 45 % legitimate, but ambulatory emergencies. Furthermore a concentration of emergency departments should take place with a simultaneous supply of financial resources to expanding emergency departments with high patient flow.
Background
The monitoring of wound‐healing processes is indispensable for the therapeutic effectiveness and improved care of chronic wounds. Histological sections provide the best morphological ...assessment of wound recovery, but cause further tissue destruction and increase the risk of infection. Therefore, it is reasonable to apply a diagnostic tool that allows a non‐invasive and reliable observation of morphological changes in wound healing.
Methods
Optical coherence tomography (OCT) is an imaging technique for in vivo evaluation of skin diseases with a resolution close to histopathology. The aim of this study was to investigate whether OCT is suited to display the phases of wound healing. For this purpose, six patients with chronic wounds were objectively characterized by OCT during a period of 2 weeks.
Results
Comparable results between histological findings and OCT were achieved. OCT allowed the detection of partial loss of the epidermis, vasoconstriction, vasodilatation and epithelialization.
Conclusion
Consequently, OCT could be a potential non‐invasive diagnostic tool for the characterization and monitoring of cutaneous wound‐healing processes over time.
The workload of university hospitals and hospitals with university association includes clinical patient care as well as teaching and research in particular. The current development with focus on ...financial issues leads to a reduction of teaching and research capacities. Economic focus in university medicine changes priorities of academic surgery.
An online survey questioned medical students with regard to subjective assessment of quality of the academic body of university hospitals and current teaching quality. Students evaluated the current quality of teaching of postdoctoral lecturers in relation to their career stage and made suggestions for quality of teaching improvement.
A total of 166 students participated in the survey. Of 123 students, about 78 % stated that the reputation of postdoctoral lecturers increases with the habilitation but about 85 % stated that professional expectations also rise. About 43 % of the students aim to achieve a postdoctoral lecture qualification.
Among students academic career is still attractive, but restructuring and modernization of established working models is an essential prerequisite.
Over the last few decades plastic and aesthetic surgery careers aimed at holding a chair as head of the department or clinical director. The current career trend shows a drain of academic teaching ...staff to peripheral hospitals with sole clinical focus. The achievement of a doctorate in German university medicine or obtaining the venia legendi appears to be the termination of academic careers. This brain drain with loss of expertise and scientific output imposes a problem to future progress in clinical and scientific plastic and reconstructive surgery. The causative role of our present work profile, workload and financial compensation will be discussed in this paper.
In order to understand this brain drain, the scientific and clinical developments of all habilitands, Assistant Professors and University Directors enlisted in our specialist society (DGPRAEC) were analyzed. The evaluation included the duration of the residency, the time span from being a specialist physician to habilitation, as well as gaining a leadership position after habilitation. Finally, the current activity of the members at university and non-university institutions was evaluated.
A total of 1238 members were analyzed. Among these, 177 (14.3 %) members had completed the habilitation. In total, 114 (9.21 %) were included based on full available CVs. Of the listed members, 80 members (6,5 %) had an APL professorship/university professorship in April 2017. 88 CVs showed an average time span of 4.2 years from specialization to habilitation. 80 CVs revealed a 5 year time span to achieve an APL professorship/university professorship. After an average of 4.2 years, leadership positions were held. Of the analyzed habilitations, 60 % were active in peripheral hospitals at the time April 2017.
The loss of scientific and clinical expertise should be prevented in order to preserve academic plastic surgery with focus on patient care, academic education and research. This could be achieved by creating more attractive working conditions.
Purpose: The development of upper extremity prosthetic replacement has progressed rapidly. These technological advances in bionics provide a reason to reconsider extensive upper limb reconstructive ...surgery. The purpose was to determine the level of knowledge and awareness among clinicians about important advances in bionic limb replacement. Methods: A multicenter and multi-discipline cross-sectional inquiry was designed to survey clinicians at German university hospitals regarding their knowledge of modern bionic prosthesis. Anonymous questionnaires were collected by email, telephone interview, and from submission within the hospital. The questionnaire was divided into 10 parts consisting of 40 questions. Seven parts queried factual knowledge and three parts queried self-perception of knowledge and awareness of surgical reconstruction for severe hand injuries and outcome of plexus brachialis lesions. Anonymous surveys were circulated to a representative sample of institutional specialists, residents and students in departments for plastic/hand surgery, plastic surgery only, orthopedics and trauma/hand surgery.Results: 105 questionnaires were returned by 30 specialists, 35 residents and 40 students. Specialists in plastic and reconstructive surgery departments with an additional hand surgery focus attained the highest accurate response rate (mean value=67% ± SD 13%). Specialists in other departments as well as residents and students attained lower scores. Additionally, the perception of the outcome of severe hand injuries and plexus brachialis lesions seems not to be satisfying and suggests a need to improve outcomes. Most survey responses indicated an insufficient ability to consult and supervise on patients for supply with bionic prosthesis.Conclusion: Survey findings indicate room for improving the state of knowledge and awareness regarding modern bionic prosthesis, especially among residents and students. In general, there is a perception of insufficient information regarding bionic prosthetic supply after severe hand injuries and unsuccessful reconstruction of plexus brachialis lesions. Modern bionic replacement options could significantly lower financial and social burdens of hand trauma compared to traditional surgeries. The lack of knowledge regarding this option may prevent or slow its implementation at hospitals. It is important to integrate bionic prosthetic supply at specialized centers after exact definition of surgical indication.
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