Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb^® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications.

The treatment of severe burn injuries, which occur particularly in the context of armed conflicts, is based on a multimodal treatment concept. In addition to complex intensive care therapy, the surgical reconstruction options of plastic surgery and typical antiseptic wound treatment are the main focuses. In recent years, atmospheric cold plasma therapy (ACPT) has also become established for topical, antiseptic wound treatment and for the optimization of re-epithelialization. This case report shows a successful treatment of extensive burn injuries using dermal skin substitute matrix and topical treatment with a large-area cold plasma device to control multi-resistant pathogen colonization. This case report illustrates the importance of ACPT in burn surgery. However, larger case series and randomized controlled trials in specialized centers are needed to assess its place in future clinical practice.

Secondary infections of skin grafts pose a continuous problem in burn patients, very often leading to loss of transplanted skin grafts and making multiple surgical revisions necessary. We present a case report about persisting Pseudomonas aeruginosa infection in burn patients with known diabetes. The burn wounds in lower extremities required repeated debridements, multiple skin grafting attempts and finally an application of the dermal scaffold NovoSorb BTM. With these measures, we managed to undertake a successful reconstruction of infected burn defects and pre-vent an amputation. We concluded that the NovoSorb BTM could be seen as an additional promising tool in a burn surgery armamentarium. In cases where radical surgical wound decontamination is not possible without risking the loss of the limb, the application of NovoSorb BTM over a contaminated field can win extra time for topical infection treatment and additionally provide an excellent skin grafting ground.

We report here a 46-year-old male patient with a 14 cm segmental bone defect of the radial shaft after third degree open infected fracture caused by a shrapnel injury. The patient underwent fixed-angle plate osteosynthesis and bone reconstruction of the radial shaft by a vascularized 3D-printed graft cage, including plastic coverage with a latissimus dorsi flap and an additional central vascular pedicle. Bony reconstruction of segmental defects still represents a major challenge in musculo-skeletal surgery. Thereby, 3D-printed scaffolds or graft cages display a new treatment option for bone restoration. As missing vascularization sets the limits for the treatment of large-volume bone defects by 3D-printed scaffolds, in the present case, we firstly describe the reconstruction of an extensive radial shaft bone defect by using a graft cage with additional vascularization.

Introduction: Osteoarthritis of the first carpometacarpal joint is a common pathology of the hand, which may show an increasing prevalence in Germany due to the demographic development. In recent years, not only the current gold standard - the resection arthroplasty of the thumb saddle joint - has been used, but also therapeutic thumb saddle joint arthroscopy. In addition to the patient’s clinical complaints, radiographic diagnostics have been used to decide on treatment, although it has not been proven whether there is a correlation between imaging and clinical complaints. Materials and methods: Between 2020 and 2022, 20 articular surfaces of the thumb saddle joint undergoing resection arthroplasty for symptomatic basal thumb osteoarthritis were prospectively examined, mapped and compared with preoperative conventional radiographs. Results: The evaluation of the corresponding articular surfaces showed a higher cartilage destruction at the articular surfaces of the trapezium compared to the first metacarpal. No correlation was found between the stage of osteoarthritis and the Eaton-Littler classification. Conclusions: Overall, there is a patient-specific heterogeneity of the cartilage damage of the articular surface of the trapezium bone, as well in the metacarpal bone I base in relation to the radiographic diagnosis. Furthermore, an inhomogeneity of the radiographic stage of osteoarthritis of the carpometacarpal joint according to Eaton and Littler in relation to the intraoperatively assessed cartilage damage. The statistical significance of the surgically assessed cartilage damage in relation to the conventional radiographs could not be demonstrated. Thus, the treatment of symptomatic osteoarthritis of the carpometacarpal joint should primarily address the patient’s individual complaints. The radiographic classification according to Eaton and Littler can be used as an additional factor to decide on the surgical procedure but should not delay the therapeutic treatment. Level of evidence: III.

Intermediate and deep second-degree skin burn injuries are an ongoing challenge for burn surgeons, with the difficult decision regarding whether to handle them with either conservative or operative methods. In this study, the outcome of similar deep second-degree skin burn injuries is shown with the example of four family members. Clinical outcomes of the four family members which were treated at our burn center in 2017 were analyzed. The areas of burned skin (IIa°-IIb°) extended from 14% to 38% of the total burned skin area. Surgical treatment was adjusted to the rate of epithelialization after the first debridement. The excellent cosmetic long-term results of this patient cohort support the importance of stage-related therapy of deep dermal burn injuries. An initial debridement followed by early coverage is the key to early reconstitution of the epidermal barrier. However, with regard to the late effects of skin substitutes, more sensory alterations, dysesthesia, hyperpigmentation and unstable skin areas are still visible after coverage with glycerol conserved skin. The best results were seen after the use of autologous STGS and synthetic skin.