Soft tissue sarcomas (STSs) are tumors that are challenging to treat due to their pathologic and molecular heterogeneity and their tumor biology that is not yet fully understood. Recent research indicates that dysregulation of cyclin-dependent kinase (CDK) signaling pathways can be a strong driver of sarcogenesis. CDKs are enzyme forms that play a crucial role in cell-cycle control and transcription. They belong to the protein kinases group and to the serine/threonine kinases subgroup. Recently identified CDK/cyclin complexes and established CDK/cyclin complexes that regulate the cell cycle are involved in the regulation of gene expression through phosphorylation of critical components of transcription and pre-mRNA processing mechanisms. The current and continually growing body of data shows that CDKs play a decisive role in tumor development and are involved in the proliferation and growth of sarcoma cells. Since the abnormal expression or activation of large numbers of CDKs is considered to be characteristic of cancer development and progression, dysregulation of the CDK signaling pathways occurs in many subtypes of STSs. This review discusses how reversal and regulation can be achieved with new therapeutics and summarizes the current evidence from studies regarding CDK modulation for STS treatment.

The rat median nerve model is a well-established and frequently used model for peripheral nerve injury and repair. The grasping test is the gold-standard to evaluate functional recovery in this model. However, no comprehensive review exists to summarize the course of functional recovery in regard to the lesion type. According to PRISMA-guidelines, research was performed, including the databases PubMed and Web of Science. Groups were: (1) crush injury, (2) transection with end-to-end or with (3) end-to-side coaptation and (4) isogenic or acellular allogenic grafting. Total and respective number, as well as rat strain, type of nerve defect, length of isogenic or acellular allogenic allografts, time at first signs of motor recovery (FSR) and maximal recovery grasping strength (MRGS), were evaluated. In total, 47 articles met the inclusion criteria. Group I showed earliest signs of motor recovery. Slow recovery was observable in group III and in graft length above 25 mm. Isografts recovered faster compared to other grafts. The onset and course of recovery is heavily dependent from the type of nerve injury. The grasping test should be used complementary in addition to other volitional and non-volitional tests. Repetitive examinations should be planned carefully to optimize assessment of valid and reliable data.

Background: Extralevator abdominoperineal excision (ELAPE) is a relatively new surgical technique for low rectal cancers, enabling a more radical approach than conventional abdominoperineal excision (APE) with a potentially better oncological outcome. To date, no standard exists for reconstruction after extended or extralevator approaches of abdominoperineal (ELAPE) resection for lower gastrointestinal cancer or inflammatory tumors. In the recent literature, techniques with myocutaneous flaps, such as the VY gluteal flap, the pedicled gracilis flap, or the pedicled rectus abdominis flaps (VRAM) are primarily described. We propose a tailored concept with the use of bilateral adipo-fasciocutaneous inferior gluteal artery perforator (IGAP) advancement flaps in VY fashion after ELAPE surgery procedures. This retrospective cohort study analyzes the feasibility of this concept and is, to our knowledge, one of the largest published series of IGAP flaps in the context of primary closure after ELAPE procedures. Methods: In a retrospective cohort analysis, we evaluated all the consecutive patients with rectal resections from Jan 2017 to Sep 2021. All the patients with abdominoperineal resection were included in the study evaluation. The primary endpoint of the study was the proportion of plastic reconstruction and inpatient discharge. Results: Out of a total of 560 patients with rectal resections, 101 consecutive patients with ELAPE met the inclusion criteria and were included in the study evaluation. The primary direct defect closure was performed in 72 patients (71.3%). In 29 patients (28.7%), the defect was closed with primary unilateral or bilateral IGAP flaps in VY fashion. The patients’ mean age was 59.4 years with a range of 25–85 years. In 84 patients, the indication of the operation was lower rectal cancer or anal cancer recurrence, and non-oncological resections were performed in 17 patients. Surgery was performed in a minimally invasive abdominal approach in combination with open perineal extralevatoric abdominoperineal resection (ELAPE) and immediate IGAP flap reconstruction. The rate of perineal early complications after plastic reconstruction was 19.0%, which needed local revision due to local infection. All these interventions were conducted under general anesthesia (Clavien–Dindo IIIb). The mean length of the hospital stay was 14.4 days after ELAPE, ranging from 3 to 53 days. Conclusions: Since radical resection with a broad margin is the standard choice in primary, sphincter-infiltrating rectal cancer and recurrent anal cancer surgery in combination with ELAPE, the choice technique for pelvic floor reconstruction is under debate and there is no consensus. Using IGAP flaps is a reliable, technical, easy, and safe option, especially in wider defects on the pelvic floor with minimal donor site morbidity and an acceptable complication (no flap necrosis) rate. The data for hernia incidence in the long term are not known.

Introduction: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are high-energy wrist injuries often linked to significant post-traumatic osteoarthritis. This study aims to determine whether PLD and PLFD yield different radiological outcomes following surgical treatment while identifying prognostic factors for worse outcomes. Materials and methods: We retrospectively analyzed 51 patients treated for perilunate injuries between 2000 and 2022. Radiographic evaluation included postoperative carpal alignment, scapholunate distance, ulnar translocation, and postoperative arthrosis according to the Kellgren-Lawrence scale. Logistic regression models were used in the study. The analyzed explanatory variables included: type of injury (PLFD/PLD), Mayfield classification, capsulodesis, repair of intercarpal- and extrinsic ligaments, and number of wrist transfixations. The significance level was set at p ≤ 0.05. The calculations were performed with R (version 4.3.2). Results: Among 51 patients, the mean follow-up was 4.33 years (1-22.13), and the mean age was 37.76 years. PLFD accounted for 55% of cases. Patients in the PLD group were older at the time of injury ( p = 0.0031) compared to PLFD. Older patients presented also with higher stages of perilunate instability ( p = 0.0061). Midcarpal arthrosis was the most common site of wrist degeneration (58.8%). Ordinal logistic regression indicated that PLFD was associated with a lower risk of midcarpal arthrosis (OR = 0.293, p = 0.04), while a higher number of wrist transfixations increased the risk of advanced arthrosis (OR = 2.427, p = 0.02), The logistic regression model detected a positive effect of the number of wrist transfixations on lunate fovea arthrosis ( p = 0.048). The number of wrist transfixations did not correlate with the number of fractures ( p = 0.06), Mayfield classification ( p = 0.16), or intraoperative reduction outcome ( p = 0.6). Conclusion: PLD and a greater number of wrist transfixations were associated with a higher risk of wrist arthrosis. Limiting wrist pinning to essential procedures may help prevent additional iatrogenic chondral lesions.

Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare secondary angiosarcoma that typically develops subsequent to breast-conserving therapy for breast cancer. The parameters of the resection width and depth remain the subject of considerable controversy. More recent data indicate that radical resection of the complete radiation field at the thorax is associated with improved local control and survival. Objectives: The present study investigates the radical resection technique of the entire radiation field and subsequent defect coverage in RAASB, as well as the medium-term follow-up. Design: Monocentric, retrospective, and non-comparative study. Methods: From January 2017 to January 2024 a total of 10 patients with RAASB were treated at our hospital. The radical resection technique was employed in the treatment of all patients, encompassing the entire radiation field. Three patients received local flaps (two of whom received vertical and transversal rectus abdominis muscle flaps and one received a local random pattern flap), while the remaining seven were treated with split-thickness skin grafts for defect coverage. Results: The median age at initial diagnosis of breast cancer was 59.3 ± 9.41 years, while that of RAASB was 66.2 ± 8.32 years. The median latency period between the start of irradiation of the chest wall and the initial presentation of RAASB was 6.5 ± 3.08 years. The cumulative median total radiation dose was 57.23 ± 8.34 Gray (cumulative Gray) in 9 of the 10 patients. The overall survival (OS) was 80% in the cohort, with a median follow-up period of 40.0 ± 27.96 months. Three patients exhibited local relapses following radical resection, with two of these patients ultimately succumbing to their condition. Conclusion: Patients with RAASB may benefit from a radical resection of the entire radiation field. Despite the relatively mutilating nature of the procedure, the radical resection technique may have the potential to reduce the rate of local recurrence and prolong OS.

Zusammenfassung: Mikrochirurgische Präparations- und Nahttechniken erfordern hartnäckiges Üben, eine gewisse Frustrationstoleranz und Ausdauer. Gerade Neulinge üben oftmals am „trockenen Modell“ um einen fließenderen Übergang bezüglich der späteren Anwendung am Patienten im Operationssaal zu erreichen. Ob am OP-Handschuh, Schweineherz, als Virtual Reality Tool, Rattenmodell mit Lupenbrille oder Mikroskop – viele verschiedene mikrochirurgische Übungsmodelle sind bekannt. Seit einigen Jahren sind auch Eigenbauten mit Smartphone-Kamera als Vergrößerungshilfe beschrieben. Neuerdings gibt es nun ein kommerzielles System aus den USA, welches es dem Trainee relativ einfach und kostengünstig erlaubt, zu jeder Zeit und fast an jedem Ort mikrochirurgische Basistechniken und das Handling von Faden und Instrumenten zu erlernen oder fortgeschrittene Knotentechniken wie den „Through-the-loop“-Knoten am Modell zu perfektionieren. Hierzu wird ein herkömmliches Smartphone als Mikroskopersatz in einen 3D-Schwenkarm eingespannt und mikrochirurgische Techniken können über das Display des Gerätes geübt werden. Passend zum Übungssystem gibt es vorgefertigte „Übungskarten“ mit eingebauten kleinen Plastikröhrchen verschiedener Stärke (1–3 mm), an denen unterschiedliche Anastomosetechniken geübt werden können.Wir glauben, dass zukünftig derartige Modelle in allen mikrochirurgischen Kliniken zum Standardrepertoire in der mikrochirurgischen Ausbildung für junge Assistenzärzte und Studierende gehören könnten. Sie sind preiswert, praktikabel und jederzeit an jedem Ort anwendbar.