Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed.

This systematic review addresses the crucial role of anticoagulation in microsurgical procedures, focusing on free flap reconstruction and replantation surgeries. The objective was to balance the prevention of thrombotic complications commonly leading to flap failure, with the risk of increased bleeding complications associated with anticoagulant use. A meticulous PubMed literature search following Evidence-Based-Practice principles yielded 79 relevant articles, including both clinical and animal studies. The full-texts were carefully reviewed and evaluated by the modified Coleman methodology score. Clinical studies revealed diverse perioperative regimens, primarily based on aspirin, heparin, and dextran. Meta-analyses demonstrated similar flap loss rates with heparin or aspirin. High doses of dalteparin or heparin, however, correlated with higher flap loss rates than low dose administration. Use of dextran is not recommended due to severe systemic complications. In animal studies, systemic heparin administration showed predominantly favorable results, while topical application and intraluminal irrigation consistently exhibited significant benefits in flap survival. The insights from this conducted systematic review serve as a foundational pillar towards the establishment of evidence-based guidelines for anticoagulation in microsurgery. An average Coleman score of 55 (maximum 103), indicating low overall study quality, however, emphasizes the need for large multi-institutional, randomized-clinical trials as the next vital step.

Facial palsy (FP) is a functional disorder of the facial nerve involving paralysis of the mimic muscles. According to the principle “time is muscle,” early surgical treatment is tremendously important for preserving the mimic musculature if there are no signs of nerve function recovery. In a 49-year-old female patient, even 19 months after onset of FP, successful neurotization was still possible by a V-to-VII nerve transfer and cross-face nerve grafting. Our patient suffered from complete FP after vestibular schwannoma surgery. With continuous application of electrostimulation (ES) therapy, the patient was able to bridge the period between the first onset of FP and neurotization surgery. The significance of ES for mimic musculature preservation in FP patients has not yet been fully clarified. More attention should be paid to this form of therapy in order to preserve the facial musculature, and its benefits should be evaluated in further prospective clinical studies.

Summary: Digital-nerve lesions result in a loss of tactile sensation reflected by an anesthetic area (AA) at the radial or ulnar aspect of the respective digit. Available tools to monitor the recovery of tactile sense have been criticized for their lack of validity. Precise quantification of AA dynamics by three-dimensional (3D) imaging could serve as an accurate surrogate to monitor recovery after digital-nerve repair. For validation, AAs were marked on digits of healthy volunteers to simulate the AA of an impaired cutaneous innervation. The 3D models were composed from raw images that had been acquired with a 3D camera to precisely quantify relative AA for each digit (3D models, n = 80). Operator properties varied with regard to individual experience in 3D imaging and image processing. In addition, the concept was applied in a clinical case study. Results showed that images taken by experienced photographers were rated as better quality ( P < 0.001) and needed less processing time ( P = 0.020). Quantification of the relative AA was not altered significantly, regardless of experience level of the photographer ( P = 0.425) or image assembler ( P = 0.749). The proposed concept allows precise and reliable surface quantification of digits and can be performed consistently without relevant distortion by lack of examiner experience. Routine 3D imaging of the AA has the great potential to provide visual evidence of various returning states of sensation and to convert sensory nerve recovery into a metric variable with high responsiveness to temporal progress.

Einleitung Es gibt keine wissenschaftliche Evidenz aus randomisiert-kontrollierten Studien, die für eine routinemäßige Anlage von subkutanen Drainagen bei körperformenden Eingriffen in der Plastischen Chirurgie spricht. Die vorliegende Studie untersucht, inwiefern sich ein Verzicht auf Wunddrainagen bei Abdominoplastik auf das Seromvolumen, die stationäre Verweildauer und postoperative Komplikationen auswirkt. Material und Methoden Die Studienteilnehmer wurden prospektiv in zwei Gruppen mit Anlage von Drainagen (MD) und ohne Anlage von Drainagen (OD) bei Abdominoplastik randomisiert. Einschlusskriterien waren eine Abdominoplastik mit horizontaler oder kombiniert horizontal/vertikaler Schnittführung unter Schonung der Scarpa-Faszie und ein BMI ≤ 30 kg/m². Ausschlusskriterien beinhalteten eine simultane Liposuction des Operationsgebietes, bekannte Gerinnungsstörungen sowie ein ASA-Score ≥ 3. Das kumulative Seromvolumen über einen Beobachtungszeitraum von 4 Wochen wurde als primärer Endpunkt definiert. Die stationäre Verweildauer und revisionspflichtige Komplikationen stellten sekundäre Endpunkte dar. Resultate Bei 53 Studienteilnehmern wies das kumulative Seromvolumen keinen statistisch signifikanten Unterschied zwischen den beiden Studienpopulationen MD (30/53) und OD (23/53) auf (M_MD 493 ± SD 407 ml; M_OD 459 ± SD 624 ml; p = 0,812). Verglichen mit dem MD-Patientenkollektiv, konnte durch den Verzicht auf Wunddrainagen in der OD-Kohorte eine signifikant kürzere mittlere stationäre Verweildauer erzielt werden (M_MD 5,1 ± SD 1,4 d; M_OD 4,2 ± SD 1,5 d; p = 0,023). Beide Studiengruppen hatten identische Komplikationsraten (n_MD = 1; n_OD = 1). Schlussfolgerung Bezugnehmend auf die Ergebnisse der vorliegenden Erhebung, kann bei präadipösen Patienten (BMI ≤ 30 kg/m²) ein routinemäßiger Verzicht auf Drainagen bei Abdominoplastik (horizontale, kombiniert horizontale/vertikale Schnittführung) in Erwägung gezogen werden. Die Anlage von Drainagen sollte lediglich auf patientenindividueller Basis erfolgen. Introduction There is insufficient scientific evidence from randomised controlled trials to support the routine use of closed-suction drains in body contouring procedures. The aim of this study was to evaluate cumulative seroma volume, length of hospital stay and complication rates in abdominoplasty patients without drains in direct comparison with a cohort receiving drains. Material and Methods Abdominoplasty patients were prospectively randomised in two study groups with (MD) and without (OD) placement of closed-suction drains. Patients with a BMI ≤ 30 kg/m² undergoing horizontal or combined horizontal/vertical incision abdominoplasty were included. Scarpa’s fascia was preserved during dissection. Exclusion criteria comprised simultaneous liposuction, coagulation disorders and ASA score ≥ 3. Cumulative seroma volume over a four-week follow-up period was assessed as the primary outcome measure. Secondary outcome measures were complications requiring surgical revision and length of hospital stay. Results This trial did not identify a statistically significant difference in cumulative seroma volume between the MD (30/53) and OD (23/53) cohorts in 53 patients (M_MD 493 ± SD 407 ml; M_OD 459 ± SD 624 ml; p = 0.812). However, a significantly shorter average length of hospital stay was observed in the OD population (M_MD 5.1 ± SD 1.4 d; M_OD 4.2 ± SD 1.5 d; p = 0.023). Complication rates were equal in both study groups (n_MD = 1; n_OD = 1). Conclusion The results of this trial do not justify routine placement of closed-suction drains in abdominoplasty procedures (horizontal or combined horizontal/vertical incision) in the pre-obese patient cohort (BMI ≤ 30 kg/m²). Drain placement should be evaluated on an individual patient-specific basis. Received: 19 December 2019 Accepted: 27 April 2020 Publication Date: 21 August 2020 (online) © Georg Thieme Verlag KG Stuttgart · New York