Background: Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications. Methods: Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications. Results: Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes. Conclusion: Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient’s outcome.

Background and Objectives: This study aims to review how the introduction of propranolol as the primary treatment option for children with infantile hemangiomas (IHs) has affected the use of other treatment options at our institution and to determine the indications for surgical treatment of children with IHs in the propranolol era. Patients and Methods: The authors conducted a single-center, noncompeting, historical/retrospective cohort study to review all cases referred to the institution for IH evaluation from 2005 to 2020. The authors analyzed the complete charts of patients who received surgery from 2011 to 2020 and evaluated the reasons for each surgical intervention. Detailed descriptive statistics are provided. Logistic regression analysis and Pearson’s χ ²-test were applied. Results: During the study period, 592 children received treatment. From 2011, oral propranolol (n=268; 74%) and surgery (n=95; 26%) were the only treatments of choice for complicated IH cases. A significant decrease in the frequency of surgical treatment was observed (P=0.01). The authors identified four main indications for surgical treatment: (1) patients with ulceration and IH size appropriate for surgical resection (15%); (2) patients whose parents preferred surgical treatment (19%); (3) patients who presented late and underwent surgery before the age of three (29%); and (4) patients with sequelae after IH involution and excision after the third year of life (37%). Conclusions: Despite the significant decrease in the need for surgical treatment of children with IHs since the introduction of propranolol, there are still several clear indications for treating IH cases where surgery plays a crucial role.

Wound healing is a complex process that is still not fully understood despite extensive research. To address this, we aimed to design and characterize a standardized porcine model for the evaluation of wound healing, dressings, cell therapies, and pharmaceutical agents. Using a standardized approach, we examined the wound healing process in 1.2 mm-deep dermatome wounds at defined positions in 11 female pigs. Unlike previous studies that have only described/analyzed selected punch biopsies, we performed and described histological analyses along the complete wound length using quantitative morphometric methods. All animals remained fully healthy following surgery and showed no signs of infection. Our histopathological evaluation using a predetermined grading score and quantitative manual morphometry demonstrated the impact of different tissue sampling methods, sampling sites, and residual dermis thickness on wound healing. Our study presents a reproducible model for wound healing evaluation and demonstrates the usefulness of porcine models for assessing dermal and epidermal wound healing. The use of histological analyses over the complete wound length provides advantages over previous studies, leading to the possibility of a deeper understanding of the wound healing process. This model could potentially facilitate future research on novel wound dressings and local wound healing therapies.

Congenital cystic lymphangiomas (CCL) or lymphatic malformations (LMs) are benign malformations due to a developmental disorder of lymphatic vessels. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option. In a single center retrospective study we analyzed 37 consecutive patients (30 children, 3 adolescents and 4 adults) who were diagnosed with lymphangioma and subsequently treated with OK-432 (Picibanil®) in a general hospital between October 2000 and November 2021. The median follow-up period was 2.5 months (range 0.7–56.7 months). The lymphangiomas were localized in the head and neck region (n = 25), the thorax/abdomen (n = 6) and extremities (n = 6). The majority of patients had 1 injection with OK-432 (n = 28), five patients had 2 injections, three patients had 3 injections and one patient had more than 3 injections. The most common complications were swelling (89%), fever (81%), redness at the injection site (81%) and pain (73%). The response to therapy was excellent or good in 32 patients (86.4%), 2 patients had a medium response and 3 patients did not show any response. The clinical reaction after the instillation of OK-432 is not predictive for the quality of outcome. The application of Picibanil is safe and without serious side effects. Parents and patients prefer local sclerotherapy versus surgery as it has less complications. We therefore suggest that Picibanil sclerotherapy should be the first-line treatment for macrocystic and mixed type lymphangiomas.

Nasal Glioma (NG) represents a rare congenital abnormality of the neonate, which can be associated with skull defects or even a direct communication to the central nervous system. MRI serves valuable information for differentiation from encephalocele, dermoid cyst and congenital hemangioma. Complete resection remains the treatment of choice. We present two cases of NG, which were both suspected during prenatal ultrasound and MRI. In the first case, postnatal MRI showed a transcranial continuity. Mass excision was performed and the defect was covered by a glabellar flap allowing a good cosmetic result. Postnatal MRI excluded a trans-glabellar communication in the second case. After surgical excision, the resulting skin defect was covered with a full thickness skin graft harvested from the right groin. In cases of NGs complete resection and cosmetic appealing results can be achieved and might necessitate a multidisciplinary approach.

Background: Defects of the foot and ankle area pose a significant challenge for both patients and surgeons. While the primary objective of microvascular free flap reconstructions of lower leg defects is limb preservation, there should be an effort to obtain the best functional and aesthetic results possible and to restore the patient’s quality of life. The aim of this study was to investigate the long-term post-operative functional outcome, health-related quality of life, scar quality, and aesthetic satisfaction in patients following microsurgical reconstructions of defects of the foot and ankle area. Methods: We conducted a monocentric, controlled cohort study of adult patients who underwent microsurgical reconstructions for defects of the foot and ankle area between 2006 and August 2022 at our department. As a control, we recruited healthy individuals. Patient-Reported Outcome Measures questionnaires were used to assess long-term results regarding functionality (LEFS: Lower Extremity Functional Scale), health-related quality of life (SF-36: Short-Form 36 Health Survey Questionnaire), scar quality (PSAS: Patient Scar Assessment Scale), aesthetic satisfaction (Aesthetic Likert Scale), pain at rest and activity (10-point Numeric Rating Scale) and usage of footwear. Results: Of the 55 potential patients who had received microvascular free flaps for reconstructions of ankle and foot defects and were eligible for study inclusion, 13 (23.6%) agreed to participate in this study. The study cohort consisted of 84.6% male subjects and the mean follow-up period was 8.6 years (±5.2). Significant moderate limitations were observed with regard to physical function of the lower extremity (LEFS: 42.5 ± 20.5, p = 0.002). Significant limitations were found in the SF-36 subscales of pain (55.8 ± 34.5, p = 0.019), physical functioning (55.0 ± 29.7, p = 0.013), and physical role functioning (38.5 ± 44.0, p = 0.006). The study yielded favorable outcomes with regard to aesthetic satisfaction (14.3 ± 4.4) and scar quality (23.5 ± 13.5). Out of all the patients, 61% were required to wear orthopedic shoes or insoles. Conclusions: Patients undergoing microsurgical reconstructions for ankle and foot defects experience moderate long-term physical limitations and persistent pain during activity. Furthermore, we observed a significant long-term impact on specific physical domains of health-related quality of life, whereas mental health seems less affected.