Untersuchung zur optimalen Anwendungshäufigkeit von Stoßwellen zur maximalen Stimulation der Angiogenese

Ziel der Untersuchungen war es, die Mikrozirkulation, Leukozyten-Endothelzell-Interaktion und die Angiogenese nach tiefgradiger Verbrennung unter dem Einfluss drei verschiedener Wiederholungsfrequenzen von Stoßwellen zu analysieren. Es wurden standardisiert tiefgradige Verbrennungen an den Ohren von haarlosen Mäusen gesetzt. Tiere der Kontrollgruppe erhielten keine, der Gruppe A eine, der Gruppe B zwei und der Gruppe C drei Stoßwellenanwendungen. Die intravitale Fluoreszenzmikroskopie wurde verwendet, um die mikrozirkulatorischen Parameter, die Leukozyten-Endothelzell-Interaktion und die Angiogenese zu erheben. Die Stoßwellen-Behandlungsgruppen zeigten im Vergleich zur Kontrollgruppe eine signifikant beschleunigte Angiogenese. Die Ergebnisse zeigen, dass mehrfache Anwendungen sinnvoll zu sein scheinen um die Angiogenese – als wichtigstem Parameter der Wundheilung - zu stimulieren

The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients

Background: Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. Methods: We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. Results: The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: p = 0.013; OS: p = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; p < 0.001) and OS (5-year: 82.8 vs. 61.8; p = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. Conclusions: The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner

The impact of surgical margins and adjuvant radiotherapy in patients with undifferentiated pleomorphic sarcomas of the extremities

$\textit {Background:}$ Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. $\textit {Methods:}$ We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. $\textit {Results:}$ The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: $\it p$ = 0.013; OS: $\it p$ = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; $\it p$ < 0.001) and OS (5-year: 82.8 vs. 61.8; $\it p$ = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. $\textit {Conclusions:}$ The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner

Microsurgical reconstruction of extensive oncological scalp defects

Although most small to medium defects of the scalp can be covered by local flaps, large defects or complicating factors, such as a history of radiotherapy, often require a microsurgical reconstruction. Several factors need to be considered in such procedures. A sufficient preoperative planning is based on adequate imaging of the malignancy and a multi-disciplinary concept. Several flaps are available for such reconstructions, of which the latissimus dorsi and anterior-lateral thigh flaps are the most commonly used ones. In very large defects, combined flaps, such as a parascapular/latissimus dorsi flaps, can be highly useful or necessary. The most commonly used recipient vessels for microsurgical scalp reconstructions are the superficial temporal vessels, but various other feasible choices exist. If the concomitant veins are not sufficient, the jugular veins represent a safe back-up alternative but require a vessel interposition or long pedicle. Post-operative care and patient positioning can be difficult in these patients but can be facilitated by various devices. Overall, microsurgical reconstruction of large scalp defects is a feasible undertaking if the mentioned key factors are taken into account

New model for long-term investigations of cutaneous microcirculatory and inflammatory changes following irradiation

Radiotherapy is used for curative and palliative treatment. However, its negative effect on normal tissue is a limiting factor for the deliverable dose. Microcirculatory breakdown and prolonged inflammation in particular are major features of late side effects. The purpose of this study was to develop a reliable animal model that will allow a long-term $\textit {in vivo}$ analysis of microcirculation and inflammation following irradiation. A single dose of 90 Gy was delivered to the ears of hairless mice ($\it {n}$ = 15). Intravital fluorescent microscopy was used to assess microcirculatory parameters and leukocyte behaviour. Values for the identical (control) areas were obtained before as well as during the following days, weeks and months following irradiation. The arteriolar and venular diameter increased up to Day 14, decreased during the following months, and increased again after one year. The red blood cell velocity increased up to 145% on Day 3, decreased on Day 7 to 115%, and stayed above baseline value the whole year. The integrity loss of the endothelium increased up to Day 7 and continued up to Day 75 after radiation. After one year, the oedema was at the baseline level. Leukocytes showed their maximal activity at one year after trauma. An increase was measured up to Day 25; the lowest values were measured at Day 40 post-irradiation, followed by a repeated increase. The present model allows a certain visualization of microcirculatory disturbances and inflammation over a period of months. This permits the possibility of long-term investigations of the underlying pathophysiology following irradiation, including possible drug interactions