Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity

Amniotic Band Syndrome (ABS) is a complex condition characterized by constricting rings and tissue synechiae, resulting in tissue necrosis and congenital anomalies. In newborns and infants with ABS, tissue necrosis can be profound, requiring a tissue defect reconstruction, realized by a Keystone Perforator Island Flap (KF). Primarily used for reconstruction after skin cancer excisions, KF’s applications expanded to defects of various etiologies and disorders throughout the body. Subsequently, additional KF types adapted to the particular tissue defects were developed. The KF’s preparation is relatively simple to perform leading to shorter operative times, and the postoperative monitoring is less laborious. Individualized surgical approaches and timing are essential for addressing the varied manifestations of ABS, with immediate treatment recommended for vascular compression, all-layered tissue necrosis, and nerve compression cases. To our knowledge, there is no published case in which a KF was used for the reconstruction of tissue defects and release of constriction rings in the context of an amniotic band syndrome. Therefore, the purpose of this article is to introduce the established surgical technique of KFs as an innovative surgical approach with satisfying reconstructive results for tissue defects and constriction ring release in ABS.</p

Auswirkung von Sympatischer Renaler Denervation bei nierentransplantierten Patienten - eine randomisierte Studie zur Durchführbarkeit und Wirksamkeit

Kidney transplanted patients frequently suffer high blood pressure values. These high values are major risk factors to graft failure and cardiovascular morbidity. These risks should be averted by renal denervation – a catheter based ablation procedure. This technique intends to interrupt conduction pathways of the central nervous system, which are responsible for elevated blood pressure values. Subject of the randomized study was to examine the feasibility and efficacy of renal sympathetic denervation compared to only medication therapy. After 6 months, we determined a significant reduction in office blood pressure and a decrease in nighttime values in 24h blood pressure recordings.Erhöhte Blutdruckwerte sind ein häufiges Problem für nierentansplantierte Patienten. Aufgrund dieser erhöhten Werte besteht ein bedeutendes Risiko für ein vorzeitiges Transplantatversagen und kardiovaskuläre Morbidität. Bei der Therapie mittels renaler Denervation handelt es sich um ein kathetergestützes Ablationsverfahren. Ziel dieser Methode ist die Durchtrennung von Leitungsbahnen, welche zu einer Fehlregulation des Blutdrucks führen können. Gegenstand der randomisierten Studie war die Untersuchung der Durchführbarkeit und Wirksamkeit dieses Verfahrens, verglichen mit einer alleinigen medikamentösen Therapie. Nach 6 Monaten zeigten sich eine signifikante Reduktion der Office Blutdruckwerte und ein Rückgang der nächtlichen Werte in der 24h Blutdruckmessung