Retrospektive Analyse der Defektrekonstruktion mit der Temporalisfaszienlappenplastik

The reconstructive surgery presents one of the pillars of plastic surgery, in which different kinds of flap procedures are used. The temporoparietal fascia flap (TPFF) constitutes a flap, that is variably applicable and repeatedly descripted in the literature as a free or a pedicled tissue transfer for various indications. The aim of the study is to evaluate this method of defect reconstruction based on the temporoparietal fascia flaps, which were performed by the Department of Plastic and Hand Surgery at the University Hospital Erlangen. Both free and pediced flap techniques will be compared to each other and the outcome of the whole collective and its influencing factors will be identified. For this study 23 temporoparietal fascia flaps are examined, including 14 free and 9 pedicled flap procedures, which were performed by the Department of Plastic and Hand Surgery at the University Hospital Erlangen in the period from 2007 to 2016. In the analysis the collective is initially examined using desctriptive statistics. In this regard the following parameters are taken into account: type of flap, distribution of surgical procedures over time, patient age, gender distribution, composition of the surgical team, follow-up period, defect size, reason for defect reconstruction, defect location, comorbidities, number of previous surgeries and total number of surgical procedures. Comparing the free to the pediculated flap, the correlation of the parameters indication, the tissue transplants used, comorbidities, duration of surgery, length of hospitalization, minor and major complications is evaluated in each case with the type of flap surgery. The parameters used to calculate the impact on the outcome of the overall collective include the duration of surgery, patient age, indication and number of comorbidities. This study presents successfully the diversity of the temporoparietal fascia flap with regard to the various locations of defects and the versatile indications for which the both techniques of TPFF were applied. When comparing the free and the pedicled flaps, it can be detected a significant difference in surgery time in the whole and postoperative length of hospitalization. Looking at the complication rate, the comparison of both techniques shows no significant distinction, neither in minor nor in major complications. The alopecia, which is a frequently mentioned complication in the recent literature, is not detected in any of the 23 patients, thus there are aesthetically pleasing results at the donor site. The outcome of the whole collective is measured by the postoperative length of hospitalization and by the appearance of postoperative complications. With regard to the factors influencing the outcome of the whole collective, the patients with lengthy surgery time tend to have a longer duration of hospitalization, but this is not statistically significant. The age of the patients has no statistically significant effect on the outcome. The length of the postoperative hospitalization is significantly depending on the indication, but the appearance of complications is not depending on the indication. The influence of comorbidities is also demonstrated by a significantly longer postoperative hospitalization in patients with 3 or more comorbidities. To summarize, the results clarify, that the temporoparietal fascia flap can be recommended with corresponding indication because of its diverse applications and its low complication rate especially in combination with careful surgical preparation. The temporoparietal fascia flap shows an appealing aesthetic result at the donor site while avoiding the incidence of alopecia.Die rekonstruktive Chirurgie ist eine der Säulen der Plastischen Chirurgie, in welcher unterschiedliche Lappenplastiken zum Einsatz kommen. Die Temporalisfaszienlappenplastik (TPFF) ist eine vielseitig anwendbare Lappenplastik, die in der gestielten oder der freien Variante bei jeweils unterschiedlichen Indikationen schon mehrfach in der Literatur beschrieben wurde. Die Studie macht sich zum Ziel, diese Methode der rekonstruktiven Chirurgie anhand der in der Plastisch- und Handchirurgischen Klinik in Erlangen durchgeführten Temporalisfaszienlappenplastiken zu untersuchen. Es sollen die beiden Varianten der gestielten und der freien Lappenplastik verglichen und der Outcome des Gesamtkollektivs und dessen Einflussfaktoren ermittelt werden. Für diese Studie werden 23 Temporalisfaszienlappenplastiken, darunter 14 freie und 9 gestielte Varianten, welche in der Plastisch- und Handchirurgischen Klinik des Universitätsklinikums Erlangen im Zeitraum von 2007 bis 2016 durchgeführt wurden, retrospektiv analysiert. In der Auswertung wird das Kollektiv zunächst anhand deskriptiver Statistik untersucht. Hierbei werden die Parameter Art der Lappenplastik, die Verteilung der operativen Eingriffe über den Zeitraum, das Patientenalter, die Geschlechterverteilung, die Zusammensetzung des Operationsteams, der Nachuntersuchungszeitraum, die Defektgröße, die Defektätiologie, die Defektlokalisation, die Komorbiditäten, die Anzahl der Voroperationen und die Gesamtzahl der operativen Eingriffe miteinbezogen. Im Vergleich der freien mit der gestielten Lappenplastik wird der Zusammenhang der Parameter Indikation, Beschaffenheit der verwendeten Gewebetransplantate, Komorbiditäten, Operationsdauer, Dauer des stationären Aufenthaltes, Minor- und Majorkomplikationen jeweils mit der Art der Lappenplastik evaluiert. Zu den Parametern, anhand welcher der Einfluss auf den Outcome des Gesamtkollektivs berechnet wird, zählen die Operationsdauer, das Patientenalter, die Defektätiologie und die Anzahl der Komorbiditäten. In dieser Studie kann die Vielfältigkeit der Temporalisfaszienlappenplastik an den unterschiedlichen Defektlokalisationen und den diversen Indikationen der beiden Varianten dargestellt werden. Beim Vergleich der freien und der gestielten TPFF kann ein signifikanter Unterschied in der Operationsdauer, der gesamten und der postoperativen stationären Aufenthaltsdauer ermittelt werden. Bei Betrachtung der Komplikationsrate wird im Vergleich der beiden Varianten kein signifikanter Unterschied gefunden, weder bei den Majorkomplikationen, noch bei den Minorkomplikationen. Die in der Literatur häufig aufgezeigte Komplikation der Alopezie wird bei keinem der 23 Patienten beschrieben und somit werden ästhetisch ansprechende Ergebnisse an den Entnahmestellen verzeichnet. Der Outcome des Gesamtkollektivs wird anhand der Länge des postoperativen Aufenthaltes und anhand des postoperativen Auftretens von Komplikationen gemessen. Hinsichtlich der Einflussfaktoren auf den Outcome des Gesamtkollektivs zeigen Patienten mit einer längeren Operationszeit tendenziell längere stationäre Aufenthalte, jedoch statistisch nicht signifikant. Das Alter der Patienten hat keinerlei statistisch signifikanten Einfluss auf den Outcome. Die Länge des postoperativen, stationären Aufenthalts ist signifikant von der Indikation abhängig; das Auftreten von Komplikationen jedoch nicht. Der Einfluss der Komorbiditäten zeigt sich ebenso anhand eines signifikant längeren postoperativen stationären Aufenthalts bei Patienten, welche 3 oder mehr Komorbiditäten aufweisen. Zusammenfassend geht aus den Ergebnissen dieser Studie hervor, dass die Temporalisfaszienlappenplastik aufgrund ihrer vielfältigen Anwendung und ihrer geringen Komplikationsrate insbesondere in Kombination mit einer sorgfältigen, chirurgischen Präparation bei entsprechender Indikationsstellung empfohlen werden kann. Die Temporalisfaszienlappenplastik zeigt ein ansprechendes, ästhetisches Ergebnis an der Entnahmestelle bei erfolgreicher Vermeidung des Auftretens der Alopezie

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Introduction: Soft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity. Methods We analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest. Results: 14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient. Conclusion The free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications

Artifact reduction of coaxial needles in magnetic resonance imaging-guided abdominal interventions at 1.5 T: a phantom study

Needle artifacts pose a major limitation for MRI-guided interventions, as they impact the visually perceived needle size and needle-to-target-distance. The objective of this agar liver phantom study was to establish an experimental basis to understand and reduce needle artifact formation during MRI-guided abdominal interventions. Using a vendor-specific prototype fluoroscopic T1-weighted gradient echo sequence with real-time multiplanar acquisition at 1.5~T, the influence of 6 parameters (flip angle, bandwidth, matrix, slice thickness, read-out direction, intervention angle relative to B0) on artifact formation of 4 different coaxial MR-compatible coaxial needles (Nitinol, 16G-22G) was investigated. As one parameter was modified, the others remained constant. For each individual parameter variation, 2 independent and blinded readers rated artifact diameters at 2 predefined positions (15~mm distance from the perceived needle tip and at 50% of the needle length). Differences between the experimental subgroups were assessed by Bonferroni-corrected non-parametric tests. Correlations between continuous variables were expressed by the Bravais-Pearson coefficient and interrater reliability was quantified using the intraclass classification coefficient. Needle artifact size increased gradually with increasing flip angles (p = 0.002) as well as increasing intervention angles (p < 0.001). Artifact diameters differed significantly between the chosen matrix sizes (p = 0.002) while modifying bandwidth, readout direction, and slice thickness showed no significant differences. Interrater reliability was high (intraclass correlation coefficient 0.776-0.910). To minimize needle artifacts in MRI-guided abdominal interventions while maintaining optimal visibility of the coaxial needle, we suggest medium-range flip angles and low intervention angles relative to B0

Optimized visualization of focal liver lesions and vascular structures in real-time T1-weighted gradient echo sequences for magnetic resonance-guided liver procedures

PURPOSEThis study aimed to determine the optimal sequence parameters of a real-time T1-weighted (T1w) gradient echo (GRE) sequence for magnetic resonance (MR)-guided liver interventions.METHODSWe included 94 patients who underwent diagnostic liver MR imaging (MRI) and acquired additional real-time T1w GRE sequences with a closed 1.5-T MRI scanner 20 min after a liver-specific contrast agent was injected. In four measurement series, one of the following four sequence parameters was changed, and repeated scans with different values for this parameter were acquired: flip angle (FA) (10–90°), repetition time (TR) (5.47–8.58 ms), bandwidth (BW) (300–700 Hz/pixel), and matrix (96 × 96–256 × 256). Two readers rated the visualizations of the target and risk structures (7-point Likert scale) and the extent of artifacts (6-point Likert scale); they also quantified the lesion–liver contrast ratio, the lesion–liver contrast-to-noise ratio (CNR), and the liver signal-to-noise ratio (SNR). Substratification analyses were performed for differences in overall visual and quantitative assessments depending on the lesion size, type, and the presence of cirrhosis.RESULTSFor the utilized FAs and matrix sizes, significant differences were found in the visual assessments of the conspicuity of target lesions, risk structures, and the extent of artifacts as well as in the quantitative assessments of lesion–liver contrast ratios and liver SNRs (all P < 0.001). No differences were observed for modified TR and BW. Significantly increased conspicuity of the target and vascular structures was observed for both higher FAs and matrix sizes, while the ghosting artifacts increased and decreased, respectively. For primary liver tumors compared with metastatic lesions, and for cirrhotic livers compared with normal liver parenchyma, significantly decreased conspicuity of the target lesions (P = 0.005, P = 0.005), lesion–liver CNRs (P = 0.005, P = 0.032), and lesion–liver contrast ratios (P = 0.015, P = 0.032) were found. All results showed no significant correlation with lesion size.CONCLUSIONWe recommend an FA of 30°–45° and a matrix size of 128 × 128–192 × 192 for MR-guided liver interventions with real-time T1w sequences to provide a balance between good visualizations of target and risk structures, high signal intensities, and low ghosting artifacts. The visualization of the target lesion may vary due to clinical conditions, such as lesion type or associated chronic liver disease

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Abstract Introduction Soft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity. Methods We analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest. Results 14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient. Conclusion The free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications

Artifact characterization of Nitinol needles in magnetic resonance imaging-guided musculoskeletal interventions at 3.0 tesla: a phantom study

PURPOSETo characterize the artifacts of an 18-gauge coaxial nickel-titanium needle using a balanced steady-state free precession sequence in magnetic resonance imaging-guided interventions at 3.0 tesla.METHODSThe influence of flip angle (FA), bandwidth, matrix, slice thickness (ST), and read-out direction on needle artifact behavior was investigated for different intervention angles (IA). Artifact diameters were rated at predefined positions. Subgroup differences were assessed using Bonferroni-corrected non-parametric tests and correlations between continuous variables were expressed using the Bravais–Pearson coefficient. Interrater reliability was quantified using intraclass correlation coefficients (ICCs), and a contrast-enhanced target lesion to non-enhanced muscle tissue contrast ratio was quantified.RESULTSThe artifact diameters decreased with an increase in FA for all IAs (P 7 mm, and, if possible, an IA of 45°–60°. The visibility of the target lesion and the needle’s artifact behavior must be weighed up against each other when choosing the ST, while higher FAs (40°–60°) and matrices (224 × 224/256 × 256) are associated with low artifacts and sufficient lesion visibility

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder