Biomedical subjects

P M Vogt

Publications and source records attributed to P M Vogt.

At least 19 recordsLinked to original sources

PubMed2006

PVP-iodine in hydrosomes and hydrogel--a novel concept in wound therapy leads to enhanced epithelialization and reduced loss of skin grafts.

BACKGROUND: Moist wound treatment improves healing at a possibly increased risk of bacterial infection and many local antiseptics impair healing. A moist treatment modality with efficient antimicrobial activity would be desirable. METHODS: In this monocentric, randomized, observer blinded, phase III study, a new hydrosome polyvinyl-pyrrolidone (PVP)-iodine preparation in hydrogel containing iodine in a 3% concentration (Repithel) was investigated for its effect on epithelialization in patients receiving meshed skin grafts. Grafts of 167 patients (donor site defects, burn wounds, or chronic defects) were dressed either with Repithel (n=83) covered with a gauze (Jelonet), or Jelonet-gauze only (n=84) until healing. RESULTS: Grafts receiving Repithel healed significantly earlier (9.4 days versus 12.4 days; p<0.0001) and faster than controls as measured by neo-epithelialization of mesh holes between days 7 and 11 (91.2+/-22.8% versus 82.3%+/-28.6, p<0.0001). A subgroup analysis showed that the effects on grafted burn wounds (p=0.0042) and chronic defects (p<0.0001) was more significant than on donor sites. Also a higher take rate of grafts (p=0.0053) and a reduced loss of grafts was observed with Repithel treatment (8 grafts versus 20 grafts) (p=0.0063, respectively). Smokers had improved graft take (p=0.0069) and higher rate of epithelialization (p=0.0040) compared to smokers of the control group. CONCLUSIONS: The results demonstrate significant clinical advantages of Repithel. This new local wound healing drug combines antisepsis and wound moisture efficiently resulting in significantly enhanced epithelialization, decreased transplant losses, and significantly improved healing especially in smokers.

Anti-Infective Agents, Local↗

PubMed2006

Effect of polyvinylpyrrolidone-iodine liposomal hydrogel on wound microcirculation in SKH1-hr hairless mice.

AIM: Polyvinylpyrrolidone-iodine liposomal hydrogel (PVP-ILH) is a hydrogel formulation based on polyvinylpyrrolidone-iodine (PVP-I) and liposomes. The beneficial effects of PVP-ILH on wound healing have been previously shown. The aim of this study was to investigate the effects of topically applied PVP-ILH on wound microcirculation. MATERIALS AND METHODS: Experiments were performed on wounds in male SKH1-hr hairless mice (n = 48). Mice were randomized into five treatment groups: mice treated with polyacrylic acid (PAA) and PAA 1:10 as well as PVP-ILH and PVP-ILH 1:10. Mice treated with sodium chloride served as control. Immediately as well as 3, 7, and 14 days after wounding, intravital fluorescent microscopy (IFM) was performed to determine wound surface area and standard microcirculatory parameters. RESULTS: Topically administered PVP-ILH reduced wound size significantly faster compared to controls. Standard microcirculatory parameters, e.g. functional capillary density (FCD) and plasma leakage, showed no differences. FCD increases in all groups after wound creation. Using PVP-ILH, a trend towards higher FCD was observed. CONCLUSION: The wound model in hairless mice in combination with IFM is suitable to qualitatively assess wound microcirculation over a period of 2 weeks even after topical application of pigmented ointments. PVP-ILH showed a positive effect on dermal wound healing and wound microcirculation.

Animals↗

PubMed2006

[A mixture of antimicrobial peptides and fibrin glue in treatment of partial-thickness burn wounds].

BACKGROUND: Antimicrobial peptides are naturally occurring cationic peptides. The first-line of defense in infected burns is the innate immune system, of which antimicrobial peptides are essential parts. To facilitate their topical use in infected partial-thickness burns, the efficacy of a mixture with fibrin glue in vitro and in vivo was tested. METHODS: After in vitro tests, 15 male Sprague-Dawley rats received partial-thickness burns. Afterwards, the wounds were infected with multiresistant Pseudomonas aeruginosa. The animals received PG-1 (100 microg/ml, n=5), fibrin glue (n=5), or a mixture of both (n=5) topically. The efficacy of the materials was previously proven by radial diffusion assay. After 24 h, the infected and burned skin was harvested and quantitative bacterial counts per gram of skin performed. RESULTS: The biologic effect of the peptides was confirmed in vitro. The PG-1 and fibrin glue groups did not show significant differences in bacterial numbers, whereas the mixture group showed significant reduction in Pseudomonas in vivo (P<0.04 and P<0.01). CONCLUSION: A mixture of an antimicrobial peptide and commercially available fibrin glue is capable of significantly reducing bacteria in infected partial thickness burns in vivo compared to controls.

Animals↗

PubMed2006

[Resection of infected achilles tendon. Results after soft tissue coverage without tendon reconstruction].

BACKGROUND: Structural full-thickness defects of the Achilles tendon represent a severely disabling injury which should be treated by reconstruction. This study presents functional outcomes from standardised follow-up of non-reconstructed Achilles tendons with soft tissue coverage alone. PATIENTS AND METHODS: Seven patients were treated with various techniques of soft tissue reconstruction without restoration of the Achilles tendon. After a mean of 11 months postoperatively, the lower extremity was evaluated generally with regard to function, AOFAS score (ankle and hindfoot), and isokinetic torque testing by the Biodex system. RESULTS: All patients showed high mobility, muscle strength, and range of motion at follow-up. The average AOFAS score was 84.7 (maximum 100), and the torque loss in plantar flexion was 44.5% on average compared to the uninvolved side and thus comparable with results after secondary tendon reconstruction. CONCLUSION: After complete loss of the Achilles tendon, compensatory techniques can hinder significant loss of torque and endurance, compared with secondary tendon reconstruction, allowing unsupported mobility and even top athletic performance.

Achilles Tendon↗

PubMed2006

[Early surgical management of severe burns].

The success of modern burn therapy is based on an understanding of the pathophysiology and application of burn intensive care implying fluid resuscitation and management of pulmonary or other organ failure. With the development of early eschar excision and wound closure by immediate grafting, survival and cosmetic outcome were further improved. Especially in post-acute therapy, early physical rehabilitation, early reintegration, and early plastic surgical correction of the sequelae are indispensable for the outcome.

Burns↗

PubMed2006

[Burns surgery].

Explore the source record for details and available documents.

Burns↗

PubMed2006

[Diagnosis and treatment of posttraumatic pseudolipomas. A retrospective analysis].

BACKGROUND: Both trauma and lipomas are frequently encountered in day-to-day clinical practice. Although lipomas are defined both clinically and pathologically as benign fatty tissue tumours, their aetiology is still not clear. METHODS: In this study 19 patients with 23 posttraumatic lipomas were analysed retrospectively with reference to ultrasound and MRI diagnosis, history, laboratory results and histopathological investigations. RESULTS: The mean age of the patients was 50.5 years (+/-15.5). The causative soft tissue trauma dated back an average of 2.6 years. When the histories were taken, 16 of the 19 patients reported vast, slow-resorbing posttraumatic haematomas. Nine of the 23 lipomas were sited in the upper extremity, 3 in the lower extremity, 9 in the trunk and 2 in the face. All were located epifascially. In 22 cases the lipomas were excised, and in 1 case the lipoma was removed by liposuction. Histological examination demonstrated capsulated benign fatty tissue tumours in 19 cases and uncapsulated benign fatty tissue tumours in 4. The average body mass index (BMI) was 29 kg/m(2). Removal of the tumour resulted in a good aesthetic result in all patients. CONCLUSIONS: The link between a blunt soft tissue injury and the development of a posttraumatic lipoma is still the subject of controversy; there are two mechanisms that seem more likely than any others proposed: (1) the "pseudolipoma" as the result of a prolapse of fatty tissue as an immediate result of trauma and (2) the development of a lipoma by way of differentiation of pre-adipocytes mediated by cytokines released by a posttraumatic haematoma. There appears to be a correlation between an increased partial thromboplastin time (PTT) and the development of posttraumatic lipomas. The generalised increase in the volume of body fat documented by the elevated BMI supports the idea that lipomas arise from the prolapse of adipose tissue. However, there is no single mechanistic explanation for the development of posttraumatic lipomas. They are probably caused by multiple factors and not by isolated pathological mechanisms.

Adolescent↗

PubMed2006

[Nordic pole walking injuries--nordic walking thumb as novel injury entity].

BACKGROUND: Nordic pole Walking (NW) as trend sport is associated with beneficial effects on the cardiovascular system. Data regarding the injury and overload injury rates are pending. METHODS: 137 athletes (74 % females, 53 +/- 12 years, weight 73 +/- 13 kg, height 169 +/- 11 cm) were prospectively ask using a two-sided questionnaire. Mean NW experience was 212.8 weeks with 2.9 +/- 1.8 hours/week. The overall exposure was 29 160 h. RESULTS: NW injury rate was 0.926/1000 h. Falls were evident in 0.24/1000 h. The upper extremity was involved more frequently (0.549/1000 h) than the lower extremity (0.344/1000 h). The most severe injury was a concomitant shoulder dislocation and luxation of the proximal interphalangeal joint of the index finger after a fall. The most frequent injury in NW was a distorsion of the ulnar collateral ligament of the thumb (0.206/1000 h) after fall. Shoulder injuries account for 0.171/1000 h with 0.069/1000 h shoulder dislocations. Distal radius fractures were rare as ankle sprains and shinspints (0.034/1000 h). Muscle injuries were encountered only at the gastrocnemius muscle (0.137/1000 h). No knee ligament injuries were noted. In 5%, NW injuries caused interruption of the performance, with all patients returning to sport within 4 weeks on the same level as before. DISCUSSION: Nordic Walking is safe. Most frequently, a Nordic walking thumb is encountered during a fall with the athlete holding on to the NW pole until the very last moment before the hand hits the ground with the pole handle as hypomochlium that forces the thumb into abduction and extension. Modifications of the grip construction as well as information of the athlete and behaviour changes may be preventive measures.

Accidental Falls↗

PubMed2006

[Efficacy of treatment with Repithel and Jelonet in comparison to treatment with Jelonet alone - a randomized clinical trial in patients receiving meshed skin grafts].

UNLABELLED: Moist wound treatment is a well recognized method for the treatment of aseptic acute and chronic wounds. While the moist environment is beneficial to the woundhealing process, it also increases the risk of bacterial superinfection. We here report on the results of a clinical phase-III-study in which we tested the effect of a new PVP-iodine liposomal hydrogel (Repithel) on split-thickness skin grafts. This formulation optimizes moist wound treatment by improving the cell proliferation rate while preventing wound infection. AIM: The aim of this phase-III-study was to analyse the efficacy and tolerance of Repithel in patients receiving meshed skin grafts. METHODS: 167 patients with transplantation wounds were either treated with lipid gauze alone (control group) or with lipid gauze and Repithel. In both groups the extent of neoepithelization, the frequency and severity of graft losses and the time until complete wound closure was achieved were determined. Analysis of the re-epithelization was achieved by photoplanimetry. Impedance measurements gave additional information on the regeneration of the epidermal barrier. RESULTS: Wounds receiving Repithel showed a significantly faster neoepithelisation than wounds which were treated with lipid gauze alone. Treatment with Repithel significantly reduced both the number of graft losses and the size of area lost. The time until wounds were closed completely was significantly shorter in patients receiving Repithel than in controls. The positive effects of Repithel on wound healing were especially observed in smokers, patients with chronic wounds, burns or infected wounds. CONCLUSIONS: Repithel supports healing of meshgraft transplants and reduces the risk of graft loss. Patients who heal poorly benefit particularly from the Repithel treatment.

Anti-Infective Agents, Local↗

PubMed2006

[Plastic reconstruction of postoncologic defects in the pelvic area].

The surgical management of defects in the pelvic region is a great surgical challenge. Primary tumor recurrences have to be addressed and local infections require appropriate therapy such as rigorous debridement and antibiotic therapy. Plastic surgery provides tissue reconstruction by well perfused flaps and also reestablishment of anatomic structures in the ano-genital region. An early reconstruction also reduces the wound complications of adjuvant or post oncologic therapy and reduces the rate of wound healing problems.

Adult↗

PubMed2006

[Apoptosis and its role in plastic surgery].

Apoptosis and cell proliferation are the main mechanisms of cell homeostasis. The pathogenesis of approximately 70 % of all diseases results from an imbalance between these two counterparts. Therefore, research on apoptosis is a main target in biological and clinical fields. Many signalling pathways and proteins involved in their regulation have been characterized. In order to evaluate the relevance of apoptosis in plastic surgery, the literature was reviewed for its impact on ischemia and reperfusion concerning flap surgery as well as wound healing and angiogenesis. Furthermore, the relevance of apoptosis in ageing, allotransplantation and tumors was investigated. In all subsections of plastic surgery, a high impact was identified. More studies on the influence and regulation of apoptosis can bring further understanding on the disease patterns of plastic surgery and other specialties as well as the development of new therapeutic options. Research focusing on apoptosis is therefore an essential means for the advancement of and future trends in plastic surgery.

Aging↗

PubMed2006

Repithel: removing the barriers to wound healing.

BACKGROUND: Various standardized and/or validated models exist to test wound healing products. This article discusses their usefulness in clinical practice. OBJECTIVES: Major barriers to wound healing have been identified after intense interaction of research and practitioners. Although extensively tested, wound healing products are still associated with trial and error due to the high variability and complexity associated with the treatment of wounds. Therefore, the results of preclinical testing are compared and contrasted with clinical observations of a liposomal hydrogel containing 3% povidone-iodine (Repithel, PVP-ILH) to assess their expressiveness and to give the practitioner more guidance in application. METHODS: Testing of PVP-ILH included physicochemical testing according to ISO norms, testing in in vitro and in vivo models. The obtained results are compared to the clinical profile of the obtained product in randomized controlled trials and ultimately expressive case studies. RESULTS: PVP-ILH displays good local tolerance, the basis for use in sensitive and predamaged tissue. As observed in laboratory testing, it readily provides moisture and takes up limited amounts of moisture. This was also seen in the clinical testing, as the ability to keep wounds moist and incorporate a certain -- but not large -- amount of exudates. Clinical results also show clean, well-debrided wounds, an effect that (in the absence of an established model for wound cleansing) was traced to the hydrogel component carbomer. DISCUSSION: Recent consensus advocates the concept of wound bed preparation as a systematic approach to removing barriers to healing (TIME). Based on the results, tissue (removing non-viable tissue and debris) and moisture (balance) can now be better understood, and infection/inflammation (control) and edge (progressing, non-advancing or undermining wound edges) are reviewed together with previously published data to assess all aspects potentially impeding wound healing. CONCLUSION: PVP-ILH successfully removes barriers to wound healing, thus laying the foundation to high-quality wound closure. Results from many scientific disciplines can help the user to better understand a product, standardization of testing is the only way of making results comparable.

Absorption↗

PubMed2005

[Indications and safety aspects of vacuum-assisted wound closure].

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Contraindications↗

PubMed2005

[Surgical therapy for hand infections. Part I].

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and beta-hemolytic group A streptococci. We find Pasteurella canis and P. multocida from cat and dog bite wounds and Eikenella corrodens from human bite wounds. The "fight-bite clenched fist" wound, with penetration of the metacarpophalangeal joint and its high risk of septic arthritis, has always to be suspected when patients present with human bites. The therapy of hand infection is based on three principles: surgical treatment, adequate antimicrobial therapy, and early physiotherapy. Early infectious conditions of the hand, e.g. cellulitis and early paronychia, may be treated without surgery. Antimicrobial treatment must be specific for the pathogen and its resistance to antimicrobial agents. Bite wounds should be treated with beta-lactam antibiotics and beta-lactamase inhibitors. Staphylococci and streptococci can be covered by first and second generation cephalosporins. The increasing resistance of staphylococci to antibiotics has to be taken into account. Infections with anaerobic and gas-producing bacteria are rare but occur predominantly in diabetics and immune-compromised individuals.

Animals↗

PubMed2005

[Surgical therapy for hand infections Part 2].

Arthritis, Gouty↗

PubMed2005

[Plasma concentration of endothelin-1 after myocutaneous latissimus dorsi-transplantation -- role in reperfusion injury].

The success of a free flap transplantation is based on a sufficient microanastomosis which meets the following requirements: a pedicle placed without kinking or twisting, a good drainage, a well defined recipient vessel and integrity of the endothelium. The aim of this study was to determine whether operation-related ischaemia through flap transplantation and tourniquet induces an increase of Endothelin-1 plasma levels as one cause of vasospasm during microvascular procedures. We focused our attention in particular on the reperfusion period which is often limited to an irreversible perfusion failure of microcirculation due to free radicals, interleukin and Endothelin-1. Twenty-one patients with tissue injury of the lower leg were included in our study, fourteen underwent a latissimus dorsi muscle transplantation with a combined ischaemia, seven patients had a tourniquet ischaemia for tumour resection, debridement and local flap transfer. The duration of ischaemia varied due to the course of operation. The withdrawal of venous blood via central vein catheter, flap vein and wound bed followed a fixed time table pre- and post-reperfusion (T1: preoperative day via cubital vein, T2: 6th postoperative day, T3: 5 min, T4: 10 min, T5: 15 min, T6: 1 h post-declamping and after tourniquet ischaemia via central vein catheter and T7: within 5 min from the flap vein immediate after recharging the flap). The vessel anastomosis determined the withdrawal from the local wound bed. ET-1 in venous blood samples were measured with ELISA. The duration of ischaemia in the tourniquet group ranged from 22 min up to 210 min with a mean of 76.58 min and in the latissimus group from 87 min up to 203 min with a mean of 139.21 min. The mean ET-1 plasma concentration measured systemically before operation in the 21 patients was 0.51 +/- 0.08 pg/ml (Mean +/- SD). This result corresponds with data published in literature. The locally measured plasma levels of ET-1 after tourniquet and flap ischaemia were increased with 0.34 up to 3.90 pg/ml (0.95 +/- 0.79 pg/ml [Mean +/- SD]) for the tourniquet group and with 0.34 up to 14.87 pg/ml (1.85 +/- 3.64 pg/ml [Mean +/- SD]) for the latissimus group. This is an increase compared to systemically measured values as 0.75 +/- 0.06 pg/ml (Mean +/- SD) for the tourniquet group and 0.58 +/- 0.21 pg/ml (Mean +/- SD) for the latissimus group. We conclude that Endothelin-1 is increased locally in the early reperfusion period after free latissimus dorsi-transplantation.

Adult↗

PubMed2005

[Breast cancer -- plastic surgical strategies for the treatment of tumour infiltration of the thoracic wall and brachial plexus].

Extensive locoregional recurrency or metastatic involvement of brachial plexopathy is a condition that is often associated with advanced systemic breast cancer. In the past the role of surgeon was restricted due to a scepticism as to whether any benefit will be provided for the patient. In the recent 25 years however safe and refined plastic surgical approaches have been developed that provide more options to treat even complex recurrent disease. The strategy of plastic surgery in an interdisciplinary approach of gynecology, oncology and radiotherapy as well as thoracic surgery is outlined.

Breast Neoplasms↗

PubMed2004

[Outpatient hand surgery--possibilities and limitations].

On January 1st 2004, a new contract between the government, health insurance services, and hospitals was inaugurated in Germany. The aim of the contract is to decrease costs for surgical therapies by abolishing or at least minimizing hospitalization of patients. Hand surgery is widely affected by the new contract, since a very large part of surgical therapies for the hand was declared to be compulsory outdoor and another major part to be preferable outdoor. The surgeon may decide whether a patient needs inpatient or outpatient treatment but has to justify his decision. Hospitals and surgical clinics are both allowed to offer outpatient hand surgery and get the same payment under the same regulations. For most hospitals, structural changes will be necessary to offer outpatient surgery without financial loss. In our experience a personal and regular contact between patient and surgeon is most necessary for the best surgical result. Many of the compulsory outpatient operations in hand surgery can be done sufficiently and at high standard. This may not be the case for the second group to be handled not compulsory outdoor. The new contract allows hospitals to offer postoperative care for only 14 days, whereas many specific hand surgical procedures will need the surgeon's control and care for a much longer time. On the other hand, clinics and general practitioners have strict limitations for the prescription of hand therapies. We believe that the quality of hand surgery is highly dependent on sufficient postoperative treatment. If the postoperative care is neglected or restricted, secondary costs such as sick leave will increase.

Ambulatory Surgical Procedures↗