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Biomedical subjects

W Mühlbauer

Publications and source records attributed to W Mühlbauer.

At least 19 recordsLinked to original sources
PubMed1997

[Cultivated keratinocytes on micro-carriers: in vitro studies of a new carrier system].

Epidermal grafts from confluently cultivated keratinocytes have been used since the early eighties for the treatment of severe burns, where the shortage of donor sites for split-thickness skin grafts did not allow for adequate wound coverage. The difficult handling of these grafts as well as the advanced differentiation of their epithelial cells into a multilayer sheet poses a problem for their clinical application. The aim of the study was to characterize cultivated keratinocytes, as well as to observe their migration and proliferation from the MC onto a surface. Keratinocytes were isolated from human foreskin and cultivated in serum-free and serum-containing medium according to a modified method by Rheinwald and Green. Collagen-coated Dextran beads were used as MC. The MC were colonized with keratinocytes using the Spinner culture technique. After seeding the colonized MC into culture flasks, their migration and proliferation was monitored regularly through immunohistochemical studies and measurement of the metabolic cell activity. Immunohistological staining proved that the cells isolated from human foreskin represent keratinocytes of the basal type. Keratinocytes, cultivated with serum-containing and serum free medium, both adhered to the surface of the MC, then migrated onto the surface of the flasks and proliferated to form a multilayer of epithelial cells. In the long-term, a flexible epithelial graft consisting of poorly differentiated keratinocytes should be available, which is simple to produce and easy to handle. This would be an alternative method for treating wounds, where the conventional multilayer epithelial graft (ET) is insufficient.

Burns↗
PubMed1996

Craniosynostosis suggestive of Saethre-Chotzen syndrome: clinical description of a large kindred and exclusion of candidate regions on 7p.

We describe the clinical manifestations of an autosomal dominant form of craniosynostosis in a large family with eight affected relatives. Unilateral or bilateral coronal synostosis, low frontal hair line, strabismus, ptosis, and partial cutaneous syndactyly of fingers and toes are findings suggestive of the diagnosis of Saethre-Chotzen syndrome. The disease locus was excluded from the two adjacent Saethre-Chotzen candidate regions on 7p by linkage analysis with markers D7S664 and D7S507. This indicates heterogeneity of Saethre-Chotzen syndrome with a locus outside the candidate regions on 7p.

Acrocephalosyndactylia↗
PubMed1995

Treatment of partial thickness burns of the hand with the preshaped, semipermeable Procel Burn Cover: results of a multicentre study in the burn centres of Berlin, Duisburg and Munich.

The results of a prospective clinical study conducted in three German burn centres are reported. The subject of the evaluation was to show the effectiveness of a new, preshaped, semipermeable burn dressing that is resistant to fluids and bacteria but highly permeable to vapour. The dressing was used in conjunction with 1 per cent silver sulphadiazine cream in treating partial thickness burns of the hand. In 49 patients, 72 partial thickness burned hands were treated. The application proved to be very easy. The time for a dressing change was short (5-10 min). The duration of treatment was 13 days on average. Complications due to infections did not occur. Because of the semipermeable properties of the dressing material, skin macerations occurred in only a few instances (13 per cent) as a result of inappropriate cream application or extremely high exudation rates, and these did not adversely affect the healing process. Patients achieved the ability to perform activities of daily living early with positive results for the patients, the physician and the nursing team.

Adolescent↗
PubMed1995

[Keratinocyte culture and transplantation in burns].

The culture and transplantation of keratinocytes are considered an important progress in the treatment of severe burns. The keratinocyte grafts take best (50 to 90%) on remaining dermal structures after deep dermal (II b) burns. Since 1988 we culture also donor keratinocytes. They are cryopreserved in the 'skin bank' in large quantities. As vital wound cover they allow for a rapid and near scarless reepithelialization. For deep (III) burns we use composite grafts of cultured auto-keratinocytes on allo-dermis with increasing success (up to 75% take rate) without rejection.

Adult↗
PubMed1995

[Use of keratinocyte cultures in treatment of severe burns--experiences up to now, outlook for further subsequent developments].

There is a world-wide growing interest in cultured epithelium. It is commonly accepted that cultured epithelial auto- or allografts can stimulate wound healing and shorten re-epithelialization time. Sheets of cultured autologous epidermal cells have been used for more than 15 years as grafts to achieve permanent coverage of full-thickness burn wounds. Yet many surgeons who have used cultured epidermal grafts have reported a substantial variability in their outcome. The best results have been obtained by performing early excision, followed by temporary coverage with a cadaver homograft. Within 3 weeks the donor allodermis is incorporated and forms a neodermis. The epidermal parts of the donor skin are removed after about 3 weeks and cultured epidermal autografts are transplanted (composite graft technique). There is some hope that progress in the cultivation procedure and a modified transplantation technique will shorten the healing time. In our opinion, great progress was made when cryopreserved allogeneic epithelial grafts became available for the treatment of deep dermal burn wounds. We obtained a good re-epithelialization rate (56%) after 9.5 days in 56 cases. In the last 25 cases, the re-epithelialization time was 72% after 11.5 days. Especially burn wounds of the face have been treated successfully, avoiding over-grafting and achieving highly acceptable, aesthetic and functional results. Many laboratories are developing dermal equivalents, combining synthetic and biological materials in order to form a multilayer neodermis. Although it seems possible to cultivate adnexae of the skin, a neodermis with cultivated adnexae is not yet in sight.

Adult↗
PubMed1994

CT-guided stereolithography as a new tool in craniofacial surgery.

CT-guided stereolithography provides an acrylic model which exactly replicates the original structure. It allows optimal preoperative planning and intraoperative management. This application proved advantageous in surgical correction of a wide midline craniofacial cleft in a baby.

Face↗
PubMed1994

Composite grafts of autogenic cultured epidermis and glycerol-preserved allogeneic dermis for definitive coverage of full thickness burn wounds: case reports.

In patients with extensive deep burns and scarce donor sites autogenic cultured epithelial grafts (auto-CEG) have become a real alternative. In deep burns the 'take' rate of auto-CEG applied directly on subcutaneous fat, fascia or muscle is unreliable and frequently disappointing. The auto-CEG seems to need a dermal base. Improved results have been reported when auto-CEG were applied to the dermal base of a viable cryopreserved donor skin. We extended this principle by using the dermal layer of non-viable glycerol-preserved donor skin (GPDS). We report on two patients with deep burns of 55 and 80 per cent TBSA in whom we used the composite grafting of auto-CEG on non-viable allogeneic dermis from GPDS. The estimated 'take' rates were 70 and 77 per cent. The grafted areas remained stable for 4 and 8 months respectively. The two-layer skin substitute gave a permanent cover for full thickness burn wounds of higher quality and better 'take' rate than previous results, where the auto-CEG had been grafted directly onto the debrided wounds.

Adult↗
PubMed1994

[Pancraniofacial synostosis--indications for early craniofacial operation].

Premature synostosis of all major cranial sutures represents a rare craniofacial anomaly often leading to serious consequences. It is regularly associated with Kleeblattschädel-syndrome (clover-leaf skull) but can also be observed in Crouzon's craniofacial dysostosis, Apert's acrocephalosyndactyly, Pfeiffer's-syndrome and severe plagiocephaly. Since the disease not only affects the cranial vault but also the facial skeleton, we simply termed it pancraniofacial synostosis (PCS). Radical surgical therapy is frequently necessary after birth for vital indication. This study presents results and complications of 12 children with PCS. Eleven children were operated on by subtotal craniectomy and advancement of the fronto-orbito-facial skeleton. Concomitant hydrocephalus was shunted preoperatively. Four children with impending loss of vision and intracranial hypertension had to be operated on under emergency conditions only a few weeks after birth. One child with normal intracranial pressure has been closely followed for over ten years without surgery. Lethal complications occurred in three of four children that had been operated on under emergency conditions. Craniofacial surgery significantly improved intracranial hypertension, exorbitism, nasopharyngeal obstruction, and aesthetic appearance in all of the remaining children. Total craniofacial correction in PCS can safely be achieved at an age of three to twelve months. Emergency surgery carries a much higher risk. Simultaneous mid-face advancement should be avoided in those cases if at all possible.

Cephalometry↗
PubMed1993

Early radical treatment of pancraniofacial synostosis.

Premature fusion of all major cranial and facial sutures, termed pancraniofacial synostosis by us, was first described as "Kleeblattschädel deformity," but can also be found in anomalies such as Crouzon's disease, Apert's syndrome, Pfeiffer's syndrome, and severe forms of plagiocephaly. This rare craniofacial anomaly often presents an immediate threat to life right after birth. Early subtotal craniectomy frequently combined with frontoorbitofacial advancement must be performed to decrease intracranial pressure, preserve vision, and open up the blocked upper airway. Concomitant hydrocephaly is shunted preoperatively for internal decompression. Eleven patients with pancraniofacial synostosis underwent craniofacial surgery in infancy or early childhood. Only shunting of the hydrocephalus was done in 1 child. Two children died in the course of an emergency procedure and 2 children died after secondary operations for miniplate removal and revision of a valve shunting the hydrocephalus several months after the initial successful craniofacial surgery. The remaining 8 children have developed satisfactorily so far. Further corrective surgeries had to be performed in 2 patients. Good functional and aesthetic improvement could be obtained. In view of the high mortality especially after emergency procedures, we believe that early total craniofacial mobilization should be reserved for severe cases where the natural course is dismal without immediate intervention and temporary procedures such as shunting and tracheostomy are not sufficient. Elective surgeries after the age of 3 months can be performed safely in milder cases.

Cerebrospinal Fluid Shunts↗
PubMed1993

Simultaneous construction of an internal and external nose in an infant with arhinia.

We report on the simultaneous construction of an internal and external nose in an infant born with arhinia. The indication for this very early reconstruction was due to respiratory distress and the associated feeding problems. It was possible to create two nasal cavities separated by a septum and to form an external nose from pre-expanded skin and a secondary arm flap for the tip supported by a frontal bone flap with intrinsic growth potential and auricular cartilage grafts for the tip. The 4-year-old child has excellent function of the nose with an acceptable appearance. Her psychological development is normal. Respiratory distress and associated feeding problems necessitated the use of oropharyngeal and orogastric tubes in a female infant born without a nose (arhinia). Over a period of many weeks, with attempts to remove the tube resulting in aspiration, we decided to create a functional nasal airway and an external nose simultaneously at this early stage. At the age of 20 weeks, two nasal cavities were created by using a buccal sulcus incision and connected to the existing nasopharynx and partially lined with split skin grafts. An external nose was created using the expanded midfacial skin and supporting it, an osteoperiosteal flap from the frontal bone. Later, a Tagliacozzi flap had to be added for the nasal tip. The newly constructed nose functions well and appears to aid favorably in the normal psychosocial development of the now 4-year-old girl.

Female↗
PubMed1992

[Skin culture--keratinocytes].

Our efforts to cultivate keratinocytes and to use cultivated epidermal grafts which are then transplanted onto deep second- and third-degree burns and donor sites date back in 1987. Our laboratory is now able to provide our intensive care unit with cultured epidermografts as a routine procedure. Furthermore, we have developed a simple method for cryopreservation of cultured human epidermal keratinocytes. So in 1980, a skin bank was set up which provides us with cryopreserved allogenic cultured epidermis. Indications, operative management, and results are presented and accompanied by typical clinical cases.

Burns↗
PubMed1992

[Senile ectropion and entropion].

Senile ectropium and entropium are a result of progressive loss of tissue elasticity in the lower lid of the aging patient. In case of ectropium slackening takes place near the lid margin, whereas entropium may develop if this process occurs at a certain distance from the lid margin. Based on these facts, wedge tarsectomy together with a lateral blepharorrhaphy as described by Kuhnt-Blascovicz is the logical treatment for ectropium, while a wedge resection of the tarsus plus formation of a tight muscle sling of the infratarsal portion of the orbicularis muscle is our preferred method to correct the entropium.

Aged↗
PubMed1991

[Dupuytren's contracture. When operate? Conservative preliminary treatment?].

The etiology, symptomatology, clinical findings, course and staging of Dupuytren's contracture are discussed. Surgery is indicated from the second stage onwards; since pain very rarely occurs, it plays no role in establishing the indication for operation. The surgical techniques available are described. Conservative therapy has no influence on the course of the condition, while radiotherapy is inadmissible on account of its side effects. Physical therapy and physiotherapeutic pre-operative measures can improve the results of surgery.

Combined Modality Therapy↗
PubMed1991

Asymmetrical cranio-orbital facial stenosis.

Cranio-orbital facial scoliosis is the result of unilateral premature stenosis of the craniofacial skeleton. Plagiocephaly is only a subform of the syndrome. The deformity progresses unless operative treatment is given. Operative treatment is indicated for functional, aesthetic, and psychosocial reasons. We advocate early operation in infancy (3 to 6 months) consisting of wide resection of the stenosed sutures of the cranium and orbit, repositioning, and remodeling relying on the spontaneous autodynamic reshaping of the nasoethmoidal complex and the midface structures during the course of further growth. In adolescents and adults, multisegmental osteotomies and remodeling into a definitive position are necessary.

Craniofacial Dysostosis↗
PubMed1991

Skin banking: a simple method for cryopreservation of split-thickness skin and cultured human epidermal keratinocytes.

A simple unit has been developed for the simultaneous passive cooling of small and large amounts of allograft or autograft split-thickness skin, as well as cultured human epidermis. An expanded polystyrene box of variable size, aluminum plates, and cellulose tissue are fused. This unit is cooled in a -70 degrees C constant-temperature mechanical refrigerator. Maximal cooling rates of -1.3 degrees C min-1 are obtained in a box with a constant wall thickness of cellulose tissue. The cooling rate can be varied by altering the number of cellulose layers. Exothermic temperature plateaus associated with skin cooled in this unit last for less than 0.3 minutes. The viability of the cryopreserved skin was determined by using up to four methods simultaneously: a dye-exclusion test with trypan blue; glucose consumption; production of lactate; and carbon-13 nuclear magnetic resonance spectroscopy. Using a cryoprotectant medium with 15% (vol/vol) glycerol for split-thickness skin 0.25 mm thick, a storage time of up to 509 days at -70 degrees C was observed, with only a small decrease in viability (trypan blue, 62.5%; glucose consumption, 71 to 90% compared with freshly harvested skin). Storage in liquid nitrogen did not significantly improve results (p greater than 0.05).

Adult↗
PubMed1991

Increasing the vascular pedicle length in a free flap using a two-stage preliminary ectopic transfer.

The length of the vascular pedicle is critically important in the use and safety of a free flap. A lengthening of the artery and vein, until now, has been achieved through the use of either an autologous vein interposition graft or an arteriovenous loop. In such patients, the risk is nevertheless increased and does so proportionally to the increasing length of the venous interposition. We present a 30-year-old male electrician who had lost his left forearm and most of his right ulna after high-voltage electrical trauma. Lengthening of the vascular pedicle of a free fibula flap was achieved by anastomosis to the thoracodorsal vessels for 4 weeks. After this time, the flap was raised again together with the pedicle of the latissimus dorsi and used safely for reconstruction of the ulnar defect. Postoperative recovery after both operations was uneventful and the aim of reconstruction fully realized. In our opinion, this procedure provides an interesting alternative in patients in whom the length of the vascular pedicle is crucial but the designated flap has only a short pedicle.

Adult↗
PubMed1991

[Fasciocutaneous flap--a simple alternative to the musculocutaneous or free, microvascular flap of the lower extremity?].

Fasciocutaneous flaps demonstrate, in comparison to subcutaneous transposition flaps, far better local hemodynamic circulation and the length to width ratio can be increased to 3:1 or 5:1 so that they provide a simple method of closure in soft tissue defects. Fasciocutaneous flaps can be prepared rapidly and simply, due to the subfascial dissection, so that traumatic soft tissue defects can be closed directly. The donor site is closed with a split skin graft. Free musculocutaneous flaps and regional musculocutaneous island flaps are far more useful in large muscular defects, degloving injuries and osteomyelitis.

Fractures, Open↗