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Schmitt S.,University of Heidelberg | Schafer U.F.,Saarland University | Dobler L.,Aesthetic and Reconstructive Surgery | Reichling J.,University of Heidelberg
Forschende Komplementarmedizin | Year: 2010

Background: Rose oil is the essential oil extracted from the petals of the damask rose. It is an ingredient of cosmetic as well as health care products and it is used in folk medicine and in aromatherapy. It is well known that essential oils are able to permeate the skin whereas the lipophilic properties of the compounds as well as the application site have an influence on their permeation behaviour. In this paper, we investigated the influence of the application site on the permeation of rose oil. Method: We tested the permeation of rose oil and its major ingredients through human heat-separated epidermis of abdominal skin, breast skin, and skin from the upper arm. Results: We found that no application site is suited best for all substances tested to permeate the skin. It depends on the structure of the essential oil ingredients which application site should be chosen for topical application, which is already known for pharmaceuticals. Furthermore, when investigating the permeation of essential oils, we found that not only the Papp value but also the lag-time should be considered. Conclusion: The application site of substances to permeate the skin has a great influence on the permeation behaviour. As essential oils are volatile mixtures and their retention on the surface of the skin amounts only to a few hours, the lag-time should be considered in addition to the Papp-value. © 2010 S. Karger AG.


Matiasek J.,Aesthetic and Reconstructive Surgery | Matiasek J.,Innsbruck Medical University | Djedovic G.,Innsbruck Medical University | Djedovic G.,St Markus Hospital | And 7 more authors.
Journal of Wound Care | Year: 2015

Skin transplantation is a commonly used surgical technique; however, the complication rate, including postoperative infection and delayed wound healing due to inefficient perfusion, is significantly higher in patients suffering from comorbidities. Hence, a subsequent repeat procedure is often necessary. In this report, two case studies are presented in which an octenidine-based antiseptic is used with a tie-over dressing (TOD) instead of povidone iodine (PVP-iodine), following a split-thickness skin graft. The two patients selected were deemed to be at high risk of impaired wound healing due to comorbidities. The first patient, a confirmed smoker with diabetes, presented with a nodular melanoma that was resected and covered with a split-thickness skin graft. After 5 days of negative pressure wound therapy as a TOD, in combination with PVP-iodine, the graft became necrotic. A second split-thickness skin graft was performed and an antiseptic regimen with octenidine in combination with the same TOD resulted in a completely healed transplant. The second patient, also a confirmed smoker with diabetes and receiving oral corticosteroid treatment, was diagnosed with a skin necrosis on her leg. Following the split-thickness skin graft, octenidine and TOD were applied. The patient's skin graft completely healed without any adverse events. These two case studies indicate that the combination of octenidine and TOD following split-thickness skin transplantation is safe, well-tolerated and appears to have positive benefits in the reconstruction of defects in patients with impaired wound healing. © 2015 MA Healthcare Ltd.


Matiasek J.,Aesthetic and Reconstructive Surgery | Matiasek J.,Innsbruck Medical University | Djedovic G.,Innsbruck Medical University | Djedovic G.,St Markus Hospital | And 9 more authors.
Journal of Wound Care | Year: 2014

Effective wound bed preparation is an essential element in the healing of chronic wounds, including pressure ulcers (PUs). Negative pressure wound therapy (NPWT) reduces oedema, stimulates the formation of granulation tissue and helps remove wound exudate. This helps prepare the wound bed for secondary healing, skin grafting or coverage with flaps. Combining NPWT with an instillation phase using an antiseptic (octenidine based) irrigation solution is a novel approach to PU management. Three patients with Category 4 gluteal PUs were treated with NPWT and instillation fluid, following surgical debridement of necrotic tissue. The aim was to achieve optimal wound bed preparation prior to wound closure by local fasciocutaneous flap. The antiseptic efficacy of octenilin wound irrigation solution in microorganism eradication was quantified by in vitro tests simulating real conditions using leg ulcer vacuum exudates. All wounds completely healed after four weeks, and no adverse incidents occurred due to instillation of octenidine. No recurrence of the PU occurred during a one year follow-up. © 2014 MA HEALTHCARE LTD


Neuwirth M.,Aesthetic and Reconstructive Surgery | Burger H.,Aesthetic and Reconstructive Surgery | Palle W.,Deutsch Ordens Spital Friesach | Rab M.,Aesthetic and Reconstructive Surgery
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2016

Introduction Secondary reconstructions of isolated and combined tendon defects are still a challenge for plastic surgeons. Due to its reliable anatomy, reconstructive potential and low donor-site morbidity, the medial femoral condyle is an ideal area for harvesting isolated and combined tendon flaps. This study evaluates our preliminary results with the vascularized adductor magnus tendon flap. Patient and methods The study included six patients who received a vascularized tendon flap (upper extremity: three patients; lower extremity: three patients) from 2011 to 2015. For three patients, the adductor magnus tendon was used as a single flap; for the other three patients, the tendon was included in a composite flap. A retrospective chart review provided the patients' demographic data, surgical details and the post-operative course. The further objective and patient-reported outcome was evaluated with a long-term follow-up. Results All of the free vascularized flaps healed without complications and with good vascularization upon duplex ultrasonography. One patient did, however, require revision surgery in the late post-operative course. At the end point, all patients showed good functional results without any donor-site morbidity. Conclusion For carefully selected isolated and combined tendon defects on the upper and lower extremities, the vascularized adductor magnus tendon flap provides a reliable and versatile method for microsurgical reconstruction. © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons.


Djedovic G.,Innsbruck Medical University | Matiasek J.,Aesthetic and Reconstructive Surgery | Morandi E.,Innsbruck Medical University | Pierer G.,Innsbruck Medical University | And 2 more authors.
European Journal of Plastic Surgery | Year: 2015

Skin defects of the penile shaft, caused by trauma, infection, or iatrogenically after surgery are commonly treated with skin grafts. A suboptimal postoperative outcome after the use of skin grafts is affected by the trend towards wound bed and skin graft contraction in this often-expanding region. We report on our experience using a new technique for defect coverage of the penile shaft with respect to its elasticity demands during erection and its mechanical demands during sexual intercourse. Furthermore we would like to illustrate the advantages of the application of a dermal substitute together with split-thickness skin grafts compared to the use of split-thickness skin grafts alone. At the follow-up, the patient did not report any impairment during erection or after sexual intercourse. The aesthetic outcome was natural and pleasing. The use of acellular dermal templates together with unmeshed split-thickness skin grafts has proven its superior functional and aesthetic outcome in several demanding regions. With the aid of negative-pressure wound therapy, a single procedure for penile defect coverage is possible. Our reported procedure revealed a natural and pleasing outcome, with no sexual impairment and high patient satisfaction. Level of Evidence: Level V, therapeutic study © 2015, Springer-Verlag Berlin Heidelberg.


PubMed | Aesthetic and Reconstructive Surgery and Innsbruck Medical University
Type: Case Reports | Journal: Journal of wound care | Year: 2015

Skin transplantation is a commonly used surgical technique; however, the complication rate, including postoperative infection and delayed wound healing due to inefficient perfusion, is significantly higher in patients suffering from comorbidities. Hence, a subsequent repeat procedure is often necessary. In this report, two case studies are presented in which an octenidine-based antiseptic is used with a tie-over dressing (TOD) instead of povidone iodine (PVP-iodine), following a split-thickness skin graft. The two patients selected were deemed to be at high risk of impaired wound healing due to comorbidities. The first patient, a confirmed smoker with diabetes, presented with a nodular melanoma that was resected and covered with a split-thickness skin graft. After 5 days of negative pressure wound therapy as a TOD, in combination with PVP-iodine, the graft became necrotic. A second split-thickness skin graft was performed and an antiseptic regimen with octenidine in combination with the same TOD resulted in a completely healed transplant. The second patient, also a confirmed smoker with diabetes and receiving oral corticosteroid treatment, was diagnosed with a skin necrosis on her leg. Following the split-thickness skin graft, octenidine and TOD were applied. The patients skin graft completely healed without any adverse events. These two case studies indicate that the combination of octenidine and TOD following split-thickness skin transplantation is safe, well-tolerated and appears to have positive benefits in the reconstruction of defects in patients with impaired wound healing.


Jandali Z.,Aesthetic and Reconstructive Surgery | Loh C.Y.Y.,Ninewells Hospital | Athanassopoulos T.,Aesthetic and Reconstructive Surgery | Muller K.,Ninewells Hospital
Indian Journal of Plastic Surgery | Year: 2014

Objective: Following massive weight loss (MWL) medial contouring of the thigh is frequently requested to improve appearance and function. Thigh lifting can be associated with significant complications. We present a case series of post bariatric patients undergoing thigh lift using staged the liposuction, a modified T incision and a buried de-epithelialised dermal flap. Materials and Methods: From January to December 2012, 21 consecutive patients underwent a modified medial thigh lift. A retrospective review of the case notes was performed to assess complications that occurred. Results: There were no major post-operative complications in terms of reoperation, hematoma, thromboembolism and no seromas. Seven patients, all of which were smokers had minor superficial wound healing complications. Aesthetic outcomes were satisfactory for all patients at a minimum follow-up of 6 months. Conclusions: The modified 'T' incision with staged liposuction is described. We have found the technique to be useful for a variety of different thighs. It is a reproducible method for contouring the medial thigh in MWL patients. In this series, our overall complications were low, and no seromas occurred.


PubMed | Ninewells Hospital and Aesthetic and Reconstructive Surgery
Type: Journal Article | Journal: Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India | Year: 2014

Following massive weight loss (MWL) medial contouring of the thigh is frequently requested to improve appearance and function. Thigh lifting can be associated with significant complications. We present a case series of post bariatric patients undergoing thigh lift using staged the liposuction, a modified T incision and a buried de-epithelialised dermal flap.From January to December 2012, 21 consecutive patients underwent a modified medial thigh lift. A retrospective review of the case notes was performed to assess complications that occurred.There were no major post-operative complications in terms of reoperation, hematoma, thromboembolism and no seromas. Seven patients, all of which were smokers had minor superficial wound healing complications. Aesthetic outcomes were satisfactory for all patients at a minimum follow-up of 6 months.The modified T incision with staged liposuction is described. We have found the technique to be useful for a variety of different thighs. It is a reproducible method for contouring the medial thigh in MWL patients. In this series, our overall complications were low, and no seromas occurred.


PubMed | Aesthetic and Reconstructive Surgery
Type: Case Reports | Journal: Journal of wound care | Year: 2014

Effective wound bed preparation is an essential element in the healing of chronic wounds, including pressure ulcers (PUs). Negative pressure wound therapy (NPWT) reduces oedema, stimulates the formation of granulation tissue and helps remove wound exudate. This helps prepare the wound bed for secondary healing, skin grafting or coverage with flaps. Combining NPWT with an instillation phase using an antiseptic (octenidine based) irrigation solution is a novel approach to PU management. Three patients with Category 4 gluteal PUs were treated with NPWT and instillation fluid, following surgical debridement of necrotic tissue. The aim was to achieve optimal wound bed preparation prior to wound closure by local fasciocutaneous flap. The antiseptic efficacy of octenilin wound irrigation solution in microorganism eradication was quantified by in vitro tests simulating real conditions using leg ulcer vacuum exudates. All wounds completely healed after four weeks, and no adverse incidents occurred due to instillation of octenidine. No recurrence of the PU occurred during a one year follow-up.


Lipoatrophy is a condition that affects certain individuals, most commonly those who are infected with the human immunodeficiency virus.[1-3] Injectable fillers are used for the treatment of these dermal contour deformities to smooth dermal depressions formed by the loss of volume. These dermal fillers (also known as soft tissue augmentation devices) can correct contour deformities caused by lipoatrophy in patients who are human immunodeficiency virus positive or negative. The product used in this study is a patented, second-generation, injectable, dermal collagen stimulator that combines glycolic acid and polylactic acid. The glycolic acid used is not a polymer, but rather an acid derived from sugar cane. Its chemical structure corresponds to that of an alpha-hydroxy acid. Glycolic acid is a well-characterized agent that is present in a number of cosmetic products. Polylactic acid is a synthetic, biocompatible, biodegradable, inert, synthetic polymer from the poly a-hydroxy-acid family that is believed to stimulate fibroblasts to produce more collagen, thus increasing facial volume. Together, polylactic acid and glycolic acid act in concert to 1) stimulate collagen production and 2) hydrate the outer layers of the skin. A multicenter, clinical investigation authorized by the Mexican Secretariat of Health was conducted between September 20, 2002, and September 19, 2004. This clinical study was conducted in male patients between 32 and 60 years of age with lipoatrophy as a result of highly active antiretroviral therapy for human immunodeficiency virus infection. The study objective was to measure the improvement of contour deformities after the injection of a dermal collagen stimulator containing glycolic acid and polylactic acid. In addition to safety, this dermal filler was assessed when used to correct volume deformities caused by lipoatrophy in subjects who are human immunodeficiency virus positive. Thirty male subjects participated and were treated as follows: seven in two sessions, eight in three sessions, 14 in four sessions, and one in five sessions. Each treatment session was separated by approximately 20 days as per the manufacturer's instructions. The follow-up phase consisted of four observation periods over two years from the last injection. The primary efficacy endpoint was measurement of correction of human immunodeficiency virus highly active antiretroviral therapy induced facial lipoatrophy. Using a multipoint scale of facial divergence, correction was measured as a percentage of correction (diversion correction percentage) from baseline. A secondary endpoint was safety based upon the incidence and type of adverse events experienced. All 30 patients completed the active treatment phase with 100 percent (N=30) undergoing at least two treatments at Days 1 and 20 after entry into study. Seventy-four percent (n=23) underwent a third treatment at Day 60, and 50 percent (n=15) received a fourth treatment at Day 80. A single subject received a fifth treatment at Day 100. There were no serious adverse events and no adverse events noted during the study period. Histology through skin biopsy (2mm punch) was performed on 10 subjects, and all subjects had dermal skin thickness measured with ultrasound. Histology demonstrated a foreign body reaction with multinucleated giant cells with phagocytized lactate crystals. New collagen formation was demonstrated. United States measurements of dermal skin thickness increase ranged from 0.22cm to 0.37cm. All subjects were rated for expected injection events to include erythema, edema, ecchymosis, and hematoma. This dermal collagen stimulator containing glycolic acid and polylactic acid represents a tangible alternative in therapeutic and aesthetic medicine. More than four years of clinical trials have demonstrated that this dermal collagen stimulator helps to improve the exterior quality of the skin while restoring lost facial volumes. Patient satisfaction was high due to its effectiveness and long-lasting results, which in some cases have lasted more than two years.

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