Ludwigshafen University of Business and Society

Plastic and reconstructive surgery (PRS) encompasses a wide range of procedures, and postoperative complications remain a persistentchallenge. While preoperative laboratory values (PLVs) are routinely assessed, their predictive value for postoperative outcomes inPRS is unclear. This study evaluates the association between PLVs and postoperative morbidity to enhance risk stratification. The ACS-NSQIP database (2008-2022) was analyzed for PRS patients. PLVs included sodium, blood urea nitrogen, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white blood cell count, hematocrit, platelets, partial thromboplastin time, international normalized ratio, and prothrombin time (PT). Multivariate logistic regression identified independent predictors of complications, while decision tree analysis established risk thresholds, validated through cross-validation. A total of 200,015 patients with a mean age of 50.3±14.5 years and a mean BMI of 29.1±6.8 kg/m2 were included in this study. Albumin levels emerged as the strongest predictor for the occurrence of any complications. Patients with albumin ≤ 3.3 g/dL had a 36.5% risk for the occurrence of any complication compared to 10.4% in those with higher levels. In the high-risk group, prolonged PT (> 16.2s) further increased risk for the occurrence of any complications. Also, in the lower-risk group (albumin > 3.3 g/dL), prolonged PT (> 13.7 s) were found to significantly influence complication occurrence. Further, multivariate analysis confirmed reduced albumin (OR 0.460) as the strongest independent predictors for any complication occurrence. Albumin and PT are key predictors of 30-day postoperativecomplications in PRS. Preoperative optimization of these values can enhance patient safety and surgical outcomes. Findings support integrating targeted preoperative evaluations into clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Weight extremes are linked to morbidity, yet their impact on burn outcomes remains underinvestigated. Prior studies suggest an 'obesity paradox', showing survival benefits and better functional outcomes in obese patients. This study used the global real-world database TriNetX to assess the association between body mass index (BMI) and clinical outcomes in adult burn patients, categorized using WHO definitions. After 1:1 propensity score matching for demographics, burn severity, and smoke inhalation injury, clinical outcomes were analyzed over a six-month period following burn injury. Outcomes included mortality, sepsis, pneumonia, acute kidney injury (AKI), cardiovascular events, graft complications, skin infections, and psychological impairment. After matching, 9736 patients were included in the underweight versus normal weight comparison, 72,274 in overweight versus normal weight, 71,195 in obesity versus normal weight, and 9732 in underweight versus obesity. Underweight patients were associated with higher mortality and increased risks of sepsis, pneumonia, cardiovascular events, and psychological impairment. Overweight and obese patients showed higher survival rates and overall better clinical outcome associations. These findings are consistent with the previously described 'obesity paradox' in burn care and identify underweight burn patients as a distinct high-risk subgroup.

Since survival rates have improved over recent decades, there is an increasing number of childhood cancer survivors. Besides the late medical effects of the therapy, survivors experience financial and legal burdens and discrimination linked to their cancer history. The objective of this study was to examine the prevalence and types of discrimination faced by childhood cancer survivors in Germany. We conducted a survey in the German childhood cancer community assessing domains of discrimination. Within 111 participants, recruited through social media campaigns and direct outreach to organizations in the field of pediatric oncology, 76.6% (n = 85) reported experiencing at least one form of discrimination. The most common areas of discrimination involved various types of insurance coverage (51.4%), employment (27.9%), and educational matters (16.2%). Our findings highlight the significant prevalence of lifelong financial and legal burdens and discrimination among childhood cancer survivors. It reveals the urgent need for education, awareness campaigns regarding cancer survival, and legal measures to end discrimination and to establish equal treatment in terms of social and financial issues. Our results contribute to the ongoing discussion surrounding the law named "Right to be Forgotten" and advocate an implementation in Germany.

ABSTRACTBackgroundMicrovascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions.MethodsA narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability.ResultsFlap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions—such as thin fasciocutaneous or muscle flaps on well‐perfused beds—were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap “training,” showed potential to promote vascular remodeling, but clinical evidence remains limited.ConclusionFlap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.

Background:Despite class 1 recommendations and clinical evidence supporting optical coherence tomography (OCT), its adoption is limited. While randomised controlled trials show clinical benefits of OCT under strict protocols, its real-world performance is unclear.Aims and methods:All-comEr Registry of OCT (AERO) to Investigate the MLD-MAX Algorithm for OCT-guided-precision-PCI in Daily Routine (ILUMIEN-V-AERO; NCT05324683) is a prospective, multicentre OCT registry aiming to recruit 2,000 patients across sites in the UK, Germany and Saudi Arabia. The study seeks to evaluate the real-world use of an algorithmic approach to OCT-guided percutaneous coronary intervention (PCI) (MLD-MAX) and directly compares its outcomes to those from the ILUMIEN-IV randomised controlled trial. The primary endpoint for this comparison is post-PCI minimum stent area relative to the reference segments. Secondary endpoints include OCT imaging assessments (minimum stent area, edge dissection, stent malapposition, mean stent expansion, plaque protrusion, reference segment disease), procedural outcomes (procedural and fluoroscopy time, contrast use, renal replacement therapy) and clinical endpoints (a composite endpoint of target lesion failure [cardiac death, ischaemia-driven target lesion revascularisation, target vessel MI] and unplanned hospitalisation for unstable angina). All patients will undergo clinical follow-up at 30 days and 6 months to assess target lesion failure. Beyond the inclusion criteria of the ILUMIEN-IV trial, this study will explore the role of OCT in diagnosing acute coronary syndrome, its application in guiding drug-coated balloon PCI and the impact of core laboratory support and critical evaluation on operator performance.Conclusion:ILUMIEN-V-AERO is a large, prospective registry designed to assess the real-world performance of OCT and provide insights into its role in underexplored areas of PCI guidance.

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury (TBI) frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent TBI remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with TBI, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5%) had a TBI. Mortality was highest in this group (22.2%) compared to isolated burns (3.7%), burns with other trauma (7.4%), and electrical burns (4.8%). Surgical delays (>72h) occurred only in burn patients with TBI (22.2%), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (P = .018) and longer operative times (P = .048). Complications were more frequent: wound infections (48.1%) and graft loss (22.2%) were significantly higher in the TBI group. In conclusion, burns with concomitant TBI define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.

Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future.