Justus Osterloh

Purpose: Soft tissue sarcomas are rare malignant tumors of mesenchymal origin characterized by their heterogeneity and diagnosis is challenging despite integrated histopathology and molecular testing. DNA methylation profiling offers an objective approach for tumor classification, but clinical implementation data in soft tissue sarcoma remain limited. Methods: In this single-center study, 40 tumor samples from 34 patients were evaluated by routine pathology and array-based DNA methylation profiling and classified using two versions of the sarcoma methylation classifier (V12.3 and V13.1). Results: With version V12.3, 16 samples (40%) achieved a high calibrated score ≥ 0.9, among which 87.5% (14/16) were consistent with the histopathologic diagnosis. With V13.1, 29 samples (72.5%) reached a high calibrated score (≥ 0.9) and the classifier’s diagnosis aligned with the histopathologic diagnosis in 28 cases (96.6%). Conclusion: Overall, DNA methylation-based classification is a valuable adjunct diagnostic tool to confirm or refine the histopathologic diagnosis. V13.1 substantially improved classification confidence and agreement compared with V12.3. However, a considerable subset of specimens remained below the high-confidence threshold, underscoring the need for further technical and workflow optimization before routine clinical implementation.

Background: Free functional gracilis transfer (FFGT) is the gold standard for dynamic facial reanimation in long‐standing facial paralysis and its success depends on the availability of reliable recipient vessels. In patients with compromised vessels due to prior surgery, radiation, or trauma, arteriovenous (AV) loops are a well‐established reconstructive strategy. However, their role in facial reanimation remains scarcely reported. Methods: We retrospectively analyzed all patients with facial paralysis receiving facial reanimation with FFGT at our center between January 2010 and March 2025. All patients with absent or compromised standard recipient vessels, who underwent facial reanimation using FFGT in combination with an AV loop, were included. A sequential approach with preoperative Doppler examination, intraoperative flow assessment, AV loop construction, and continuous Cook‐Schwartz Doppler monitoring was used before gracilis harvest. Each case was compared with an age‐matched cohort of patients who underwent conventional FFGT without AV loops to contextualize operative and ischemia times. Primary outcomes were technical success and perioperative complications. Results: Out of 196 patients who underwent facial reanimation, four patients (4/196, 2.0%) with compromised recipient vessels who received AV loop‐assisted FFGT were identified (mean age 57 years (range: 40–65) years). The mean follow‐up time was 19.3 months (13–30 months). No AV‐loop thrombosis, flap loss, hematoma, wound complications, or donor‐site morbidity occurred. Compared with age‐matched controls, operative times were prolonged, whereas ischemia times remained comparable. Functional smile restoration was achieved in two of four patients within 12 months. Conclusions: AV loop‐assisted FFGT is a technically feasible salvage approach for facial reanimation in patients with compromised recipient vessels, enabling restoration of vascular access and expanding reconstructive options. Trial Registration: FRKS (Freiburger Reister Klinischer Studien), No. FRK005908

Background: Whether unilateral digital artery injuries benefit from surgical repair remains controversial, as perfusion is typically preserved by the remaining, contralateral artery. Evidence on the long-term patency and hemodynamic effects of reconstructed unilateral arteries is limited. This study aimed to evaluate the patency and flow characteristics of digital arteries after microsurgical repair using duplex ultrasonography. Methods: A retrospective single-center study was conducted including patients with unilateral digital artery injuries at the level of the digit who underwent primary microsurgical anastomosis between 2017 and 2022. Patients with fractures, proximal injuries, or vein grafts were excluded. Duplex ultrasonography was used to assess arterial patency and blood flow at follow-up. Results: Twenty-seven patients were examined at a mean follow-up of 37 months (range 16–82). Duplex ultrasonography demonstrated anterograde flow in 26 of 27 reconstructed arteries (96.3%). The median flow volume in the repaired artery (1.1 ml/min, interquartile range [IQR]: 0.5–2.8) was significantly lower than in the contralateral artery of the same digit (3.6 ml/min, IQR: 1.4–7.7) and the corresponding artery of the contralateral hand (2.8 ml/min, IQR: 1.3–6.8). No significant compensatory increase was observed in the intact artery of the injured digit compared with its contralateral counterpart. Conclusion: Duplex sonography demonstrates that repaired unilateral digital arteries remain patent in the long term, despite reduced flow compared with contralateral controls. While the functional benefit of arterial repair remains uncertain, long-term patency suggests a potential role for repair in selected cases to support vascular integrity.

Introduction: Scapholunate instability is a common and challenging wrist pathology with no universally accepted surgical solution. The all-dorsal scapholunate reconstruction technique restores the dorsal ligament with an extensor carpi radialis brevis tendon autograft. The aim of this study was to assess outcomes in patients with a chronic scapholunate ligament rupture. Methods: We retrospectively analysed 31 patients. Outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score and a visual analogue scale score for pain. Clinical examination included wrist range of motion and grip strength. The radiological parameters measured were scapholunate (SL) angle and gap. Follow-up averaged 39 months (range 12–84) for all outcomes. Results: Postoperatively median pain scores improved from 5 to 2 and disability scores from 58 to 48, although changes were not statistically significant. Median wrist extension at final follow-up measured 50° (IQR 42.5 to 70) and flexion 45° (IQR 39 to 60). Radiographically, there was persistent carpal malalignment with a median SL angle of 66° (IQR 58 to 73), a static SL gap of 3 mm (IQR 2.2 to 4) and a dynamic SL gap of 4.8 mm (IQR 3.3 to 5.4). Median grip strength improved from 28 kg (IQR 20 to 40) preoperatively to 29 kg (20–37) postoperatively. Five patients required salvage procedures owing to progressive symptomatic osteoarthritis. Complications included complex regional pain syndrome ( n = 3), transient nerve symptoms ( n = 2), anchor-site osteolysis ( n = 13) and isolated scaphocapitate joint osteoarthritis ( n = 5). Conclusion: The relative simplicity and preservation of wrist function with the all-dorsal reconstruction technique justify its continued use, despite high complication and revision incidences. Level of Evidence: Level IV

The goal of reconstructive surgery in treating tissue defects is to achieve a stable reconstructive outcome while minimizing donor site morbidity. As a result, tissue engineering has emerged as a key focus in the pursuit of this goal. One approach is to create a tissue container that can be preconditioned and later transplanted into the defect area. The characteristics of the matrices used in the tissue container are critical to this approach’s success. Matrices generated with recombinant, functionalized spider silk (eADF4(C16)-RGD) have been reported to be biocompatible and easy to vascularize. However, the effect of exogenously added proangiogenic cells, such as endothelial cells (T17b), on the vascularization process of matrices generated with this hydrogel in vivo has not been described yet. In this study, we implanted arteriovenous (AV) loop containers filled with a spider silk hydrogel consisting of an eADF4(C16)-RGD matrix and encapsulated, differentiated endothelial T17b cells producing the reporter protein TNFR2-Fc-Flag-GpL. The histological and µCT analyses revealed spontaneous angiogenesis and fibrovascular tissue formation in the container at 2 and 4 weeks post-implantation. The reporter protein was detected after 4 weeks. No severe immune response was observed. Altogether, this study demonstrates that cell-supplemented recombinant spider silk is a highly promising hydrogel to produce matrices for tissue engineering applications.

Background: Patient informed consent is a crucial subject in preoperative care of patients before elective hand surgery, ensuring that patients have the necessary information and a comprehensive understanding to make autonomous decisions. The use of video-based informed consent systems is an innovative concept to enhance the consent process with multimedia tools. In addition to the conventional process, mostly relying on verbal communication and written documents, the video-based approach aims to present information in a standardized and visually appealing format. Methods: In this study, 33 patients were asked to watch a video on a tablet about the planned elective hand surgery after a conventional pre-treatment consultation including informed consent throughout verbal explanations and paper forms by an attending physician or resident. All patients were asked to complete a questionnaire after watching the video. Results: An overwhelming majority of participants, specifically 97.0%, stated that the video improved their understanding of the upcoming surgery. 90.9% of the participant would refer the video to other patients undergoing elective hand surgery, while 72.7% of participants indicated that they would have appreciated the opportunity to view an informational video before undergoing different types of surgeries in the past. Conclusion: The use of a video-based patient information system in elective hand surgery had a positive impact on patient education and satisfaction with the informed consent process. Therefore, it is a powerful tool in preoperative management to guarantee a standardized and educative informed consent.