Page 122 - JSOM Winter 2018

Is There an Indication for Pre-hospital Trepanation? When MSCs were injected into wound margins we observed a
G. Freude , U.M. Mauer , R. Dulou , J.M. Delmas significantly accelerated wound closure as well as a histologi-
2
2
1
1
1 Dep. of Neurosurgery; Bundeswehrkrankenhaus Ulm, Germany; cally reduced scar formation in contrast to the control group
2 Dep. of Neurosurgery; Hôpital d´Instruction des Armées Percy, (injection of phosphate-buffered saline [PBS]).
Clamart, France
We were able to show that the TNF-α stimulated protein 6
raumatic brain injury (TBI) can be a severe injury. In case (TSG-6), which is released by MSCs, following injection into
Tof a severe traumatic brain injury the patient should arrive wound margins, suppressed the release of TNF-α from ac-
in a trauma center within 60 minutes. Computed tomogra- tivated macrophages. This is of major importance because
phy scan of the brain has to be performed quickly in order TNF-α leads to an enhancement of the inflammatory response
to assess the extent of intracranial injury. In the case of post- causing impaired wound healing and most likely the extend
traumatic unconsciousness, direct transport to a trauma cen- of scar formation. Furthermore, our results showed that the
ter with neurosurgical care is recommended. If required after injection of MSCs or recombinant TSG-6 lead to a suppres-
the computed tomography an operation should be performed. sion of myofibroblast differentiation which eventually is re-
Glasgow Coma Scale (GCS) score under 9, intubation and sponsible for the characteristic tissue organization of scars in
ventilation should be performed. Normoventilation, normox- adult wound healing. Following this perception, we were able
emia and normotension should be achieved. to show that injecting MSCs in acute wounds leads to a signifi-
According to the literature and examples there is no indication cantly reduced scar depth and a better scar texture compared
for pre-hospital trepanation in military missions or in the civil- to PBS-injected control wounds.
ian emergency medical service. Trepanation without diagnos- This study provides insight into what we believe to be a previ-
tic is life-threatening for the patient. Critical bleeding of the ously undescribed multifaceted role of MSCs-released TSG-6
scalp must be stopped in pre-hospital settings. in wound healing. MSCs-released TSG-6 was identified to
improve wound healing by limiting macrophages activation,
A Look to Future – Ways to a Complete Scarless inflammation and fibrosis. TSG-6 and MSCs-based therapies
Regeneration After Severe Skin Trauma may thus qualify as promising strategies to enhance tissue re-
Major (MC) Dr. med. Torsten Andres, Department of Orthopaedics pair and to prevent excessive scar formation.
and Trauma Surgery, Septic and Reconstructive Surgery, and
Sports Traumatology, German Armed Forces Hospital of Ulm
GU-Trauma – What We Can Do and
he treatment of soft tissue injuries is the dominating op- What We Should Be Able to Do
Terative procedure curing soldiers wounded in action. Fre- A. Martinschek, Department of Urology,
quently, the initial injury and/or further surgical treatment Bundeswehr Hospital of Ulm, Ulm, Germany
leave huge soft tissue defects which need to be reconstructed Introduction
due to functional and aesthetic reasons. Additionally, the The GU-tract is most often affected in polytrauma patients re-
mainly young and prior to the trauma active patients have sulting from blast injuries. As part of a multinational team,
high expectations concerning their outcome. Although recon- currently one German urologist is on deployment at Bagram
structive possibilities and skills in central Europe and north- Airfield, Afghanistan. GU-trauma-cases become more fre-
ern America are consistently impressive, the mostly severe and quent and these mutilating injuries are resulting in voiding
multiple wounded soldiers often stretch the caring surgeon to and sexual dysfunctions, leaving the patients stigmatised and
his limits. While tissue defects and their reconstruction are a handicapped, not able to start a family.
relevant task especially in the acute and post-acute phase of re-
habilitation, functional restrictions and psychological burden Aim of the Talk
because of scar formation are medium- to long-term problems Training and qualification of urologist on missions are suf-
which must be avoided as good as possible. ficient for managing acute trauma cases for medical evacua-
tion and protection of sexual and voiding function. Critical
Modern science might offer great options for the treatment discussion should be raised about currently used protection
of different types of defects in future, e.g. the use of stem cell wear and the possibilities of recovering of reproductive and
supported or based therapies in severe injuries of the skin. rehabilitation of sexual function.
Options for reducing or avoiding scar formation might come
along with these attempts. Topics:
It is well known that proper activation of macrophages in the German urologists are well trained in managing GU-trauma
inflammatory phase of acute wound healing is essential for to the kidney, ureter, bladder, penis, urethra and testicles.
physiologic tissue repair. While fetal wound healing is able to GU-traumatic cases are rarely life-threatening and often part
proceed without scars, massive macrophage inflammatory re- of complex injuries. Acute urological care for GU-trauma is
sponses may be causal for the fibrotic response always accom- only the first part on the way to total rehabilitation. There
panying adult wound healing. The presented study addressed are open questions on preservation of reproductive function
the question whether mesenchymal stem cells (MSCs)—due and restoring sexual life in young soldiers after surviving
to their anti-inflammatory properties—represent a strategy to life-threatening blast injuries.
control macrophage activation and scar formation in a murine
model of full-thickness skin wounds. Conclusion
Acute management of GU-trauma is demanding, but German
urologists are well trained. Current focus has to be the late
sequela of blast injuries and their total rehabilitation including
sexual and reproductive function.

120 | JSOM Volume 18, Edition 4 / Winter 2018