on behalf of the guideline group "Functional Somatic Symptoms"* T he German clinical practice guideline on the management of patients with unspecific, functional, and somatoform physical symptoms (1, 2) expired in March 2017. Between November 2016 and July 2018, the guideline was updated and thoroughly revised by a group under the coordination of the German College of Psychosomatic Medicine (Deutsches Kollegium für Psychosomatische Medizin, DKPM) and the German Society of Psychosomatic Medicine and Medical Psychotherapy (Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie, DGPM) and in accordance with the requirements of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften, AWMF). Particular attention was paid to userfriendly language and relevance to daily practice. The long version of the guideline and the guideline methods report are available (in German) on the AWMF website (3). The patient guideline is currently undergoing revision. Characterization of the clinical pictureThe term "functional somatic symptoms" refers to a broad spectrum of symptom patterns of greatly varying severity (4-6):• Persistent unspecific symptoms that are burdensome enough for the patient to consult a doctor but are not classified as disease ("medically unexplained symptoms" or "persistent physical symptoms"). These can nevertheless discernibly impair the patient's everyday functioning.• Defined symptom clusters present over an extended period in the form of functional somatic syndromes (such as fibromyalgia syndrome or irritable bowel syndrome). These are mostly associated with a significant limitation of everyday functioning.• Conditions that fulfill the criteria of pronounced (multi)somatoform disorders and the newly defined somatic stress disorders. These presuppose considerable impairment of everyday functioning and are also associated with psychobehavioral symptoms. Functional somatic symptoms as outlined above are to be distinguished from the commonly occurring transitory indispositions that rarely prompt a visit to the doctor and affect everyday functioning only slightly for a limited time, if at all. These are of no medical significance.

Indocyanine green fluorescence angiography allows a perfusion analysis of amputation stumps and therefore a prediction of the expected tissue necrosis. This tool may allow reliable prediction of amputation level.

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