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Zanin EM, Arpini NE, Roth JC, Avalos GV, Duarte DW, Martins Collares MV. Dermal Matrix Graft Effects on Facial Growth in a Veau-Wardill-Kilner Palatoplasty Model: An Experimental Study in Rats. Cleft Palate Craniofac J 2024; 61:733-739. [PMID: 36373603 DOI: 10.1177/10556656221139674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty-due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation. The objective of this work was to test the use of an acellular dermal matrix (Mucograft®) in an experimental model of Veau-Wardill-Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa. Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau-Wardill-Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated. There were significant statistical differences between the groups for palate length growth (7.6 mm + -0.38 mm vs 5.5 mm + -0.36 mm, P = .009) and for palate width growth (1.47 mm + -0.8 mm vs -0.09 mm + -0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups. The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.
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Affiliation(s)
| | - Nícolas Endrigo Arpini
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Julia Caletti Roth
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Galo Verdugo Avalos
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daniele Walter Duarte
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Ávila León JL, Rivero CR, Guerrero Serrano L, Alviar JD, Rodríguez MA, Arocha AM, Pineda GG. Immediate Results of the Use of Split-Thickness Skin Autografts With and Without Acellular Dermal Matrix in Patients with Burns: A Comparative Study in a Colombian Population. J Burn Care Res 2024; 45:348-355. [PMID: 37668065 DOI: 10.1093/jbcr/irad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Dermal substitutes have become fundamental tools for covering skin defects, most recently with biological subtypes such as glycerolized acellular dermal matrix (GADM). However, literature regarding this matter is scarce in Latin America and Colombia. In this descriptive observational study, we compared the use of partial skin autografts (PSA) combined with GADM and autografts without GADM. Patients were selected from the burn unit of a hospital in northeastern Colombia between 2021 and 2022. Two study groups were defined: one receiving GADM plus PSA and the other control receiving only a partial split-thickness autograft. A total of 29 patients with 68 body areas were included, with an average age of 20 years. Most cases involved third-degree burns caused by flame. Hospitalization time was the same for both groups (41 days). The percentage of grafts taken was similar in both groups; in the GADM with autografts group, it was 94.7% compared with 96% in the control group. The presence of complications was similar in both groups. GADM produced in local tissue banks is a cost-effective alternative. It can be used in a single surgical procedure without increasing complications, providing a postsurgical course similar to autografts alone. Granting the potential long-term benefits that dermal matrices give for healing in these patients, which should be evaluated in subsequent studies.
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Affiliation(s)
- Jorge Luis Ávila León
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - Carlos Ramírez Rivero
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - Linda Guerrero Serrano
- District Institute of Science, Biotechnology, and Innovation in Health (IDCBIS), Bogota, 110110, Colombia
| | - Juan Darío Alviar
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - María Angélica Rodríguez
- Hospital Universitario de Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | | | - German Gómez Pineda
- Hospital Universitario de Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
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Gil-Pallares P, González-Moure C, Mosquera-Fernández A, Rosende-Maceiras L, Usero-Bárcena T, Peña-López S, Figueroa-Silva O, Suárez-Amor Ó, Taboada-Paz L, Monteagudo B, de Las Heras-Sotos C. Reconstruction of plantar surgical defects with synthetic dermal matrix and split-thickness skin grafts: A case series and functional podiatry outcomes. Australas J Dermatol 2023; 64:e357-e360. [PMID: 37724606 DOI: 10.1111/ajd.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Reconstruction of surgical defects after wide local excision of acral melanoma on the sole should allow patients to walk and bear weight. Moreover, certain options such as local transposition flaps can compromise follow-up. We present a case series of surgical defects on weight-bearing areas of the sole reconstructed using a synthetic dermal matrix and a split-thickness skin graft. This approach prevents surrounding tissue displacement and results in good functional outcomes assessed by baropodometry and computer-based podoscopy.
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Affiliation(s)
- Pedro Gil-Pallares
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
- Universidad de Santiago de Compostela, Santiago, Spain
| | | | - Abián Mosquera-Fernández
- Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, A Coruña, Spain
| | | | - Teresa Usero-Bárcena
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sandra Peña-López
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Olalla Figueroa-Silva
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Laura Taboada-Paz
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Benigno Monteagudo
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
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Caputo G, Scarabosio A, Di Filippo J, Contessi Negrini F, Albanese R, Mura S, Parodi PC. Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management. Medicina (Kaunas) 2023; 59:1231. [PMID: 37512043 PMCID: PMC10383214 DOI: 10.3390/medicina59071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.
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Affiliation(s)
- Glenda Caputo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Jacopo Di Filippo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sebastiano Mura
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
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Kakagia DD, Georgiadis G, Drosos G. Dermal Matrices: Game Changers in Leg and Foot Soft Tissue Reconstruction? A Case Series. Int J Low Extrem Wounds 2023; 22:56-62. [PMID: 34060922 DOI: 10.1177/1534734621990311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.
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Affiliation(s)
| | | | - George Drosos
- Democritus University Hospital, Alexandroupolis, Greece
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Deganello A, Bosio P, Giannini L, Parolini F, Berretti G, Sordi A, Rampinelli V, Gualtieri T. Matrix for Mucosal Regeneration in Transoral Glossectomy for Squamous Cell Carcinoma: Objective and Subjective Functional Evaluation. Curr Oncol 2023; 30:1354-1362. [PMID: 36826065 PMCID: PMC9954828 DOI: 10.3390/curroncol30020104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Numerous options to manage local reconstruction following transoral partial glossectomy are possible. In this work, we present our experience using a matrix for mucosal regeneration, Integra®, after transoral resections of squamous cell carcinoma of the oral tongue. METHODS A retrospective analysis of patients treated for tongue carcinoma and reconstruction with Integra®, from September 2017 to September 2022. Functional outcomes were evaluated by measuring swallowing and speech abilities, tongue motility, and subjective quality of life. RESULTS The series accounts for 13 consecutive patients, staged from Tis to T3, no positive resection margins were found, average defect size was 17.8 cm2. The average histologically measured depth of invasion was 4.1 mm (range 2-12 mm), and no recurrences were observed during follow-up. All patients maintained excellent swallowing function, the average number of recognized words by an external listener during a phone call was 70.5 out of 75, the lingual motility test was good (a mean score of 4.5 out of 6 movements correctly executed) and subjective questionnaires results were optimal. Less satisfying functional results were recorded in elderly patients receiving a wider surgical resection. CONCLUSIONS This reconstructive technique for allows obtaining optimal healing and functional outcomes in patients with tumors suitable for transoral glossectomy.
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Affiliation(s)
- Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence: ; Tel.: +39-0223902793
| | - Paolo Bosio
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Lorenzo Giannini
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
| | - Federico Parolini
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giulia Berretti
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandra Sordi
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Vittorio Rampinelli
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Tommaso Gualtieri
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
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Kuang B, Pena G, Cowled P, Fitridge R, Greenwood J, Wagstaff M, Dawson J. Use of Biodegradable Temporising Matrix (BTM) in the reconstruction of diabetic foot wounds: A pilot study. Scars Burn Heal 2022; 8:20595131221122272. [PMID: 36157311 PMCID: PMC9500262 DOI: 10.1177/20595131221122272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Complex diabetes-related foot wounds are at high risk of infection and subsequent major amputation unless healed expediently. Biodegradable Temporising Matrix (BTM) is a synthetic matrix that facilitates the organisation of the extracellular matrix, resulting in a neodermis layer over these difficult-to-heal areas. The aim of this study was to evaluate the efficacy of using BTM in the reconstruction of challenging diabetic foot wounds. Methods Eighteen patients with complex diabetic foot wounds (exposed tendon, fascia, joint, bone), or chronic ulcers at high shear stress locations had BTM applied. Indications for BTM application were high shear stress location (66.6%), exposed bone (16.6%), exposed fascia (5.6%), exposed tendon (5.6%) and chronic non-healing wound (5.6%). The time to complete healing, infection rate and incidence of subsequent wound breakdown was analysed. Discussion Thirteen of 18 patients completed the BTM treatment regime with all these patients achieving complete wound healing at a median time of 13 weeks. One patient had partial treatment with BTM and four patients were withdrawn from the study following BTM application. The rate of infection and re-ulceration were both 15.4%. Conclusion This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic diabetic foot wounds with exposed deep structures and chronic wounds subject to high shear stress. The re-ulceration and infection rates were relatively low for this high-risk population. BTM may also offer promise as an alternative to free flaps. Lay Summary The prevalence of diabetes and its complications, including foot ulcers and wounds, have significantly increased worldwide over the last 40 years. Increasingly patients are admitted to hospital for antibiotics, debridements and subsequent amputations from these wounds. Complex diabetes-associated wounds are those at highest risk of these complications or necessitating more extensive, complex operations such as free flaps. These wounds may have exposed deep structures, be at risk of high shear stress or be chronic non-healing wounds. Temporisers are a type of material which integrates into the wound and promotes in-growth of tissue, ideal for healing over these difficult to heal areas. Biodegradable Temporising Matrix (BTM) is a synthetic temporising matrix which has demonstrated positive outcomes in facilitating healing in burns and plastics wounds, but its effectiveness in diabetic foot wounds has not yet been proven. This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic complex diabetic foot wounds and potentially avoiding more complex operations.
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Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Guilherme Pena
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - John Greenwood
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marcus Wagstaff
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joseph Dawson
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
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Abstract
OBJECTIVE The extracellular matrix (ECM) is one of the most important elements in wound healing. Absence or dysfunction of the ECM may impair wound healing. The application of acellular dermal matrix (ADM) as a substitute for ECM has been suggested. This study investigated the clinical application and wound healing effects of a paste-type ADM in patients presenting with hard-to-heal wounds due to various causes. METHOD Patients with a hard-to-heal wound for >1 month, from September 2017 to February 2019, were included in this study. After debridement, the paste-type ADM was applied, at zero (baseline), two and four weeks. After application of the paste-type ADM, a conventional dressing was applied using polyurethane foam. Wound size, the formation of granulation tissue, re-epithelialisation, complete healing and adverse events were recorded at zero (baseline), one, two, four, eight and 12 weeks after the initial treatment. RESULTS A total of 18 patients took part (eight male, 10 female, mean age of 56±16.16 years). The mean wound area decreased from 17.42±10.04cm2 to 12.73±7.60cm2 by week one (p<0.05), to 10.16±7.00 by week two (p<0.0005), to 5.56±5.25 by week four (p<0.0001), to 2.77±5.15 by week eight (p<0.0001) and to 2.07±4.78 by week 12 (p<0.0001). The number of patients with >75% re-epithelialisation increased from two (11.1%) at two weeks to five (27.8%) at four weeks, to 11 (61.1%) at eight weeks and to 13 (72.2%) at 12 weeks. The number of patients showing complete wound healing was two (11.1%) at four weeks, nine (50.0%) at eight weeks and 12 (66.7%) at 12 weeks. No adverse events were reported during treatment. CONCLUSION The paste-type ADM used in this study is a viable option for facilitating wound healing; it can shorten hospitalisation, and promote a faster recovery and return to normal life activities.
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Affiliation(s)
- Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
| | - Hyung Sup Shim
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Seoul, Korea
| | | | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Abstract
OBJECTIVE Soft tissue defects, especially those involving exposed vital structures, present a reconstructive challenge because poor vascularity of such defects typically makes immediate skin grafting unviable. Where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for defects with denuded vital structures. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine-derived extracellular matrix graft in the reconstruction of complex soft tissue defects involving exposed vital structures. METHOD Six cases of soft tissue defects exhibiting denuded vital structures underwent reconstruction using an ovine forestomach matrix graft as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporised defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialisation were monitored until closure and the final aesthetic and functional outcomes were evaluated. RESULTS Complete healing was achieved in all cases, with defect granulation becoming observable within one to two weeks and complete granulation occurring within one to six weeks. Granulation tissue resulting from the graft was suitable for skin grafting, with 100% take of skin grafts after one week and complete re-epithelialisation in two to three weeks in the four cases that received a skin graft. Good cosmetic, functional and patient satisfaction outcomes were achieved in all cases. CONCLUSION The present series demonstrates our initial use of an extracellular matrix-based dermal matrix in reconstructing defects with exposed vital structures. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.
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Affiliation(s)
- Gregory A Bohn
- Department of Surgery, Central Michigan School of Medicine, St. Joseph Hospital, 200 Hemlock Rd, Tawas City, Michigan 48763, US
| | - Abigail E Chaffin
- Department of Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, Louisiana 70112, US
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Araco A, Francesco A. Prospective randomized clinical study of a new topical formulation for face wrinkle reduction and dermal regeneration. J Cosmet Dermatol 2021; 20:2832-2840. [PMID: 33453095 DOI: 10.1111/jocd.13937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A new topical formulation (TF) based on 3 main lifting components has been developed to reduce superficial facial wrinkles. OBJECTIVES Determine the effectiveness of this new TF in reducing superficial face wrinkles and restructuring the dermal matrix. METHODS Women, aged 30-65 y.o. with moderate to severe crow's feet wrinkles were included. EXCLUSION CRITERIA men; younger than 30 or older than 65 years old; smokers. Patients received 15 IU of botulinum toxin on crow's feet and 2 creams. Fifty patients (Group 1) applied the TP (Product A) and 50 (Group 2) a placebo (Product B). Assessments were made by digital macro-photography's, Antera 3D, and a patient satisfaction questionnaire. RESULTS From April to June 2019, 100 women were enrolled in the study and were divided into two homogeneous groups. No major or minor side effects were reported. In group 1, wrinkles, texture, static and dynamic crow's feet wrinkles improved significantly at 3 and 6 months. Patients were very satisfied at 3 months and satisfied at 6 months. In group 2, wrinkles and texture improved significantly at 3 months but did not improve at 6 months. Static and dynamic crow's feet wrinkles improved significantly at 1 and 3 months but did not improve significantly at 6 months. CONCLUSIONS Our prospective and randomized study has shown that the new TF is safe and effective in reducing superficial face wrinkles and producing dermal regeneration. It, therefore, prolongs the duration of the botulinum toxin. Further controlled study would be necessary to compare the new TF to neurotoxin treatment, or its action alone.
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Affiliation(s)
- Antonino Araco
- Aesthetic Medicine Department, Cosmetic Surgeon at Univeristy Tor Vergata of Roma, Rome, Italy
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Carvalho-Júnior JDC, Zanata F, Aloise AC, Ferreira LM. Acellular dermal matrix in skin wound healing in rabbits - histological and histomorphometric analyses. Clinics (Sao Paulo) 2021; 76:e2066. [PMID: 33681941 PMCID: PMC7920408 DOI: 10.6061/clinics/2021/e2066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To analyze the histology and histomorphometry of healing associated with acellular dermal matrix in skin wounds in rabbits. METHODS Twelve male rabbits were divided into two groups: the control group (CG) and the matrix group (MG). Three skin wounds with a total area of 20 × 20 mm were created on the dorsal region of each animal. Photographic records of the lesions taken over a 21-day period and use of the ImageJ program allowed calculation of the wound contraction rate. The lesions were biopsied on days 3, 14 and 21 for histomorphometric analysis to define the thicknesses of the dermis and epidermis (hematoxylin-eosin) and calculate the densities of type I and type III collagen (picrosirius). RESULTS No significant difference in the healing rate was found between the groups (p>0.05). The MG presented greater epidermal thickness on day 3 (p<0.05) and on days 14 and 21 (p<0.001). The MG presented greater dermal thickness throughout the study period (p<0.05). The type I collagen density was higher in the MG throughout the study period (p<0.05), and the type III collagen density was higher in the MG on days 3 and 14 (p<0.05) and on day 21 (p<0.001). CONCLUSION The use of acellular dermal matrix increased the thickness of the dermal and epidermal layers and the amount of type I and III collagen during skin wound healing and did not alter the rate of wound contraction.
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Affiliation(s)
| | - Fabiana Zanata
- Divisao de Cirurgia Plastica e Reconstrutiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Antônio Carlos Aloise
- Divisao de Cirurgia Plastica e Reconstrutiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Lydia Masako Ferreira
- Divisao de Cirurgia Plastica e Reconstrutiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Borovkova NV, Makarov MS, Ponomarev IN, Andreev YV, Storozheva MV, Budaev AA. Experimental Study of the Effect of Biological Matrixes with Stabilized and Non-Stabilized Platelets on Reparative Process in the Wound Equivalent to Deep Burn. Bull Exp Biol Med 2020; 170:128-134. [PMID: 33231804 DOI: 10.1007/s10517-020-05019-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/26/2022]
Abstract
We studied reparative effect of platelet-filled biological matrixes in the treatment of mice with wounds equivalent to deep burn. The wound coatings were based on decellularized dermal matrix without platelets (control), with native platelets, and with platelets stabilized with 2.5 μM nanosilver. In 3 days, the epithelial layer and derma were absent in all groups and extensive scab was formed. Dermal matrix with platelets simulated intensive migration of macrophages and fibroblasts to the wound bottom; in the control group, this migration was absent. In 14 days, granulation tissue appeared in the wound bottom in animals of all groups; in the experimental groups, the number of vessels was 2-4-fold higher than in the control, though the number of inflammatory cells in experimental groups remained high. On day 21, the scab on the most of the wound area was absent in all animals of the experimental groups and epithelialization and hair growth were pronounced, comparing to control. Nevertheless, in experiment dermal layer was not already completed, inflammation reaction remained.
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Affiliation(s)
- N V Borovkova
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia
| | - M S Makarov
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia.
| | - I N Ponomarev
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia
| | - Yu V Andreev
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia
| | - M V Storozheva
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia
| | - A A Budaev
- N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department, Moscow, Russia
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13
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Fiorentini C, Bedini A, Mandel VD, Bacca E, Menozzi M, Reggiani C, De Pace B, Meschiari M, Santoro A, Franceschini E, Mussini C, Terrenato I, Giacomelli L, Magnoni C. Comparison of two perioperative antibiotic schedules in patients undergoing surgical reconstruction with dermal matrix after excision of skin cancer. Int Wound J 2020; 17:937-943. [PMID: 32232964 PMCID: PMC7948944 DOI: 10.1111/iwj.13354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022] Open
Abstract
Perioperative antibiotic treatment duration in skin reconstruction with dermal substitutes is not well established. This study compares the incidence of infective complications after two different durations of perioperative antibiotic treatment in patients undergoing surgical reconstruction with skin dermal substitutes (SDS) after excision of skin cancer. Infective complications at the site of SDS were compared in subjects undergoing surgical reconstruction who received either a > 24-hour (extended protocol) or a ≤ 24-hour (short protocol) perioperative antibiotic treatment. Of 116 patients undergoing SDS surgical reconstruction, 62 (53.4%) received an extended schedule, and 54 (46.6%) received a short schedule. The two groups were similar for gender, age, comorbidities, American Society of Anesthesiologists score, and type of skin cancer. Overall incidence rate of infection was 20.7% (24/116). No differences in terms of risk of infection were observed between the two groups (OR: 1.04, 95% CI: 0.42-2.55; P = .937). Patients undergoing SDS reconstruction in the limb/foot had a higher risk of infection in comparison with those undergoing SDS reconstruction in the chest/head (OR: 2.69, 95% CI: 1.06-6.86; P = .038). The short protocol was demonstrated to be beneficial to patients undergoing surgical reconstruction with SDS. A ≤ 24-hour perioperative antibiotic schedule did not increase the infection rate, potentially allowing a reduction of antibiotic exposure.
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Affiliation(s)
- Chiara Fiorentini
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Andrea Bedini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | | | - Erica Bacca
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Marianna Menozzi
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Camilla Reggiani
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Barbara De Pace
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Marianna Meschiari
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Antonella Santoro
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Erica Franceschini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Cristina Mussini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Irene Terrenato
- Biostatistics‐Scientific DirectionIRCCS Regina Elena National Cancer InstituteRomeItaly
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated DiagnosticsUniversity of GenoaGenoaItaly
- Polistudium srlMilanoItaly
| | - Cristina Magnoni
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
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14
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Rikimaru H, Rikimaru-Nishi Y, Yamauchi D, Ino K, Kiyokawa K. New Alternative Therapeutic Strategy for Gustilo Type IIIB Open Fractures, Using an Intra-Wound Continuous Negative Pressure Irrigation Treatment System. Kurume Med J 2019; 65:177-183. [PMID: 31723082 DOI: 10.2739/kurumemedj.ms654009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of Gustilo type IIIB and IIIC open fractures remains a challenging problem, because the infection rate is 15-45%. Infection can lead to serious complications such as osteomyelitis or amputation. The intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) was developed for infected wounds and intractable ulcers, and is very effective in suppressing infection and accelerating wound healing. Here the IW-CONPIT was applied to severe open fractures for the purpose of preventing infection. After thorough debridement and lavage of the wound, bony stabilization is performed by external fixation. Dermal matrix is grafted onto any areas where the bone or tendon is exposed. A sponge containing two tubes is placed over the entire surface of the wound including the dermal matrix. Then it is covered with a film dressing to make the wound completely airtight. A bottle of physiologic saline solution is attached to one tube, and a continuous aspirator is attached to the other. This system maintains negative pressure on the wound surface, which is continuously irrigated. Thirty-five patients were treated with this method. A superficial infection developed in two cases but was resolved by additional debridement and continued application of IW-CONPIT. Complete wound healing was obtained with split thickness skin graft in all cases. There were no complications such as osteomyelitis, delayed bone union or amputation. IW-CONPIT was able to definitively prevent wound infection in Gustilo type ⅢB open fractures. We believe this method will become a standard treatment option for this condition.
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Affiliation(s)
- Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Daisuke Yamauchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Koh Ino
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
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15
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Zhang L, Wang WH, Jin JY, Degan S, Zhang GQ, Erdmann D, Hall RP, Zhang JY. Induction of hair follicle neogenesis with cultured mouse dermal papilla cells in de novo regenerated skin tissues. J Tissue Eng Regen Med 2019; 13:1641-1650. [PMID: 31216101 DOI: 10.1002/term.2918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022]
Abstract
De novo skin regeneration with human keratinocytes amplified in culture is a life-saving procedure for patients with extensive skin loss and chronic wounds. It also provides a valuable platform for gene function and therapeutic assessments. Nevertheless, tissues generated in this manner lack hair follicles that are important for skin homeostasis, barrier function, and repair. In this study, we generated skin tissues with human keratinocytes combined with dermal papilla (DP) cells isolated from mouse whisker hair. For this, cultured keratinocytes and mouse DP (mDP) cells were mixed at 10:1 ratio and seeded onto devitalized human dermal matrix derived from surgically discarded human abdominoplasty skin. After 1 week in submerged culture, the cell/matrix composites were grafted onto the skin wound beds of immunocompromised NSG.SCID mice. Histological analysis of 6-week-old skin grafts showed that tissues generated with the addition of mDP cells contained Sox2-positive dermal condensates and well-differentiated folliculoid structures that express human keratinocyte markers. These results indicate that cultured mDP cells can induce hair follicle neogenesis in the de novo regenerated skin tissues. Our method offers a new experimental system for mechanistic studies of hair follicle morphogenesis and tissue regeneration and provides insights to solving an important clinical challenge in generation of fully functional skin with a limited source of donor cells.
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Affiliation(s)
- Long Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.,Department of Dermatology, Duke University Medical Center, Durham, NC
| | - Wen-Hui Wang
- Department of Dermatology, Duke University Medical Center, Durham, NC.,Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Jane Y Jin
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | - Simone Degan
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | - Guo-Qiang Zhang
- Department of Dermatology, Duke University Medical Center, Durham, NC.,Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Detlev Erdmann
- Department of Surgery, Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC
| | - Russell P Hall
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | - Jennifer Y Zhang
- Department of Dermatology, Duke University Medical Center, Durham, NC
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16
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Ahn JW, Shalabi D, Correa-Selm LM, Dasgeb B, Nikbakht N, Cha J. Impaired wound healing secondary to bevacizumab. Int Wound J 2019; 16:1009-1012. [PMID: 31111622 DOI: 10.1111/iwj.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/28/2019] [Indexed: 01/16/2023] Open
Abstract
Bevacizumab is a monoclonal antibody that exerts its antitumor activity by inhibiting vascular endothelial growth factor. Consequently, it suppresses endothelial cell proliferation, vascular permeability, and angiogenesis. This inhibitory effect contributes to tumour size reduction but causes wound-healing delay, specifically during the proliferative phase, in patients receiving bevacizumab. Although surgical wound-healing complications (WHC) associated with bevacizumab have been extensively reported, there is limited literature on peripheral WHC. More importantly, the histopathology of bevacizumab-associated WHC has not been described. We present the histopathology findings of a non-healing ulcer in a patient receiving bevacizumab, providing insight into the possible aetiology of this drug's adverse reaction. Furthermore, our patient's positive response to hyperbaric oxygen suggests its possible use for treatment of bevacizumab-associated non-healing wounds.
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Affiliation(s)
- Ji W Ahn
- Department of Dermatology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Doaa Shalabi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lilia M Correa-Selm
- Scully Welsh Cancer Center, Cleveland Clinic Indian River Hospital, Vero Beach, Florida
| | - Bahar Dasgeb
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jisun Cha
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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17
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Araco A. A prospective study comparing topic platelet-rich plasma vs. placebo on reducing superficial perioral wrinkles and restore dermal matrix. J COSMET LASER THER 2019; 21:309-315. [PMID: 31064236 DOI: 10.1080/14764172.2019.1605448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: The goal of our prospective study was to assess the efficacy of the topical Platelet-rich plasma on reducing superficial perioral wrinkles and restoring the dermal matrix. Materials and methods: 50 women with moderate to severe perioral wrinkles were treated on the perioral area by a single session of fractional CO2 laser skin resurfacing plus intradermal injection of prp. 25 patients (group 1) applied topically prp twice a day for 12 weeks as post laser treatment. 25 (group 2) applied gentamicin and betamethasone twice a day for the first 7 days and then hyaluronic acid gel for the following 12 weeks. Results: In group 1, moisture (p < 0.001), amount of collagen fiber (p < 0.001) skin elasticity (p < 0.001), PSAl (p < 0.001) and SSAl (p < 0.001) improved significantly. In group 2 all the parameters investigated improved but did not reach significant difference. Discussion: Our medical device with a plasma-like formulation is able to maintain prp active for a period of 7 days so patients are able to apply topically growth factors at home. Conclusions: Our prospective study proves that the use of topical prp reduces superficial perioral wrinkles and restore dermal matrix when used at home for 12 weeks.
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Affiliation(s)
- Antonino Araco
- Cosmetic Surgeon at Villa Salaria, private hospital , Rome , Italy
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18
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Wazir U, Mokbel K. The Evolving Role of Pre-pectoral ADM-assisted Approach in Implant-based Immediate Breast Reconstruction Following Conservative Mastectomy: An Overview of the Literature and Description of Technique. In Vivo 2019; 32:1477-1480. [PMID: 30348704 DOI: 10.21873/invivo.11402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The recent development of acellular dermal matrix (ADM) devices has enhanced implant-based breast reconstruction surgery following conservative mastectomy for therapeutic and risk-reducing purposes leading to improved aesthetics. In the traditional sub-pectoral approach, coverage of the implant is provided by the pectoral muscles superiorly and the ADM inferiorly. The need to eliminate breast animation, reduce post-operative dysfunctional pain and the risk of capsular contracture, have stimulated surgeons to investigate the feasibility of placing the implant over the pectoralis major muscle with complete coverage with ADM thus inventing a novel pre-pectoral approach. MATERIALS AND METHODS We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction. Also, we describe our technique, and present pictures of the post-operative result. RESULTS AND CONCLUSION The early reported results of the pre-pectoral breast reconstruction approach are encouraging and confirmed the potential benefits of eliminating breast animation and reducing postoperative pain. However, most of these studies had a small sample size (<100 patients) and were retrospective in nature with a limited follow-up duration and lack of data regarding the objective aesthetic assessment and oncological outcome. Nevertheless, suitable patients undergoing conservative mastectomy and implant-based reconstruction should be offered this option while further evaluation is being performed.
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Affiliation(s)
- Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, U.K.
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19
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Ribeiro L, Serras R, Guimarães D, Vilela M, Mouzinho M. Bilateral third-degree burn of the legs: lower limb salvage with dermal regenerative matrix. Ann Burns Fire Disasters 2018; 31:228-232. [PMID: 30863258 PMCID: PMC6367860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Abstract
Third-degree burns of the lower extremities are among the most difficult burn injuries to treat as they frequently expose bone, tendons or articular surfaces. Coverage with a flap is the ideal treatment, but local tissue is often unavailable, and free flaps require sophisticated equipment and perfect microsurgical technique. We demonstrate a treatment option to obtain a stable cutaneous coverage for this kind of injury, consisting in an association of skin grafts, amniotic membrane and bilaminar dermal matrix templates. This combined treatment proved to be an excellent option to cover a wide area of tibial exposure with low donor site morbidity and good functional and aesthetic results. This shows that artificial dermis is a good alternative for treating bone exposure, especially in patients for whom a classic flap reconstruction is not suitable.
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Affiliation(s)
- L.M. Ribeiro
- Luís Mata Ribeiro
Department of Plastic and Reconstructive Surgery, Hospital São José (Centro Hospitalar Lisboa Central)Rua José António Serrano, 1150-199, LisbonPortugal+351 967811556
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20
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Jank BJ, Goverman J, Guyette JP, Charest JM, Randolph M, Gaudette GR, Gershlak JR, Purschke M, Javorsky E, Nazarian RM, Leonard DA, Cetrulo CL, Austen WG, Ott HC. Creation of a Bioengineered Skin Flap Scaffold with a Perfusable Vascular Pedicle. Tissue Eng Part A 2017; 23:696-707. [PMID: 28323545 DOI: 10.1089/ten.tea.2016.0487] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Full-thickness skin loss is a challenging problem due to limited reconstructive options, demanding 75 million surgical procedures annually in the United States. Autologous skin grafting is the gold standard treatment, but results in donor-site morbidity and poor aesthetics. Numerous skin substitutes are available on the market to date, however, none truly functions as full-thickness skin due to lack of a vascular network. The creation of an autologous full-thickness skin analogue with a vascular pedicle would result in a paradigm shift in the management of wounds and in reconstruction of full-thickness skin defects. To create a clinically relevant foundation, we generated an acellular skin flap scaffold (SFS) with a perfusable vascular pedicle of clinically relevant size by perfusion decellularization of porcine fasciocutaneous flaps. We then analyzed the yielded SFS for mechanical properties, biocompatibility, and regenerative potential in vitro and in vivo. Furthermore, we assessed the immunological response using an in vivo model. Finally, we recellularized the vascular compartment of an SFS and reconnected it to a recipient's blood supply to test for perfusability. Perfusion decellularization removed all cellular components with preservation of native extracellular matrix composition and architecture. Biaxial testing revealed preserved mechanical properties. Immunologic response and biocompatibility assessed via implantation and compared with native xenogenic skin and commercially available dermal substitutes revealed rapid neovascularization and complete tissue integration. Composition of infiltrating immune cells showed no evidence of allorejection and resembled the inflammatory phase of wound healing. Implantation into full-thickness skin defects demonstrated good tissue integration and skin regeneration without cicatrization. We have developed a protocol for the generation of an SFS of clinically relevant size, containing a vascular pedicle, which can be utilized for perfusion decellularization and, ultimately, anastomosis to the recipient vascular system after precellularization. The observed favorable immunological response and good tissue integration indicate the substantial regenerative potential of this platform.
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Affiliation(s)
- Bernhard J Jank
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jeremy Goverman
- 2 Divison of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jacques P Guyette
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jon M Charest
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Mark Randolph
- 3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | | | | | | | | | - Rosalynn M Nazarian
- 7 Department of Pathology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - David A Leonard
- 4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | - Curtis L Cetrulo
- 3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | - William G Austen
- 2 Divison of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Harald C Ott
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,8 Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
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21
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Wagstaff M, Caplash Y, Greenwood J. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute. Eplasty 2017; 17:e3. [PMID: 28197297 PMCID: PMC5287144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis. Results: Implantation, integration, delamination, and split-skin graft application proceeded without complication, mirroring our previous experience in other wounds (including major burns). The result was a robust, supple, mobile, and well-contoured reconstruction over the deep tissues of the neck. The functional and cosmetic outcomes exceeded all expectation. Discussion: The wound environment created after necrotizing fasciitis infection and debridement is austere. In this particular case, reconstructive options were limited to large free flap repair, skin graft alone, and skin graft augmented by commercially available collagen/glycosaminoglycan dermal matrix. Each option was discarded for various reasons. Our previous success with NovoSorb BTM, developed at our center, prompted its use following regulatory approval. The patient was physiologically stronger after the temporization afforded by the biodegradable temporizing matrix over 4 weeks of integration. Conclusion: This is the first description of the successful use of an entirely synthetic biodegradable dermal substitute for the reconstruction of both necrotizing fasciitis and an anterior cervical defect.
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Affiliation(s)
- Marcus JD Wagstaff
- aAdult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia,bDepartment of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Yugesh Caplash
- bDepartment of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John E Greenwood
- aAdult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia,Correspondence:
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22
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Lyons M, Parcells AL, Granick MS. Single-Stage Dermal Matrix and Skin Grafting to Treat a Complicated Hand Wound. Eplasty 2016; 16:ic23. [PMID: 27313815 PMCID: PMC4894365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mitchell Lyons
- Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark
| | | | - Mark S. Granick
- Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark
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23
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Greenwood J, Wagstaff MJ, Rooke M, Caplash Y. Reconstruction of Extensive Calvarial Exposure After Major Burn Injury in 2 Stages Using a Biodegradable Polyurethane Matrix. Eplasty 2016; 16:e17. [PMID: 27222681 PMCID: PMC4864669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To share our experience of an extensive calvarial reconstruction in a severely burn-injured, elderly patient in a 2-stage procedure utilizing a novel biodegradable temporizing matrix (NovoSorb BTM), followed by autograft. MATERIALS AND METHODS A 66-year-old patient with 75% full-thickness burns, including 7% total body surface area head and neck, with calvarial exposure of approximately 350 cm(2), complicated by acute renal failure and smoke inhalation injury. Exposed calvarium was burred down to diploe and biodegradable temporizing matrix was applied. Over the next 29 days, the biodegradable temporizing matrix integrated by vascular and tissue ingrowth from the diploe. Delamination and grafting occurred, however, at 43 days postimplantation of biodegradable temporizing matrix due to skin graft donor-site constraints. RESULTS Graft take was complete, yielding a robust and aesthetically pleasing early result (26 days post-graft application). CONCLUSIONS Biodegradable temporizing matrix offers an additional resource for reconstructive surgeons faced with fragile patients and complex wounds.
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Affiliation(s)
- John Edward Greenwood
- aAdult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia,Correspondence:
| | - Marcus James Dermot Wagstaff
- aAdult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia,bDepartment of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia
| | - Michael Rooke
- aAdult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia
| | - Yugesh Caplash
- bDepartment of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia
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24
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Abstract
Skin aging is caused by several factors capable of deteriorating dermal matrix and is visibly noticed in skin color and skin contour deformities. In addition to the prevention of skin aging by application of antioxidants and sunscreens, treatment of skin wrinkles with those of dermal fillers is also recommended. Dermal filler products with enhanced injectability and longer duration are being developed continuously. Biodegradable polymers such as skin elastic fibers and dermal matrix mimetic used for treatment of skin wrinkle are summarized in this article. Additionally, the importance of amino acids, enzymes, and proteins in aesthetic of skin is addressed. Thus, elective agents are proposed for the dermatologists, cosmetic formulators, and the individuals facing skin aging problems. The candidate natural peptides from marine sources are additionally presented for widening the choice of actives application for treating aging.
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Affiliation(s)
- Nattaya Lourith
- a School of Cosmetic Science , Mae Fah Luang University, Chiang Rai, Thailand; Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University , Chiang Rai , Thailand
| | - Mayuree Kanlayavattanakul
- a School of Cosmetic Science , Mae Fah Luang University, Chiang Rai, Thailand; Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University , Chiang Rai , Thailand
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25
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Abstract
BACKGROUND Rhinophyma is a rare, disfiguring disease characterized by a slow progressive overgrowth of the soft tissue of the nose associated with end-stage severe acne rosacea. OBJECTIVE We present a case of severe rhinophyma treated successfully using PlasmaBlade and acellular dermal matrix with split-thickness skin graft. METHODS This procedure combines deep excision with PlasmaBlade followed by coverage with an acellular dermal matrix for dermal substitution and split-thickness skin graft. RESULTS Functional and aesthetic results were satisfactory. CONCLUSION We offer a new approach to surgical treatment of rhinophyma. Total excision of phymatous tissue and single session replacement of epidermal-dermal components is an effective treatment for patients with severe rhinophyma, resulting in satisfactory functional and aesthetic outcome. This combined treatment modality prevents the recurrence of rhinophyma. It should be considered an appropriate alternative in cases of severe rhinophyma.
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Affiliation(s)
- Adem Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | - Adem Topkara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | - Ramazan Hakan Özcan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | - Sadık Şentürk
- Department of Plastic and Reconstructive Surgery, Mevlana University Hospital, Konya, Turkey
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Marano AA, Feintisch AM, Datiashvili R. Giant Congenital Melanocytic Nevus of the Buttock. Eplasty 2015; 15:ic31. [PMID: 26171106 PMCID: PMC4473815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Andrew A. Marano
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark,Correspondence:
| | - Adam M. Feintisch
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Ramazi Datiashvili
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark
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Zanotti B, Zingaretti N, Almesberger D, Verlicchi A, Stefini R, Ragonese M, Guarneri GF, Parodi PC. Enhancing dermal and bone regeneration in calvarial defect surgery. Indian J Plast Surg 2015; 47:325-32. [PMID: 25593416 PMCID: PMC4292108 DOI: 10.4103/0970-0358.146581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. OBJECTIVES The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. MATERIALS AND METHODS The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone/prosthesis interface during surgery, and in a further 5 patients, characterized by thin, hypotrophic skin coverage of the cranial lacuna, a sheet of dermal matrix was applied between the prosthesis and the overlying soft tissue. In several of the former groups, platelet gel mixed with hydroxyapatite granules was used to fill small gaps between the skull and the implant. To confirm osteointegration, cranial computed tomography (CT) scans were taken at 3-6 month intervals for 1-year, and magnetic resonance imaging (MRI) was used to confirm dermal integrity. RESULTS Clinical examination performed a few weeks after surgery revealed good dermal regeneration, with thicker, healthier skin, apparently with a better blood supply, which was confirmed by MRI at 3-6 months. Furthermore, at 3-6 months, CT showed good biomimetism of the porous hydroxyapatite scaffold. Locations at which platelet gel and hydroxyapatite granules were used to fill gaps between the implant and skull appeared to show more rapid integration of the implant than untreated areas. Results were stable at 1-year and remain so to date in cases where follow-up is still ongoing. CONCLUSIONS Bone remodeling time could be reduced by platelet gel application during cranioplasty with porous hydroxyapatite implants. Likewise, layering dermal matrix over such implants appears to promote dermal tissue regeneration and the oshtemo mimetic process. Both of these strategies may, therefore, reduce the likelihood of postsurgical fracture by promoting mechanical resistance.
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Affiliation(s)
- Bruno Zanotti
- Neurosurgery Clinic, University of Udine, Reggio Emilia, Italy
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, Italy
| | - Daria Almesberger
- Department of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, Italy
| | - Angela Verlicchi
- Neurology Unit, Free University of Neuroscience "Anemos", Reggio Emilia, Italy
| | | | - Mauro Ragonese
- Urologic Clinic, Catholic University Medical School of Rome, Italy
| | - Gianni Franco Guarneri
- Department of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, Italy
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28
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Fridman NV, Fetisova NV. [The review of the peptides used in dermatocosmetology]. Adv Gerontol 2015; 28:769-774. [PMID: 28509469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The review of the peptides used in dermatocosmetology is represented. The purpose of this review is a search of results of the basic scientific researches confirming or disproving efficiency and/or safety of peptide molecules used in a modern dermatocosmetology. Questions of forms of application, biological availability, reliability of the rendered anti-aging effects are considered.
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Affiliation(s)
- N V Fridman
- Clinic of phlebology and medical cosmetology «ArtMediA», Saint-Petersburg, 191036, Russian Federation;
| | - N V Fetisova
- Clinic of phlebology and medical cosmetology «ArtMediA», Saint-Petersburg, 191036, Russian Federation;
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29
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Bayar GR, Aydıntuğ YS, Günhan O, Oztürk K, Gülses A. Ex vivo produced oral mucosa equivalent by using the direct explant cell culture technique. Balkan Med J 2012; 29:295-300. [PMID: 25207018 DOI: 10.5152/balkanmedj.2012.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 02/01/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is the histological and immunohistochemical evaluation of ex vivo produced oral mucosal equivalents using keratinocytes cultured by direct explant technique. MATERIAL AND METHODS Oral mucosa tissue samples were obtained from the keratinized gingival tissues of 14 healthy human subjects. Human oral mucosa keratinocytes from an oral mucosa biopsy specimen were dissociated by the explant technique. Once a sufficient population of keratinocytes was reached, they were seeded onto the type IV collagen coated "AlloDerm" and taken for histological and immunohistochemical examinations at 11 days postseeding of the keratinocytes on the cadaveric human dermal matrix. RESULTS Histopathologically and immunohistochemically, 12 out of 14 successful ex vivo produced oral mucosa equivalents (EVPOME) that consisted of a stratified epidermis on a dermal matrix have been developed with keratinocytes cultured by the explant technique. CONCLUSION The technical handling involved in the direct explant method at the beginning of the process has fewer steps than the enzymatic method and use of the direct explant technique protocol for culturing of human oral mucosa keratinocyte may be more adequate for EVPOME production.
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Affiliation(s)
- Gürkan Raşit Bayar
- Department of Oral and Maxillofacial Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Yavuz Sinan Aydıntuğ
- Department of Oral and Maxillofacial Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Omer Günhan
- Department of Pathology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Kamile Oztürk
- Department of Biology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aydın Gülses
- Surgical Infirmary, 2 Army Corps, Commando Troop No:5, Gökçeada, Çanakkale, Turkey
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