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Babu B, Gaba S, John JR, Subair M. Comparison of Efficacy of Vacuum Dressing Versus Conventional Dressing Over Autologous Split Skin Grafts in Burn Wounds: A Single-Center Prospective Cohort Study. J Burn Care Res 2024; 45:468-477. [PMID: 37950743 DOI: 10.1093/jbcr/irad181] [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: 07/07/2023] [Indexed: 11/13/2023]
Abstract
This study was carried out to compare the efficacy of vacuum dressing and conventional dressing over split skin grafts in burn patients. It was a single-center prospective cohort study on patients, with less than 40% TBSA burn, undergoing skin grafting at 2 different sites simultaneously over the burn wounds. One site underwent conventional dressing following grafting, and the other underwent vacuum dressing. The primary objective was to compare the percentages of skin graft uptake on Day 5 and Day 14. The secondary objectives were to compare the duration of dressings, time for complete epithelization, need for regrafting, and wound swab culture positivity rates. Three independent examiners assessed the efficacy of dressings in terms of epithelization percentage, need for continued dressing, graft loss, wound swab culture positivity rate, and qualitative assessment of grafts. A total of 16 patients were included in the study. The graft loss, number of days of dressings, and complete epithelization time were statistically lower in the negative-pressure wound therapy (NPWT) group compared with the conventional group (P values .007, .006, and 0009, respectively). The percentage of epithelization was also found to be higher in the NPWT group (P = .006). The incidence of positive cultures and clinically significant graft loss was found to be lower in the NPWT group. However, this was not found to be statistically significant. NPWT dressings can be used in burn wounds following skin grafting and have been found to reduce the time for epithelization compared to conventional dressing.
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Affiliation(s)
- Basil Babu
- Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Sunil Gaba
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Jerry R John
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Mohsina Subair
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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2
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Lee KI, Lin YN. One-stage reconstruction of extensive exposed tibia on malnourished patient using single-layer Integra and amino acid supplements: A case report and literature review. Medicine (Baltimore) 2024; 103:e37098. [PMID: 38306507 PMCID: PMC10843514 DOI: 10.1097/md.0000000000037098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Extremity injuries resulting from motor vehicle collisions, especially those leading to bone-exposed wounds, present challenges for achieving effective wound coverage. Such injuries are susceptible to complications including infections, osteomyelitis, and unexpected amputations due to inadequate blood supply. Severe traumatic degloving injuries often entail damage to the surrounding blood vessels, making local or free flaps impractical choices in many cases. Consequently, treatment options may vary based on distinct clinical scenarios, with no standardized guidelines available. Our study introduces an integrated approach utilizing dermal substitutes and skin grafts as a safer treatment modality for managing large-area tibial exposure resulting from traffic accidents. PATIENT CONCERNS A 66-year-old male with a compromised nutritional status was struck by a car while riding a motorcycle. Previous attempts using double-layer Integra and negative pressure wound therapy (NPWT) for two-stage reconstruction have been unsuccessful. DIAGNOSES Computed tomography imaging studies revealed multiple comminuted and displaced fractures involving the left femoral shaft, left proximal tibia, left patella, and proximal fibula, as well as a fracture of the right fibular shaft and an avulsion fracture of the right distal medial femur. The patient's condition corresponded to Type 3B in the Gustilo classification for open fractures, and the patient had an Injury Severity Score of 25. INTERVENTIONS We applied a one-stage reconstruction involving single-layer Integra, split-thickness skin grafts, NPWT, and nutritional supplements containing various amino acids. OUTCOMES By implementing an integrated treatment approach and providing diligent wound care over a total of 2 months, the patient achieved successful healing and expressed satisfaction with the postoperative results. LESSONS This study offers insights into the effectiveness of employing one-stage reconstruction for traumatic injuries with extensive exposed tibias. In addition, it underscores the impact of a patient's nutritional status on wound healing and introduces a potential solution for similar challenging cases.
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Affiliation(s)
- Kuan-I Lee
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yun-Nan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [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: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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Sundberg JP, Rice RH. Phenotyping mice with skin, hair, or nail abnormalities: A systematic approach and methodologies from simple to complex. Vet Pathol 2023; 60:829-842. [PMID: 37191004 DOI: 10.1177/03009858231170329] [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: 05/17/2023]
Abstract
The skin and adnexa can be difficult to interpret because they change dramatically with the hair cycle throughout life. However, a variety of methods are commonly available to collect skin and perform assays that can be useful for figuring out morphological and molecular changes. This overview provides information on basic approaches to evaluate skin and its molecular phenotype, with references for more detail, and interpretation of results on the skin and adnexa in the mouse. These approaches range from mouse genetic nomenclature, setting up a cutaneous phenotyping study, skin grafts, hair follicle reconstitution, wax stripping, electron microscopy, and Köbner reaction to very specific approaches such as lipid and protein analyses on a large scale.
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Affiliation(s)
- John P Sundberg
- The Jackson Laboratory, Bar Harbor, ME
- Vanderbilt University Medical Center, Nashville, TN
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Su S, Xiong D, Zeng Z, Ding X, Kuang J, Lin Y, Wu Y. Repair of pressure ulcers in the elderly using autologous microskin implantation and negative pressure wound therapy: A retrospective study. Technol Health Care 2023:THC230707. [PMID: 37694328 DOI: 10.3233/thc-230707] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Pressure ulcers remain a worldwide problem. OBJECTIVE To introduce an intermittent and feasible wound treatment method for the treatment of pressure ulcers in elderly patients. METHODS This surgical procedure was performed on eight elderly patients suffering from pressure ulcers. Microskin measuring 0.1 × 0.1 centimeters was cut from a small amount of thin skin and then grafted onto the wound surface in conjunction with closed negative pressure therapy. RESULTS Seven patients had their wounds closed after a single surgery, while one patient required two surgeries to close the wound. CONCLUSION Autologous microskin implantation for the treatment of pressure ulcers in the elderly is an effective method to close the wound, which can prevent the elderly from living with wounds in their later years and is a viable treatment option.
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Affiliation(s)
- Shunqing Su
- Department of Wound Repair, Dalang Hospital, Dongguan, China
- Department of Wound Repair, Dalang Hospital, Dongguan, China
| | - Disheng Xiong
- Department of Wound Repair, Dalang Hospital, Dongguan, China
- Department of Wound Repair, Dalang Hospital, Dongguan, China
| | - Zhijian Zeng
- Anorectal Department, Dalang Hospital, Dongguan, China
| | - Xiumei Ding
- Department of Wound Repair, Dalang Hospital, Dongguan, China
| | - Jinan Kuang
- Department of Wound Repair, Dalang Hospital, Dongguan, China
| | - Yuechun Lin
- Department of Wound Repair, Dalang Hospital, Dongguan, China
| | - Yongwei Wu
- Department of Wound Repair, Dalang Hospital, Dongguan, China
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Vecin NM, Kirsner RS. Skin substitutes as treatment for chronic wounds: current and future directions. Front Med (Lausanne) 2023; 10:1154567. [PMID: 37711741 PMCID: PMC10498286 DOI: 10.3389/fmed.2023.1154567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 01/30/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
Chronic wounds such as diabetic foot ulcers and venous leg ulcers place a significant burden on the healthcare system and in some cases, have 5-year mortality rates comparable to cancer. They negatively impact patients' quality of life due to pain, odor, decreased mobility, and social isolation. Skin substitutes are an advanced therapy recommended for wounds that fail to show decrease in size with standard care. The choice of substitute used should be based on evidence, which often differs based on wound etiology. There are more than 75 skin substitutes currently available, and that number is rising. In this review, we discuss current management and future directions of chronic wounds while providing a review of available randomized control trial data for various skin substitutes.
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Affiliation(s)
- Nicole M. Vecin
- Departments of Medical Education and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Robert S. Kirsner
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Cantatore F, Pagliara E, Marcatili M, Bertuglia A. Negative-Pressure Wound Therapy (NPWT) in Horses: A Scoping Review. Vet Sci 2023; 10:507. [PMID: 37624295 PMCID: PMC10458497 DOI: 10.3390/vetsci10080507] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Obtaining a healthy wound environment that is conductive to healing in horses can be challenging. Negative-pressure wound therapy (NPWT) has been employed in humans to enhance wound healing for decades. The existing evidence for the effectiveness of NPWT remains uncertain in equine medicine. The aim of this review is to investigate NPWT applications and benefits in horses. A scoping review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews on three databases (PubMed, Web of Science-Thompson Reuters, and Wiley Online Library). Twenty-four manuscripts were considered. After removing duplicates, 17 papers underwent abstract screening. Of these, 16 + 1 (cited by others) were evaluated for eligibility according to PICOs, including no case reports/retrospective studies, four original articles, and three reviews. Fifteen manuscripts met the inclusion criteria. The focus of the articles was wound management; they included three reports of wounds communicating with synovial structures. Traumatic wounds and surgical-site infections are indications for NPWT. NPWT presents several advantages and few complications making it an attractive alternative to conventional wound management. However, randomized controlled trials should be performed to quantify the benefits and establish precise protocols in horses.
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Affiliation(s)
- Federica Cantatore
- Pool House Equine Clinic, IVC Evidensia, Crown Inn Farm, Fradley, Lichfield WS13 8RD, UK;
| | - Eleonora Pagliara
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (E.P.); (A.B.)
| | - Marco Marcatili
- Pool House Equine Clinic, IVC Evidensia, Crown Inn Farm, Fradley, Lichfield WS13 8RD, UK;
| | - Andrea Bertuglia
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (E.P.); (A.B.)
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8
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Sanches‐Pinto DC, Eriksson E, Gomez DS, Nunes MPT, Gemperli R, Soriano FG. Minced skin grafts for chronic wounds compared to conventional mesh grafts. Health Sci Rep 2023; 6:e1353. [PMID: 37359407 PMCID: PMC10285033 DOI: 10.1002/hsr2.1353] [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] [Received: 02/01/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aims Skin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting. Methods In a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 × 5 cm and the mesh grafts expansion was set at 1:3. Results In the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching, and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG). Conclusion The MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge.
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Affiliation(s)
- Débora C. Sanches‐Pinto
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
| | | | - David S. Gomez
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
| | - Maria P. T. Nunes
- Department of Internal Medicine, School of MedicineUniversity of São PauloSão PauloBrazil
| | - Rolf Gemperli
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
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9
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Papadopoulou S, Nikolaidou E, Joycey AP, Tzimorota Z, Karagergou E. Reconstruction of Bilateral Upper and Lower Eyelid Ectropion Caused by a Liquid Unblocker Chemical Burn. Cureus 2023; 15:e40880. [PMID: 37492843 PMCID: PMC10363769 DOI: 10.7759/cureus.40880] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Liquid drain unblockers, although meant to be used by professionals with protective equipment, are sometimes used in the household without any precautions. This could lead to severe chemical burns, as in the case we present with severe eyelid ectropion. This study aims to stress the need for preventive measures regarding the use of chemicals and for close observation and timely surgical intervention in chemical burn patients to prevent and limit disfigurement. A 45-year-old woman was injured while using an unblocker (90% sulfuric acid) at home. Accidentally, a quantity of the liquid was spilled on her face. She was initially examined in ophthalmology emergencies because of the obvious ocular involvement, and the cutaneous component was underestimated. On the third post-burn day, she was referred as an outpatient to our clinic, and because of the soft consistency and patchy pattern of the burn, she was asked to revisit in a week. Unfortunately, she reappeared two months post-burn with severe ectropion of all four eyelids and a high risk of corneal abrasion, desiccation, and further damage to the already injured left eye as well as the right eye. She underwent three operations in six months and a fourth 15 months after the accident, with the release of the scarred eyelids with full-thickness skin grafts, Z-plasties, and V-Y plasties. After four operations and sessions of triamcinolone acetonide intralesional injection, the patient has a satisfactory eyelid position and function with adequate closure and scar maturation. Domestic use of strong industrial chemicals is dangerous, and public education for prevention is urgently needed. On the other hand, it is mandatory to follow up very closely with chemical burn patients to prevent severe sequelae, especially in the delicate and contraction-prone periocular and perioral areas. Reconstruction, in these cases, is a complex task. Often, several surgeries are needed to restore acceptable function and appearance. Burn disfigurement and self-stigma will follow the patients to some extent throughout their lives.
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Affiliation(s)
- Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eirini Nikolaidou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Andrew P Joycey
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Zoi Tzimorota
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
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10
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Ng-Wong YK, Alexander B, Bartl M, Loftis CE, Hammad D, Dulgheru EC, De La Garza M, Nunez AC. Deeper Seated Than Skin Deep: Report of a Rare Case of Follicular Occlusion Tetrad and a Literature Review. Cureus 2023; 15:e39474. [PMID: 37362514 PMCID: PMC10290440 DOI: 10.7759/cureus.39474] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Follicular occlusion tetrad (FOT) is a clinical syndrome consisting of hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal cyst (PC). These entities typically occur independently, but occasionally present simultaneously comprising FOT. The four components share similar pathophysiology affecting the apocrine glands, follicular hyperkeratinization being the hallmark of each entity. Understanding shared similarities of each disease is paramount for the treatment approach as the relapsing and chronic nature of this syndrome can be burdening to patients. We present the case of a 22-year-old obese Hispanic man with a history of tobacco use who presented with worsening skin lesions. The patient developed extensive facial cystic acne 5 years before presentation, followed by left axillary hidradenitis suppurativa lesions two years before the presentation and right axillary involvement one year after. Skin manifestations then expanded to include the lower back, gluteal and perineal areas. The patient was diagnosed with FOT and despite conservative medical management, his lesions failed to improve. He ultimately underwent multiple staged excisional debridement surgeries and skin grafts. Our case underlines the presence of a syndromic association of cutaneous lesions that share a common pathogenesis and emphasizes that this entity requires a multidisciplinary approach. New biologic therapies continue to emerge and may potentially prevent the need for surgical intervention and the burden associated with it.
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Affiliation(s)
- Yilen K Ng-Wong
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Blesset Alexander
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Mery Bartl
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Christine E Loftis
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Dina Hammad
- Rheumatology, University of Florida, Gainesville, USA
| | | | - Mauricio De La Garza
- Plastic and Reconstructive Surgery Institute, Doctors Hospital at Renaissance, Edinburg, USA
| | - Aidee C Nunez
- Plastic Surgery, Doctors Hospital at Renaissance, Edinburg, USA
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Vathulya M, Rao S, Malik A, Sinha S, Kumar N, Kapoor A, Bahurupi Y. Is "Initial Size of the Graft the Real Culprit behind Primary Contraction of Full-Thickness Skin Graft"? - A Cross-Sectional Study. Arch Plast Surg 2023; 50:106-115. [PMID: 36755654 PMCID: PMC9902097 DOI: 10.1055/s-0042-1756297] [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] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 02/09/2023] Open
Abstract
Background Primary contraction of full-thickness graft has been traditionally quoted to be 40%. There are lacunae in literature to elaborate on the factors influencing it ever since. Methods About 75 subjects who underwent full-thickness grafting procedures to resurface small defects were included in the study. The initial and final graft dimensions after primary contraction were traced on X-ray templates and the percentage of contraction was evaluated using the graphical method. This was further correlated with age, collagen, elastic matrix metalloproteinases-1 (MMP-1) and -2 content along with dermal thickness of the skin specimen sent from the graft. Results The primary contraction of the graft had a very significant correlation only with the initial size of graft harvested with a linear regression of 33.3% and a Spearman's correlation of 0.587 significant at a p -value of 0.001. Conclusion This study though preliminary tries to highlight an important factor that primary contraction of grafts is a physical phenomenon independent of its contents like collagen, elastin, or MMP-1 and -2 or age and dependent on its initial size of harvest instead.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence Madhubari Vathulya, MS, MCh Department of Burns and Plastic Surgery, All India Institute of Medical SciencesRishikesh 249203, UttarakhandIndia
| | - Shalinee Rao
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akanksha Malik
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Smita Sinha
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nikhilesh Kumar
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Salvia G, Michelucci A, Granieri G, Manzo Margiotta F, Bevilacqua M, Fidanzi C, Panduri S, Romanelli M, Dini V. An Integrated Systemic and Local Wound Management in Recalcitrant Pyoderma Gangrenosum. INT J LOW EXTR WOUND 2023:15347346221148818. [PMID: 36597572 DOI: 10.1177/15347346221148818] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis, whose management still represents a clinical challenge due to frequent unresponsive cases. The aim of our study was to evaluate the efficacy of a novel, combined approach including local wound management, based on the principle of PG-TIME and a systemic therapy with an anti interleukin (IL)-17A monoclonal antibody (mAb). We presented a case of a 37-year-old female patient, affected by multi-refractory PG. The patient was treated with a combined approach of both local and systemic therapy. Wound clinical improvement was assessed by Wound Bed Score (WBS), wound size was evaluated through 3D camera laser scanner, and pain was evaluated with visual analog scale (VAS). After 52 weeks of therapy, the association of local wound management with ixekizumab 80 mg [160 mg at time (T) 0; 80 mg every 2 weeks until week 12; 80 mg every 4 weeks] allowed us to perform skin grafting and obtain complete wound healing. Our clinical case demonstrated the efficacy of a novel combination therapy for the treatment of recalcitrant PG based on IL-17 mAbs and local wound management built on the main features of PG-TIME.
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Affiliation(s)
- Giorgia Salvia
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | - Marco Romanelli
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
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13
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Gierek M, Ochała-Gierek G, Kitala D, Łabuś W, Bergler-Czop B. Surgical management of hidradenitis suppurativa. Postepy Dermatol Alergol 2022; 39:1015-20. [PMID: 36686007 DOI: 10.5114/ada.2022.115323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/06/2022] [Indexed: 01/25/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic disease, which causes painful discomfort. The main regions involved in this disease are axillary, inguinal and perianal. The etiology is unknown at present. It is suggested that genetics, smoking and diabetes are involved in HS. General treatment consists of antibiotics and anti-inflammatory biological drugs. HS is a multidisciplinary disease, which involves surgical treatment as well. We would like to present surgical treatment in HS. Deroofing and drainage/incisions are the most frequent techniques in general surgery departments. The article describes additional techniques such as skin grafts and flaps. We conclude that local flaps are the best choice in surgical treatment.
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Zongo N, Guigemdé RA, Yaméogo PB, Somé RO, Traore B, Dem A. Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review. J Surg Oncol 2022; 126:1512-1519. [PMID: 35997990 DOI: 10.1002/jso.27077] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Dermatofibrosarcoma is a locally malignant tumor. This gives surgery a place of choice. The advent of imatinib has improved outcomes. Our aim is to describe the indications, techniques and results of surgery. METHODS A retrospective, multicenter, descriptive study conducted in four West African surgical oncology units. It covers dermatofibrosarcoma surgery performed between January 1, 1988 and December 31, 2020. We took into account the surgical procedure, the mode of skin coverage, adjuvant treatments and survival. Comparisons were possible using Student's t-test and Pearson's χ2 . RESULTS We recorded 81 cases of dermatofibrosarcoma. Surgery was effective in 90.1% of cases. Wide resection was the principle with a mean resection margin of 3.8 ± 1.9 cm. healing by primary intention, flaps and healing by secondary intention were the methods of skin coverage in 30.1%, 24.7% and 41.1% respectively. The type of skin coverage was related to the topography and size of the tumor (p < 0.0001). The healing time is associated with the type of skin cover. The recurrence rate was not related to the type of skin coverage (p = 0.8). CONCLUSIONS Wide and deep resection in the absence of Mohs micrographic surgery ensures healthy margins. Oncoplasty reduces the healing time without increasing the risk of recurrence.
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Affiliation(s)
- Nayi Zongo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - R Adeline Guigemdé
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Parateyandé B Yaméogo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | | | - Bangaly Traore
- General Surgery Department, Sanon Sourou Hospital, Bobo Dioulasso, Burkina Faso
| | - Ahmadou Dem
- Institut Joliot Curie de Dakar (Senegal), Cheikh Anta Diop University of Dakar, Dakar, Senegal
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15
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Marques RR, Coltro PS, Almeida JB, Castro JCD, Junior JAF. Treating complex palmar-plantar wounds using a bilaminar 'trapdoor' technique: a case series. J Wound Care 2021; 30:868-873. [PMID: 34644142 DOI: 10.12968/jowc.2021.30.10.868] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar-plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. METHOD This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar 'trapdoor' technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. RESULTS At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar-plantar region. CONCLUSION This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar-plantar recipient region. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Pedro Soler Coltro
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Juliano Baron Almeida
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Abstract
Practical relevance: Open wounds and their treatment present a common challenge in veterinary practice. Approaching 15 years ago negative pressure wound therapy (NPWT) started to be incorporated into clinical veterinary medicine, and its availability is becoming more widespread in Europe and the USA. Use of this therapy has the potential to significantly increase the healing rate of open wounds as well as free skin grafts in small animals, and it has been occasionally described for the management of feline wounds. Aim: This review describes the mechanisms of action of, and indications for, NPWT, and offers recommendations for NPWT specific to feline patients. Evidence base: The information presented is based on the current evidence and the author’s clinical experience of the technique gained over the past 12 years. Comparative studies of different treatment options are lacking and, since wound healing in cats and dogs differs, cat-specific studies are especially needed. Well-designed wound healing studies comparing different advanced techniques will improve open wound healing in cats in the future, and potentially allow better understanding of the role of NPWT in this setting.
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Affiliation(s)
- Mirja C Nolff
- Clinic for Small Animal Surgery, Tierspital Zürich, University of Zürich, Winterthurerstrasse 260, 8057 Zürich, Switzerland
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17
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De Rose DU, Piersigilli F, Goffredo BM, Danhaive O, Dotta A, Auriti C. Treatment with Micafungin in a Preterm Neonate with an Invasive Candida parapsilosis Infection after a Severe Terlipressin-Induced Skin Necrosis. Pathogens 2021; 10:pathogens10070890. [PMID: 34358040 PMCID: PMC8308678 DOI: 10.3390/pathogens10070890] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 12/18/2022] Open
Abstract
Candida parapsilosis infections are increasingly reported in preterm neonates, but the optimal treatment remains uncertain. We report the clinical history of an extremely preterm neonate, who developed a devastating skin necrosis due to terlipressin administration, with subsequent superinfection by Candida parapsilosis. The infant underwent multiple curettages and skin grafts to resolve skin lesions and was treated with systemic micafungin administration at a high dose (8 mg/kg/day), with resolution of the fungal infection.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.D.)
| | - Fiammetta Piersigilli
- Division of Neonatology, Cliniques Saint-Luc, Catholic University of Louvain, 1200 Brussels, Belgium; (F.P.); (O.D.)
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Olivier Danhaive
- Division of Neonatology, Cliniques Saint-Luc, Catholic University of Louvain, 1200 Brussels, Belgium; (F.P.); (O.D.)
- Division of Neonatology, San Francisco Benioff Children’s Hospital, University of California, San Francisco, CA 94158, USA
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.D.)
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.D.)
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
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18
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Meuli JN, Pantet O, Berger MM, Waselle L, Raffoul W. Massive burns: retrospective analysis of changes in outcomes indicators across 18 years. J Burn Care Res 2021; 43:232-239. [PMID: 33886955 PMCID: PMC8737114 DOI: 10.1093/jbcr/irab072] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years. METHODS Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. RESULTS Patients' characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables. CONCLUSION Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.
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Affiliation(s)
- Joachim N Meuli
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
| | - Olivier Pantet
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Mette M Berger
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Laurent Waselle
- Cell Production Center, Lausanne University Hospital, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
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Abstract
Pediatric penile skin grafting is rarely performed. We present a case series of four pediatric patients receiving skin grafting due to the loss of penile skin. The four boys were followed up for 1 to 5 years. One full-thickness skin graft and three split-thickness skin grafts (STSGs) survived well with low Vancouver scar scale scores. One boy gradually developed lymphedema of the distal foreskin and underwent a second preputioplasty. He presented with normal erectile function and did not experience any pain. We propose thick STSGs as the most appropriate choice for pediatric penile skin reconstruction. Lymphedema of the foreskin is an important long-term complication of penile skin grafting.
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Affiliation(s)
- Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Liu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuexian Fu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xingang Yuan
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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20
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Fortunel NO, Martin MT. When the Search for Stemness Genes Meets the Skin Substitute Bioengineering Field: KLF4 Transcription Factor under the Light. Cells 2020; 9:E2188. [PMID: 32998444 DOI: 10.3390/cells9102188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
The transcription factor “Kruppel-like factor 4” (KLF4) is a central player in the field of pluripotent stem cell biology. In particular, it was put under the spotlight as one of the four factors of the cocktail originally described for reprogramming into induced pluripotent stem cells (iPSCs). In contrast, its possible functions in native tissue stem cells remain largely unexplored. We recently published that KLF4 is a regulator of “stemness” in human keratinocytes. We show that reducing the level of expression of this transcription factor by RNA interference or pharmacological repression promotes the ex vivo amplification and regenerative capacity of two types of cells of interest for cutaneous cell therapy: native keratinocyte stem and progenitor cells from adult epidermis, which have been used for more than three decades in skin graft bioengineering, and keratinocytes generated by the lineage-oriented differentiation of embryonic stem cells (ESCs), which have potential for the development of skin bio-bandages. At the mechanistic level, KLF4 repression alters the expression of a large set of genes involved in TGF-β1 and WNT signaling pathways. Major regulators of TGF-β bioavailability and different TGF-β receptors were targeted, notably modulating the ALK1/Smad1/5/9 axis. At a functional level, KLF4 repression produced an antagonist effect on TGF-β1-induced keratinocyte differentiation.
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21
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Abstract
Objective To evaluate the efficacy of different surgical procedures on post burn contracture of hand. Methods A quasi-experimental study design was conducted at the Department of Plastics and Reconstructive Surgery, Dow University of Health Science, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan from 1st June 2019 to 30th November 2019. Ninety-three participants of burned hand contracture of either gender, aged between 6- 60 years were included in the study. Resurfacing surgery with skin graft and loco-regional flaps were done according to type of contracture with individualization for each patient. All patients were kept under follow up for ninety days to assess efficacy of contracture release for each surgical procedure was noted. SPSS version 23 was used to analyse data. Results Full thickness skin graft (FTSG) was performed in 60.2% cases, 17.2% with split thickness skin graft (STSG) and 12.9% with cross finger flaps. About 25% of recurrence was observed in cross finger flaps, whereas no recurrence was seen in Z-plasties and posterior interosseous flap. The significant association was between recurrence and surgical procedures (p<0.05). Conclusion Z-plasty followed by FTSG was effective in the management of post burn contractures of hand.
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Affiliation(s)
- Suneel Kumar
- Suneel Kumar, FCPS-2, Post Graduate Trainee of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Faisal Akhlaq Ali Khan
- Faisal Akhlaq Ali Khan, Chairperson and Assistant Professor, Head of Department of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Hyder Ali
- Hyder Ali, Assistant Professor of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Saba Kiran
- Saba Kiran, FCPS-2, Post Graduate Trainee of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
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22
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Xu Z, Tsai HI, Xiao Y, Wu Y, Su D, Yang M, Zha H, Yan F, Liu X, Cheng F, Chen H. Engineering Programmed Death Ligand-1/Cytotoxic T-Lymphocyte-Associated Antigen-4 Dual-Targeting Nanovesicles for Immunosuppressive Therapy in Transplantation. ACS Nano 2020; 14:7959-7969. [PMID: 32515579 DOI: 10.1021/acsnano.9b09065] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
T cell activation by immune allorecognition is a major contributing factor toward the triggering of organ rejection. Immunosuppressive drugs have to be taken after organ transplantation, but long-term use of these drugs increases the risks of infection and other serious disorders. Here, we showed dysregulation of programmed cell death-ligand 1/programmed cell death 1 (PD-L1/PD-1) and cytotoxic T-lymphocyte-associated protein 4/cluster of differentiation 80 (CTLA-4/CD80) in the spleen of two organ transplantation models. Using a bioengineering approach, cellular exosome-like nanovesicles (NVs) displaying PD-L1/CTLA-4 dual-targeting cargos were designed, and their specificity to bind their ligands PD-1 and CD80 on T cell and dendritic cell surfaces was confirmed. These NVs consequently enhanced PD-L1/PD-1 and CTLA-4/CD80 immune inhibitory pathways, two key immune checkpoints to co-inhibit T cell activation and maintain peripheral tolerance. It was also confirmed that PD-L1/CTLA-4 NVs led to the reduction of T cell activation and proliferation in vitro and in vivo. Finally, it was demonstrated that PD-L1/CTLA-4 NVs reduced density of CD8+ T cells and cytokine production, enriched regulatory T cells, and prolonged the survival of mouse skin and heart grafts. Taken together, these data supported the idea that PD-L1/CTLA-4 dual-targeting NVs exert immune inhibitory effects and may be used as a prospective immunosuppressant in organ transplantation.
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Affiliation(s)
- Zhanxue Xu
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Hsiang-I Tsai
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Youmei Xiao
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Yingyi Wu
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Dandan Su
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Min Yang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Hualian Zha
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Fuxia Yan
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Xiaoyan Liu
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Fang Cheng
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
| | - Hongbo Chen
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, 518107, Shenzhen, China
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23
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Zang J, Feng S, Yang H, Guo X. Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e19361. [PMID: 32118779 PMCID: PMC7478681 DOI: 10.1097/md.0000000000019361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ± 5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ± 6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ± 6.7 days) than in the skin grafts group (24.1 ± 5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.
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Abstract
Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV.
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Affiliation(s)
- Bien R. Ferrari
- Bien R. Ferrari, Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, HPC BB81 P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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Izmiryan A, Ganier C, Bovolenta M, Schmitt A, Mavilio F, Hovnanian A. Ex Vivo COL7A1 Correction for Recessive Dystrophic Epidermolysis Bullosa Using CRISPR/Cas9 and Homology-Directed Repair. Mol Ther Nucleic Acids 2018; 12:554-567. [PMID: 30195791 PMCID: PMC6077132 DOI: 10.1016/j.omtn.2018.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
Abstract
Recessive dystrophic epidermolysis bullosa is a rare and severe genetic skin disease resulting in blistering of the skin and mucosa. Recessive dystrophic epidermolysis bullosa (RDEB) is caused by a wide variety of mutations in COL7A1-encoding type VII collagen, which is essential for dermal-epidermal adhesion. Here we demonstrate the feasibility of ex vivo COL7A1 editing in primary RDEB cells and in grafted 3D skin equivalents through CRISPR/Cas9-mediated homology-directed repair. We designed five guide RNAs to correct a RDEB causative null mutation in exon 2 (c.189delG; p.Leu64Trpfs*40). Among the site-specific guide RNAs tested, one showed significant cleavage activity in primary RDEB keratinocytes and in fibroblasts when delivered as integration-deficient lentivirus. Genetic correction was detected in transduced keratinocytes and fibroblasts by allele-specific highly sensitive TaqMan-droplet digital PCR (ddPCR), resulting in 11% and 15.7% of corrected COL7A1 mRNA expression, respectively, without antibiotic selection. Grafting of genetically corrected 3D skin equivalents onto nude mice showed up to 26% re-expression and normal localization of type VII collagen as well as anchoring fibril formation at the dermal-epidermal junction. Our study provides evidence that precise genome editing in primary RDEB cells is a relevant strategy to genetically correct COL7A1 mutations for the development of future ex vivo clinical applications.
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Affiliation(s)
- Araksya Izmiryan
- Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Imagine Institute, 24 bd du Montparnasse, Paris, France; University Paris Descartes-Sorbonne Cité, Paris, France
| | - Clarisse Ganier
- Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Imagine Institute, 24 bd du Montparnasse, Paris, France; University Paris Descartes-Sorbonne Cité, Paris, France
| | | | - Alain Schmitt
- Electronic Microscopy Facility, INSERM UMR 1016, Cochin Institute, Paris, France
| | - Fulvio Mavilio
- University Paris Descartes-Sorbonne Cité, Paris, France; Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Imagine Institute, Paris, France
| | - Alain Hovnanian
- Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Imagine Institute, 24 bd du Montparnasse, Paris, France; University Paris Descartes-Sorbonne Cité, Paris, France; Department of Genetics, Necker Hospital for Sick Children, APHP, Paris, France.
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26
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Forbat E, Ali FR, Mallipeddi R, Al-Niaimi F. Laser Corrective Surgery with Fractional Carbon Dioxide Laser Following Full-thickness Skin Grafts. J Cutan Aesthet Surg 2018; 10:157-159. [PMID: 29403188 PMCID: PMC5782441 DOI: 10.4103/jcas.jcas_59_17] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Full-thickness skin grafts (FTSGs) are frequently used to treat patients with burn injuries and to repair defects rendered by excisional (including Mohs) surgery. The evidence for corrective laser surgery after scar formation is well established. With regard to laser treatment of FTSG, the evidence is sparse. Laser treatment after FTSG is a novel concept, with minimal literature. We present a case series, one of the first to our knowledge, of the treatment of FTSG with fractional CO2 laser in five patients after Mohs surgery.
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Affiliation(s)
- Emily Forbat
- King Edward VII Hospital, 5-10 Beaumont Street, London, UK
| | - Faisal R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Raj Mallipeddi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Firas Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Triana Junco P, Dore M, Nuñez Cerezo V, Jimenez Gomez J, Miguel Ferrero M, Díaz González M, Lopez-Pereira P, Lopez-Gutierrez JC. Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management. European J Pediatr Surg Rep 2017; 5:e47-e50. [PMID: 28868232 PMCID: PMC5578817 DOI: 10.1055/s-0037-1606282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/16/2017] [Indexed: 10/26/2022] Open
Abstract
Introduction The penis eventually needs specific cutaneous coverage in the context of reconstructive procedures following trauma or congenital anomalies. Local flaps are the first choice but are not always available after multiple previous procedures. In these cases, skin graft and dermal matrices should be considered. Materials and Methods This study was a retrospective review of the past 4 years of four patients with severe loss of penile shaft skin who underwent skin reconstruction. Dermal matrices and skin grafts were utilized. Dermal matrices were placed for a median of 4.5 weeks (3.0-6.0 weeks). The skin graft was harvested from the inner thigh region for split-thickness skin graft (STSG) and the inguinal region for full-thickness skin graft (FTSG). Results The four patients presented with complete loss of skin in the penile shaft. One patient had a vesical exstrophy, one had a buried penis with only one corpus cavernosum, one had a wide congenital lymphedema of the genitalia, and one had a lack of skin following circumcision at home. They underwent reconstruction with three patients undergoing split-thickness skin graft; two dermal matrices; and one full-thickness graft, respectively, thereby achieving a good cosmetic and functional result. There were no complications, and all the patients successfully accepted the graft. Conclusion Dermal matrices and skin grafts may serve as effective tools in the management of severe penile skin defects unable to be covered with local flaps.
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Affiliation(s)
- Paloma Triana Junco
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Mariela Dore
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - Pedro Lopez-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
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Abstract
Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.
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Affiliation(s)
- Yanzhao Dong
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University
- Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yisheng Wang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University
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Lotz C, Schmid FF, Oechsle E, Monaghan MG, Walles H, Groeber-Becker F. Cross-linked Collagen Hydrogel Matrix Resisting Contraction To Facilitate Full-Thickness Skin Equivalents. ACS Appl Mater Interfaces 2017; 9:20417-20425. [PMID: 28557435 DOI: 10.1021/acsami.7b04017] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Full-thickness skin equivalents are gathering increased interest as skin grafts for the treatment of large skin defects or chronic wounds or as nonanimal test platforms. However, their fibroblast-mediated contraction and poor mechanical stability lead to disadvantages toward their reproducibility and applicability in vitro and in vivo. To overcome these pitfalls, we aimed to chemically cross-link the dermal layer of a full-thickness skin model composed of a collagen type I hydrogel. Using a noncytotoxic four-arm succinimidyl glutarate polyethylene glycol (PEG-SG), cross-linking could be achieved in cell seeded collagen hydrogels. A concentration of 0.5 mg of PEG-SG/mg of collagen led to a viability comparable to non-cross-linked collagen hydrogels and no increased release of intracellular lactate dehydrogenase. Cross-linked collagen hydrogels were more mechanically stable and less prone to enzymatic degradation via collagenase when compared with non-cross-linked collagen hydrogels. Remarkably, during 21 days, cross-linked collagen hydrogels maintain their initial surface area, whereas standard dermal models contracted up to 50%. Finally, full-thickness skin equivalents were generated by seeding human epidermal keratinocytes on the surface of the equivalents and culturing these equivalents at an air-liquid interface. Immunohistochemical stainings of the cross-linked model revealed well-defined epidermal layers including an intact stratum corneum and a dermal part with homogeneously distributed human dermal fibroblasts. These results indicate that cross-linking of collagen with PEG-SG reduces contraction of collagen hydrogels and thus increases the applicability of these models as an additional tool for efficacy and safety assessment or a new generation of skin grafts.
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Affiliation(s)
- Christian Lotz
- Department of Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg 97070, Germany
| | - Freia F Schmid
- Translational Center Würzburg 'Regenerative Therapies in Oncology and Musculoskeletal Diseases', Würzburg Branch of the Fraunhofer Institute for Interfacial Engineering and Biotechnology , Würzburg 97070, Germany
| | - Eva Oechsle
- Translational Center Würzburg 'Regenerative Therapies in Oncology and Musculoskeletal Diseases', Würzburg Branch of the Fraunhofer Institute for Interfacial Engineering and Biotechnology , Würzburg 97070, Germany
| | - Michael G Monaghan
- Department of Cell and Tissue Engineering, Fraunhofer Institute for Interfacial Engineering and Biotechnology , Stuttgart 70569, Germany
| | - Heike Walles
- Department of Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg 97070, Germany
- Translational Center Würzburg 'Regenerative Therapies in Oncology and Musculoskeletal Diseases', Würzburg Branch of the Fraunhofer Institute for Interfacial Engineering and Biotechnology , Würzburg 97070, Germany
| | - Florian Groeber-Becker
- Translational Center Würzburg 'Regenerative Therapies in Oncology and Musculoskeletal Diseases', Würzburg Branch of the Fraunhofer Institute for Interfacial Engineering and Biotechnology , Würzburg 97070, Germany
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Hartmann D, Ruzicka T, Flaig MJ, Antal AS. [Giant carcinoma of the face in the elderly - Hikikomori senectorum]. MMW Fortschr Med 2017; 159:56-58. [PMID: 28321723 DOI: 10.1007/s15006-017-9392-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, Frauenlobstraße 9-11, D-80337, München, Deutschland.
| | - Thomas Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Attila S Antal
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, München, Deutschland
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Abstract
Congenital bilateral ectropion of the upper eyelids is a rare, benign condition reported in ophthalmic literature. It is more frequently associated with Down’s syndrome, ichthyosis, and sporadic cases in newborns from black population. We report three cases of congenital bilateral upper eyelid ectropion associated with Down’s syndrome. Management of these patients usually requires medial and lateral canthoplasties, full-thickness pentagonal resection of the upper eyelids and placement of skin grafts. We present herein the evolution of one of these patients and we will discuss the mechanism of the eyelid ectropion and its treatment.
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Affiliation(s)
- Rafael Corredor-Osorio
- Department of Oculoplastic and Orbit, Institute of Ophthalmology, "Conde de Valenciana", México City, México
| | - José Luis Tovilla-Pomar
- Department of Oculoplastic and Orbit, Institute of Ophthalmology, "Conde de Valenciana", México City, México
| | - José Luis Tovilla-Canales
- Department of Oculoplastic and Orbit, Institute of Ophthalmology, "Conde de Valenciana", México City, México
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Salibi A, Chasapi M, Farroha A. The modified use of Surfasoft® in skin grafts: case series. Ann Burns Fire Disasters 2016; 29:202-205. [PMID: 28149250 PMCID: PMC5266238] [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: 03/22/2016] [Accepted: 05/08/2016] [Indexed: 06/06/2023]
Abstract
Surfasoft® is a monofilament woven polyamide thread. Its use over skin grafts has always been combined with other occlusive dressings. Its rapid application and transparent property makes it an ideal primary dressing in the absence of any occlusive layers after the first two days following skin graft application. We describe this modified use in our case series. We modified the use of Surfasoft® in four different burns patients and one skin cancer case. Surfasoft® was predominantly used on difficult sites and secured with either staples or sutures. A secondary occlusive dressing was only applied in the first 48 hours, then removed, leaving Surfasoft® as a single dressing until it spontaneously separated from the graft approximately 7-10 days post op. Complete healing of grafts was defined when dressing was no longer required. The majority of burns were full thickness with an average TBSA of 6.5%. Distribution was mainly to the neck and upper torso areas. The skin cancer was located on the right shoulder region. Graft healing was completed in 3-4 weeks following surgery. No complications were reported. Advantages of the modified Surfasoft® in addition to factors associated with graft survival in our series are discussed. The modified Surfasoft® was shown to be a simple and reliable dressing for meshed STSGs in both burns and elective procedures. We believe that it can be effectively used in sites associated with poor tolerance to conventional dressing and when nursing resources are limited.
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Affiliation(s)
- A. Salibi
- Department of Burns and Plastics, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - M. Chasapi
- Department of Burns and Plastics, Royal Preston Hospital, Preston, UK
| | - A. Farroha
- Department of Burns and Plastics, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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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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Imbernón-Moya A, Vargas-Laguna E, Lobato-Berezo A, Martínez-Pérez M, Churruca-Grijelmo M, Aguilar-Martínez A, Fernández-Cogolludo E, Gallego-Valdés MÁ. Simultaneous onset of basal cell carcinoma over skin graft and donor site. JAAD Case Rep 2016; 1:244-6. [PMID: 27051742 PMCID: PMC4809222 DOI: 10.1016/j.jdcr.2015.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Adrián Imbernón-Moya
- Correspondence to: Adrián Imbernón-Moya, MD, Palos de la Frontera 23, Bloque 2. 1° C, Madrid, Spain 28911.
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35
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Yang M, Meyerson J. Reconstruction of Dorsal Wrist Defects. Eplasty 2015; 15:ic51. [PMID: 26396663 PMCID: PMC4564974] [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: 11/17/2022]
Affiliation(s)
- Maelee Yang
- The Ohio State University Wexner Medical Center, Columbus,Correspondence:
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36
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Abstract
BACKGROUND AND OBJECTIVE Selecting the appropriate technique for surgical incisions, and reconstruction of facial defects after skin tumour excision has always been one of the surgeon's biggest concerns. The aim of this study is to compare the results between the local flap and skin graft to reconstruct cheek defects after basal cell carcinoma excision. PATIENTS AND METHODS In this retrospective study, 40 patients with skin defects resulting from skin tumour (Basal cell carcinoma) excision in cheek zones (16 sub-orbital, 18 bucco-mandibular and six auricular) were treated using local flap (n = 20) and skin graft (n = 20) from October 2010 to April 2012. All patients were followed up for 12 months, postoperatively. In addition, general assessments including complications, patient satisfaction, tissue co-ordination, skin colour and hospitalisation days were obtained. RESULTS Five patients had postoperative hyper-pigmentation complication in the skin graft group and none occurred in the local flap (P = 0.046). In the early postoperative period (2 weeks), mean scores in patient satisfaction, tissue co-ordination and skin colour were statistically significant increase in the local flaps (P < 0.001, P < 0.001, P < 0.001, respectively) and in the later postoperative period (12 months) only mean scores in skin colour significantly increased in the local flaps (P < 0.001). The mean postoperative length of hospitalisation days was 1.7 ± 0.4 days in the local flap group, and 3.63 ± 1.16 days in the skin graft group (P = 0.001). CONCLUSION In the local flap group: Patient satisfaction, tissue co-ordination and skin colour were improved after 2 weeks. Also in 12-months follow up visits, skin colour was improved significantly and the hyperpigmentation was reduced. Generally, in this study the local flaps had better results in clinical outcomes and patient satisfaction. However, for each cheek defect the surgeon must choose the appropriate reconstruction strategy to avoid undesirable outcomes.
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Affiliation(s)
- Ali Ebrahimi
- Department of Plastic Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehdi Ashayeri
- Department of Plastic Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Rasouli
- Department of Plastic Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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37
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Miller JD, Rankin TM, Hua NT, Ontiveros T, Giovinco NA, Mills JL, Armstrong DG. Reduction of pain via platelet-rich plasma in split-thickness skin graft donor sites: a series of matched pairs. Diabet Foot Ankle 2015; 6:24972. [PMID: 25623477 PMCID: PMC4306752 DOI: 10.3402/dfa.v6.24972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Received: 05/19/2014] [Revised: 11/01/2014] [Accepted: 11/09/2014] [Indexed: 11/27/2022]
Abstract
In the past decade, autologous platelet-rich plasma (PRP) therapy has seen increasingly widespread integration into medical specialties. PRP application is known to accelerate wound epithelialization rates, and may also reduce postoperative wound site pain. Recently, we observed an increase in patient satisfaction following PRP gel (Angel, Cytomedix, Rockville, MD) application to split-thickness skin graft (STSG) donor sites. We assessed all patients known to our university-based hospital service who underwent multiple STSGs up to the year 2014, with at least one treated with topical PRP. Based on these criteria, five patients aged 48.4±17.6 (80% male) were identified who could serve as their own control, with mean time of 4.4±5.1 years between operations. In both therapies, initial dressing changes occurred on postoperative day (POD) 7, with donor site pain measured by Likert visual pain scale. Paired t-tests compared the size and thickness of harvested skin graft and patient pain level, and STSG thickness and surface area were comparable between control and PRP interventions (p>0.05 for all). Donor site pain was reduced from an average of 7.2 (±2.6) to 3 (±3.7), an average reduction in pain of 4.2 (standard error 1.1, p=0.0098) following PRP use. Based on these results, the authors suggest PRP as a beneficial adjunct for reducing donor site pain following STSG harvest.
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Affiliation(s)
- John D Miller
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Timothy M Rankin
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Natalie T Hua
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tina Ontiveros
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Nicholas A Giovinco
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joseph L Mills
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - David G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA;
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38
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Abstract
The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.
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Affiliation(s)
- A G Barabás
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - M A Pickford
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
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Taudorf EH, Danielsen PL, Paulsen IF, Togsverd-Bo K, Dierickx C, Paasch U, Haedersdal M. Non-ablative fractional laser provides long-term improvement of mature burn scars--a randomized controlled trial with histological assessment. Lasers Surg Med 2014; 47:141-7. [PMID: 25154734 DOI: 10.1002/lsm.22289] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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] [Accepted: 07/28/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Non-ablative fractional laser-treatment is evolving for burn scars. The objective of this study was to evaluate clinical and histological long-term outcome of 1,540 nm fractional Erbium: Glass laser, targeting superficial, and deep components of mature burn scars. MATERIALS & METHODS Side-by-side scar-areas were randomized to untreated control or three monthly non-ablative fractional laser-treatments using superficial and extra-deep handpieces. Patient follow-up were at 1, 3, and 6 months. Primary outcome was improvement in overall scar-appearance on a modified-Patient-and-Observer-Scar-Assessment-Scale (mPOSAS, 1 = "normal skin", 10 = "worst imaginable scar"). Secondary outcomes included histology, patient satisfaction (0-10), patient-assessed improvement, and safety. RESULTS Study was completed by 17 of 20 randomized patients with normotrophic (n = 11), hypertrophic (n = 5) or atrophic (n = 1) scars. Scar-appearance improved from laser-treatments (P < 0.001 vs. untreated) and histology at 6 months supported collagen-remodeling. Improvement appeared continuously during the post-operative period (mPOSAS baseline: 7 [5-8], 6 months: 4 [3-5] P = < 0.001). At 6 months, patients were satisfied with treatment (6 [3-9]) and 82% reported improved scar-texture. Treatments caused mild to moderate pain (4 [2-7]). Adverse effects decreased during follow-up and at final assessment, discrete erythema, hyperpigmentation or imprints from laser-grid were present in 11 patients. No patients experienced worsening of scar-appearance. CONCLUSIONS Combined superficial and deep non-ablative fractional laser-treatments induce long-term clinical and histological improvement of mature burn scars.
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Affiliation(s)
- Elisabeth H Taudorf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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40
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Gock H, Murray-Segal LJ, Winterhalter AC, Aminian A, Moore GTC, Brown SJ, d'Apice AJF, Cowan PJ. Altered glycosylation in donor mice causes rejection of strain-matched skin and heart grafts. Am J Transplant 2014; 14:797-805. [PMID: 24502456 DOI: 10.1111/ajt.12634] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/21/2013] [Accepted: 10/27/2013] [Indexed: 01/25/2023]
Abstract
Differential protein glycosylation in the donor and recipient can have profound consequences for transplanted organs, as evident in ABO-incompatible transplantation and xenotransplantation. In this study, we investigated the impact of altered fucosylation on graft acceptance by using donor mice overexpressing human α1,2-fucosyltransferase (HTF). Skin and heart grafts from HTF transgenic mice were rapidly rejected by otherwise completely matched recipients (median survival times 16 and 14 days, respectively). HTF skin transplanted onto mice lacking T and B cells induced an natural killer cell-mediated innate rejection crisis that affected 50-95% of the graft at 10-20 days. However, in the absence of adaptive immunity, the residual graft recovered and survived long-term (>100 days). Experiments using "parked" grafts or MHC class II-deficient recipients suggested that indirect rather than direct antigen presentation plays a role in HTF skin graft rejection, although the putative antigen(s) was not identified. We conclude that altered glycosylation patterns on donor tissue can trigger a powerful rejection response comprising both innate and adaptive components. This has potential implications for allotransplantation, in light of increasing recognition of the variability of the human glycome, and for xenotransplantation, where carbohydrate remodeling has been a lynchpin of donor genetic modification.
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Affiliation(s)
- H Gock
- Immunology Research Centre, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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41
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Wollina U. One-stage Reconstruction of Soft Tissue Defects with the Sandwich Technique: Collagen-elastin Dermal Template and Skin Grafts. J Cutan Aesthet Surg 2012; 4:176-82. [PMID: 22279382 PMCID: PMC3263127 DOI: 10.4103/0974-2077.91248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 11/23/2022] Open
Abstract
Background: A full-thickness soft tissue defect closure often needs complex procedures. The use of dermal templates can be helpful in improving the outcome. Objective: The objective was to evaluate a sandwich technique combining the dermal collagen–elastin matrix with skin grafts in a one-stage procedure. Materials and Methods: Twenty-three patients with 27 wounds were enrolled in this prospective single-centre observational study. The mean age was 74.8 ± 17.2 years. Included were full-thickness defects with exposed bone, cartilage and/ or tendons. The dermal collagen–elastin matrix was applied onto the wound bed accomplished by skin transplants, i.e. ‘sandwich’ transplantation. In six wounds, the transplants were treated with intermittent negative pressure therapy. Results: The size of defects was ≤875 cm2. The use of the dermal template resulted in a complete and stable granulation in 100% of wounds. Seventeen defects showed a complete closure and 19 achieved a complete granulation with an incomplete closure. There was a marked pain relief. No adverse events were noted due to the dermal template usage. Conclusions: Sandwich transplantation with the collagen–elastin matrix is a useful tool when dealing with full-thickness soft tissue defects with exposed bone, cartilage or tendons.
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Affiliation(s)
- Uwe Wollina
- Departments of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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42
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Abstract
Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.
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Affiliation(s)
- Ramesh K. Sharma
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Parashar
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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43
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Anderson JJ, Wallin KJ, Spencer L. Split thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review. Diabet Foot Ankle 2012; 3:DFA-3-10204. [PMID: 22403742 PMCID: PMC3297411 DOI: 10.3402/dfa.v3i0.10204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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] [Received: 10/02/2011] [Revised: 01/01/2012] [Accepted: 01/03/2012] [Indexed: 11/16/2022]
Abstract
We retrospectively reviewed 107 diabetic patients who received a split thickness skin graft (STSG) for treatment of a non-healing diabetic foot or leg ulcer to describe healing times based on patient characteristics, comorbidities or complications. The minimum follow-up was 6 months from the time of STSG application. The mean time to healing among all patients was 5.1 weeks (3 to 16 weeks). The mean healing time for patients with complications was 12.0 weeks (10 to 16 weeks) while the mean healing time for those without complications was 4.9 weeks (3 to 10 weeks). Overall complication rate was 2.8%. Patients with a STSG take of less than 95% had a mean healing time of 7.9 weeks compared to 4.8 weeks for those with a STSG take of 100% (p<0.001). The use of autologous STSG for treatment of non-healing diabetic foot and leg wounds is a viable method for soft tissue closure and may present a low complication rate and a satisfactory rate of healing.
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Affiliation(s)
- John J Anderson
- Alamogordo Orthopedics and Sports Medicine, Alamogordo, New Mexico, USA
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44
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Abstract
Human skin not only serves as an important barrier against the penetration of exogenous substances into the body, but also provides a potential avenue for the transport of functional active drugs/reagents/ingredients into the skin (topical delivery) and/or the body (transdermal delivery). In the past three decades, research and development in human skin equivalents have advanced in parallel with those in tissue engineering and regenerative medicine. The human skin equivalents are used commercially as clinical skin substitutes and as models for permeation and toxicity screening. Several academic laboratories have developed their own human skin equivalent models and applied these models for studying skin permeation, corrosivity and irritation, compound toxicity, biochemistry, metabolism and cellular pharmacology. Various aspects of the state of the art of human skin equivalents are reviewed and discussed.
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Affiliation(s)
- Zheng Zhang
- New Jersey Center for Biomaterials, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA.
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Le Fur N, Silvers WK, Kelsall SR, Mintz B. Up-regulation of specific tyrosinase mRNAs in mouse melanomas with the c2j gene substituted for the wild-type tyrosinase allele: utilization in design of syngeneic immunotherapy models. Proc Natl Acad Sci U S A 1997; 94:7561-5. [PMID: 9207131 PMCID: PMC23861 DOI: 10.1073/pnas.94.14.7561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The expression of cell-specialization genes is likely to be changing in tumor cells as their differentiation declines. Functional changes in these genes might yield unusual peptide epitopes with anti-tumor potential and could occur without modification in the DNA sequence of the gene. Melanomas undergo a characteristic decline in melanization that may reflect altered contributions of key melanocytic genes such as tyrosinase. Quantitative reverse transcriptase-PCR of the wild-type (C) tyrosinase gene in transgenic (C57BL/6 strain) mouse melanomas has revealed a shift toward alternative splicing of the pre-mRNA that generated increased levels of the Delta1b and Delta1d mRNA splice variants. The spontaneous c2j albino mutation of tyrosinase (in the C57BL/6 strain) changes the pre-mRNA splicing pattern. In c2j/c2j melanomas, alternative splicing was again increased. However, while some mRNAs (notably Delta1b) present in C/C were obligatorily absent, others (Delta3 and Delta1d) were elevated. In c2j/c2j melanomas, the percentage of total tyrosinase transcripts attributable to Delta3 reached approximately 2-fold the incidence in c2j/c2j or C/C skin melanocytes. The percentage attributable to Delta1d rose to approximately 2-fold the incidence in c2j/c2j skin, and to 10-fold that in C/C skin. These differences provide a basis for unique mouse models in which the melanoma arises in skin grafted from a C/C or c2j/c2j transgenic donor to a transgenic host of the same or opposite tyrosinase genotype. Immunotherapy designs then could be based on augmenting those antigenic peptides that are novel or overrepresented in a tumor relative to the syngeneic host.
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Affiliation(s)
- N Le Fur
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Abstract
Rana pipiens with skin dorosoventrally reversed can respond to stimulation of the back with forelimb wipes to the belly and to stimulation of the belly with hindlimb wipes to the back. These "misdirected wiping responses" have been explained in terms of two alternative hypotheses of nerve regeneration: nerve respecification or selective reinnervation. Experimental behavioral and neurophysiological experiments reported here support the selective reinnervation hypothesis. Severing ventral nerves, which normally innervate the belly, greatly reduced the percentage of misdirected responses on stimulation of belly skin grafted to the back, while severing dorsal nerves, which normally innervate the back, increased the percentage of misdirected responses elicited under the same circumstances. Moreover, neurophysiological recordings of grafted animals showed three effects of skin grafting on nerve distributions: (i) termination of dorsal and ventral nerve receptive field at graft edges; (ii) overlap of nonadjacent ventral nerve receptive fields; and (iii) dorsal coursing of ventral nerves to reinnervate target belly skin displaced to the back. These neurophysiological observations, and particularly the third effect, also support selective reinnervation as the mechanism of nerve regeneration in skin-grafted Rana pipiens.
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Sklar JH, Hunt RK. The acquisition of specificity in cutaneous sensory neurons: a reconsideration of the integumental specification hypothesis. Proc Natl Acad Sci U S A 1973; 70:3684-8. [PMID: 4587258 PMCID: PMC427306 DOI: 10.1073/pnas.70.12.3684] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Neuronal specificity in cutaneous sensory nerve cells has been postulated to arise from "inductive interactions" between the cell's randomly outgrown peripheral neurite and local biochemical markers in the skin. Here was apply this integumental specification hypothesis to data recently obtained on the wiping-reflex behavior of frogs skin-grafted at various times during larval life. Deductions are generated about the developmental time course of the postulated nerve-skin interactions and two predictions are formulated and tested. Because the results of serial skin rotation experiments contradict the predictions, we conclude that the currently held hypothesis must be seriously questioned.
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Abstract
Comparative study of completed down feathers from seven of the major tracts of newly-hatched Silver Campine chicks reveals tract-specific differences in the total length of the primary group of barbs and in the length of their barbule-free tips. Two classes of barbs can be distinguished on the basis of overall length in feathers of any one of the tracts: (a) those barbs that form from the first group (complement) of 9-11 barb ridges that arise in strict dorsoventral order around the circumference of the epidermal cylinder strict dorsoventral order around the circumference of the epidermal cylinder of the feather germ, and (b) those barbs that are added secondarily, later, either by the formation of a newly organized ridge between the bases of two of the original group of barb ridges, or by the splitting of one or more of the original complement of barb ridges. The primary (majority) group of ridges, only, are of use in gauging tract specificity. The statistical significance of measurements of total barb-length and the length of the barbule-free tips have been evaluated; differences between the feathers of each of the seven tracts examined can be distinguished statistically. The fact that the first feathers to form from the papillae are tract-specific shows, unquestionably, that specificity is present in the papillae from the very beginning of their organization, as might be inferred from their orderly pattern of origin in time and space within each of the various tracts.
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