Buttock Skin Research Articles

Effects of free perforator propeller flap from buttock in repairing deep wound of buttock

Objective: To explore the effects of free perforator propeller flap from buttock in repairing deep wound of buttock. Methods: From February 2016 to May 2018, 27 patients with buttock skin and soft tissue defects caused by various reasons were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of People's Liberation Army, including 19 males and 8 females, aged from 28 to 70 years. Among the protopathy, there were 14 cases of pressure sores, 7 cases of scar carcinoma, 2 cases of low-temperature scald, 2 cases of abscess, and 2 cases of pilonidal sinus. The wounds were located in the sacrococcygeal region in 15 cases, the ischial tuberosity in 8 cases, and the rest area of buttock in 4 cases after injury or lesion resection. The size of wounds ranged from 4.0 cm×4.0 cm to 12.0 cm×6.0 cm after debridement or extended resection. The free perforator propeller flaps from buttock with areas of 8.0 cm×4.0 cm-16.0 cm×6.0 cm were used to repair the wounds, and the donor sites were selected adjacent to the wounds where the skins were relatively loose. All flaps took buttock free perforator vessels as the axis and were transferred in propeller-type to repair the wounds. The donor sites were directly closed and sutured. The survival, complications, and follow-up of flaps were recorded. Results: All the flaps survived 100% in 27 patients. Congestion formed under flaps 2-6 days post operation in 2 patients due to inadequate drainage, which were healed after dressing change and drainage for 14-18 days. The sutures of flaps in the other cases were removed in 10-14 days post operation, and the wounds were healed. Follow-up for 2-12 months showed that the shapes of flaps and the donor sites were plump, which were not much different from the healthy sides, and the flaps could bear weight. Conclusions: Repairing buttock deep wound with buttock free perforator propeller flap has good effects. The donor site can be designed in the area adjacent to the wound where the skin is relatively loose and can be directly closed and sutured while repairing the wound, which can ensure plump buttock appearance.

An integrated experimental-computational study of the microclimate under dressings applied to intact weight-bearing skin.

Pressure ulcers (PUs) are one of the most prevalent adverse events in acute and chronic care. The root aetiological cause of PUs is sustained cell and tissue deformations, which triggers a synergistic tissue damage cascade that accelerates over relatively short time periods. Changes in skin microclimate conditions are known to indirectly contribute to PU-risk levels or to exacerbation of existing wounds. It is therefore surprising that information concerning heat accumulation under dressings is poor. Here, we aimed to investigate the effects of dressings on the microclimate of weight-bearing buttocks skin in 1-hour supine lying sessions. Using a novel and originally developed experimental-computational approach, we compared the combined influence of the mechanical and thermal properties of a polymeric membrane dressing (PolyMem, Ferris Mfg. Corp., Fort Worth, TX) on skin microclimate under and near the dressings with those of a standard placebo foam dressing. We specifically identified the thermal conductivity properties of dressings as being highly important in the context of protective dressing performances, given its association with potential heat accumulation under dressings. Accordingly, this article highlights, for the first time in the literature, the relevance of thermal properties of a dressing in effectively mitigating the risk of developing PUs or aggravating an injury, and offers a systematic, methodological bioengineering process for assessing the thermal performances of dressings.

In contrast to melanocytes, keratinocytes of normal human adult interfollicular epidermis do not express galectin-1

Galectins constitute a phylogenetically conserved family of proteins that specifically bind to glycoconjugates bearing β-galactoside residues. Although galectin-1 (Gal 1), the first identified member of the galectin family, is involved in highly important biological processes at the molecular and cellular level in human skin, its expression in keratinocytes of normal human adult interfollicular epidermis (NHAIE) remains in dispute, whereas that in epidermal melanocytes has drawn very little attention so far. This prompted us to investigate the expression of Gal 1 in the keratinocytes and melanocytes of NHAIE. Biopsy specimens obtained from the buttock skin of 23 healthy adult volunteers of both sexes were processed for single and double immunohistochemical staining using antibodies against Gal 1 and Melan-A. In contrast to epidermal melanocytes, which revealed a distinct Gal 1 immunoreactivity, keratinocytes of NHAIE were completely devoid of any expression of this galectin. This article simultaneously assesses Gal 1 immunoreactivity of keratinocytes and melanocytes in NHAIE for the first time. Our findings may contribute to a better understanding of alterations in Gal 1 expression in various benign and malignant cutaneous disorders and may be of importance for the future design of targeted therapies.

Wounding with a microneedling device corrects the inappropriate ultraviolet B radiation response in geriatric skin.

Non-melanoma skin cancer primarily affects geriatric patients as evidenced by the fact that only 20% of these cancers are diagnosed in patients under the age of 60years. Of importance, geriatric skin responds to procarcinogenic ultraviolet B radiation (UVB) in a manner that permits the establishment of tumor cells. Recent studies have indicated that wounding of geriatric skin with fractionated resurfacing lasers and dermabrasion upregulates fibroblast production of insulin-like growth factor-1 (IGF-1) and normalizes the procarcinogenic acute UVB response consisting of basal keratinocytes proliferating while still harboring unrepaired DNA damage. The present studies tested the ability of wounding with a commercially available microneedling device to upregulate IGF-1 levels and normalize the geriatric UVB response. Geriatric volunteers were treated with a microneedling device on buttock skin and 3months later the IGF-1 levels and UVB responses tested in wounded vs control skin. Wounding via microneedling upregulated IGF-1 and resulted in lower levels of basal keratinocytes proliferating with unrepaired DNA damage. The ability of microneedling to protect against the formation of UVB-damaged proliferating keratinocytes indicates the potential of this wounding modality to reduce aging-associated non-melanoma skin cancer.

Shifts in the skin microbiome associated with diaper dermatitis and emollient treatment amongst infants and toddlers in China.

The microbiological basis of diaper dermatitis has not been clearly elucidated; however, a better understanding of microbial colonization may be vital for developing appropriate therapies. Using 16S-rRNA gene sequencing technology, we characterized and compared the bacterial communities obtained from the buttock skin sites of children with diaper dermatitis and from healthy controls. Bacterial diversity in the buttock lesion area and subsequent recovery after emollient treatment have been discussed herein. In buttock skin of children with or without diaper dermatitis, Staphylococcus and Anaerococcus were predominant in the total skin microbiome. Compared with the healthy group, the overall skin bacterial richness and diversity were higher in children with diaper dermatitis, with the abundance of Proteobacteria being significantly higher. In the diaper dermatitis group, the richness of Enterococcus, Erwinia and Pseudomonas was significantly higher, and the levels of Clostridium and Actinomyces were significantly lower than those in healthy children. Richness of Staphylococcus aureus was significantly higher in the diaper dermatitis group, whereas that of Staphylococcus epidermidis and Bifidobacterium longum was lower. Staphylococcus epidermidis and Staphylococcus haemolyticus, the dominant species found in buttock skin, were observed to recover earlier after the disease had improved through emollient treatment. Staphylococcus epidermidis, as skin probiotic bacterium, and Blongum, Clostridium butyricum and Lactobacillus ruminis, which are intestinal probiotic bacteria, are significantly decreased in diaper dermatitis lesions. These changes in the buttock skin microflora indicate an imbalance in the microflora and suggest that the intestinal microflora may be undergoing dynamic changes. The results of this study suggest that probiotic bacterial supplementation may be useful in the treatment and prevention of diaper dermatitis.

Autologous Cell Therapy for Aged Human Skin: A Randomized, Placebo-Controlled, Phase-I Study

Introduction: Skin ageing involves senescent fibroblast accumulation, disturbance in extracellular matrix (ECM) homeostasis, and decreased collagen synthesis. Objective: to assess a cell therapy product for aged skin (RCS-01; verum) consisting of ~25 × 10⁶ cultured, autologous cells derived from anagen hair follicle non-bulbar dermal sheath (NBDS). Methods: For each subject in the verum group, 4 areas of buttock skin were injected intradermally 1 or 3 times at monthly intervals with RCS-01, cryomedium, or needle penetration without injection; in the placebo group RCS-01 was replaced by cryomedium. The primary endpoint was assessment of local adverse event profiles. As secondary endpoints, expression of genes related to ECM homeostasis was assessed in biopsies from randomly selected volunteers in the RCS-01 group taken 4 weeks after the last injection. ­Results: Injections were well tolerated with no severe adverse events reported 1 year after the first injection. When compared with placebo-treated skin, a single treatment with RCS-01 resulted in a significant upregulation of TGFβ1, CTGF, COL1A1, COL1A2, COL3A1, and lumican mRNA expression. Limitations: The cohort size was insufficient for dose ­ranging evaluation and subgroup analyses of efficacy. Conclusions: RCS-01 therapy is well tolerated and associated with a gene expression response consistent with an improvement of ECM homeostasis.

A rare case of brucellosis with dermatomal pattern of cutaneous manifestation.

Brucellosis is a systemic disease which may involve any organ or system of the body, and is listed in the differential diagnosis of many diseases. In spite of described cutaneous involvements, skin manifestations are not common in brucellosis, particularly papulonodular lesions with dermatomal patterns that may overlap with dermatomal skin lesions. This may prevent correct diagnosis and treatment in practice, harming patients’ health and leading to financial costs to the health system and patient. In this case, at first, due to left thigh and buttock skin lesions and dermatomal pattern, the patient was diagnosed with Herpes zoster infection. After medical treatment and no improvement of lesions, the patient was referred to the infectious clinic with low back pain; magnetic resonance imaging (ordered by a neurosurgeon) suggested infectious spondylodiscitis. At the infectious ward, brucellosis spondylitis was diagnosed and a biopsy was taken from dermatomal lesions. The patient’s follow-up after 1, 2, and 3 months revealed that treatment of brucellosis had led to healing of lesions. Surprisingly, the histopathological assessment of the biopsy suggested psoriasis vulgaris. This was a rare case of manifestation of cutaneous brucellosis which could not even be diagnosed by histopathological assessment.

751 A comparative analysis of skin aging-associated secreted proteins (SAASP) produced by dermal fibroblasts from intrinsically versus extrinsically aged human skin

Skin aging results to a large extent from the accumulation of senescent dermal fibroblasts. In a previous systematic molecular analysis of normal human dermal fibroblasts (NHDF) isolated from intrinsically aged human skin of donors aged 18-25 versus 35-49 versus ≥ 60 years we observed that intrinsic aging of NHDF is associated with the development of a protein secretion pattern referred to as SAASP. In the present study we asked if and how this secretory phenotype might differ between NHDF isolated from intrinsically versus extrinsically aged human skin. We again obtained NHDF from young versus middle aged versus old donors. In this study, however, for each donor NHDF were isolated not only from intrinsically aged, i.e. buttock skin, but also from extrinsically aged, i.e. neck skin. Quantitative, label-free mass spectrometry analysis of the proteome of these cells revealed an age-dependent progressive loss of protein diversity, which was significantly more pronounced in extrinsically aged NHDF. This was not reflected by changes in the secretome of the same cells. Accordingly, quantitative analysis of the entire secretome present in conditioned cell culture supernatants derived from these cells showed that the diversity of proteins in the secretome was not reduced if compared between the three age groups for intrinsic and extrinsic aging, respectively. In fact, secretome diversity even increased for intrinsically versus extrinsically aged NHDF of old donors. Subsequent network and enrichment analysis revealed that the secretomes of extrinsically versus intrinsically aged NHDF differ from each other also at a functional level. As an example, in old donors, secreted proteins relevant for extracellular matrix organization were significantly less abundant in extrinsically aged NHDF. These results demonstrate that the SAASP produced by NHDF profoundly differs between intrinsically versus extrinsically aged human skin, indicating that the relationship between intrinsic and extrinsic skin aging is highly complex in nature.

Aging in Skin of Color: Disruption to Elastic Fiber Organization Is Detrimental to Skin’s Biomechanical Function

Skin aging is a complex process involving the additive effects of time-dependent intrinsic aging and changes elicited via skin's interaction with the environment. Maintaining optimal skin function is essential for healthy aging across global populations; yet most research focuses on lightly pigmented skin (Fitzpatrick phototypes I-III), with little emphasis on skin of color (Fitzpatrick phototypes V-VI). Here, we explore the biomechanical and histologic consequences of aging in black African-American volunteers. We found that healthy young buttock and dorsal forearm skin was biomechanically resilient, highly elastic, and characterized histologically by strong interdigitation of rete ridges, abundant organized fibrillar collagen, and plentiful arrays of elastic fibers. In contrast, intrinsically aged buttock skin was significantly less resilient, less elastic, and was accompanied by effacement of rete ridges with reduced deposition of both elastic fibers and fibrillar collagens. In chronically photoexposed dorsal forearm, significant impairment of all biomechanical functions was identified, with complete flattening of rete ridges and marked depletion of elastic fibers and fibrillar collagens. We conclude that in skin of color, both intrinsic aging and photoaging significantly impact skin function and composition, despite the additional photoprotective properties of increased melanin. Improved public health advice regarding the consequences of chronic photoexposure and the importance of multimodal photoprotection use for all is of global significance.

Differential reorganisation of cutaneous elastic fibres: a comparison of the in vivo effects of broadband ultraviolet B versus solar simulated radiation

Long-term exposure of human skin to ultraviolet radiation (UVR) in sunlight negatively impacts its appearance and function with photoaged skin having a characteristic leathery, rough appearance, with deep wrinkles. These clinical features of photodamage are thought to result from UVR-induced remodelling of the dermal extracellular matrix, particularly the elastic fibre system. There are few in vivo human data on the impact of acute UVR exposure on this fibre system and particularly solar-simulated radiation (SSR)-mediated effects. We examined the differential effect of broadband UVB and SSR on the human dermal elastic fibre system, and specifically the microfibrillar components fibrillin-1, fibulin-2 and fibulin-5. Healthy white Caucasian adults (skin type II–III) were recruited and irradiated with 3× their minimal erythema dose of broadband UVB (n = 6) or SSR (n = 6) on photoprotected buttock skin. Punch biopsies were taken 24 h after irradiation and from unirradiated control skin. Overall, histological assessment of elastic fibres revealed significantly less elastic fibre staining in broadband UVB (P = 0.004) or SSR (P = 0.04) irradiated skin compared to unirradiated control skin. Significantly less staining of fibrillin-1-positive microfibrils was also observed in the papillary dermis of UVB irradiated skin (P = 0.02) but not skin exposed to SSR. Conversely, immunohistochemistry for fibulin-5-positive microfibrils revealed significantly less expression in skin exposed to SSR (P = 0.04) but not to broadband UVB. There was no significant change in fibulin-2-positive microfibrils following either broadband UVB or SSR irradiation. Thus, broadband UVB and SSR mediate differential effects on individual components of the dermal elastic fibre network in human skin. Further human studies are required to explore the mechanisms underlying these findings and the impact of potential photoprotective agents.

PREVENTION OF DIAPER DERMATITIS IN INFANTS

Diaper dermatitis (DD) is one of the most common skin conditions in neonates and infants, with a peak between the ages of 9 and 12 months. Appropriate skin care practices that support skin barrier function and protect the buttocks skin from urine and feces are supposed to be effective in the prevention of DD. Despite many recommendations for parents on proper diaper skin care, there is no up-to-date synthesis of the available evidence to develop recommendations for DD prevention practice. The article contains a systematic literature review on the efficacy of nonmedical skin care practices on the diapered area of healthy, full-term infants ages 0 to 24 months. Found some studies covering skin care practices such as cleansing, bathing, and application of topical products. DD prevalence and incidence and physiologic skin parameters were used as efficacy parameters. The results of this review indicate that cleansing of the diaper area using baby wipes or water and a washcloth have comparable effects on diapered skin. Bathing with a liquid baby cleanser twice weekly seems comparable with water alone. The application of ointments containing zinc oxide or petrolatum with or without vitamin A seems to have comparable effects on DD severity. There seems to be no information on whether single skin care practices such as cleansing, bathing, and application of topical preparations can prevent DD. High-quality randomized clinical trials are needed to show the effectiveness of skin care practices for controlling and preventing DD.

1172 Palmitoyl-KVK-L-ascorbic acid improves matrix abnormality associated with skin aging via inhibition of DNA methyltransferase 1

DNA methyltransferase 1 (DNMT1) is the most abundant DNA methyltransferase responsible for the maintenance of and also de novo DNA methylation. Here we investigated the effects of palmitoyl-KVK-L-ascorbic acid (VCC2,Duo-VitapepTM), a vitamin C-conjugated peptide with a potent DNMT1 inhibitory activity,on the expression of type I collagen and matrix metalloproteinase (MMP)-1 in vitro and in vivo. VCC2 showed a significant reduction of DNMT1 expression in UV-irradiated human dermal fibroblasts. Moreover, treatment of VCC2 or knockdown of DNMT1 significantly reversed matrix derangements associated with skin aging. Mechanistically, VCC2 could ameliorate the increased MMP-1-luc promoter activity induced by DNMT1 overexpression. Next, we examined whether VCC2 improved the matrix abnormalities found in intrinsically aged human skin in vivo. Indeed, topical application of VCC2 for 5 days led to increased type I procollagen expression and decreased MMP-1 expression in buttock skin from six elderly subjects. Collectively, our findings suggest that topical application of VCC2 may improve the matrix abnormalities and phenotypes associated with aged skin via DNMT1 regulation, suggesting that targeting epigenetic modifications may be an effective therapeutic modality against skin aging.

1145 Acute UV irradiation and intrinsic aging modulate various histone deacetylases expression levels in human skin in vivo

Epigenetic regulation is widely considered to play an important role in aging, but experimental evidence to support this hypothesis for skin aging in vivo is scarce. Histone deacetylases(HDACs) are conserved enzymes that remove acetyl groups from lysine side chains in histones and other proteins. There are 11 HDACs and 7 sirtuins(Sirts) as histone deacetylases that play a critical role in epigenetics. Previously, our group demonstrated the role of histone acetylation in UV-induced inflammation and matrix impairment. Here, to understand the histone acetylation alterations occurring during the aging process, we investigated the changes HDACs and Sirts expressions in UV-irradiated human skin, and the intrinsically aged and photoaged human skin in vivo. We found that acetyl-H3 level was increased and HDAC4, 11, and Sirt4 mRNA were significantly deceased in UV-irradiated skin. In intrinsically aged skin, acetyl-H3 level was increased and HDAC4, 5, 10, 11, and Sirt6, 7 mRNA were significantly deceased. However, histone acetylation and HDACs expressions in photoaged forearm skin were not different from those in intrinsically aged buttock skin in the same individuals. Thus, our results suggested that decreased HDACs expression by acute UV irradiation and intrinsic aging may contribute to increased histone acetylation. Therefore, epigenetic regulation that reduces histone acetylation by increasing the expression of HDACs may prevent skin aging.

V09-01 BLADDER EXSTROPHY RADIAL ARTERY PHALLOPLASTY: EXSTROPHY RELATED ISSUES AND SAPHENOUS VEIN INTERPOSITION GRAFT

You have accessJournal of UrologyPediatric Urology1 Apr 2018V09-01 BLADDER EXSTROPHY RADIAL ARTERY PHALLOPLASTY: EXSTROPHY RELATED ISSUES AND SAPHENOUS VEIN INTERPOSITION GRAFT Giovanni Chiriaco, Gideon Blecher, Mark Johnson, Philippa Sangster, Nim Christopher, and David Ralph Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Gideon BlecherGideon Blecher More articles by this author , Mark JohnsonMark Johnson More articles by this author , Philippa SangsterPhilippa Sangster More articles by this author , Nim ChristopherNim Christopher More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2173AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder exstrophy is a congenital abnormality that occurs along a spectrum of the exstrophy-epispadias complex. Cases of penile reconstruction are often difficult in men with bladder exstrophy due to prior and potential future surgeries and abnormal anatomy. Interposition grafts may be used in cases where vessels cannot be anastomosed directly. METHODS This video shows the surgical steps of complex penile reconstruction and discusses specific exstrophy related issues. A 37 year old man with micropenis secondary to bladder exstrophy previously underwent numerous reconstructive procedures including failed mitrofanoff channel. He had multiple abdominal scars and a stretched penile length of 5cm. His condition was impairing his psychological heath and sexual relationships. Full thickness buttock skin grafts are harvested. The radial artery forearm flap is dissected and cephalic vein, radial artery and cutaneous sensory nerves are isolated. The micropenis is disassembled, the glans divided and the corpora cavernosa amputated. For arterial supply usual end-to-side radial artery to common femoral anastomosis is not possible, due to pelvic distraction and vessels being further away from the phallus. Multiple prior and potential surgeries (for example Mitrofanoff revision) could risk the inferior epigastric artery injury with potential abdominal skin or neophallus devascularisation. Thus interposition graft is required – at the groin, the long saphenous vein has issues with tortuosity, valves and higher risk of thrombosis and bleeding. The ankle segment is better suited as it is straight, smaller and will appropriately limit inflow thus reducing bleeding. With an operative microscope, the radial artery is anastomosed to the distal end of the saphenous vein graft, the cephalic vein to the great saphenous vein and an end-to-side anastomosis is next performed between the interposition graft and the common femoral artery. The ilio-inguinal nerve is then sutured to the sensory phallus nerves. The previously harvested skin grafts are applied to the forearm. A Doppler ultrasound is used to confirm the arterial flow. RESULTS The post operative time has been uneventful and a saphenous vein interposition graft was successfully used. CONCLUSIONS Typically, a tension free anastomosis is created from the inferior epigastric artery to the radial artery phalloplasty. We demonstrate the use of a saphenous vein interposition graft between the radial artery and the common femoral artery for the creation of a tension free anastomosis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e903 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giovanni Chiriaco More articles by this author Gideon Blecher More articles by this author Mark Johnson More articles by this author Philippa Sangster More articles by this author Nim Christopher More articles by this author David Ralph More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective.

Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication.

Cancer associated fibroblasts (CAFs) are activated in cutaneous basal cell carcinoma and in the peritumoural skin

BackgroundCutaneous basal cell carcinoma (BCC) is the commonest cancer worldwide. BCC is locally invasive and the surrounding stromal microenvironment is pivotal for tumourigenesis. Cancer associated fibroblasts (CAFs) in the microenvironment are essential for tumour growth in a variety of neoplasms but their role in BCC is poorly understood.MethodsMaterial included facial BCC and control skin from the peritumoural area and from the buttocks. With next-generation sequencing (NGS) we compared mRNA expression between BCC and peritumoural skin. qRT-PCR, immunohistochemical and immunofluorescent staining were performed to validate the NGS results and to investigate CAF-related cyto-and chemokines.ResultsNGS revealed upregulation of 65 genes in BCC coding for extracellular matrix components pointing at CAF-related matrix remodeling. qRT-PCR showed increased mRNA expression of CAF markers FAP-α, PDGFR-β and prolyl-4-hydroxylase in BCC. Peritumoural skin (but not buttock skin) also exhibited high expression of PDGFR-β and prolyl-4-hydroxylase but not FAP-α. We found a similar pattern for the CAF-associated chemokines CCL17, CCL18, CCL22, CCL25, CXCL12 and IL6 with high expression in BCC and peritumoural skin but absence in buttock skin. Immunofluorescence revealed correlation between FAP-α and PDGFR-β and CXCL12 and CCL17.ConclusionMatrix remodeling is the most prominent molecular feature of BCC. CAFs are present within BCC stroma and associated with increased expression of chemokines involved in tumour progression and immunosuppression (CXCL12, CCL17). Fibroblasts from chronically sun-exposed skin near tumours show gene expression patterns resembling that of CAFs, indicating that stromal fibroblasts in cancer-free surgical BCC margins exhibit a tumour promoting phenotype.

627 A single sunburn influences the immune component of human skin for up to 14 days

Sunburn is prevalent and while the clinical effects disappear quickly, repeated episodes have long term consequences such as skin cancer. Pro-inflammatory eicosanoid expression and leukocyte infiltration characterise the peak of the sunburn response, however, little is known of these processes during the resolution phase. We examined changes in eicosanoid expression and leukocyte infiltration up to 14 days post acute sunburn. Photoprotected buttock skin was exposed to 3xMED of broadband UVR and skin erythema measured over 14 days (n=13; 20-58yrs, 8F, phototype I-III). Biopsies and suction blister fluid were sampled from unexposed and UVR-exposed skin over the 14 day time-course and analysed by immunohistochemistry (neutrophil elastase, CD4, CD8, CD68, CD1a, COX-2, EP4) and LC-MS/MS (eicosanoids). Erythema, COX-2, eicosanoid production and infiltration of innate immune cells (neutrophils and macrophage), peaked at D1 post UVR. By D7 erythema showed 60% resolution, while expression of the prostaglandin E2 receptor EP4 remained elevated at D14. Infiltration of adaptive immune cells (CD4+, CD8+ T cells) peaked at D4-D7 and remained above baseline at D14 (p<0.01, p<0.001 respectively). Moreover, the CD4+:CD8+ ratio rose post-UVR, peaking at 4.3:1 at D1, compared with 2:1 at D0. In contrast, epidermal Langerhans cell numbers showed maximum reduction (∼50%) at D4-D7 (p<0.01), only fully returning to baseline at D14. Acute UVR exposure has profoundly impacts epidermal antigen presenting cell number persisting for up to 2 weeks following the initial insult. Thus a single sunburn may trigger a prolonged immunosuppressive environment compromising ability to respond to neoplastic change and exogeneous challenge.

Organization of the dermal matrix impacts the biomechanical properties of skin.

Human skin has the crucial roles of maintaining homeostasis and protecting against the external environment. Skin offers protection against mechanical trauma due to the reversible deformation of its structure; these biomechanical properties are amenable to dynamic testing using noninvasive devices. To characterize the biomechanical properties of young, black African/African-Caribbean and white Northern European skin from different anatomical sites, and to relate underlying skin architecture to biomechanical function. Using cutometry and ballistometry, the biomechanical properties of buttock and dorsal forearm skin were determined in black African/African-Caribbean (n = 18) and white Northern European (n = 20) individuals aged 18-30 years. Skin biopsies were obtained from a subset of the volunteers (black African/African-Caribbean, n = 5; white Northern European, n = 6) and processed for histological and immunohistochemical detection of the major elastic fibre components and fibrillar collagens. We have determined that healthy skin from young African and white Northern European individuals has similar biomechanical properties (F3): the skin is resilient (capable of returning to its original position following deformation, R1), exhibits minimal fatigue (R4) and is highly elastic (R2, R5 and R7). At the histological level, skin with these biomechanical properties is imbued with strong interdigitation of the rete ridges at the dermoepidermal junction (DEJ) and candelabra-like arrays of elastic fibres throughout the papillary dermis. Dramatic disruption to this highly organized arrangement of elastic fibres, effacement of the rete ridges and alterations to the alignment of the fibrillar collagens is apparent in the white Northern European forearm and coincides with a marked decline in biomechanical function. Maintenance of skin architecture - both epidermal morphology and elastic fibre arrangement - is essential for optimal skin biomechanical properties. Disruption to underlying skin architecture, as observed in the young white Northern European forearm, compromises biomechanical function.

Fractional laser-assisted drug uptake: Impact of time-related topical application to achieve enhanced delivery.

Ablative fractional laser (AFXL) is acknowledged to increase uptake of topically applied agents in skin. AFXL channels gradually close over time, which may impair this capability. The time frame for applying a drug after AFXL exposure remains to be established. The aim of this study, was to investigate the importance of time-related topical application after AFXL exposure and to relate resultant uptake in skin with AFXL channel morphology and skin integrity. Buttock skin of healthy volunteers (n = 11) was exposed to 10,600 nm fractional CO2 laser using 5% density, 120 μm beam diameter, 15 mJ pulse energy. Sodium fluorescein (NaF) a small, hydrophilic molecule (370 MW, log P = -1.52) was applied under standardized conditions at specific time points after laser exposure (0, 2, 5, 10, 30, 60, 90 minute, 6, 24, and 48 hours). Fluorescence photography collected fluorescence images up to 180 minute after NaF application. Optical coherence tomography (OCT) assessed AFXL channel dimensions and transepidermal water loss (TEWL) estimated loss of skin integrity. Fluorescence intensities (FI) were significantly elevated when NaF was applied up to 6 hours after laser exposure compared to non-laser-processed skin (median FI 1947 arbitrary units [interquartile range 1,246-3,560] versus 1,004 [350-1,538], P < 0.02). The highest FI occurred when NaF was applied within 30 minute after laser exposure and similar FI were reached for applications at 0, 2, 5, 10, and 30 minute after AFXL exposure (0 minute: 3,866 [3,526-4,575], 30 minute: 3,775 AU [3,070-4,484], P > 0.1). NaF application later than 30 minute after AFXL exposure resulted in gradually decreasing FI, becoming similar to intact skin when applied at 24-48 hours after AFXL exposure (P > 0.2). OCT images demonstrated that AFXL channels closed over time (100% [100-100%] open up to 30 minute, 75% [4-86%] at 6 hours and 3% [0-15%] at 24-48 hours after AFXL exposure). TEWL measurements proved loss of skin integrity up to 6 hours after AFXL exposure, while integrity was similar in laser-exposed and non-laser-exposed skin at 24-48 hours. The time frame to maintain enhanced drug delivery sustained for several hours after AFXL exposure, corresponding to channel morphology and loss of skin integrity. Lasers Surg. Med. 49:348-354, 2017. © 2016 Wiley Periodicals, Inc.

Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR.

Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction. From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR (P < .05). At a mean 18.6 months follow-up (range: 4-47), buttock claudication and sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR (P < .05); HA coil embolization was significantly associated with buttock claudication and sexual dysfunction (P < .05). Whenever anatomically feasible, at least 1 HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate.