Cm Of Skin Research Articles

A Novel Dressing Composed of Adipose Stem Cells and Decellularized Wharton’s Jelly Facilitated Wound Healing and Relieved Lymphedema by Enhancing Angiogenesis and Lymphangiogenesis in a Rat Model

Lymphedema causes tissue swelling due to the accumulation of lymphatic fluid in the tissue, which delays the process of wound-healing. Developing effective treatment options of lymphedema is still an urgent issue. In this study, we aim to fabricate tissue-engineered moist wound dressings with adipose stem cells (ASCs) and decellularized Wharton's jelly (dWJ) from the human umbilical cord in order to ameliorate lymphedema. Rat ASCs were proliferated and an apparent layer was observed on dWJ at day 7 and 14. A rat tail lymphedema model was developed to evaluate the efficacy of the treatment. Approximately 1 cm of skin near the base of the rat tail was circularly excised. The wounds were treated by secondary healing (control) (n = 5), decellularized Wharton's jelly (n = 5) and ASC-seeded dWJ (n = 5). The wound-healing rate and the tail volume were recorded once a week from week one to week five. Angiogenesis and lymphangiogenesis were assessed by immunochemistry staining with anti-CD31 and anti-LYVE1. The results showed that the wound-healing rate was faster and the tail volume was lesser in the ASC-seeded dWJ group than in the control group. More CD31+ and LYVE-1+ cells were observed at the wound-healing area in the ASC-seeded dWJ group than in the control group. This proves that tissue-engineered moist wound dressings can accelerate wound-healing and reduce lymphedema by promoting angiogenesis and lymphangiogenesis.

Abstract P4-12-17: Initial clinical experience and acute toxicity report of patients treated with accelerated partial breast irradiation (APBI) using the GammaPodTM

Abstract Introduction/Background: Recent reports of APBI show low rates of local recurrence when used for appropriately selected patients as defined by the ASTRO consensus guideline. Multiple techniques of APBI exist which vary in invasiveness and side effect profiles. The GammaPod was FDA cleared for use in breast cancer in 2017. The device includes a novel breast cup system which immobilizes and localizes the breast using a vacuum and stereotactic coordinate reference frame. It also includes a unique table top for CT simulation, planning system and algorithm and the treatment unit itself which comprises 25 rotating Co-60 sources. Here we report the initial clinical experience and toxicity report of patients treated with the GammaPod using APBI. Materials and Methods: Fourteen consecutive patients treated from November 2018 - March 2019 were retrospectively reviewed under institutional IRB approval. All patients underwent lumpectomy followed by adjuvant radiation therapy using a dose of 30 Gy delivered in 5, 6 Gy fractions prescribed to the planning target volume (PTV). The PTV constituted the lumpectomy cavity as defined by clips and post-operative changes plus a 1 cm expansion for microscopic disease (clinical target volume) and 0.3 cm expansion for set up uncertainty not to include the first 0.5 cm of skin or the chest wall (PTV). Patients were evaluated for side effects before each fraction and 1 month following completion of therapy. Toxicities were evaluated using CTCAE v 4.03 criteria. Descriptive statistics were used to evaluate patient toxicity outcomes. Results: Thirteen of fourteen patients completed treatment. One patient discontinued therapy due to spiritual beliefs. A total of 66 treatments were delivered. Median patient age was 67 (range: 40-76). Three patients had stage 0 disease while the remainder had stage I disease. All had estrogen receptor positive disease. Radiation therapy started a median of 52 days (range: 34-130) following surgery and was completed in a median of 10 elapsed days (range: 8-15). During treatment, one patient developed petechiae, one patient mild discomfort and three patients small subcentimeter superficial blisters related to the vacuum suction applied from the immobilization device. These were all self-limited and resolved without medical intervention. Five patients each experienced one grade 1 toxicity: two patients reported grade 1 breast pain, two patients grade 1 erythema and one patient grade 1 hyperpigmentation. No patient reported fatigue during their treatment. There were no grade 2 or higher toxicities reported during or within the first 30 days after completion of treatment. Conclusions: APBI using the GammaPod was well tolerated with a low acute toxicity profile compared to published rates using whole breast irradiation or APBI using three-dimensional conformal RT. While these results are encouraging, increased patient numbers and longer follow up are needed to more accurately compare this novel APBI modality with other APBI techniques. Citation Format: Elizabeth M Nichols, Sarah McAvoy, Stewart Becker. Initial clinical experience and acute toxicity report of patients treated with accelerated partial breast irradiation (APBI) using the GammaPodTM [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-17.

Anterolateral Thigh Myocutaneous Flap for Reconstruction of a Large Anterior Neck Sinus Caused by Tuberculous Lymphadenitis: a Case Report

Tuberculosis remains a major global health problem and persistent lymphadenitis or incorrect treatment may result in sinus formation. We present a case of a large anterior neck sinus caused by tuberculous lymphadenitis. We designed an anterolateral thigh myocutaneous flap with 6 × 5 cm of skin and 10 × 7 cm of muscle for the reconstruction of the large sinus. The descending branch of the lateral circumflex femoral artery and 2 venae comitantes were anastomosed with superior thyroid arteries and two anterior neck veins. The patient experienced complete survival of the flap and did not complain of any discomfort. The donor site healed well, and weakness of the lower limb was absent. In conclusion, an anterolateral thigh myocutaneous flap is a good choice for the reconstruction of a neck sinus caused by tuberculous lymphadenitis.

Produção de lágrima após exérese parcial da glândula lacrimal principal em cães

Background : : : : The partial loss of the lacrimal gland by obstruction, injury, removal of tumor tissue or other pathological changes may lead to loss of tear flow, bringing harmful consequences to the body. The aim was to evaluate the production of tears after removal of approximately 50% of the main lacrimal gland. Materials, Methods & Results : For this, lacrimal glands from the left eyes of seven dogs, male, adult, with weight ranging from 6 to 13kg were partially removed. In each animal, an incision of approximately 3.0 cm of skin, orbicularis and cutaneous muscle of the eye between the eyeball and the zygomatic process of frontal bone of the lateral left side was performed. After incision of the conjunctiva, close to the zygomatic process, the orbital ligament was located and partially sectioned to expose the main lacrimal gland. With a stainless steel wire graph, the gland was measured and retired approximately 50% of the parenchyma. The fragment was placed in a bottle containing 10% formalin for histological evaluation. The tears production was measured with lacrimal Schirmer test at 28 oC and 70% relative humidity 24 hours before surgery and on the 15th, 30th and 60th days after surgery. At the 60th day, samples of gland lacrimal of the same animals were colleted for histopathologic examination of number, mean diameter of the acini and their nuclei, nucleus: cytoplasm ratio and cell area in a sample of 30 acini per animal and the density of collagen fibers. In the evaluations of the tears production with the Schirmer Test, between the pre-operative (PE), 15, 30 and 60 days post-operatively (PO) were noticed significant differences (p=0.0033) at times between PE and 15 days of PO and between 15 and 60 days of PO. By comparing histological evaluation of lacrimal gland samples in the PE and after 60 days, there were significant differences in the lacrimal gland of nuclear area (p > 0), nuclear cytoplasm proportion (p=0.0006) and cell area (p=0.0083). The collagen fibers formation did not differ significantly between PE and 60 days after partial removal of the gland (p=0.7104). All the ethical principles of ethical use of animals in experiments recommended by the Brazilian College of Animal Experimentation and Ethics Committee of the use of animals at the Federal University of Uberlandia. Discussion : The partial removal allowed the lacrimal gland remaining to offset the production of aqueous tear film: the values found in tear production were above normal throughout the trial period. Induction of cells secreting tears to hyperactivity occurred to offset the demand of production after removing part of the gland. Thus, it was stimulated increase nuclear - giant and multiple nuclei in constant transcription-protein synthesis – and small cytoplasm with little storage tear. This fact explains the increase in cell at 60 days, the decrease in tear production after 24 hours and its return to normal parameters at 60 days postoperatively. In this experiment, the density of collagen fibers found throughout the parenchyma tear between the PE and after 60 days postoperatively was not significant, possibly due to the deposition of fibers are directed to the incision site and the inflammatory reaction, along with the deposition collagen fibers was terminated with 60 days postoperatively. Therefore, the partial removal of the main tear gland in dogs does not interfere significantly in the fall of tear production on day 60 of evaluation in which the tears production came back within the normal patterns.

The effect of Manual Skin Brushing on H-Reflex Amplitude in Normal Human Subjects

Objective : To observe the effect of brushing on triceps surae muscle and different part of lower limb in normal healthy subjects. Materials and Method : Total 90 healthy subjects aged between 20 to 40 years were included in the study. They were divided into three groups according to the application of brushing area. 30 subjects were included in each group (15 males, 15 females). The brushing was applied on only dominant side of the subjects. The H-reflex was measured before brushing, during brushing and after brushing. After measuring pre-brushing H-reflex amplitude, 3 minutes rest interval was given to all groups. Then, brushing was applied for duration of 60 seconds at frequency of 100 strokes min-1 in all groups in distal to proximal direction. After 10 minutes, post- brushing the H-reflex was measured. Direct brushing was applied on area of 2cm × 10 cm of skin over triceps surae muscle in first group. In second group, brushing was applied on adhesive tape placed over area of 2cm × 10 cm of triceps surae muscle. Brushing was applied to the skin overlying tibialis anterior, posterior aspect of the knee joint and posterior aspect of the ankle joint consecutively in third group. 30 minutes rest interval given before switching to next part of brushing in group 3. Results : Result shows the decrease of H-reflex amplitude during direct brushing over triceps sure muscle as compared to brushing over adhesive tape. The maximum reduction of H-reflex amplitude was found during brushing in popliteal fossa amongst three different areas. Skin brushing has no long lasting effects. Conclusion : Manually skin brushing has an inhibitory effect on H-reflex excitability in normal subjects. Though the effects of brushing are not long lasting but it can be used one of the facilitory technique for eliciting muscle tone in neurological disorders.

The Minimal Access Deep Plane Extended Vertical Facelift

Modern facelift techniques have benefited from a "repopularization" of shorter incisions, limited skin elevation, and more limited dissection of the superficial musculoaponeurotic system (SMAS) and platysma in order to shorten postoperative recovery times and reduce surgical risks for patients. The authors describe their minimal access deep plane extended (MADE) vertical vector facelift, which is a hybrid technique combining the optimal features of the deep plane facelift and the short scar, minimal access cranial suspension (MACS) lift. The authors retrospectively reviewed the case records of 181 patients who underwent facelift procedures performed by the senior author (AAJ) during a two year period between March 2008 and March 2010. Of those patients, 153 underwent facelifting with the MADE vertical technique. With this technique, deep plane dissection releases the zygomatico-cutaneous ligaments, allowing for more significant vertical motion of the midface and jawline during suspension. Extended platysmal dissection was utilized with a lateral platysmal myotomy, which is not traditionally included in a deep plane facelift. The lateral platysmal myotomy allowed for separation of the vertical vector of suspension in the midface and jawline from the superolateral vector of suspension that is required for neck rejuvenation, obviating the need for additional anterior platysmal surgery. The average age of the patients was 57.8 years. The average length of follow-up was 12.7 months. In 69 consecutive patients from this series, average vertical skin excision measured 3.02 cm on each side of the face at the junction of the pre auricular and temporal hair tuft incision (resulting in a total excision of 6.04 cm of skin). Data from the entire series revealed a revision rate of 3.9%, a hematoma rate of 1.9%, and a temporary facial nerve injury rate of 1.3%. The common goal of all facelifting procedures is to provide a long-lasting, natural, balanced, rejuvenated aesthetic result with few complications and minimal downtime. The MADE vertical facelift fulfills these criteria and often yields superior results in the midface and neck areas, where many short scar techniques fail. Furthermore, this procedure can be performed under local anesthesia, which is a benefit to both patients and surgeons.

Total Face Reconstruction Using a Pre-expanded, Bilateral, Extended, Parascapular Free Flap

A 37-year-old male sustained extensive, self-inflicted gasoline burns to his head, face, chest, upper extremities, and anterior thighs. Although he underwent initial resuscitation and skin grafting at a regional burn center, he presented to our clinic with thick, unstable burn scars covering his face and scalp. He had multiple functional and esthetic needs that are described. He required approximately 30 x 35 cm of skin to resurface his entire face and anterior scalp. His back and buttocks were his only unscarred, potential donor sites. Authors have described use of a bilateral parascapular free flap for similar deformities. This patient required pre-expansion of this free flap to maximize available tissue and minimize the donor defect. This technique provided this patient with a large area of healthy skin and soft tissue that will ultimately provide this patient with an improved functional and esthetic result.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi - Technical Note -

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.

Use of a Semitendinosus Myocutaneous Flap for Soft‐Tissue Reconstruction of a Grade IIIB Open Tibial Fracture in a Dog

To describe the clinical use of a semitendinosus myocutaneous flap for soft-tissue reconstruction of a grade IIIB open tibial fracture. Case report. A 5-year-old castrated male Labrador retriever with a grade IIIB open tibial fracture. A myocutaneous flap was created by elevating the origin of the semitendinosus muscle and the associated overlying skin. The flap was rotated distally based on the distal vascular pedicle into a soft-tissue defect overlying the central and distal third of the tibia. The flap allowed one-stage reconstruction of a severe soft-tissue defect overlying denuded bone in a grade IIIB open tibial fracture. The muscular portion of the flap survived; however, there was necrosis of 3 cm of skin extending distally beyond the muscular portion of the flap. Distal rotation of the semitendinosus muscle and overlying skin can be used in the treatment of severe soft-tissue defects of the canine crus. Complex soft-tissue injuries to the canine crus can be treated with a myocutaneous flap as a reasonable alternative to other reconstructive techniques.

No Vertical Scar Breast Reduction: A Good Alternative to the T-SCAR Inferior Pedicle Breast Reduction

Techniques of the no vertical scar breast reduction, as used in more than 65 patients for over three years, are detailed. This technique is basically the same as the standard inferior pedical T-scar technique, except that the verticle scar is eliminated. Refinements of the technique include avoiding the ‘armpit’ breast; creating tension-free periareolar suturing with a small areolar hole; knowing how to perform the technique when there is only 3 cm of skin between the areola and the new areola position; and applying the same technique to mastopexy.

Postmortem stability of some markers of intra-vital wounds

We have studied the diagnostic value of several markers of the intra-vital nature of wounds — cathepsin D (EC 3.4.23.5) and ions (Ca, Mg, Cu, Zn and Fe) — after the influence of putrefaction. For this purpose, we have inflicted vital wounds to six pigs, which were killed 20 min later. Ten minutes after death, wounds were excised with 5–6 cm of skin around the incision and maintained at three different temperatures (4, 18 and 28.5 ± 13.4°C). After varying periods of postmortem interval from 0 to 48 h, aliquots of each wound were taken and analyzed with atomic absorption spectrophotometry for ions and with UV-spectrophotometry for cathepsin D. Our results demonstrate that ions conserve their diagnostic ability to differentiate vital from postmortem wounds after the influence of putrefaction. Nevertheless, cathepsin D does not show this ability in these experimental conditions.