Large Skin Research Articles

Skin Cyst: A Pathological Dead-End With a New Twist of Morphogenetic Potentials in Organoid Cultures.

A cyst is a closed sac-like structure in which cyst walls wrap certain contents typically including air, fluid, lipid, mucous, or keratin. Cyst cells can retain multipotency to regenerate complex tissue architectures, or to differentiate. Cysts can form in and outside the skin due to genetic problems, errors in embryonic development, cellular defects, chronic inflammation, infections, blockages of ducts, parasites, and injuries. Multiple types of skin cysts have been identified with different cellular origins, with a common structure including the outside cyst wall engulfs differentiated suprabasal layers and keratins. The skin cyst is usually used as a sign in pathological diagnosis. Large or surfaced skin cysts affect patients’ appearance and may cause the dysfunction or accompanying diseases of adjacent tissues. Skin cysts form as a result of the degradation of skin epithelium and appendages, retaining certain characteristics of multipotency. Surprisingly, recent organoid cultures show the formation of cyst configuration as a transient state toward more morphogenetic possibility. These results suggest, if we can learn more about the molecular circuits controlling upstream and downstream cellular events in cyst formation, we may be able to engineer stem cell cultures toward the phenotypes we wish to achieve. For pathological conditions in patients, we speculate it may also be possible to guide the cyst to differentiate or de-differentiate to generate structures more akin to normal architecture and compatible with skin homeostasis.

A retrospective study to evaluate the efficacy and safety of staged purse-string sutures for the reconstruction of surgical defects on skin using computer image analysis program.

Background:Staged purse-string suturing has been recently introduced for the reconstruction of round or oval defects following tumor excision.Objective:The aim of this study was to evaluate the clinical advantage of staged purse-string suturing for the reconstruction of relatively large skin defects.Materials and Methods:Twenty-one patients who received staged purse-string sutures were included in the study. To evaluate the defects and scar sizes objectively, computer-based image analysis was used. A modified observer scar assessment scale (OSAS) was applied for evaluating the clinical efficacy.Results:The mean primary postsurgical defect size in the total 21 cases was 1446.2 ± 1187.2 mm2, and the mean final scar size was about 268.1 ± 252.3 mm2. The defect area decreased gradually as staged purse-string suturing was performed. The mean total modified OSAS was 7.96 ± 1.69.Conclusion:Staged purse-string sutures might be an alternative reconstructive method for relatively large round or oval skin defects.

Island Skin Graft Associated with Non-Adherent Mesh in a Dog’s Pelvic Limb

Background: Large skin defects are caused by tumor excision, making appropriate reconstruction and complete healing of the lesion a challenge for surgeons. There are some difficulties in reaching these goals, especially in cases of surgical wound in the limbs, due to the scarce amount of skin and its reduced elasticity, which limit the possibility of flaps when compared to the head, neck, and trunk. This study reports a case of wound closure on the lateral skin in the femoral region of a dog’s pelvic limb via island skin graft associated with the implantation of a nonadherent cellulose acetate mesh and intensive postoperative care.Case: An 8-year-old Rottweiler female dog was attended at Pontifical Catholic University of Paraná’s Veterinary Clinic (CVE), in Curitiba, Paraná, presenting a tumor located laterocaudally to the right stifle joint. After preoperative examinations, the patient underwent tumor surgery; however, two more surgical procedures were required due to suture dehiscence in the region, which resulted in increased wound size. At first, the wound was treated for granulation tissue to be formed. Subsequently, the island skin grafting technique was chosen to close the wound, associated with the implantation of a nonadherent cellulose acetate mesh imbibed with petrolatum emulsion to keep the grafted fragments in place. The mesh was fixed in a simple interrupted suture pattern using 2-0 nylon thread. The lateral regions of the chest and abdomen were chosen as donor skin beds due to their large dimensions, skin elasticity, and ease in defect reconstruction. The fragments were obtained using a 10-mm biopsy punch and scalpel, and the defects were sutured in a simple interrupted pattern using 2-0 nylon thread. The patient remained hospitalized for movement restriction and postoperative monitoring for 72 h, and the bandage remained untouched during this time interval. Thereafter, the patient was discharged and it was recommended to clean the wound with jets of 0.9% saline using a 40 × 12 needle attached to a 20 mL syringe, from a distance of 10 cm from the wound. The dressings were changed every 48 h to maintain minimum contact with the wound; however, still keeping it clean to optimize healing. Fourteen days postoperatively, the sutures as well as the non adherent mesh were removed from the donor beds. The dressing was changed and the lesion was cleaned every 24 h because the fixation between the receptor bed and the implanted tissue was considered good. After approximately 80 days, complete epithelialization of the wound was observed.Discussion: Closing of large skin defects in the limbs is challenging due to the impossibility of using other reconstructive surgery techniques, which have limited use because of the extension of the lesion. However, island skin grafting can be considered despite its slower skin healing process than that of skin flaps. Specific management is required for the successful execution of this technique, and in the present case, the application of the non adherent mesh after island skin grafting helped in the immobilization and better adhesion of the fragments to the receiving bed. Thus, it was demonstrated that in-depth knowledge of reconstructive surgery and the surgeon’s expertise favor the emergence of ideas and more effective techniques that ensure success of the surgical procedure by avoiding complications and improving the patients’ quality of life.

Use of the Keystone Perforator Flap Closure for the Anterolateral Thigh Free Flap Donor Site

Objective: The anterolateral thigh (ALT) flap is a workhorse in microsurgical reconstruction. However, a flap width greater than 8 centimeters limits primary closure and discourages some surgeons from using this flap for larger defects to avoid a large and unsightly skin grafted donor site. ALT donor site closure can be made even more challenging when a more circular shaped flap is required. Methods: This study examines the use of the keystone perforator flap to close large ALT free flap donor sites in 6 patients who underwent reconstruction for various purposes who otherwise would have required donor site skin grafting. Results: Average flap dimensions were 10.5 cm × 17 cm and mean keystone flap dimensions were 12.2 cm × 22.5 cm. Average operative time of cases was 528.3 minutes and average BMI of patients was 24.8 kg/m2. There was 1 case of partial keystone flap dehiscence that required local wound care, and 1 case of drain replacement for thigh seroma. Conclusions: This series demonstrates that keystone perforator flap closure allows the thigh to maintain a relatively normal appearance, reduces postoperative pain associated with skin grafting, and can be performed in higher BMI patients with minimal complications and without increasing operative time or sensory or motor deficits. This series to date also has the largest defects closed with keystone flaps demonstrating the feasibility of this type of closure in very large ALT donor sites.

Gigantomastia of Pregnancy: Complicationsand Treatment Cases Report at Togo

Introduction: Gigantomastia in pregnancy is a rare pathology that is often physically and psychologically complicated. Observation: We report two cases, the first of which was a 24-year-old primigravida at 24 weeks amenorrhea, presenting with bilateral gigantomastia progressing from the beginning of her pregnancy and complicated by a large hemorrhagic ulcerative necrotizing skin lesion. The second case was that of a second pregnant patient, primiparous 29-year-old with a 27-week amenorrhea pregnancy. She had consulted for an exaggerated augmentation and inflammation of both breasts with collateral venous circulation on the chest. They had hyperprolactinemia and glandular hypertrophy. Treatment was symptomatic and the evolution was spontaneously favorable in the postpartum period. Conclusion: Gigantomastia in pregnancy has hormonal origin. It often becomes complicated towards the end of the second trimester of pregnancy by trophic skin disorders, and may regress spontaneously in the postpartum.

A new model for small target adult image recognition

Abstract With the advent of the era of 5G high speed and massive information, the audience of netizens is developing at a younger age, and the proliferation of adult images on the Internet is becoming more and more serious. The recognition and filtering of adult pictures has become very important to prevent young people from contacting harmful information. But, because of the wide variety of adult images, automatic recognition in these pictures is a very difficult task. This paper proposes a new model based on Residual neutral network. Our method consists of two parts. The first part is to divide images into large target skin color image and target skin color image according to the proportion of skin color pixels of the image; The second part is to input the two types of images into two different models for recognition. According to the results of comparative experiments, the proposed network can further improve the classification accuracy of adult images of small targets with excessive background noise, which is better than other single model.

Effects of COVID-19 Lockdown on Tumour Burden of Melanoma and Cutaneous Squamous Cell Carcinoma.

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.

A case of infected revision total knee arthroplasty with a large skin defect achieved implant conservation by means of iSAP therapy

A case of infected revision total knee arthroplasty with a large skin defect achieved implant conservation by means of iSAP therapy

Foramen Caecum Vein Involved in Dural Arteriovenous Fistula Fed by Sphenopalatine Arteries: A Case Report

Anterior cranial fossa (ACF) dural arteriovenous fistulas (ACF DAVFs) are an infrequent subtype of cranial DAVFs that are usually fed by the anterior ethmoidal artery (AEA) and ophthalmic artery (OA) branches. Due to the lack of dural venous sinus in the ACF, they directly drain into cortical veins, resulting in high bleeding tendency. For this reason, ACF DAVFs have to be treated regardless of whether they are symptomatic or not. A 74-year-old man, with hypertension history, came to our attention because of ear pain, dizziness, and impaired hearing for 2 months. No other pathological conditions have been found in his medical history. The patient underwent brain magnetic resonance imaging (MRI) scan and subsequently second level diagnostic investigations with digital subtraction angiography (DSA), showing a foramen caecum (FC) patency and a persistent, enlarged, arterialized FC vein (FCV) involved in an incidental ACF DAVF (Cognard IV), fed mainly by sphenopalatine arteries (SPAs) branches bilaterally. The patient underwent open surgery performed by small high frontal craniotomy with DAVFs complete closure and without any complications. To the best of our knowledge, this is the first case ever described of FCV persistence with involvement in an intracranial vascular malformation. It has been managed by surgical intervention that can be considered, despite the large skin incision, a minimally invasive approach with an excellent cosmetic result and minimal risk of complications.

The magnitude and associated factors of post-operative pain at Debre Tabor compressive specialized hospital, Debre Tabor Ethiopia, 2018.

Objectives:Post-operative pain is a form of acute pain following surgical intervention. And it is due to skin incision, tissue dissection, manipulation, and traction during the surgical procedure. The magnitude may reach up to 85.5% globally. Age, gender, duration of surgery, and length of skin incision were the common factors for post-operative pain. This study aims to assess the magnitude and associated factors of post-operative pain among surgical patients.Methods:Institutional-based cross-sectional study design was used. The study was conducted on a total of 159 surgical patients aged 8 years and above. The data were collected using chart review and recording the status of post-operative pain by the result of the Numeric Rating Scale at 1, 6, 12, 24, and 72 h of the post-operative period. Descriptive statistics, bivariate, and multivariable logistic regression were used. An adjusted odds ratio with a 95% confidence interval was used to determine the association. A p-value of less than 0.05 was used to declare statistical significance.Results:The majority (58.5%) of the study participants were females. The percentage of moderate to severe post-operative pain (Numeric Rating Scale: 4 and above) was between 37.7% within 1 h and 76.7% at 6 h of post-operative period. On multivariable logistic regression being female gender, preoperative pain and large skin incision were significantly associated with post-operative pain.Conclusions:Post-operative pain is still high which needs the attention of health professionals working on surgical patients and considering factors associated with post-operative pain.

Retrospective Study on Safety and Efficacy of Transperitoneal Laparoscopic Surgery and Open Surgery for Retrocaval Ureter

Introduction: Retrocaval ureter is a rare congenital anomaly which remains silent until the 3rd or 4th decade of life. But once a patient develops symptoms, it mandates treatment in the form of surgical management. Open surgery has traditionally been considered as the standard of care but it has its own downside or limitations. It requires a relatively large skin incision causing significant postoperative pain and thus prolonging convalescence. Transperitoneal laparoscopic approach is the preferred approach by most surgeons owing to large working space and familiar anatomy. Aim: To compare the safety and efficacy of transperitoneal laparoscopic and open surgery for definitive management of retrocaval ureter. Materials and Methods: Clinical data of fifteen patients, that underwent surgery for retrocaval ureter from December 2013 to January 2020 and the study of this data was done from June 2020, at Urology Department were analysed retrospectively. Out of 15 patients, seven were treated by open surgery while eight underwent transperitoneal laparoscopic surgery. Ureter was transpositioned to normal anatomic position followed by uretero-ureterostomy. Student t-test was applied to interpret and analyse the data obtained in both the groups using SPSS version 24. Results: Total of 15 patients data was studied (7 open surgery + 8 transpertional laparoscopic surgery, age 21-45 years). Intraoperative and postoperative data were compared between the transperitoneal laparoscopic and open surgery group. A statistically significant difference was found for operative time (p-value <0.001), estimated blood loss (p-value <0.05), analgesic requirement (p-value <0.001), drain removal (p-value <0.05) and hospital stay (p-value <0.001) between the two groups. Superficial surgical site infection was noted in two patients in open surgery group. For rest 13 patients postoperative period was uneventful. The follow-up of all patients was done for 12-36 months. Conclusion: Transperitoneal laparoscopic uretero-ureterostomy as a definitive treatment of retrocaval ureter is safe, effective and reliable option with less trauma and faster recovery. This minimally invasive technique can be considered as the first choice for treatment of retrocaval ureter on account of familiar anatomy and easier learning curve in contrast to retroperitoneal laparoscopic or robotic surgery.

Full-thickness skin grafts (FTSG) with a new technique

Introduction: Full-thickness skin grafts (FTSG) have long been an indispensable and frequently practiced standard procedure in plastic surgery. The defatting and thinning of the grafts with scissors or scalpel to a thickness of 0,8 – 1,2 mm is very time-consuming even for experienced surgeons in the case of large transplants. Devices for full-thickness skin graft defatting are not available on the market. For this reason, we developed a relatively simple device that enables complete and safe degreasing and thinning of the graft in the shortest possible time. Materials and Methods: The machine has a dimension of 38cm width, 24cm length, 23cm height. The cutting thickness can be set to 0.6mm, 0.8mm, and 1.0mm. The central part is a crimper run manually with a crank to guide the specimen through a cutting blade. The machine is made of stainless steel, can be completely disassembled, and is easy to sterilize. Results: With this device small and very large skin grafts up to 15 cm in width can get completely defatted within a few seconds. Discussion: The time for defatting is reduced by many times. Precious operating time is spared. It can be assumed that the healing of the graft is improved due to a more complete defatting, a much shorter manipulating time of the skin and a more even cut surface compared to the manual procedure. The risk of defects in the graft and of injury of the surgeon is minimized compared to manual preparation.

Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects

To investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects. The clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side. Eighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° ( t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° ( t=0.444, P=0.660). The application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.

External auditory canal reconstruction with inferior pedicled square screw flap from the preauricular area after resection of external auditory canal cancer.

BackgroundThe postoperative reconstruction of ear canal cancer with a local flap such as the snail flap technique has been reported for cases with few tissue defects. The snail flap technique requires a large skin incision and is at risk of facial neuropathy. We have devised a new flap that addresses these problems.MethodsAn 80‐year‐old woman underwent total right ear canal resection for cancer of the right ear canal, and the defect of the ear canal was reconstructed using a local flap. The local flap was used by making a rectangular incision in front of the auricle and rolling it into a cylindrical shape. We named this flap a square screw flap.ResultsThe patient was discharged 1 week after surgery without complications.ConclusionsThis method is considered to be useful for reconstruction of the ear canal with a small defect.

A shotgun metagenomic investigation of the microbiota of udder cleft dermatitis in comparison to healthy skin in dairy cows.

Udder cleft dermatitis (UCD) is a skin condition affecting the fore udder attachment of dairy cows. UCD may be defined as mild (eczematous skin changes) or severe (open wounds, large skin changes). Our aims were to compare the microbiota of mild and severe UCD lesions with the microbiota of healthy skin from the fore udder attachment of control cows, and to investigate whether mastitis-causing pathogens are present in UCD lesions. Samples were obtained from cows in six dairy herds. In total, 36 UCD samples categorized as mild (n = 17) or severe (n = 19) and 13 control samples were sequenced using a shotgun metagenomic approach and the reads were taxonomically classified based on their k-mer content. The Wilcoxon rank sum test was used to compare the abundance of different taxa between different sample types, as well as to compare the bacterial diversity between samples. A high proportion of bacteria was seen in all samples. Control samples had a higher proportion of archaeal reads, whereas most samples had low proportions of fungi, protozoa and viruses. The bacterial microbiota differed between controls and mild and severe UCD samples in both composition and diversity. Subgroups of UCD samples were visible, characterized by increased proportion of one or a few bacterial genera or species, e.g. Corynebacterium, Staphylococcus, Brevibacterium luteolum, Trueperella pyogenes and Fusobacterium necrophorum. Bifidobacterium spp. were more common in controls compared to UCD samples. The bacterial diversity was higher in controls compared to UCD samples. Bacteria commonly associated with mastitis were uncommon. In conclusion, a dysbiosis of the microbiota of mild and severe UCD samples was seen, characterized by decreased diversity and an increased proportion of certain bacteria. There was no evidence of a specific pathogen causing UCD or that UCD lesions are important reservoirs for mastitis-causing bacteria.

Expanded Forehead Stepped Flaps for Delayed Three-Stage Repair of Midface Skin Lesions

The forehead flap is the best flap for nasal defect repair and nasal reconstruction. It is also an ideal option for repairing skin lesions in the midface (including the nasal area, inner area of the cheek, and upper lip of the perioral area). However, the traditional frontal myocutaneous flap is relatively bulky for repairing pure skin lesions. In addition, the original forehead flap is generally not sufficient to cover a large wound area. If a large forehead flap is removed, the donor site cannot be sutured in one stage. In this study, an expanded forehead stepped flap was used to overcome the shortcomings of the traditional frontal myocutaneous flap. In stage one surgery, a rectangular expander (80–100 mL) was implanted on the side of the forehead. The expansion pot was built-in, and the excess expansion amount was 160–200 mL. After 4 weeks of rest, stage two operation was performed to remove the skin lesions in the midface. The pulsation point of the supratrochlear artery on one side was used as the pedicle, and the flap was designed diagonally to the upper region of the opposite side. The flap was designed according to the size and shape of the wound. The distal portion of the flap was separated in the superficial layer of the frontalis muscle, approximately 1.7 cm above the superior orbital edge, and cut into the submuscle. The flap pedicle was cut from the superficial layer of the periosteum to form a stepped flap. Then, the flap was rotated downward to repair the wound in the midface. Five weeks later, stage three of the operation which involved flap pedicle division, was performed. Expanded forehead stepped flaps were used in 12 cases with 6–36 months of follow-up. In all cases, the blood supply to the flaps was good, and their color, texture, and thickness matched well with those of the surrounding skin. All patients were satisfied with the outcome of the repair. Expanded forehead stepped flaps present an ideal option for repairing wounds after large skin lesion resections in the midface since they have multiple edges from a reliable blood supply, easiness to transfer, and well-matched color, texture, and thickness to those of the surrounding skin of the face to no need for many auxiliary incisions.

A Novel Abdominal Decompression Technique to Treat Compartment Syndrome After Burn Injury

BackgroundPrevalence of abdominal compartment syndrome (ACS) is estimated to be 4%-17% in severely burned patients. Although decompressive laparotomy can be lifesaving for ACS patients, severe complications are associated with this technique, especially in burn populations. This study outlines a new technique of releasing intraabdominal pressure without resorting to decompressive laparotomy. Materials and methodsTen fresh tissue cadavers were studied; none of whom had had prior abdominal surgery. Using Veress needles, abdomens were insufflated to 30 mm Hg and subsequently connected to arterial pressure transducers. Two techniques were then used to incise fascia. First, large skin flaps were raised from a midline incision (n = 5). Second, small 2 cm cutdowns at the proximal and distal extent of midaxillary, subcostal, and inguinal incisional sites were made, followed by tunneling a subfascial plane using an aortic clamp with fascial incisions made through the grooves of a tunneled vein stripper (n = 5). Pressures were recorded in the sequence of incisions mentioned previously. ResultsThe open midline flap technique decreased abdominal pressure from a mean pressure of 30 ± 1.8 mm Hg to 6.9 ± 5.0 mm Hg (P < 0.01). The minimally invasive technique decreased intraabdominal pressure from 30 ± 0.9 to 5.8 ± 5.2 mm Hg (P < 0.01). This technique significantly reduced intraabdominal pressure via extraperitoneal component separation and fascial release at the midaxillary, subxiphoid, and inguinal regions. ConclusionsThis technique offers the benefit of reducing the morbidity, mortality, and complications associated with an open abdomen, which may be beneficial in the burn injury population.

Identification of KRAS mutation in a patient with linear nevus sebaceous syndrome: a case report

BackgroundLinear nevus sebaceous syndrome (LNSS) is a rare genetic disease characterized by large linear sebaceous nevus typically on the face, scalp, or neck. LNSS could be accompanied by multisystem disorders including the central nervous system. Herein, we report gene mutational profile via whole exome sequencing of both lesional and non-lesional skin samples in a LNSS patient.Case presentationA 17-year-old girl presented with multisystem abnormalities, including large skin lesions, ocular disorders, abnormal bone development and neurological symptoms. A diagnosis of LNSS was established based on clinical manifestations, histopathological and imaging findings. The skin lesions were resected and no recurrence was noted at the time of drafting this report. Whole exome sequencing of genomic DNA revealed the following 3 mutations in the lesions of the index patient: KRAS (c.35G > A, p.G12D), PRKRIR (c.A1674T, p.R558S), and RRP7A (c. C670T, p.R224W), but no mutation was found in the healthy skin and peripheral blood sample of the index patient, or in the blood samples of her parents and sibling. PCR-mediated Sanger sequencing of DNA derived from lesional skin sample of the index patient verified KRAS mutation, but not PRKRIR (c.A1674T, p.R558S) and RRP7A (c. C670T, p.R224W). None of the 3 mutations was found in Sanger sequencing in skin lesions of 60 other cases of nevus sebaceous patients.ConclusionsOur findings show the relevance of KRAS mutation to LNSS, providing new clues in understanding related genetic heterogeneity which could aid genetic counselling for LNSS patients.

Clinical evidences of urea at low concentration.

Urea is a hygroscopic molecule that, because of its moisturising properties, is topically used for the treatment of skin dryness at concentrations ranging from 2% to 12% in different formulations. Based on existing literature, low-concentration urea-containing products are effective in the treatment and/or prevention of xerosis in some skin disorders such as ichthyosis, atopic dermatitis and psoriasis, or unrelated to specific skin diseases. Generally, urea formulations at low concentration are well-tolerated and suited for the treatment of large skin areas, once or twice daily, even for a long period of time. At low concentrations stinging and burning sensation is rare and transient, whit no reported sensitisation despite its widespread use.

The Effect of Flaxseed Extract on Skin Elasticity of The Healing Wound In Rabbits

Introduction: Management of disturbed wounds, large skin defects and the areas where skin tension precludes wound closure is of high clinical importance. Healing in wounds occurs through epithelization and contraction processes (second-intentions healing) that may result in certain undesirable complications including keloid and formation of a fragile epithelial layer. Materials and methods: 27 white New Zealand rabbit included in this study divided into 3 groups; one group of 9 rabbits received Flaxseed gel topically for three time intervals (1, 7, and 14 days); a second group received Fucidin cream as positive control, while a third group has not received any treatment as negative control, Skin elasticity measurements were performed using the DermaLab system. Results: Throughout the study, skin elasticity was significantly greater in Flaxseed group than in others. Flaxseed decrease elasticity value from (3.46 ± 2.05). Hence, Young's modulus of skin elasticity in flaxseed group was (2.46 ± 1.02) after 14 days (p = 0.003), while no significant differences were evident in both Fucidin group (1.16 ± 0.77) and non-treated group (1.86 ± 1.40) (p = 0.019), accordingly flaxseed extract more reproducible than other groups demonstrating comparable efficacy in skin elasticity and distensibility. Conclusions: This study showed the therapeutic effect of flaxseed on biologic tissue. Elasticity evaluation demonstrated increased density and firmness in the network of collagen fibers in the dermis and subcutis during wound healing process promise in generating therapeutic gel to be used in wound healing process.