Large Skin Research Articles

0860 Comparative description of sleep, thyroid-stimulating hormone and calcium metabolism in 5 vitiligo patients under phototherapy

Abstract Introduction Vitiligo is an autoimmune skin disease represented by melanocytes destruction. Clinically, it evolves with spots that are lighter than normal skin color. Periodical evaluation of patients is recommended, including thyroid function. Phototherapy is its gold standard treatment, consisting in specific range of ultraviolet B (UVB) light sections. Sleep may play an immunological role, and should be investigated in vitiligo. The study aimed to compare results of thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium and vitamin D 1.25(OH)2D and 25(OH)D; and Pittsburgh Sleep Quality Index (PSQI) scores of vitiligo patients before and after phototherapy period. Methods Five individuals with vitiligo were evaluated at a University Dermatology Service, following ethical guidelines. Blood collection and PSQI application were performed before and after phototherapy. Laboratory elements were those related to calcium metabolism (PTH, calcium and vitamin D) and TSH. Results The sample included 4 female individuals with 21, 46, 65 and 70 years old; and a 57 years old male. Three of them had large skin involvement and 2 had localized vitiligo. After 6 months under phototherapy, patients returned for reassessment. All showed skin lesions improvement. Quantitative increase in TSH, PTH, 1.25(OH)2D and 25(OH)D was observed; serum calcium varied among the sample. Regarding PSQI before phototherapy, all 5 scores were >5 (1 score>10). The PSQI was reapplied only in 3 of the 5 volunteers after phototherapy; 2 scores reduced, and 1 score increased. This results, although from few individuals, alert to the possible role of UVB phototherapy on TSH and calcium metabolism substrates. Vitamin D increase may be associated to improvement of subjective sleep of 2 individuals. It was described that vitamin D in sufficient concentration could be related to better sleep quality. Phototherapy, by acting on clinical improvement of vitiligo, may influence subjective sleep, as reported in PSQI; and it could influence on melatonin and circadian rhythm. Conclusion The interaction between vitiligo/autoimmunity, phototherapy, vitamin D and sleep is complex and may have interrelated pathways. A better understanding of this pathophysiology through larger studies is worthy for benefiting clinical management of vitiligo and associated sleep disorders. Support (if any) AFIP, CAPES and CNPq.

Visualizing dynamic three-dimensional changes of human reticular dermal collagen under mechanical strain

In clinical practice, plastic surgeons are often faced with large skin defects that are difficult to close primarily. Management of large skin wounds e.g. burns or traumatic lacerations requires knowledge of skin biomechanic properties. Research into skin microstructural adaptation to mechanical deformation has only been performed using static regimes due to technical limitations. Here, we combine uniaxial stretch tests with fast second harmonic generation imaging and we apply this for the first time to investigate dynamic collagen rearrangement in reticular human dermis. Ex vivo human skin from the abdomen and upper thigh was simultaneously uniaxially stretched while either periodically visualizing 3D reorganization, or visualizing 2D changes in real time. We determined collagen alignment via orientation indices and found pronounced variability across samples. Comparing mean orientation indices at the different stages of the stress strain curves (toe, heel, linear) showed a significant increase in collagen alignment during the linear part of the mechanical response. We conclude that fast SHG imaging during uni-axial extension is a promising research tool for future studies on skin biomechanic properties.

NIR- and pH-responsive injectable nanocomposite alginate-graft-dopamine hydrogel for melanoma suppression and wound repair

Surgical excision, chemotherapy, and radiotherapy are the main approaches used for treating melanoma. Unfortunately, surgical excision usually inevitably causes large area skin defects. In addition, chemotherapy and radiotherapy are often accompanied by adverse reactions and multi-drug resistance. To overcome these limitations, a near-infrared (NIR)- and pH-responsive injectable nanocomposite hydrogel was developed using sodium alginate-graft-dopamine (SD) and biomimetic polydopamine-Fe(III)-doxorubicin nanoparticles (PFD NPs) for treating melanoma and promoting skin regeneration. Firstly, the SD/PFD hydrogel can precisely deliver anti-cancer agents to the tumor site to reduce its loss and off-target toxicity. Then, PFD can convert light into heat energy under NIR irradiation to kill cancer cells. Meanwhile, doxorubicin can be administered continuously and controllably by NIR- and pH-responsive. Additionally, the SD/PFD hydrogel can also relieve tumor hypoxia by decomposing endogenous hydrogen peroxide (H2O2) into oxygen (O2). Therefore, photothermal, chemotherapy, and nanozyme synergetic therapy resulted in the tumor suppression. Specifically, the SA-based hydrogel can kill bacteria, scavenge reactive oxygen species, promote the proliferation and migration of cells, and significantly accelerate skin regeneration. Therefore, this study provides a safe and effective strategy for melanoma treatment and wound repair.

MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS

You have accessJournal of UrologyCME1 Apr 2023MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS Sailakshmi Senthil Kumar, Helen Sun, Nicholas Sellke, Kimberly Tay, Donald Bodner, Shubham Gupta, Kirtishri Mishra, and Kyle Scarberry Sailakshmi Senthil KumarSailakshmi Senthil Kumar More articles by this author , Helen SunHelen Sun More articles by this author , Nicholas SellkeNicholas Sellke More articles by this author , Kimberly TayKimberly Tay More articles by this author , Donald BodnerDonald Bodner More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s gangrene (FG) is a necrotizing infection of the male genitalia associated with significant loss of genital tissue. Traditionally, loss of >50% of scrotal skin is thought not to be amenable to primary closure and is often left to heal by secondary intention due to concern for infection recurrence. We hypothesize that delayed primary closure (DPC) for FG patients is feasible and safe for large skin defects. METHODS: A single institution retrospective review was done from October 2020 to October 2022 of adult males that underwent DPC for FG. Patients were assessed for overall stability at serial debridements and a healthy wound bed prior to closure. All patients had minimum follow-up at 1 and 4 weeks for drain removal and wound check. Additional follow-ups were scheduled as needed. Clinical data including demographics, medical history, length of stay, operative details, and complications were collected. RESULTS: We identified 13 patients that underwent DPC. Average age was 61.3 years and average BMI was 36.2 kg/m2. The majority of patients had hypertension and/or diabetes mellitus (84.6%). Median number of FG debridements was 2 (IQR 2-3), with a median time to closure of 6 days (IQR 3-11) and length of stay of 11 days (IQR 9-16). Average genital defect size was 119 cm2 (range 44-346 cm2). Five patients (38.4%) were closed using scrotal flaps alone; other closures used advancement flaps from the inner thigh, lower abdomen, and perineum. There were 4 Clavien-Dindo III complications: 2 partial flap necrosis, 1 wound dehiscence, and 1 instance of bleeding. Three were successfully managed by re-exploration and re-closure. One flap failure occurred in a patient with pre-existing radiation and rectourethral fistula. After re-closure attempt, the wound re-opened and was left to heal by secondary intention. The majority of patients were able to be discharged home directly (69.2%). At an average follow-up of 3.5 months, 46.2% of patients had no known complications. One patient (7.7%) experienced superficial genital cellulitis at 6.5 weeks post-op which was successfully managed with antibiotics. CONCLUSIONS: Our data from a single institution shows that DPC is safe and effective with few infectious sequelae. Patients with large defects may benefit from less complex wound management requirements and discharge directly to home. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e197 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sailakshmi Senthil Kumar More articles by this author Helen Sun More articles by this author Nicholas Sellke More articles by this author Kimberly Tay More articles by this author Donald Bodner More articles by this author Shubham Gupta More articles by this author Kirtishri Mishra More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement PDF downloadLoading ...

Dumanian Technique for Repair of Complex Incisional Hernias

Incisional hernia is protrusion of tissue at or near the site of an incision from a previous surgery. It is a challenging procedure to repair complex incisional hernias. Most of the numerous reconstructive techniques are unable to achieve goals of hernioplasty owing to various factors being planar mesh impose the risk of pain and infection whereas conventional suture repairs can fail due to suture pull through, rupture or slipping of knot. The open components separation technique (CST) creates large undermining skin flaps especially useful in patients with complex hernias who require judicial approximation of the midline fascia. Another novel technique for repair of such hernias is the Dumanian Technique : using mesh as a suture material and has been shown to improve the ultimate tensile strength (UTS) and thus prevent surgical failure. Both the techniques are implemented in our case to achieve successful abdominal closure.

3D bioprinting strategies and their application in studies in vivo and in vitro animal models for skin regeneration: a concise systematic review and meta-analysis

Introduction: Annually, 50% of medical expenses worldwide stem from damage to the body's tissues and organs. Large skin defects can be caused by tumor excision, venous ulcers, diabetic foot ulcers, and burns. The 3D bioprinting of skin has an advantage compared to other technologies for skin substitutes, the capacity for directional and spatial handling at the cellular level with variable density. Objective: It was to identify the most efficient 3D bioprinting strategies and their application in studies in vivo and in vitro animal models, to demonstrate state of art in skin regeneration, and to direct new clinical research with translational studies. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from November 2022 to February 2023 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 237 articles were found and 97 articles were evaluated in full, and 16 were included and described in the present study. According to the GRADE instrument, most studies (X2 =90.5%>50%) followed a controlled clinical study model and had a good methodological design. the biases did not compromise the scientific basis of the studies. Conclusion: Most organotypic skin models have an epidermal layer of keratinocytes and a dermal layer of fibroblasts embedded in an extracellular matrix-based biomaterial. Furthermore, skin comprising epidermis, dermis, and hypodermis stratified with blood vessels, nerves, muscles, and cutaneous appendages can be fabricated. These findings provided evidence for further advances in translational studies in humans.

Clinic and anatomic aspects of verification and monitoring of various types of equine sarcoid in the western regions of Ukraine

Sarcoid is the most common skin tumor reported worldwide in equids, donkeys, zebras, and mules of all ages and sexes. The bovine papillomavirus (BPV) plays an important role in the pathogenesis of the disease. Globally, the incidence of equine sarcoid ranges from 12 % to 67 % of all skin neoplasms. Unfortunately, no attention is paid to the study of sarcoid epizootology in Ukraine. There are no reports on the clinical types of neoplasms, their pathohistological characteristics, and treatment methods. Our study aimed to describe the clinical manifestations of different anatomical types of equine sarcoid, ranging from small single lesions to multiple aggressive fibroblastic tumors, which were registered in horses from private farms and stables in the western regions of Ukraine during 2019–2022. According to its macroscopic features, sarcoid was divided into six clinical and anatomical types: hidden, verrucous, nodular, fibroblastic, mixed, and malignant. In general, 1012 horses were examined, of which 328 animals were clinically diagnosed with sarcoid. Neoplasms were localized in different parts of the body and belonged to different sarcoid types.The smallest number of neoplasms was detected in the area of the head around the eyes in the form of single nodules (2.3 %), on the neck (5.4 %), and limbs (14.8 %). Most of the multiple focal sarcoid tumors were localized in the chest area (26.5 %) and in the area of the abdominal wall and groin (51 %). Both depigmentation and hyperkeratinization of the affected areas were the typical morphological features of all sarcoid types. Hidden sarcoid was characterized by lesions of the skin’s superficial layers with well-defined areas of alopecia. Verrucous sarcoid was mainly localized in the neck and groin areas with the formation of irregularly shaped and large skin thickenings characterized by damage to the deep dermis layers. The third type of sarcoid is nodular, which was visually manifested in the form of mobile spherical subcutaneous nodules of small sizes. They were usually localized in the groin, prepuce, inner thighs, and eyelids. Fibroblastic type is one of the most aggressive equine sarcoids. It is characterized by rapid growth with the formation of massive tumors on the leg with an ulcerated surface and marked vascularization. Mixed sarcoid combined verrucous, fibroblastic and nodular types with predominant signs a particular type of tumor. Malignant form of sarcoid was relatively rare but particularly aggressive. Tumors spread along the course of lymphatic vessels with the formation of nodes and ulcers. This sarcoid was detected only in two horses. In general, it should be noted that sarcoid is not a fatal neoplasm for horses. However, its location, size, and the possibility of progression to a more aggressive form commonly leads to deterioration of the exterior and culling of thoroughbred animals.

Spiderplasty and Bow-tie Tension Relieving Suture Techniques for Large Skin Defects in Dogs

Background: In veterinary practice, cutaneous injuries are a very common occurrence. Various methods have been employed to close large skin defects like skin graft or flap often associated with relatively more complex surgical procedures. Use of tension relieving suture techniques like spider plasty and bow tie technique allow the mobilization of adjacent local tissue to cover large cutaneous defects which was thus utilised in the study. Methods: Twelve dogs brought to the Madras Veterinary College Teaching Hospital, Chennai,TANUVAS with large diameter open wounds were selected for the study. Irrespective of the stage of closure the two tension relieving suture techniques, i.e. Spiderplasty and Bow-tie, were performed for closure of the large wounds. The preoperative and postoperative wounds assessment were performed through subjective evaluation, planimetry, bacteriological examination and histopathological evaluation. Result: The Spiderplasty technique was more time consuming, required more surgical expertise and had slightly lower cost efficiency ratio. It could however be better utilised to close wounds located in confined anatomical areas, as compared to the Bow-tie procedure which was limited by its requirement to resect 36% of adjacent normal tissue.

High Expansion Auxetic Skin Graft Simulants for Severe Burn Injury Mitigation.

Burn injuries are commonly treated with split-thickness skin grafting. However, low expansions offered by spilt-thickness skin grafting inhibit the treatment of large and severe burn injuries when limited donor skin is available. To overcome this gap, in this work, it was attempted to study the expansion potential of skin grafts with novel auxetic incisions with rotating rectangle (RR), honeycomb (HC), alternating slit (AS), H-shaped (HS), Y-shaped (YS), and I-shaped (IS) unit cells, through development of skin graft simulants. Clinically relevant biaxial load testing was conducted to estimate the stress-strain response, void area, and meshing ratio. Moreover, hyperelastic constitutive models were employed to characterize the non-linear biomechanical behavior of the skin graft simulants. The maximum void area increase was observed in the HS skin graft simulant, indicating low skin cover. Overall, the IS auxetic skin graft design exhibited meshing ratio higher than traditional grafts (>3:1), low void area and stresses, which can be beneficial for large skin cover and burn wound healing. With further optimization and clinical tests, the auxetic skin graft designs may find a place with the graft manufacturers for fabrication of grafts with better surgical outcomes for severe burn injuries.

High-Frequency Ultrasound in Diagnosis and Treatment of Non-Melanoma Skin Cancer in the Head and Neck Region

Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and basosquamous cell carcinomas (BSC) together with Merkel cell carcinoma (MCC), which are rare types but with a very aggressive pattern and poor prognosis. The pathological diagnosis is hard to assess without a biopsy, even by the dermoscopy. Moreover, the staging can be problematic because there is no access clinically to the thickness of the tumor and the depth of the invasion. The aim of this study was to evaluate the role of ultrasonography (US), which is a very efficient imaging method, non-irradiating and cheap, in diagnosis and treatment of non-melanoma skin cancer in the head and neck region. Thirty-one patients with highly suspicious malignant lesions of the head and neck skin were evaluated in the Oral and Maxillo-facial Surgery Department and Imaging Department in Cluj Napoca, Romania. All tumors were measured with three transducers: 13 MHz, 20 MHz and 40 MHz. Doppler examination and elastography were also used. The length, width, diameter, thickness, the presence of necrosis, status of regional lymph nodes, the presence of hyperechoic spots, strain ratio and vascularization were all recorded. After that, all patients were treated by surgical resection of the tumor and reconstruction of the defect. Immediately after surgical resection, all tumors were measured again after the same protocol. The resection margins were evaluated by all three types of transducers in order to detect malignant involvement and the results were compared with the histopathological report. We found that the 13 MHz transducers offered a big picture of the tumor but the level of details, in the form of the presence of the hyperechoic spots, is reduced. We recommend this transducer for evaluation of surgical margins or for the large skin tumors. The 20 and 40 MHz transducers are better for viewing the particularities of malignant lesions and for an accurate measurement; however, in the case of large size lesions, assessing all three dimensions of the tumor can be difficult. The intralesional hyperechoic spots are present in case of BCC and they can be used for differential diagnosis of BCC.

Case report and literature review on a large MBC with ulceration.

Metaplastic breast cancer (MBC) is a rare tumor of the breast, and skin ulceration of breast tumors is a difficult clinical problem that reduces the patient's quality of life. There are currently no Standard Treatment Guidelines for MBC at present, and the treatment for the skin ulceration of breast tumors is limited in clinics. Here, we report the case of a patient with a large MBC and skin ulceration, accompanied by exudation and odor. The combined treatment of albumin paclitaxel and carrelizumab (anti-PD-1 immunotherapy) was effective in reducing the tumor, but it increased the severity of the skin ulceration. After taking traditional Chinese medicine, the skin ulceration healed completely. Then the patient underwent a mastectomy and radiotherapy. The patient has a high quality of life and was in good condition after the comprehensive treatment. This suggests that traditional Chinese medicine may have a good auxiliary therapeutic effect on the skin ulceration of MBC.

Quantification of elastic anisotropy of human skin in vivo with dynamic optical coherence elastography and polarization-sensitive OCT

The complex structure of skin ensures a broad range of biological functions. The loss of a large skin area due to trauma or disease usually requires reconstructive surgery that often involves grafting or flapping. The clinical need for non-contact objective measurements of skin elasticity is necessary to guide grafting procedures to minimize complications such as secondary contracture or hypertrophic scars. Here, we report a non-contact and non-invasive method combining acoustic micro-tapping optical coherence elastography (AμT-OCE) with polarization-sensitive (PS-) optical coherence tomography (OCT) to quantify anisotropic elastic properties of skin. We show that all three elastic constants that define skin’s anisotropic elastic deformation and the orientation of collagen fibers in the dermis can be determined from propagating elastic waves over the skin surface. Measurements were performed on healthy volunteers in vivo. A nearly incompressible transverse isotropic model of skin elasticity was used to reconstruct the moduli from experimental data after being validated in extensive numerical simulations. Finally, we demonstrate that combining several OCT modalities (structural OCT, OCT angiography, PS-OCT, and AμT-OCE) may provide rich information about skin and demonstrate the potential for complex characterization of scar.

Strategy for resurfacing complex extremity defect with chimeric, linked flaps: A review with a 10-year experience at major trauma center

For the reconstruction of the extensive and/or three-dimensional soft-tissue defect in upper and lower extremities, chimeric flaps composed of multiple flaps or tissues with separate vascular supplies can supply economical use of tissue and superior esthetic results. Herein, we investigated the effectiveness of the thoracodorsal axis chimeric flap through the review the largest collection of long-term data. A retrospective review of all patients who received the thoracodorsal axis chimeric flap in complex three-dimensional defects of extremities between January of 2012 and December of 2021. A total of 55 type I/IP classical chimeric flaps, 19 type II/IIP anastomotic chimeric flaps, five type III perforator chimeric flaps, and seven type IV mixed chimeric flaps were analyzed. As the reconstructed area became proximal, flap dimensions increased significantly. And the optimal flap type depended on the location. The TDAp flap can provide large dimensions of skin paddle with latissimus dorsi and serratus anterior muscles with acceptable donor-site morbidities. The TDAp chimeric flaps constructed by microvascular anastomosis of two free flaps can provide large skin dimensions but also tissues with different properties. These characteristics make it possible to resurface the large and extensive defects, reconstruct the complex distal extremity defects, needing tissues with different properties, and cover the three-dimensional defect, obliterating the dead space. The thoracodorsal axis chimeric flap could be a favorable option for extensive, complex, or three-dimensional defects of the upper and lower extremities based on its reliability of the vascular system.

Difficulties in diagnosing ALK-negative anaplastic large cell lymphoma manifesting from a skin lesion

Anaplastic large cell lymphoma is a rare form of non-Hodgkin's lymphoma that requires an early diagnosis and urgent therapy due to aggressive tumor process. Clinically, most non-Hodgkin's lymphoma present with lymphoadenopathy and В-symptoms (such as weakness, drowsiness, fatigue, subfebrile fever, profuse night sweats). However, anaplastic large cell lymphoma may present with nonspecific skin lesions with minimal or no B-symptoms. The skin lesions are heterogeneous, which may also delay verification of the diagnosis.
 We present a case of widespread anaplastic large cell lymphoma skin lesions mimicking a case of erysipelas, which progressed rapidly from a single rash on the wrist to an extensive lesion of the right breast within 1 month. Prior to verification of the diagnosis, the patient was treated for erysipelas, pyoderma, and herpes zoster with no response to therapy. Immunohistochemical examination of a skin biopsy confirmed the diagnosis of ALK-negative anaplastic large cell lymphoma. At the time of publication, the patient had completed 1 course of the CHOEP regimen, and 6 cycles of the program were planned.
 Our case demonstrates the necessity of a broad differential diagnosis of rashes torpid to the current therapy.

Skin Capacitive Image Stitching and Occlusion Measurements

The aim of this study is to develop new analysis techniques for skin capacitive image stitching and occlusion measurements. Through image stitching, small skin capacitive images can be stitched into large skin capacitive images and, therefore, provide more skin image information. Through occlusion, e.g., keeping the measurement device on skin for a period of time, the skin health status can be studied through time-dependent response curves. Results show that time-dependent skin capacitive imaging curves can tell us the information about transdermal water loss (TEWL) as well as skin surface profiles. By using the structural similarity index measure (SSIM), the TEWL map can be constructed, which shows the water loss map on the skin surface. We first present the theoretical background and then the experimental results.

Skin-Fat Composite Grafts for Reconstructing Large Full-Thickness Skin Defects.

The uppermost layer of subcutaneous tissue has a rich vascular network, the subdermal plexus and multiple perforating vessels in the interlobular septa. When skin-fat composite grafts (SFCGs) include this uppermost layer, they can be readily vascularized to enhance survival. The authors describe their clinical experience with large SFCG transplantations. This retrospective study included patients who underwent SFCG transplantation for large, full-thickness skin defects, formed after burn scar contracture or contraction deformity excision. The recipient tissue bed was prepared by retaining the deepest layer of scar tissue or reticular dermis to preserve the interlobular septa, subdermal plexus, and ascending arterioles above the subcutaneous tissue. The SFCG was prepared by trimming fat lobules and preserving the interlobular septa and vessels to form a 1- to 4-mm-thick base of subdermal fat tissue. The trimmed SFCG was placed onto the defective tissue and secured with a tie-over dressing. Among 86 grafts, 76 (88.4%) survived completely (sizes, 6 to 161 cm 2 ; mean surface area, 68.7cm 2 ). Focal skin sloughing or graft loss occurred in 10 cases. These events were followed by spontaneous healing in eight cases. Focal hypertrophic scars formed in six cases. In 15 cases, hyperpigmentation occurred, but improved gradually. Most transplantations achieved satisfactory pliability (93.0%), contour (90.7%), and color (88.4%). SFCGs survived better than expected with minimal complications, probably because of the preservation of rich vascular networks in both the recipient and SFCG tissues. Therefore, SFCG transplantation may be a good option for reconstructing full-thickness skin defects with a large surface area. Therapeutic, IV.

Sinomenine promotes flap survival by upregulating eNOS and eNOS-mediated autophagy via PI3K/AKT pathway

Large skin defects and surgical tissue reconstructions are frequently covered utilizing random flaps. The flap has the advantage of being designed according to the size and shape of a surgical wound. However, the necrosis of the distal part of the flap restricts the clinical application of flaps. Sinomenine (SIN) is the major active component of sinomenium acutum. SIN has been demonstrated to inhibit oxidative stress and stimulate autophagy in a cell, animal, and clinical studies. The protective and proliferative effects of sinomenium on HUVECs were evaluated by scratched test, CCK-8, and EDU assays. For the flap survival, we established a mouse random pattern flap model and observed the effects of SIN injected intraperitoneally. The survival area and blood flow intensity of the flap in sinomenium group were significantly increased compared to the control group. Our results demonstrate that SIN promotes flap survival. Sinomenium enhances eNOS expression in the flap and reduces the level of oxidative stress, promotes autophagy flux increase, reduces apoptosis, and promotes angiogenesis. Having a therapeutic benefit of SIN, Autophagy inhibitor 3-MA shows its critical role by reversing the beneficial effects of SIN, and the nitric oxide synthase inhibitor l-NAME both stimulated HUVECs that explore the relationship between autophagy flux and nitric oxide synthase. Furthermore, the mechanism in our study reveals the changes in the signal pathway of PI3K/AKT, the protective effect of SIN during antioxidant activity, the activation of eNOS through PI3K/AKT signaling pathway affects autophagy through the eNOS system, and promote the random flap survival.

Management of asymptomatic cutaneous lumbosacral findings in newborns: a neurosurgical perspective.

The purpose of this study was to find areas of agreement among pediatric neurosurgeons with respect to the clinical management of asymptomatic newborns with a variety of lumbosacral skin findings. An electronic survey containing 18 clinical images and brief vignettes was sent to pediatric neurosurgeons within the American Academy of Pediatrics Section of Neurological Surgery (AAP SONS). In total, 38% (n = 21) of AAP SONS members submitted complete responses to the survey. Respondents were asked if they would advise routine care, watchful waiting, imaging, or subspecialty consultation for each clinical case. Responses were categorized into two groups: 1) watchful waiting and/or routine care, or 2) imaging and/or subspecialty consultation. Consensus was categorized as good (> 90% of responses in the same group), modest (70%-90%), and poor (< 70%). Demographic information, local factors impacting management, and experiences with local referral patterns were also collected. Among the pediatric neurosurgeons within the AAP SONS network, the authors found high levels (> 90%) of agreement that subcutaneous lipomas, faun tail nevi, large skin tags, and deep/atypical lumbosacral dimples in asymptomatic newborns should prompt an imaging study. Similarly, the authors found high agreement that simple coccygeal dimples do not need imaging. The management of some types of lumbosacral vascular marks and gluteal crease deviations had poor agreement (< 70%). When imaging was recommended, there was preference for spinal MRI in most cases (67%). Pediatric neurosurgeons generally agree that imaging of the spine is indicated for asymptomatic newborns with subcutaneous lipomas, faun tail nevi, large skin tags, or deep/atypical lumbar dimples (deep or atypical appearing). They also agree that imaging is unnecessary for infants with simple coccygeal dimples. There was a notable lack of consensus on the appropriate management of certain gluteal cleft deviations and cutaneous vascular marks.

λ approach for the repairment of large skin defects after resection of preauricular fistula with cellulitis in children

Objective:To explore the feasibility and advantages of λ approach for the repairment of large skin defects after resection of preauricular fistula with cellulitis in children. Methods:The clinical data of patients with preauricular fistula with cellulitis treated by λ approach from January 2016 to January 2021 were analyzed retrospectively. Results:After follow-up for 10-18 months, the primary healing rate of incision was 97.8%, and the survival rate of λ flap was 100%. Conclusion:λ approach is a safe, effective and cosmetic method. It can be used to repair the large skin defects after resection of preauricular fistula with cellulitis in children.

Predictors of radiation-induced skin reactions in patients with T-cell skin lymphomas after total skin irradiation: retrospective cohort study

INTRODUCTION: Skin reactions negatively affect a patient’s quality of life and may require radiation therapy premature interruption, what impairs illness control. Numerous agents determine tissue radiosensitivity, but demographic and lifestyle factors remain poorly understood. Those kind of patients herapeutic algorithm demands studies.OBJECTIVE: Radiation-induced skin reactions (RISR) formation and severity prognostic factors determination for primary malignant skin lymphomas patients.MATERIALS AND METHODS: 45 patients malignant T-cell skin lymphoma study, aged 38 to 82 years (29 mycosis fungoides patients, 2 lymphomatoid papulosis, 14 patients with primary anaplastic large cell skin lymphoma) received fast electrons total skin irradiation on the basis of the Federal State Institution «Russian Radiology and Surgical Technologies Scientific Center named after Academician A.M.Granov» of the Ministry of Health of the Russian Federation from 2012 to June 2022. Radiation therapy performed in the usual fractionation mode on linear electron accelerators Elekta Precise with 4–6 MeV bremsstrahlung total doses from 14 to 30 Gy (22±2.4 Gy). In order to identify the role of possible prognostic factors of skin toxicity — gender, age, body mass index (BMI), smoking status, lymphoma body surface area (BSA), the presence of concomitant diseases (diabetes mellitus and arterial hypertension) and previous chemotherapy.Statistics: Statistical analysis was performed using the IBM SPSS Statistics v. 26 program (developed by IBM Corporation). The value of p&lt;0.05 was considered statistically significant. Verification of the sample belonging to the normal general population was carried out using the Shapiro–Wilk criterion. Spearman's rank correlation coefficient was used for correlation analysis. The regression parameters were estimated using the least squares method.RESULTS: The analysis revealed positive associations between the severity of RISR and predictor factors: BMI (r=0.799, p&lt;0.01), smoking status (r=0.655, p&lt;0.01), age (r=0.534, p&lt;0.05), presence of diabetes mellitus (r=0.456, p&lt;0.05), arterial hypertension (r=0.227, p&lt;0.05), previous chemotherapy (r=0.422, p&lt;0.01) and lymphoma body surface area (r=0.378, p&lt;0.01). Severity of RISR scale value increase by those parameters. Negative links found between the severity of RISR and the total focal dose (SOD) of the beginning of their formation (r=–0.109, p&lt;0.05).CONCLUSION: Formation and severity prognostic factors for the RCC upon fast electrons total skin exposure for patients with primary malignant T-cell skin lymphomas (mycosis fungoides, lymphomatoid papulosis, primary anaplastic large cell lymphoma of the skin) were identified.