Subcutaneous Defect Research Articles

Exploratory Investigation of Zinc-Modified Borosilicate Bioactive Glass: A New Methodology for Its Biocompatibility, Immunoregulation, and Pro-Angiogenic Property Evaluation.

The assessment of biodegradable materials, such as bioactive glass, under the existing ISO 10993 standard test methods poses a significant challenge due to potential cell viability impairment caused by the accumulation of degraded products in a static environment. Therefore, innovative methodologies are urgently needed to tailor the unique biodegradation characteristics of these materials, providing more precise and scientific insights into biosafety and efficacy verification. Motivation by its bidirectional regulation of angiogenesis and immunity, zinc (Zn) was incorporated into sol-gel-derived borosilicate bioactive glasses (SBSGs) to fabricate Zn-incorporated borosilicate bioactive glasses (SBSG-Zn) to complement the tissue repair capabilities of bioactive glasses. Both SBSG and SBSG-Zn glasses consist of nanosized particles, slit mesoporous pores, high specific surface areas, and bioreactivity. In vitro comparative analysis, conducted according to ISO 10993 standards, demonstrates that only at suitable dilution rates─such as the 8-fold dilution employed in this study─do extracts of SBSG and SBSG-Zn glasses exhibit low cytotoxicity when cultured with human umbilical vein endothelial cells (HUVECs). Notably, SBSG-Zn glasses show optimal promotion of angiogenic gene expression in HUVECs. Furthermore, within an appropriate concentration range of released ions, SBSG-Zn glass extracts not only promote cell survival but also modulate the expression of anti-inflammatory genes while simultaneously inhibiting pro-inflammatory genes concurrently. After being implanted in rat subcutaneous defect models, both SBSG and SBSG-Zn glasses demonstrated the local immunoregulation and angiogenic effects. SBSG-Zn stands out by demonstrating superior modulation of M1/M2 polarization in macrophages as validated by altered secretion of key factors in macrophages and expression of relevant growth factors in HUVECs. These findings underscore the potential for convenient manipulation of localized angiogenic and immunoregulation through the incorporation of zinc into bioactive glass, emphasizing the importance of ensuring the appropriate ion doses are applied for achieving optimal therapeutic efficiency.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cellular direct conversion by cell penetrable OCT4-30Kc19 protein and BMP4 growth factor

BackgroundThe number of patients suffering from osteoporosis is increasing as the elderly population increases. The demand for investigating bone regeneration strategies naturally arises. One of the approaches to induce bone regeneration is somatic cell transdifferentiation. Among the transcriptional regulators for transdifferentiation, octamer-binding transcription factor 4 (OCT4) is famous for its role in the regulation of pluripotency of stem cells. Bone morphogenetic protein 4 (BMP4) is another factor that is known to have a significant role in osteogenic differentiation. Previous studies have achieved transdifferentiation of cells into osteoblasts using viral and plasmid deliveries of these factors. Although these methods are efficient, viral and plasmid transfection have safety issues such as permanent gene incorporations and bacterial DNA insertions. Herein, we developed a cell penetrating protein-based strategy to induce transdifferentiation of endothelial cells into osteoblasts via nuclear delivery of OCT4 recombinant protein combined with the BMP4 treatment. For the nuclear delivery of OCT4 protein, we fused the protein with 30Kc19, a cell-penetrating and protein stabilizing protein derived from a silkworm hemolymph of Bombyx mori with low cytotoxic properties. This study proposes a promising cell-based therapy without any safety issues that existing transdifferentiation approaches had.MethodsOCT4-30Kc19 protein with high penetrating activities and stability was synthesized for a protein-based osteogenic transdifferentiation system. Cells were treated with OCT4-30Kc19 and BMP4 to evaluate their cellular penetrating activity, cytotoxicity, osteogenic and angiogenic potentials in vitro. The osteogenic potential of 3D cell spheroids was also analyzed. In addition, in vivo cell delivery into subcutaneous tissue and cranial defect model was performed.ResultsOCT4-30Kc19 protein was produced in a soluble and stable form. OCT4-30Kc19 efficiently penetrated cells and were localized in intracellular compartments and the nucleus. Cells delivered with OCT4-30Kc19 protein combined with BMP4 showed increased osteogenesis, both in 2D and 3D culture, and showed increased angiogenesis capacity in vitro. Results from in vivo subcutaneous tissue delivery of cell-seeded scaffolds confirmed enhanced osteogenic properties of transdifferentiated HUVECs via treatment with both OCT4-30Kc19 and BMP4. In addition, in vivo mouse cranial defect experiment demonstrated successful bone regeneration of HUVECs pretreated with both OCT4-30Kc19 and BMP4.ConclusionsUsing a protein-based transdifferentiation method allows an alternative approach without utilizing any genetic modification strategies, thus providing a possibility for safer use of cell-based therapies in clinical applications.

Detection and identification of subcutaneous defects using ultrasonic waves in reflective test

Non-destructive ultrasonic evaluation is one of the methods used for inspection in mechanical engineering. This method has diverse applications in various fields, including industry and medicine. The main purpose of this research is to identify a subcutaneous defect with ultrasonic waves. This is done by sending ultrasonic waves into the skin tissue and receiving backward echoes, simulating them using a software, and calculating the time difference using the speed of sound. In this research, the behavior of longitudinal and transverse waves is investigated in collisions with a defect by describing the genesis and application history as well as the principles and definitions of ultrasonic waves. In the test, first, the method of identifying the subcutaneous defect is explained. Then, the dimensions and stiffness of the defect are determined by analyzing the information obtained from the location. Using the 3.5-MHz probe, the defect was detected at a distance of 1.8 mm, indicating a high level of reliability compared to the sonography imaging device. This was while the 10-MHz probe failed to detect the defect just near the skin surface. The results confirm the choice of this method as a suitable method for detecting the subcutaneous defect.

Determination of the lateral extent of the subcutaneous wound bed in canine cadavers after closure of skin defects to replicate tumor excision.

To determine the extent of subcutaneous involvement after primary closure of experimental skin defects. Experimental study. Eight large, mixed breed dog cadavers. Standardized, circular skin defects with diameters of 2, 4, 6, or 8 cm were created at the lateral thorax or abdomen by using a matrix to ensure even distribution, with eight defects of each diameter. The wound beds were covered in 60% barium sulfate paste prior to primary closure. Computed tomography and a dedicated viewing program were used to measure the distance from the edge of the subcutaneous defect to the incision at set intervals along the incision. The mean ± SD maximum lateral extension was 6.4 ± 1.9, 14.1 ± 4.9, 18.5 ± 6.9, and 26.0 ± 9.6 mm for 2-, 4-, 6-, and 8-cm defects, respectively. Extension >2 cm from the incision occurred in zero of eight, one of eight, five of eight, and six of eight defects after closure of 2-, 4-, 6-, and 8-cm defects, respectively. Extension >3 cm from the incision occurred in zero of eight, zero of eight, two of eight, and five of eight defects after closure of 2-, 4-, 6-, and 8-cm defects, respectively. The lateral extent of the subcutaneous wound bed extended past previously recommended revision margins of 2 to 3 cm in some defects measuring greater than 4 cm in diameter. Surgeons and radiation oncologists should consider the potential extent of the subcutaneous defect when planning revision therapy, especially after large resections.

Shape memory histocompatible and biodegradable sponges for subcutaneous defect filling and repair: greatly reducing surgical incision.

Reducing surgical incision for large area subcutaneous defect filling and repair is a great challenge in the biomedical field, especially for plastic surgery. In this study, a novel hydroxyethyl cellulose/soy protein isolate (HEC/SPI) composite sponge (EHSS) with a fluid responsive shape memory property was constructed, whose thickness could be controlled by hot-pressing conditions to reduce the required surgical incision greatly. Effects of the main factors such as pressure, temperature and hot-pressing cycles on the recovery degree of EHSS were investigated systematically. The structure and physical properties of the sponges were characterized by FTIR spectroscopy, XRD, SEM etc. The results showed that EHSS could be pressed into thin disks with much smaller thickness, and the thickness retention ratio and recovery ratio were affected by hot-pressing conditions such as pressure and temperature. Especially, EHSS could be hot-pressed into a dense thin disk (EHSS-PT-130) at 130 °C with the pressure of 30 MPa, which could quickly recover its original shape by soaking in hydrophilic fluids. EHSS-PT-130 also exhibited good hydrophilicity, cytocompatibility, histocompatibility and in vivo biodegradability. Compared with the original EHSS, in vivo shape memory EHSS-PT-130 required much smaller surgical incision to reach the same repair effect and no need of extra sterilization, showing potential application for subcutaneous defect filling and repair.

Contribution of INTRAMUSCULAR Autologous Adipose Tissue-Derived Stem Cell Injections to Treat Cutaneous Radiation Syndrome

Cutaneous radiation syndrome caused by high dose located irradiation is characterized by delayed symptoms, incomplete wound healing, and poor revascularization. Subcutaneous adipose tissue derived stromal/stem cells have been shown to improve skin repair in a minipig model of cutaneous radiation syndrome despite a subcutaneous defect being a consequence of radio-induced muscular fibrosis. Based on the pro-myogenic potential of stromal/stem cells, a new protocol combining subcutaneous and intramuscular injections was evaluated in a preliminary study. Six female minipigs were locally irradiated at the dose of 50 Gy using a Co source (0.6 Gy min) and randomly divided into two groups. Three animals received the vehicle (phosphate-buffer-saline solution) and three animals received three injections of 75 × 10 adipose tissue derived stromal/stem cells each time (day 25, 46, and 66 post-irradiation). Pigs were euthanized on day 76 post-irradiation before development of clinical skin symptoms. All minipigs exhibited a homogeneous skin evolution. Macroscopic observation of irradiated muscles showed prominent fibrosis and necrosis areas in controls as opposed to adipose tissue-derived stromal/stem cells injected animals. Moreover, muscle biopsy analysis highlighted a recruitment of myofibroblasts (Immune Reactive Score: p < 0.01), an interleukin 10 secretion and a muscle regeneration pathway activation after intramuscular injections of adipose tissue-derived stromal/stem cells (western-blot: respectively, 200-fold change difference and twofold higher in treated animals). Globally, these preliminary data suggest that intramuscular injections of adipose tissue-derived stromal/stem cells improve muscle regeneration in the cutaneous-radiation syndrome. Further work is ongoing to evaluate this therapeutic strategy on a larger animal number with a longer clinical follow-up.

Highly Porous β-TCP Block with Triple Pore Structure in Rat Subcutaneous Tissue and Sheep Iliac Critical Bone Defect

Bio-absorbable materials have been strongly needed in bone regenerative surgery. β-TCP ceramics have been widely used as bone tissue scaffold materials, due to their bio-compatibility and bio-degradation. The aims of this study are to estimate blood permeation into different porous β-TCP blocks (75% and 67% in porosity), and to evaluate the behaviors of the 75% porous β-TCP block in rat subcutaneous tissue and sheep iliac bone defect by histological observation and 3-dimensional (3D) imaging analysis by μ-CT. The 75% β-TCP block revealed better performance in blood permeation than the 67% β-TCP in a dish including 3ml of sheep blood at 2 and 10 minutes. Almost area of the 75% β-TCP block turned to red at 10 minutes. In rat subcutaneous tissue, the bulk region of the 75% β-TCP was stained with HE. TRAP-positive multinucleated giant cells appeared on the surface of bulk at 4 weeks. In sheep iliac bone defect (10×15×9 mm3) model, μ-CT showed bone ingrowth into almost pores of the 75% β-TCP block at 2 months, and the block was absorbed and replaced by new bone until 4 months. The block was reduced to one-third in horizontal length and from 10 mm to 4 mm in vertical length at 2 months by 3D images. Body fluid stained by HE was found in the bulk region. We believe the body fluid permeation inside the bulk of the 75% porous β-TCP should contribute to the initial cell adhesion, proliferation and differentiation, and its biodegradation. It was concluded that the super porous β-TCP block with hydrophilic property might be a biological scaffold, harmonized with bone remodeling.

The Oblique Rectus Abdominis Musculocutaneous Flap for Reconstruction after Resection of a Spermatic Cord Liposarcoma.

The Oblique Rectus Abdominis Musculocutaneous Flap for Reconstruction after Resection of a Spermatic Cord Liposarcoma.

Right Parasternal Cardiac Surgery after Radical Treatment of Left Breast Cancer

A 74-year-old woman required surgical treatment of severe aortic valve stenosis and two-vessel coronary artery disease consisted of a significant stenosis of the left anterior descending branch and right coronary ostium. She had previously undergone radical mastectomy and radiation therapy for left breast cancer. Severe dermal sclerosis and subcutaneous tissue defect at the chest midline, which would cause poor wound healing because of insufficient blood flow, precluded conventional median sternotomy and a left mini-thoracotomy. Therefore, we selected a hybrid treatment approach using a combination of surgery and percutaneous coronary intervention. We performed aortic valve replacement and coronary bypass grafting to the right coronary artery using a right parasternal approach followed by percutaneous coronary intervention of the left anterior descending artery on postoperative day 13. Wound healing was quite satisfactory

Treatment of Atypical Pyoderma Gangrenosum on the Face

Treatment of Atypical Pyoderma Gangrenosum on the Face

Abdominoplasty and thoraco-epigastric flaps for large anterior trunk defects after dermatofibrosarcoma protuberans wide resection: Two illustrative cases

INTRODUCTIONExcision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASEThe authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSIONThe local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSIONThe authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.

Effect of different stunning methods of pigs on subcutaneous veining defect and meat quality of raw ham

In the last 20 years, the incidence of veining defect on pigs raw hams has progressively risen, up to reach worrying levels. Excluding the research by Gallo et al. (1999) regarding the heritability, the literature does not report scientific data about the cause of this defect. This investigation is part of a larger research programme aimed at studying some of the causes which may determine the appearance and gravity of the problem (Russo et al., 2003)...

Lipostructure® pour restauration morphologique dans le syndrome de Parry-Romberg : à propos de 12 cas cliniques

Progressive hemifacial atrophy, widely referred to as Parry-Romberg syndrome, is rare pathologic process characterized by idiopathic, self-limited, unilateral atrophy of different anatomic layers of the face. Restoration of contour and symmetry is the main challenge in cases of Parry-Romberg syndrome. Several means are tested but with a few satisfactions. Through this work, the authors report their personal experience with lipofilling in surgical treatment of this affection where sociopsychological impacts cannot be underestimated. A retrospective study during one period being spread out over 4 years, undertaken on 12 patients presenting Parry-Romberg syndrome who profited from a lipofilling as described by S.R. Coleman "Lipostructure®". The average age of our patients was of 32 years old with a clear female prevalence. The right and left sides of the face was involved with equal frequency. The second territory of the trigeminal nerve was the most affected (75 % of cases). The moderate forms were found in 58,3 % of cases the results were collected after an average retreat 18 months. A subjective satisfaction was noted in 83 % of cases. Complications with type of pseudokystes and hypercorrection were observed in 16,4 % of cases. The lipofilling is a simple and reproducible process to established subcutaneous defect in hemifacial progressive atrophy. It constitutes for us a very good means in primary treatment of volumetric facial restoration in Parry-Romberg syndrome making it possible to obtain good results and to preserve some patients from hard surgery.

Externalized Ileocolic Anastomosis: Case Report

A 6-year-old, spayed female Labrador retriever was presented 48 hours after an intestinal resection and anastomosis for management of a small intestinal foreign body. Abdominal ultrasound confirmed the presence of peritoneal effusion. Cytology of fluid collected by abdominocentesis revealed a large number of degenerate neutrophils with intracellular cocci. A diagnosis of septic peritonitis was made, presumably because of dehiscence of the anastomosis. Upon repeat exploratory celiotomy, the intestinal anastomosis (located 4 cm orad to the cecum) was found to be leaking intestinal contents into the abdomen. The distal ileum, cecum, and proximal colon were resected. An end-to-end, ileocolic anastomosis was performed and subsequently exteriorized into the subcutaneous space via a paramedian incision through the abdominal wall. The anastomosis was inspected daily for 4 days before it was returned to the abdomen and the subcutaneous defect was closed. Serial cytology of the peritoneal fluid, which was performed during this 4-day postoperative period, confirmed progressive resolution of peritonitis. The dog was discharged from the hospital 2 days following return of the anastomosis into the abdomen. Externalized intestinal anastomosis is used with good success in human medicine for repair of colonic injuries. In this case, externalization of the anastomosis permitted healing of the intestinal anastomosis in an environment isolated from the detrimental effects created by septic peritonitis. In addition, direct visualization of the anastomosis allowed assessment of healing. To our knowledge, this procedure has not been previously reported in companion animals.

Primary Burkitt Lymphoma of the Chest Wall

Abstract Introduction Burkitt lymphoma (BL) originating in the skin and soft tissue is very rare. To our knowledge, this case of primary sporadic BL presenting as an isolated chest wall mass arising from the soft tissue in an adult may be the first report. Case Report A previously healthy 33-year-old Caucasian man presented with a 1-month history of a painful lump over the left breast that he initially noticed as a small “pimple-like” lesion in the area. After a week, the skin lesion became larger, erythematous, and painful. At a local hospital, he underwent an incision and drainage procedure for a presumed chest wall abscess. Several days after debridement, a similar lump recurred around the incised area, which rapidly grew in size. He also started experiencing fever and chills for which he was readmitted with a diagnosis of necrotizing chest wall infection. A second debridement with excisional biopsy of the chest wall revealed atypical lymphoid cells, prompting transfer to our institution. Upon transfer, a large, gaping, erythematous and indurated wound with indistinct, thickened borders and extensive edema and necrosis of subcutaneous tissue and musculature of almost the entire left chest wall was noted. No palpable peripheral lymphadenopathy or organomegaly were observed. He underwent minimal debridement and partial excision. The histopathology revealed atypical lymphocytes with prominent nucleoli, deeply basophilic cytoplasm, and abundant lipid vacuoles in a “starry-sky” pattern. The lymphoid population was CD-20 and CD-10 positive, negative for CD-5 and BCL-2, nearly 100% Ki-67 positive, and indeterminate for light chain restriction. Molecular cytogenetic analysis revealed fusion signals with IgH/Myc t(8;14) dual fusion probe, supporting the diagnosis of BL. Staging positron emission tomography (PET)/computed tomography (CT) scan showed a large subcutaneous defect of the left hemithorax involving the dermis, subcutaneous tissue, and musculature, measuring 19.3 × 13.9 × 31.0 cm, with maximal SUV of 9.8 and an average of 6.2. No additional involved sites were seen. The bone marrow biopsy showed minimal involvement by BL and abnormal hybridization pattern for IgH/Myc t(8;14) and Epstein-Barr virus, while the peripheral blood and cerebrospinal fluid showed no involvement. HIV and hepatitis serologies were negative. Three days after surgery, chemotherapy with granulocyte colony-stimulating factor (G-CSF) support was initiated for high-risk disease. He received CODOX-M (intravenous cyclophosphamide, doxorubicin, vincristine, methotrexate; intrathecal cytarabine, methotrexate) as cycle 1 followed by IVAC (intravenous ifosfamide, etoposide, cytarabine; intrathecal methotrexate) with rituximab as cycle 2. He developed tumor lysis without end-organ damage. However, a few days after completion of cycle 2, he developed neutropenic fever and pneumonia, and died in septic shock. Discussion Primary chest wall tumors are uncommon. Approximately 50% are malignant, and chest wall lymphoma accounts for Conclusion This case illustrates a primary sporadic BL originating in skin and soft tissue in an adult. Whether this case represents a BL that began in the skin and soft tissue and spread to the bone marrow, or began in the bone marrow and spread to the chest wall cannot be determined. The role of tumor debulking procedure is uncertain, although aggressive chemoimmunotherapy with central nervous system (CNS) prophylaxis is warranted as with other BL presentations.

Extensão máxima de retalho pediculado de omento maior através de túnel subcutâneo para ossos longos em cães

Há tempo sabe-se que o omento humano pode promover atividade angiogênica em estruturas adjacentes nas quais ele é aplicado. Na medicina veterinária, são poucas as pesquisas com retalho pediculado de omento maior como indutor angiogênico e imunogênico, porém suas propriedades de adesão e drenagem são bem conhecidas. Os objetivos deste estudo foram criar um retalho pediculado de omento maior, mensurar seu comprimento durante as etapas de criação e avaliar a possibilidade de alcance para ossos longos (fêmur, tíbia, úmero, rádio e ulna) através de túnel subcutâneo, visando a utilizá-lo futuramente como indutor angiogênico em focos de fratura, para aceleração da osteogênese e controle de infecções ósseas. Foram utilizados 30 cadáveres frescos de cães de todas as raças, com exceção dos condrodistróficos. Os resultados foram conclusivos e confirmaram a possibilidade de alcance do retalho de omento para ossos longos de cadáveres de cães em que todos os retalhos alcançaram a metáfise distal dos ossos avaliados. A média de comprimento do omento, em camada dupla, dos 30 animais avaliados foi de 30,87cm; da camada simples foi de 54,37cm e do retalho em L foi de 92,7cm. Com a extensão máxima do omento, foi possível alcançar as metáfises distais de todos os ossos propostos, com comprimento médio excedente de 29,87cm para fêmur, 20,73cm para tíbia/fíbula, 25,13cm para úmero e 16,27cm para rádio/ulna. As variáveis peso e retalho em L avaliadas estatisticamente de cada indivíduo apresentaram correlação positiva moderada. Concluiu-se que, em cadáveres de cães, é possível levar o retalho pediculado de omento maior através de túnel subcutâneo para metáfise distal de ossos longos e que, quanto maior o peso do animal, maior o comprimento do retalho em L.

A Case of Severe Moderate-temperature Facial Burn Due to a Heated Floor in a Japanese Sauna

We describe a case of severe facial burn caused by a heated floor. A 63-year-old man with a history of diabetes mellitus fell asleep on a heated floor in a Japanese sauna after drinking a large quantity of alcohol. He sustained a severe moderate-temperature burn of the nose, upper lip, left cheek, and left earlobe. After the patient's general condition had improved, the affected areas were debrided and reconstructed with flaps. The skin and subcutaneous defect of the upper lip were reconstructed with a submental artery perforator flap. The flap survived completely, and the aesthetic result was good because of a simultaneously reconstructed mustache. The pathogenesis of the moderate-temperature burn is explained by the temperature-time curve and is due mainly to a disorder of blood circulation and the individual's condition. We believe that the number of persons sustaining such burns in saunas will increase because of recent health trends in Japan. Therefore, the danger of such burns should be publicized.