Use of a non-cross-linked porcine dermal scaffold in abdominal wall reconstruction.

Background: Reconstruction of complex abdominal wall defects is challenging. The use of prosthetic mesh can be associated with surgical site infection, fistula formation, and adhesions. This study presents our experience using a non-cross-linked porcine dermal scaffold (NCPDS) in abdominal wall reconstruction.

Evaluation of appearance transfer and persistence in central face transplantation: a computer simulation analysis.

Background: Partial facial allotransplantation is an emerging option in reconstruction of central facial defects, providing function and aesthetic appearance. Ethical debate partly stems from uncertainty surrounding identity aspects of the procedure. There is no objective evidence regarding the effect of donors' transplanted facial structures on appearance change of the recipients and its influence on facial recognition of donors and recipients.

A case report of generalized pustulosis with systemic manifestations requiring burn intensive care unit admission.

Not infrequently patients are transferred to a burn center with the diagnosis of toxic epidermal necrolysis (TEN). Not all cases of generalized erythema and skin sloughing represent TEN. Acute generalized pustular psoriasis (AGPP) of the von Zumbusch type and acute generalized exanthematic pustulosis (AGEP) are two rare skin diseases that can also present with widespread erythema and skin sloughing.

Facial transplantation and immunosuppressed patients: a new frontier in reconstructive surgery.

Composite tissue transplantation in reconstructing complex facial defects has developed tremendous interest over the recent years, since the first report of partial face transplantation performed in France in 2005. However, the controversy over the ethical, immunological, and psychological issues remains. Recently, we obtained IRB approval to perform partial face transplantation at Brigham & Women's Hospital, Boston.

Routine use of wound vacuum-assisted closure does not allow coverage delay for open tibia fractures.

Background: Prevention of infection is a paramount concern after open fracture of the tibia. Previous studies have shown that delay in soft-tissue coverage may raise infection rates. Use of vacuum-assisted closure devices in open fracture wounds has become common.

The role of free-tissue transfer for head and neck burn reconstruction.

Background: The reconstruction of head and neck burns is challenging, traditionally involving skin grafting and local flaps. Free flaps have improved in versatility and variability in recent years, and are now among the techniques used for burn reconstruction.

Methods: Thirty-six free flaps for 32 patients with cervicofacial burns were reviewed retrospectively over a 17-year period (1989 to 2005) to determine indications, methods, and outcomes.

Safety evaluation of topically applied amitriptyline in porcine full-thickness wounds.

Background And Objectives: The tricyclic antidepressant amitriptyline is frequently used in pain clinics for management of pain. It has also been suggested that topical application of amitriptyline could be useful for the treatment of neuropathic pain. In this report we investigated the effect of amitriptyline on porcine full thickness wounds resembling excised burn wounds.

Systemic and localized reversible regulation of transgene expression by tetracycline with tetR-mediated transcription repression switch.

Background: We recently developed a new tetracycline-inducible gene switch employing the tetracycline operator-containing hCMV major immediate-early promoter and the tetracycline repressor, tetR, rather than the previously used tetR-mammalian cell transcription factor fusion derivatives.

Materials And Methods: The present study demonstrates that this tetR-mediated transcription repression system can function as a powerful gene switch for On-and-Off regulation of therapeutic gene expression in ex vivo gene transfer protocols. Firstly, for achieving regulated gene expression in a localized tissue environment, R11/OEGF cells, a stable line that expresses hEGF under the control of the tetR-mediated transcription repression switch, were transplanted into porcine full-thickness wounds enclosed by wound chambers.

New trends in breast cancer management: is the era of immediate breast reconstruction changing?

Objective: Review of available literature on the topic of breast reconstruction and radiation is presented. Factors influencing the decision-making process in breast reconstruction are analyzed. New trends of immediate breast reconstruction are presented.

Predictors of survival and length of stay in burn patients older than 80 years of age: does age really matter?

Predictors of survival and length of stay (LOS) in the advanced elderly with burn injuries is not well studied. Because of progress in burn wound and critical care, we hypothesized that a contemporary analysis would show improved outcomes. Clinical data were collected on 45 consecutive patients older than 80 years of age that were treated for burn injury at our institution during the past 10 years.

Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience.

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%).

Cultured autologous fibroblasts augment epidermal repair.

Background: Autologous dermal fibroblasts may be useful in the treatment of skin wounds and for the enhancement of keratinocyte proliferation. This paper addressed the following questions: (1) can cultured fibroblasts (CF) be transplanted as suspensions to full-thickness skin wounds and do they influence wound healing; (2) will the transplanted CF be integrated into the new dermis; (3) can a transgene that encodes a secretable marker, human epidermal growth factor (hEGF), be expressed in the wound fluid by the transplanted CF; and (4) do CF cotransplanted with cultured keratinocytes (CK) influence the rate of wound healing?

Methods: Suspensions of CF were transplanted alone or together with CK to full-thickness wounds covered with liquid-containing chambers in an established porcine model.

Results: Transplantation of CF accelerated reepithelialization as determined from wound histologies and sequential measurements of protein efflux over the wound surface.

Autologous skin transplantation: comparison of minced skin to other techniques.

Background: Skin grafting may be necessary to close nonhealing skin wounds. This report describes a fast and minimally invasive method to produce minced skin suitable for transplantation to skin wounds. The technique was evaluated in an established porcine skin wound healing model and was compared to split-thickness skin grafts and suspensions of cultured and noncultured keratinocytes.

Autologous keratinocyte suspensions accelerate epidermal wound healing in pigs.

Background: Tissue culture techniques enable in vitro expansion of keratinocytes that can be used to treat burns and chronic wounds. These keratinocytes are commonly grafted onto the wounds as differentiated sheets of mature epithelium. Less is however known about the effects of transplanting the cells as suspensions.

Accelerated healing of full-thickness skin wounds in a wet environment.

Full-thickness skin wounds are preferably allowed to heal under controlled hydration dressings such as hydrocolloids. It was hypothesized that a wet (liquid) environment rather than a dry or moist one would accelerate the wound healing process. We compared skin repair by secondary intention in full-thickness skin wounds in wet (saline), moist (hydrocolloid), and dry (gauze) conditions in an established porcine wound healing model.

Dermatan sulfate activates nuclear factor-kappab and induces endothelial and circulating intercellular adhesion molecule-1.

Proteoglycans (PGs) can influence cell behaviors through binding events mediated by their glycosaminoglycan (GAG) chains. This report demonstrates that chondroitin sulfate B, also known as dermatan sulfate (DS), a major GAG released during the inflammatory phase of wound repair, directly activates cells at the physiologic concentrations of DS found in wounds. Cultured human dermal microvascular endothelial cells exposed to DS responded with rapid nuclear translocation of nuclear factor-kappaB (NF-kappaB), increased expression of intercellular adhesion molecule-1 (ICAM-1) mRNA, and increased ICAM-1 cell surface protein.

Dermatan sulfate released after injury is a potent promoter of fibroblast growth factor-2 function.

Proteoglycans have been shown in vitro to bind multiple components of the cellular microenvironment that function during wound healing. To study the composition and function of these molecules when derived from an in vivo source, soluble proteoglycans released into human wound fluid were characterized and evaluated for influence on fibroblast growth factor-2 activity. Immunoblot analysis of wound fluid revealed the presence of syndecan-1, syndecan-4, glypican, decorin, perlecan, and versican.

Tissue engineering of skin.

The skin plays a crucial role in protecting the integrity of the body's internal milieu. The loss of this largest organ is incompatible with sustained life. In reconstructive surgery or burn management, substitution of the skin is often necessary.