Free muscle transfer with split thickness skin graft coverage in head and neck reconstructive surgery

NARCIS (Netherlands)

Bos, K. E.; Balm, A. J.; Schouwenburg, P. F.; Hilgers, F. J.; de Boer, J. B.

1991-01-01

Sixteen patients (eight females and eight males) who underwent microsurgical free tissue transfers for head and neck reconstruction are reviewed. In this series, the flap reconstruction was completed on eleven patients with extra-oral defects and five with intra-oral defects. Split thickness skin

Methylene Blue Dye-Induced Skin Necrosis in Immediate Breast Reconstruction: Evaluation and Management

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Ji Hwan Lee

2014-05-01

Full Text Available Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.

Tissue Expansion Using Hyaluronic Acid Filler for Single-Stage Ear Reconstruction: A Novel Concept for Difficult Areas.

Science.gov (United States)

Inbal, Amir; Lemelman, Benjamin T; Millet, Eran; Greensmith, Andrew

2017-10-16

Auricular reconstruction is one of the most challenging procedures in plastic surgery. An adequate skin envelope is essential for cartilage framework coverage, yet few good options exist without additional surgery. We propose a novel method for minimally invasive tissue expansion, using hyaluronic acid (HA) filler to allow for single-stage ear reconstruction. To introduce the novel concept of HA filler for tissue expansion in ear reconstruction, and as an alternative to traditional expansion techniques. Macrolane is a large particle HA gel developed for large volume restoration. Expansion of the non-hair-bearing mastoid skin was performed in our clinic weekly or every other week. Final expansion was completed one week prior to reconstructive surgery. Tissue from one patient's expanded pocket was sent for histological analysis. Ten patients underwent single-stage auricular reconstruction with preoperative expansion. Injection sessions ranged from 7 to 13 (mean, 9.7). Mean injected volume per session was 2.03 mL per patient, for an average total of 19.8 mL (range, 14.5-30 mL). There were no major complications. One minor complication required removal of exposed wire from the antihelix in the office. Hematoxylin and eosin stain revealed similar histology to that seen with traditional expanders. This novel expansion technique using serial HA injections allowed for optimized skin coverage in single-stage ear reconstruction. The concept of tissue expansion using HA filler is a new frontier for research that may be applicable to other arenas of reconstruction. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Fowble, Barbara, E-mail: BFowble@radonc.ucsf.edu [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Park, Catherine [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Wang, Frederick; Peled, Anne [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Alvarado, Michael; Ewing, Cheryl; Esserman, Laura [Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California (United States); Foster, Robert; Sbitany, Hani [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Hanlon, Alex [University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (United States)

2015-07-01

Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results: Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions: RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and

Development of a one-step approach for the reconstruction of full thickness skin defects using minced split thickness skin grafts and biodegradable synthetic scaffolds as a dermal substitute.

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Sharma, Kavita; Bullock, Anthony; Ralston, David; MacNeil, Sheila

2014-08-01

Tissue engineering has progressed in delivering laboratory-expanded keratinocytes to the clinic; however the production of a suitable alternative to a skin graft, containing both epidermis and dermis still remains a challenge. To develop a one-step approach to wound reconstruction using finely minced split thickness skin and a biodegradable synthetic dermal substitute. This was explored in vitro using scalpel diced pieces of split thickness human skin combined with synthetic electrospun polylactide (PLA) scaffolds. To aid the spreading of tissue, 1% methylcellulose was used and platelet releasate was examined for its effect on cellular outgrowth from tissue explants. The outcome parameters included the metabolic activity of the migrating cells and their ability to produce collagen. Cell presence and migration on the scaffolds were assessed using fluorescence microscopy and SEM. Cells were identified as keratinocytes by immunostaining for pan-cytokeratin. Collagen deposition was quantified by using Sirius red. Skin cells migrated along the fibers of the scaffold and formed new collagen. 1% methylcellulose improved the tissue handling properties of the minced skin. Platelet releasate did not stimulate the migration of skin cells along scaffold fibers. Immunohistochemistry and SEM confirmed the presence of both epithelial and stromal cells in the new tissue. We describe the first key steps in the production of a skin substitute to be assembled in theatre eliminating the need for cell culture. Whilst further experiments are needed to develop this technique it can be a useful addition to armamentarium of the reconstructive surgeon. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Breast reconstruction - natural tissue

Science.gov (United States)

... flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; DIEAP flap; Gluteal free flap; Transverse upper gracilis flap; TUG; Mastectomy - breast reconstruction with natural tissue; Breast cancer - breast reconstruction with natural tissue

A comparison of scaffold-free and scaffold-based reconstructed human skin models as alternatives to animal use.

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Kinikoglu, Beste

2017-12-01

Tissue engineered full-thickness human skin substitutes have various applications in the clinic and in the laboratory, such as in the treatment of burns or deep skin defects, and as reconstructed human skin models in the safety testing of drugs and cosmetics and in the fundamental study of skin biology and pathology. So far, different approaches have been proposed for the generation of reconstructed skin, each with its own advantages and disadvantages. Here, the classic tissue engineering approach, based on cell-seeded polymeric scaffolds, is compared with the less-studied cell self-assembly approach, where the cells are coaxed to synthesise their own extracellular matrix (ECM). The resulting full-thickness human skin substitutes were analysed by means of histological and immunohistochemical analyses. It was found that both the scaffold-free and the scaffold-based skin equivalents successfully mimicked the functionality and morphology of native skin, with complete epidermal differentiation (as determined by the expression of filaggrin), the presence of a continuous basement membrane expressing collagen VII, and new ECM deposition by dermal fibroblasts. On the other hand, the scaffold-free model had a thicker epidermis and a significantly higher number of Ki67-positive proliferative cells, indicating a higher capacity for self-renewal, as compared to the scaffold-based model. 2017 FRAME.

Tissue engineering for human urethral reconstruction: systematic review of recent literature.

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de Kemp, Vincent; de Graaf, Petra; Fledderus, Joost O; Ruud Bosch, J L H; de Kort, Laetitia M O

2015-01-01

Techniques to treat urethral stricture and hypospadias are restricted, as substitution of the unhealthy urethra with tissue from other origins (skin, bladder or buccal mucosa) has some limitations. Therefore, alternative sources of tissue for use in urethral reconstructions are considered, such as ex vivo engineered constructs. To review recent literature on tissue engineering for human urethral reconstruction. A search was made in the PubMed and Embase databases restricted to the last 25 years and the English language. A total of 45 articles were selected describing the use of tissue engineering in urethral reconstruction. The results are discussed in four groups: autologous cell cultures, matrices/scaffolds, cell-seeded scaffolds, and clinical results of urethral reconstructions using these materials. Different progenitor cells were used, isolated from either urine or adipose tissue, but slightly better results were obtained with in vitro expansion of urothelial cells from bladder washings, tissue biopsies from the bladder (urothelium) or the oral cavity (buccal mucosa). Compared with a synthetic scaffold, a biological scaffold has the advantage of bioactive extracellular matrix proteins on its surface. When applied clinically, a non-seeded matrix only seems suited for use as an onlay graft. When a tubularized substitution is the aim, a cell-seeded construct seems more beneficial. Considerable experience is available with tissue engineering of urethral tissue in vitro, produced with cells of different origin. Clinical and in vivo experiments show promising results.

A multidisciplinary protocol for planned skin-preserving delayed breast reconstruction for patients with locally advanced breast cancer requiring postmastectomy radiation therapy: 3-year follow-up.

Science.gov (United States)

Kronowitz, Steven J; Lam, Candace; Terefe, Welela; Hunt, Kelly K; Kuerer, Henry M; Valero, Vicente; Lance, Samuel; Robb, Geoffrey L; Feng, Lei; Buchholz, Thomas A

2011-06-01

The authors examined the safety of a protocol for planned skin-preserving delayed breast reconstruction after postmastectomy radiotherapy with placement of a tissue expander for patients with locally advanced breast cancer (stages IIB and III). The authors compared 47 patients treated according to the protocol between December 2003 and May 2008 with 47 disease-stage-matched control patients who underwent standard delayed reconstruction after postmastectomy radiotherapy (no skin preservation or tissue expander) during the same period. Protocol-group complication rates were 21 percent for skin-preserving mastectomy and placement of the expander (stage 1), 5 percent for postmastectomy radiotherapy, 25 percent for expander reinflation after radiotherapy, and 24 percent for skin-preserving delayed reconstruction. The complication rate for standard delayed reconstruction was 38 percent. Tissue-expander loss rates were 32 percent overall, 9 percent for stage 1, 5 percent for postmastectomy radiotherapy, and 22 percent for reinflation. Wound-healing complications after reconstruction occurred in 3 percent of protocol-group and 10 percent of control-group patients. The median follow-up time for patients still alive at last follow-up was 40 months (range, 8.5 to 85.3 months). Three-year recurrence-free survival rates were 92 percent (95 percent CI, 83 to 100 percent) and 86 percent (95 percent CI, 76 to 98 percent) for the protocol and control groups, respectively (p = 0.87). In patients with locally advanced breast cancer, skin-preserving mastectomy with a deflated tissue expander on the chest wall during postmastectomy radiotherapy does not increase locoregional recurrence risk and is associated with lower complication rates of definitive reconstruction.

Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

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Jessica F. Rose

2016-01-01

Full Text Available Background. While the benefits of using acellular dermal matrices (ADMs in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001 and seroma and prolonged JP drainage (p=0.0004; radiated reconstructed breasts were more likely to suffer infections (p=0.0085, and elevated BMI is a significant predictor for increased infection rate (p=0.0037. Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

Reconstruction of soft tissue defects around the ankle and foot

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Bharat Bhushan Dogra

2014-01-01

Full Text Available Introduction: Soft tissue defects over ankle and foot region are encountered quite frequently following road traffic trauma and surgery. Management of such cases is a challenging task for any reconstructive surgeon because of paucity of skin and relative poor vascular status of skin in this region. Hence, invariably such cases require microsurgical free flap coverage, expertise for which may not be available at all the centers, such procedures require long operating hours and suitable recipient vessel may not be available in crush injuries. Materials and Methods: Thirty consecutive patients having soft tissue defects around ankle and foot region who underwent various reconstructive procedures in a medical college hospital during last 2 years form the basis of this study. This study was carried out to enlist various etiological factors and reconstructive surgical procedures employed to manage such cases without microsurgery. Results: The age of these patients ranged from 9 to 72 years. Twenty-five patients were males while 05 were females, with a mean age of 25 years. Road traffic accidents happened to be the primary cause of such defects in as many as 15 patients, cycle spoke trauma in 02 patients, implant exposure following orthopedic surgery in 6 patients, diabetic angiopathy in 4 patients and chronic osteomyelitis in 3 patients. The site of the defect was lower fourth of tibia in 16 patients, dorsum of foot in 2 patients, sole in 5 patients, medial aspect of ankle in 02 cases, lateral aspect in 02 cases and retro calcaneal region in 03 cases. In 10 cases distally based superficial sural artery flap was used to reconstruct the defect. In step rotation flap was used to provide sensory flap cover in the weight bearing heel in 04 cases. Inferiorly based fasciocutanenous flaps in 09 cases and muscle flaps were used in 07 cases. Conclusion: Distally based sural artery based flaps are very handy to provide skin cover around ankle and malleolar

Xenobiotic metabolism in human skin and 3D human skin reconstructs: A review

NARCIS (Netherlands)

Gibbs, S.; Sandt, J.J.M. van de; Merk, H.F.; Lockley, D.J.; Pendlington, R.U.; Pease, C.K.

2007-01-01

In this review, we discuss and compare studies of xenobiotic metabolism in both human skin and 3D human skin reconstructs. In comparison to the liver, the skin is a less studied organ in terms of characterising metabolic capability. While the skin forms the major protective barrier to environmental

Biothermomechanical behavior of skin tissue

Institute of Scientific and Technical Information of China (English)

F.Xu; T.J.Lu; K.A.Seffen

2008-01-01

Advances in laser,microwave and similar tech nologies have led to recent developments of thermal treatments involving skin tissue.The effectiveness of these treatments is governed by the coupled thermal,mechanical,biological and neural responses of the affected tissue:a favorable interaction results in a procedure with relatively little pain and no lasting side effects.Currently,even though each behavioral facet is to a certain extent established and understood,none exists to date in the interdisciplinarv area.A highly interdisciplinary approach is required for studying the biothermomechanical behavior of skin,involving bioheat transfer.biomechanics and physiology.A comprehensive literature review penrtinent to the subject is presented in this paper,covering four subject areas:(a)skin structure,(b)skin bioheat transfer and thermal damage,(c)skin biomechanics,and(d)skin biothermomechanics.The major problems,issues,and topics for further studies are also outlined.This review finds that significant advances in each of these aspects have been achieved in recent years.Although focus is placed upon the biothermomechanical behavior of skin tissue,the fundamental concepts and methodologies reviewed in this paper may also be applicable for studying other soft tissues.

Utilization of reconstructed cultured human skin models as an alternative skin for permeation studies of chemical compounds

OpenAIRE

Kano, Satoshi; 藤堂, 浩明; 杉江, 謙一; 藤本, 英哲; 中田, 圭一; 徳留, 嘉寛; 橋本, フミ惠; 杉林, 堅次

2010-01-01

Two reconstructed human skin models, EpiskinSM and EpiDermTM, have been approved as alternative membranes for skin corrosive/irritation experiments due to their close correlation with animal skin. Such reconstructed human skin models were evaluated as alternative membranes for skin permeation experiments. Seven drugs with different lipophilicities and almost the same molecular weight were used as test penetrants. Relationships were investigated between permeability coefficients (P values) of ...

Immediate breast reconstruction using autologous skin graft associated with breast implant.

Science.gov (United States)

Dutra, A K; Andrade, W P; Carvalho, S M T; Makdissi, F B A; Yoshimatsu, E K; Domingues, M C; Maciel, M S

2012-02-01

Immediate breast reconstruction with skin graft is still little mentioned in the literature. Follow-up studies regarding the technique aspects are particularly scarce. The objective was to detail immediate breast reconstruction using autologous skin graft. Patients (n = 49) who underwent mastectomies and autologous immediate breast reconstruction with skin graft associated with a breast implant at A. C. Camargo Hospital (São Paulo, Brazil) between January 2007 and July 2010 were included. Information on clinical data, technique details and clinical outcome were prospectively collected. Following mastectomy, the autologous full-thickness skin graft was obtained through an inframammary fold incision along the contralateral breast in most patients. The skin graft was placed on the surface of the pectoralis major muscle after adjustments to conform to the mastectomy defect. A minimum of 10-month follow-up period was established. Patients' age ranged from 35 to 55 years and all received a silicone gel textured surface implant to obtain the necessary breast mound. The mean surgical time was 45 min, and the mean amount of skin resection was 4.5 cm in the largest diameter. Follow-up ranged from 10 to 35 months (median 23). All patients had silicone-gel textured surface implants to perform the breast mound reconstruction. No complications were observed in 87.8% of reconstructions. Forty-six patients (94%) had no complaints about the donor-site aesthetics. The result was a breast mound with a central ellipse of healed skin graft. Three (6%) poor results were observed. Thirty-six patients (67%) reported the results as good or very good. Our results lead us to conclude that autologous skin graft provided a reliable option in immediate breast reconstruction to skin-sparing mastectomy defects. The technique accomplished a single-stage implant breast reconstruction when there is inadequate skin coverage. Copyright © 2011 British Association of Plastic, Reconstructive and

Quantification of thermal damage in skin tissue

Institute of Scientific and Technical Information of China (English)

Xu Feng; Wen Ting; Lu Tianjian; Seffen Keith

2008-01-01

Skin thermal damage or skin burns are the most commonly encountered type of trauma in civilian and military communities. Besides, advances in laser, microwave and similar technologies have led to recent developments of thermal treatments for disease and damage involving skin tissue, where the objective is to induce thermal damage precisely within targeted tissue structures but without affecting the surrounding, healthy tissue. Further, extended pain sensation induced by thermal damage has also brought great problem for burn patients. Thus, it is of great importance to quantify the thermal damage in skin tissue. In this paper, the available models and experimental methods for quantification of thermal damage in skin tissue are discussed.

MicroRNAs in skin tissue engineering.

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Miller, Kyle J; Brown, David A; Ibrahim, Mohamed M; Ramchal, Talisha D; Levinson, Howard

2015-07-01

35.2 million annual cases in the U.S. require clinical intervention for major skin loss. To meet this demand, the field of skin tissue engineering has grown rapidly over the past 40 years. Traditionally, skin tissue engineering relies on the "cell-scaffold-signal" approach, whereby isolated cells are formulated into a three-dimensional substrate matrix, or scaffold, and exposed to the proper molecular, physical, and/or electrical signals to encourage growth and differentiation. However, clinically available bioengineered skin equivalents (BSEs) suffer from a number of drawbacks, including time required to generate autologous BSEs, poor allogeneic BSE survival, and physical limitations such as mass transfer issues. Additionally, different types of skin wounds require different BSE designs. MicroRNA has recently emerged as a new and exciting field of RNA interference that can overcome the barriers of BSE design. MicroRNA can regulate cellular behavior, change the bioactive milieu of the skin, and be delivered to skin tissue in a number of ways. While it is still in its infancy, the use of microRNAs in skin tissue engineering offers the opportunity to both enhance and expand a field for which there is still a vast unmet clinical need. Here we give a review of skin tissue engineering, focusing on the important cellular processes, bioactive mediators, and scaffolds. We further discuss potential microRNA targets for each individual component, and we conclude with possible future applications. Copyright © 2015 Elsevier B.V. All rights reserved.

Salient points in reconstruction of nasal skin after tumor ablation with local flaps

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Ali Ebrahimi

2016-01-01

Full Text Available Objective: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation. Patients and Methods : From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected. Results: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications. Conclusion: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate.

Fabrication of Chitin/Poly(butylene succinate/Chondroitin Sulfate Nanoparticles Ternary Composite Hydrogel Scaffold for Skin Tissue Engineering

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S. Deepthi

2014-12-01

Full Text Available Skin loss is one of the oldest and still not totally resolved problems in the medical field. Since spontaneous healing of the dermal defects would not occur, the regeneration of full thickness of skin requires skin substitutes. Tissue engineering constructs would provide a three dimensional matrix for the reconstruction of skin tissue and the repair of damage. The aim of the present work is to develop a chitin based scaffold, by blending it with poly(butylene succinate (PBS, an aliphatic, biodegradable and biocompatible synthetic polymer with excellent mechanical properties. The presence of chondroitin sulfate nanoparticles (CSnp in the scaffold would favor cell adhesion. A chitin/PBS/CSnp composite hydrogel scaffold was developed and characterized by SEM (Scanning Electron Microscope, FTIR (Fourier Transform Infrared Spectroscopy, and swelling ratio of scaffolds were analyzed. The scaffolds were evaluated for the suitability for skin tissue engineering application by cytotoxicity, cell attachment, and cell proliferation studies using human dermal fibroblasts (HDF. The cytotoxicity and cell proliferation studies using HDF confirm the suitability of the scaffold for skin regeneration. In short, these results show promising applicability of the developed chitin/PBS/CSnps ternary composite hydrogel scaffolds for skin tissue regeneration.

[Reconstruction of ankle and foot with combination of free perforator flaps and skin graft].

Science.gov (United States)

Yin, Lu; Gong, Ketong; Yin, Zhonggang; Zhang, Bo; Xu, Jianhua

2017-03-01

To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

An External Wire Frame Fixation Method of Skin Grafting for Burn Reconstruction.

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Yoshino, Yukiko; Ueda, Hyakuzoh; Ono, Simpei; Ogawa, Rei

2017-06-28

The skin graft is a prevalent reconstructive method for burn injuries. We have been applying external wire frame fixation methods in combination with skin grafts since 1986 and have experienced better outcomes in percentage of successful graft take. The overall purpose of this method was to further secure skin graft adherence to wound beds in hard to stabilize areas. There are also location-specific benefits to this technique such as eliminating the need of tarsorrhaphy in periorbital area, allowing immediate food intake after surgery in perioral area, and performing less invasive fixing methods in digits, and so on. The purpose of this study was to clarify its benefits and applicable locations. We reviewed 22 postburn patients with skin graft reconstructions using the external wire frame method at our institution from December 2012 through September 2016. Details of the surgical technique and individual reports are also discussed. Of the 22 cases, 15 (68%) were split-thickness skin grafts and 7 (32%) were full-thickness skin grafts. Five cases (23%) involved periorbital reconstruction, 5 (23%) involved perioral reconstruction, 2 (9%) involved lower limb reconstruction, and 10 (45%) involved digital reconstruction. Complete (100%) survival of the skin graft was attained in all cases. No signs of complication were observed. With 30 years of experiences all combined, we have summarized fail-proof recommendations to a successful graft survival with an emphasis on the locations of its application.

Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction

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Wojciech Dec, MD

2017-08-01

Conclusions:. Optimal aesthetic results can be achieved with: (1 restoration of breast skin envelope with tissue expansion when possible, (2 optimal positioning of a small skin paddle to be later incorporated entirely into a nipple areola reconstruction when adequate breast skin surface area is present, (3 limiting the reconstructed breast mound to 2 skin tones when large area skin resurfacing is required, (4 increasing breast volume by deepithelializing, not discarding, the inferior mastectomy flap skin, (5 eccentric division of abdominal flaps when an immediate and delayed bilateral breast reconstructions are performed simultaneously; and (6 performing second-stage breast reconstruction revisions and fat grafting.

Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR for early breast cancer: Eight years single institution experience

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Bobin Jean

2008-04-01

Full Text Available Abstract Background Skin Sparing Mastectomy (SSM and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. Methods Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. Results Mean age of the patients was 51.6(range 33–72 years. The AJCC pathologic stages were 0 (n = 51, 53.7%, I (n = 20, 21.1%, and II (n = 2, 2.1%. Twenty of the patients had recurrent disease (21.1%. The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3% patients and transverse rectus abdominis myocutaneous (TRAM flap in 4 (4.2% patients. Implants were used in 28 (29.4% patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4% patients resulting in four (6% re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144, local recurrence was seen in one patient (1.1% and systemic recurrence was seen in two patients (2.1%. Conclusion Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.

Quantification of thermal damage in skin tissue

Institute of Scientific and Technical Information of China (English)

徐峰; 文婷; 卢天健; Seffen; Keith

2008-01-01

Skin thermal damage or skin burns are the most commonly encountered type of trauma in civilian and military communities. Besides, advances in laser, microwave and similar technologies have led to recent developments of thermal treatments for disease and damage involving skin tissue, where the objective is to induce thermal damage precisely within targeted tissue structures but without affecting the surrounding, healthy tissue. Further, extended pain sensation induced by thermal damage has also brought great...

RIB FRACTURE AFTER BREAST RECONSTRUCTION WITH TISSUE EXPANDER

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Uroš Ahčan

2009-08-01

Full Text Available Breast reconstruction with tissue expansion and later exchange with prosthesis is one of the most common methods for breast reconstruction. Women that are not appropriate for reconstruction with autologous tissue, women that have small breast or have a positive family history for breast cancer are most suitable for this type of reconstruction. Surgical technique of tissue expansion is relatively easy. Complications are rarely seen. With this case report we want to show the common, although occult existence of skeletal deformities in thorax after breast tissue expansion that may lead to rib fractures.

Postoperative irradiation after reconstructive surgery: comparative study of radiosensitivity between free-skin grafts and skin flaps

International Nuclear Information System (INIS)

Sumi, Y.; Ueda, M.; Kaneda, T.; Oka, T.; Torii, S.; Sakuma, S.

1984-01-01

Radiation effects after reconstructive surgery (free-skin grafts and skin flaps) were studied in the rat, and the optimum time for irradiation was determined. The radiosensitivity of both free-skin grafts and skin flaps showed the same trend depending on time of irradiation after operation. The grafts or flaps irradiated in the hypervascular stage showed severe reactions to irradiation, whereas those irradiated in the hypovascular stage showed milder reactions in gross and microangiographic observation. Vascular damage should be given primary consideration when deciding the proper time for irradiation after reconstructive surgery. In general, free-skin grafts showed more severe reactions than skin flaps, especially in the grafts irradiated in the early stage after operation. The experimental results of this study cannot be readily transferred to a clinical setting, but they suggest that postoperative irradiation could be begun 3 to 4 weeks after operation with respect to graft or flap survival, and the results of the clinical cases almost coincide with these experimental results

Terahertz pulse imaging in reflection geometry of human skin cancer and skin tissue

International Nuclear Information System (INIS)

Woodward, Ruth M; Cole, Bryan E; Wallace, Vincent P; Pye, Richard J; Arnone, Donald D; Linfield, Edmund H; Pepper, Michael

2002-01-01

We demonstrate the application of terahertz pulse imaging (TPI) in reflection geometry for the study of skin tissue and related cancers both in vitro and in vivo. The sensitivity of terahertz radiation to polar molecules, such as water, makes TPI suitable for studying the hydration levels in the skin and the determination of the lateral spread of skin cancer pre-operatively. By studying the terahertz pulse shape in the time domain we have been able to differentiate between diseased and normal tissue for the study of basal cell carcinoma (BCC). Basal cell carcinoma has shown a positive terahertz contrast, and inflammation and scar tissue a negative terahertz contrast compared to normal tissue. In vivo measurements on the stratum corneum have enabled visualization of the stratum corneum-epidermis interface and the study of skin hydration levels. These results demonstrate the potential of terahertz pulse imaging for the study of skin tissue and its related disorders, both in vitro and in vivo

Segmented phantoms reconstruction for skin dosimetry

International Nuclear Information System (INIS)

Antunes, Paula C.G.; Siqueira, Paulo T.D.; Yoriyaz, Helio; Fonseca, Gabriel P.; Furnari, Laura; Reis, Gabriela S.

2009-01-01

There are several radio-sensitive skin diseases. Skin dosimetry is a difficult task to be properly performed, not only due to skin extension and small thickness, but also because it is usually submitted to high dose gradients. High-resolution medical images along with methods that simulate the interaction of radiation with matter, as the Monte Carlo radiation transport codes, have been widely used in medical physics procedures. These images provide the construction of realistic computational anatomical models, which after being coupled to these codes, retrieve reliable dosimetric assessments. However, present day regular images are unsuitable to correctly perform skin dose distribution evaluations. This inability is due to improper skin discrimination in most of current medical images, once its thickness stands below image resolution, i.e. pixel characteristic sizes are larger than skin thickness. This paper proposes a methodology of voxelized phantom reconstruction and segmentation, by subdividing their basic elements - voxels. It is done in order to better discriminate the skin by assigning more adequate value for skin thickness and its actual localization. Aiming at a more realistic skin modeling one is expected to get more accurate skin dose evaluations. This task is an important issue in many radiotherapy procedures. A particular interest lays in Total Skin Electron Therapy (TSET), which highlights the treatment of the whole body irradiation, a radiotherapy procedure under implementation in the Hospital das Clinicas da Universidade de Sao Paulo (HC-USP). (author)

Aesthetically and functionally satisfying reconstruction of an Achilles tendon and overlying skin defect in a 15 year old girl: a case report.

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Wurzer, Paul; Eberl, Robert; Kamolz, Lars-Peter; Parvizi, Daryousch; Rappl, Thomas; Spendel, Stephan

2015-03-01

Achilles tendon and overlying soft tissue reconstruction presents an interdisciplinary challenge. In the literature many possible procedures are described, but each reconstruction in this region has its specific demands. Single stage reconstruction is normally pursued, but it is not always the best procedure for the patient, either aesthetically or functionally. We present a case of a 15 year old girl who suffered a soft tissue defect of 10cm×6cm in size at the area of the Achilles tendon due to a contact burn by an exhaust pipe during a motorcycle accident. For this case, reconstruction of the soft tissue defect using a free temporoparietal fascial flap (TPFF) and a full-thickness skin autograft was the best means to provide a satisfying result for both the patient and the surgeon. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Prestrain-induced Reduction in Skin Tissue Puncture Force of Microneedle

International Nuclear Information System (INIS)

Kim, Jonghun; Park, Sungmin; Nam, Gyungmok; Yoon, Sang-Hee

2016-01-01

Despite all the recent advances in biodegradable material-based microneedles, the bending and failure (especially buckling) of a biodegradable microneedle during skin tissue insertion remains a major technical hurdle for its large-scale commercialization. A reduction in skin tissue puncture force during microneedle insertion remains an essential issue in successfully developing a biodegradable microneedle. Here, we consider uniaxial and equibiaxial prestrains applied to a skin tissue as mechanophysical stimuli that can reduce the skin tissue puncture force, and investigate the effect of prestrain on the changes in skin tissue puncture force. For a porcine skin tissue similar to that of humans, the skin tissue puncture force of a flat-end microneedle is measured with a z-axis stage equipped with a load cell, which provides a force-time curve during microneedle insertion. The findings of this study lead to a quantitative characterization of the relationship between prestrain and the skin tissue puncture force

Prestrain-induced Reduction in Skin Tissue Puncture Force of Microneedle

Energy Technology Data Exchange (ETDEWEB)

Kim, Jonghun; Park, Sungmin; Nam, Gyungmok; Yoon, Sang-Hee [Inha Univ., Incheon (Korea, Republic of)

2016-10-15

Despite all the recent advances in biodegradable material-based microneedles, the bending and failure (especially buckling) of a biodegradable microneedle during skin tissue insertion remains a major technical hurdle for its large-scale commercialization. A reduction in skin tissue puncture force during microneedle insertion remains an essential issue in successfully developing a biodegradable microneedle. Here, we consider uniaxial and equibiaxial prestrains applied to a skin tissue as mechanophysical stimuli that can reduce the skin tissue puncture force, and investigate the effect of prestrain on the changes in skin tissue puncture force. For a porcine skin tissue similar to that of humans, the skin tissue puncture force of a flat-end microneedle is measured with a z-axis stage equipped with a load cell, which provides a force-time curve during microneedle insertion. The findings of this study lead to a quantitative characterization of the relationship between prestrain and the skin tissue puncture force.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

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Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

2018-03-01

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

[Necrotizing fasciitis of the hand and forearm : Acute surgical treatment and defect reconstruction with MatriDerm® and split-thickness skin graft].

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Niedermueller, B; Singer, G; Pickl, P; Jesacher, M

2018-03-01

This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.

Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

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Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

2015-08-01

Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

Mechanical Stretching Promotes Skin Tissue Regeneration via Enhancing Mesenchymal Stem Cell Homing and Transdifferentiation.

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Liang, Xiao; Huang, Xiaolu; Zhou, Yiwen; Jin, Rui; Li, Qingfeng

2016-07-01

Skin tissue expansion is a clinical procedure for skin regeneration to reconstruct cutaneous defects that can be accompanied by severe complications. The transplantation of mesenchymal stem cells (MSCs) has been proven effective in promoting skin expansion and helping to ameliorate complications; however, systematic understanding of its mechanism remains unclear. MSCs from luciferase-Tg Lewis rats were intravenously transplanted into a rat tissue expansion model to identify homing and transdifferentiation. To clarify underlying mechanisms, a systematic approach was used to identify the differentially expressed genes between mechanically stretched human MSCs and controls. The biological significance of these changes was analyzed through bioinformatic methods. We further investigated genes and pathways of interest to disclose their potential role in mechanical stretching-induced skin regeneration. Cross sections of skin samples from the expanded group showed significantly more luciferase(+) and stromal cell-derived factor 1α (SDF-1α)(+), luciferase(+)keratin 14(+), and luciferase(+)CD31(+) cells than the control group, indicating MSC transdifferentiation into epidermal basal cells and endothelial cells after SDF-1α-mediated homing. Microarray analysis suggested upregulation of genes related to hypoxia, vascularization, and cell proliferation in the stretched human MSCs. Further investigation showed that the homing of MSCs was blocked by short interfering RNA targeted against matrix metalloproteinase 2, and that mechanical stretching-induced vascular endothelial growth factor A upregulation was related to the Janus kinase/signal transducer and activator of transcription (Jak-STAT) and Wnt signaling pathways. This study determines that mechanical stretching might promote skin regeneration by upregulating MSC expression of genes related to hypoxia, vascularization, and cell proliferation; enhancing transplanted MSC homing to the expanded skin; and

Human reconstructed skin xenografts on mice to model skin physiology.

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Salgado, Giorgiana; Ng, Yi Zhen; Koh, Li Fang; Goh, Christabelle S M; Common, John E

Xenograft models to study skin physiology have been popular for scientific use since the 1970s, with various developments and improvements to the techniques over the decades. Xenograft models are particularly useful and sought after due to the lack of clinically relevant animal models in predicting drug effectiveness in humans. Such predictions could in turn boost the process of drug discovery, since novel drug compounds have an estimated 8% chance of FDA approval despite years of rigorous preclinical testing and evaluation, albeit mostly in non-human models. In the case of skin research, the mouse persists as the most popular animal model of choice, despite its well-known anatomical differences with human skin. Differences in skin biology are especially evident when trying to dissect more complex skin conditions, such as psoriasis and eczema, where interactions between the immune system, epidermis and the environment likely occur. While the use of animal models are still considered the gold standard for systemic toxicity studies under controlled environments, there are now alternative models that have been approved for certain applications. To overcome the biological limitations of the mouse model, research efforts have also focused on "humanizing" the mice model to better recapitulate human skin physiology. In this review, we outline the different approaches undertaken thus far to study skin biology using human tissue xenografts in mice and the technical challenges involved. We also describe more recent developments to generate humanized multi-tissue compartment mice that carry both a functioning human immune system and skin xenografts. Such composite animal models provide promising opportunities to study drugs, disease and differentiation with greater clinical relevance. Copyright © 2017 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

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Jae Young Cho

2012-03-01

Full Text Available BackgroundAn area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion.MethodsFrom January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling.ResultsThe mean age of patients was 49.9±12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6±36.7 cm2. The mean expansion duration was 65.5±5.6 days, and the inflation volume was an average of 615±197.6 mL. Mean defect size was 122.2±34.9 cm2. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision.ConclusionsSuccessful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

A Comparison of the Local Flap and Skin Graft by Location of Face in Reconstruction after Resection of Facial Skin Cancer.

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Lee, Kyung Suk; Kim, Jun Oh; Kim, Nam Gyun; Lee, Yoon Jung; Park, Young Ji; Kim, Jun Sik

2017-12-01

Surgery for reconstruction of defects after surgery should be performed selectively and the many points must be considered. The authors conducted this study to compare the local flap and skin graft by facial location in the reconstruction after resection of facial skin cancer. The authors performed the study in patients that had received treatment in Department of Plastic Surgery, Gyeongsang National University. The cases were analyzed according to the reconstruction methods for the defects after surgery, sex, age, tumor site, and tumor size. Additionally, the authors compared differences of aesthetic satisfaction (out of 5 points) of patients in the local flap and skin graft by facial location after resection of facial skin cancer by dividing the face into eight areas. A total of 153 cases were confirmed. The most common facial skin cancer was basal cell carcinoma (56.8%, 87 cases), followed by squamous cell carcinoma (37.2%, 57 cases) and bowen's disease (5.8%, 9 cases). The most common reconstruction method was local flap 119 cases (77.7%), followed by skin graft 34 cases (22.3%). 86 patients answered the questionnaire and mean satisfaction of the local flap and skin graft were 4.3 and 3.5 ( p =0.04), respectively, indicating that satisfaction of local flap was significantly high. When comparing satisfaction of patients according to results, local flap shows excellent effects in functional and cosmetic aspects would be able to provide excellent results rather than using a skin graft with poor touch and tone compared to the surrounding normal skin.

Skin sparing mastectomy: Technique and suggested methods of reconstruction

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Ahmed M. Farahat

2014-09-01

Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. Our patients can benefit from safe surgery and have good cosmetic outcomeby applying different reconstructive techniques.

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up

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Enver Özkurt1

2018-02-01

Full Text Available Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. Study Design: Retrospective cohort. Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. Results: The median follow-up was 64 (31-114 months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72% and 16 were nipple-areola sparing mastectomy (28%. Immediate breast reconstruction surgery included tissue expander (n=46, 81% or implant (n=11, 19% placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%, luminal B (n=16, 34%, non-luminal HER2 (n=5, 10.6, triple negative breast cancer (n=3, 6.4%. The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028. Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm with a 5-year locoregional recurrence free survival of 100%. Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most

The prediction of blood-tissue partitions, water-skin partitions and skin permeation for agrochemicals.

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Abraham, Michael H; Gola, Joelle M R; Ibrahim, Adam; Acree, William E; Liu, Xiangli

2014-07-01

There is considerable interest in the blood-tissue distribution of agrochemicals, and a number of researchers have developed experimental methods for in vitro distribution. These methods involve the determination of saline-blood and saline-tissue partitions; not only are they indirect, but they do not yield the required in vivo distribution. The authors set out equations for gas-tissue and blood-tissue distribution, for partition from water into skin and for permeation from water through human skin. Together with Abraham descriptors for the agrochemicals, these equations can be used to predict values for all of these processes. The present predictions compare favourably with experimental in vivo blood-tissue distribution where available. The predictions require no more than simple arithmetic. The present method represents a much easier and much more economic way of estimating blood-tissue partitions than the method that uses saline-blood and saline-tissue partitions. It has the added advantages of yielding the required in vivo partitions and being easily extended to the prediction of partition of agrochemicals from water into skin and permeation from water through skin. © 2013 Society of Chemical Industry.

UK-based prospective cohort study to anglicise and validate the FACE-Q Skin Cancer Module in patients with facial skin cancer undergoing surgical reconstruction: the PROMISCR (Patient-Reported Outcome Measure in Skin Cancer Reconstruction) study.

Science.gov (United States)

Dobbs, Thomas; Hutchings, Hayley A; Whitaker, Iain S

2017-09-24

Skin cancer is the most common malignancy worldwide, often occurring on the face, where the cosmetic outcome of treatment is paramount. A number of skin cancer-specific patient-reported outcome measures (PROMs) exist, however none adequately consider the difference in type of reconstruction from a patient's point of view. It is the aim of this study to 'anglicise' (to UK English) a recently developed US PROM for facial skin cancer (the FACE-Q Skin Cancer Module) and to validate this UK version of the PROM. The validation will also involve an assessment of the items for relevance to facial reconstruction patients. This will either validate this new measure for the use in clinical care and research of various facial reconstructive options, or provide evidence that a more specific PROM is required. This is a prospective validation study of the FACE-Q Skin Cancer Module in a UK facial skin cancer population with a specific focus on the difference between types of reconstruction. The face and content validity of the FACE-Q questionnaire will initially be assessed by a review process involving patients, skin cancer specialists and methodologists. An assessment of whether questions are relevant and any missing questions will be made. Initial validation will then be carried out by recruiting a cohort of 100 study participants with skin cancer of the face pre-operatively. All eligible patients will be invited to complete the questionnaire preoperatively and postoperatively. Psychometric analysis will be performed to test validity, reliability and responsiveness to change. Subgroup analysis will be performed on patients undergoing different forms of reconstruction postexcision of their skin cancer. This study has been approved by the West Midlands, Edgbaston Research Ethics Committee (Ref 16/WM/0445). All personal data collected will be anonymised and patient-specific data will only be reported in terms of group demographics. Identifiable data collected will include the

An Algorithmic Approach for the Reconstruction of Nasal Skin Defects: Retrospective Analysis of 130 Cases

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Berrak Akşam

2016-06-01

Full Text Available Objective: Most of the malignant cutaneous carcinomas are seen in the nasal region. Reconstruction of nasal defects is challenging because of the unique anatomic properties and complex structure of this region. In this study, we present our algorithm for the nasal skin defects that occurred after malignant skin tumor excisions. Material and Methods: Patients whose nasal skin was reconstructed after malignant skin tumor excision were included in the study. These patients were evaluated by their age, gender, comorbities, tumor location, tumor size, reconstruction type, histopathological diagnosis, and tumor recurrence. Results: A total of 130 patients (70 female, 60 male were evaluated. The average age of the patients was 67.8 years. Tumors were located mostly at the dorsum, alar region, and tip of the nose. When reconstruction methods were evaluated, primary closure was preferred in 14.6% patients, full thickness skin grafts were used in 25.3% patients, and reconstruction with flaps were the choice in 60% patients. Different flaps were used according to the subunits. Mostly, dorsal nasal flaps, bilobed flaps, nasolabial flaps, and forehead flaps were used. Conclusion: The defect-only reconstruction principle was accepted in this study. Previously described subunits, such as the dorsum, tip, alar region, lateral wall, columella, and soft triangles, of the nose were further divided into subregions by their anatomical relations. An algorithm was planned with these sub regions. In nasal skin reconstruction, this algorithm helps in selection the methods for the best results and minimize the complications.

Use of autologous tissue engineered skin to treat porcine full-thickness skin defects

Institute of Scientific and Technical Information of China (English)

CAI Xia; CAO Yi-lin; CUI Lei; LIU Wei; GUAN Wen-xiang

2005-01-01

Objective: To explore a feasible method to repair full-thickness skin defects utilizing tissue engineered techniques. Methods: The Changfeng hybrid swines were used and the skin specimens were cut from the posterior limb girdle region, from which the keratinocytes and fibroblasts were isolated and harvested by trypsin, EDTA, and type II collagenase. The cells were seeded in Petri dishes for primary culture. When the cells were in logarithmic growth phase, they were treated with trypsin to separate them from the floor of the tissue culture dishes. A biodegradable material, Pluronic F-127, was prefabricated and mixed with these cells, and then the cell-Pluronic compounds were seeded evenly into a polyglycolic acid (PGA). Then the constructs were replanted to the autologous animals to repair the full-thickness skin defects. Histology and immunohistochemistry of the neotissue were observed in 1, 2, 4, and 8 postoperative weeks. Results: The cell-Pluronic F-127-PGA compounds repaired autologous full-thickness skin defects 1 week after implantation. Histologically, the tissue engineered skin was similar to the normal skin with stratified epidermis overlying a moderately thick collageneous dermis. Three of the structural proteins in the epidermal basement membrane zone, type IV collagen, laminin, and type VII collagen were detected using immunohistochemical methods. Conclusions: By studying the histology and immunohistochemistry of the neotissue, the bioengineered skin graft holds great promise for improving healing of the skin defects.

Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser.

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Ebrahimi, Ali; Kazemi, Hossein Mohammad; Nejadsarvari, Nasrin

2014-08-01

Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation. The aim of this study was to present our experience in management of facial soft tissue injuries from different causes. We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively. In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases. Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.

Reconstruction of Nasal Skin Cancer Defects with Local Flaps

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A. C. Salgarelli

2011-01-01

Full Text Available Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

Reconstruction of Nasal Skin Cancer Defects with Local Flaps

International Nuclear Information System (INIS)

Salgarelli, A. C.; Bellini, P.; Multinu, A.; Consolo, U.; Magnoni, C.; Francomano, M.; Fantini, F.; Seidenari, S.

2011-01-01

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

Fabrication and characterization of scaffold from cadaver goat-lung tissue for skin tissue engineering applications

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Gupta, Sweta K. [Department of Polymer and Process Engineering, Indian Institute of Technology, Roorkee (India); Dinda, Amit K. [Department of Pathology, All India Institute of Medical Sciences, New Delhi (India); Potdar, Pravin D. [Department of Molecular Medicine, Jaslok Hospital and Research Centre, Mumbai (India); Mishra, Narayan C., E-mail: mishrawise@gmail.com [Department of Polymer and Process Engineering, Indian Institute of Technology, Roorkee (India)

2013-10-15

The present study aims to fabricate scaffold from cadaver goat-lung tissue and evaluate it for skin tissue engineering applications. Decellularized goat-lung scaffold was fabricated by removing cells from cadaver goat-lung tissue enzymatically, to have cell-free 3D-architecture of natural extracellular matrix. DNA quantification assay and Hematoxylin and eosin staining confirmed the absence of cellular material in the decellularized lung-tissue. SEM analysis of decellularized scaffold shows the intrinsic porous structure of lung tissue with well-preserved pore-to-pore interconnectivity. FTIR analysis confirmed non-denaturation and well maintainance of collagenous protein structure of decellularized scaffold. MTT assay, SEM analysis and H and E staining of human skin-derived Mesenchymal Stem cell, seeded over the decellularized scaffold, confirms stem cell attachment, viability, biocompatibility and proliferation over the decellularized scaffold. Expression of Keratin18 gene, along with CD105, CD73 and CD44, by human skin-derived Mesenchymal Stem cells over decellularized scaffold signifies that the cells are viable, proliferating and migrating, and have maintained their critical cellular functions in the presence of scaffold. Thus, overall study proves the applicability of the goat-lung tissue derived decellularized scaffold for skin tissue engineering applications. - Highlights: • We successfully fabricated decellularized scaffold from cadaver goat-lung tissue. • Decellularized goat-lung scaffolds were found to be highly porous. • Skin derived MSC shows high cell viability and proliferation over the scaffold. • Phenotype of MSCs was well maintained over the scaffold. • The scaffold shows potential for applications in skin tissue engineering.

Fabrication and characterization of scaffold from cadaver goat-lung tissue for skin tissue engineering applications

International Nuclear Information System (INIS)

Gupta, Sweta K.; Dinda, Amit K.; Potdar, Pravin D.; Mishra, Narayan C.

2013-01-01

The present study aims to fabricate scaffold from cadaver goat-lung tissue and evaluate it for skin tissue engineering applications. Decellularized goat-lung scaffold was fabricated by removing cells from cadaver goat-lung tissue enzymatically, to have cell-free 3D-architecture of natural extracellular matrix. DNA quantification assay and Hematoxylin and eosin staining confirmed the absence of cellular material in the decellularized lung-tissue. SEM analysis of decellularized scaffold shows the intrinsic porous structure of lung tissue with well-preserved pore-to-pore interconnectivity. FTIR analysis confirmed non-denaturation and well maintainance of collagenous protein structure of decellularized scaffold. MTT assay, SEM analysis and H and E staining of human skin-derived Mesenchymal Stem cell, seeded over the decellularized scaffold, confirms stem cell attachment, viability, biocompatibility and proliferation over the decellularized scaffold. Expression of Keratin18 gene, along with CD105, CD73 and CD44, by human skin-derived Mesenchymal Stem cells over decellularized scaffold signifies that the cells are viable, proliferating and migrating, and have maintained their critical cellular functions in the presence of scaffold. Thus, overall study proves the applicability of the goat-lung tissue derived decellularized scaffold for skin tissue engineering applications. - Highlights: • We successfully fabricated decellularized scaffold from cadaver goat-lung tissue. • Decellularized goat-lung scaffolds were found to be highly porous. • Skin derived MSC shows high cell viability and proliferation over the scaffold. • Phenotype of MSCs was well maintained over the scaffold. • The scaffold shows potential for applications in skin tissue engineering

Evaluation of light scattering properties and chromophore concentrations in skin tissue based on diffuse reflectance signals at isosbestic wavelengths of hemoglobin

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Yokokawa, Takumi; Nishidate, Izumi

2016-04-01

We investigate a method to evaluate light-scattering properties and chromophore concentrations in human skin tissue through diffuse reflectance spectroscopy using the reflectance signals acquired at isosbestic wavelengths of hemoglobin (420, 450, 500, and 585 nm). In the proposed method, Monte Carlo simulation-based empirical formulas are used to specify the scattering parameters of skin tissue, such as the scattering amplitude a and the scattering power b, as well as the concentration of melanin C m and the total blood concentration C tb. The use of isosbestic wavelengths of hemoglobin enables the values of C m, C tb, a, and b to be estimated independently of the oxygenation of hemoglobin. The spectrum of the reduced scattering coefficient is reconstructed from the scattering parameters. Experiments using in vivo human skin tissues were performed to confirm the feasibility of the proposed method for evaluating the changes in scattering properties and chromophore concentrations in skin tissue. The experimental results revealed that light scattering is significantly reduced by the application of a glycerol solution, which indicates an optical clearing effect due to osmotic dehydration and the matching of the refractive indices of scatterers in the epidermis.

Skin-associated lymphoid tissues (SALT): origins and functions

International Nuclear Information System (INIS)

Streilein, J.W.

1983-01-01

The skin has an unusual set of immunologic requirements. It is confronted by a specialized set of pathogenic organisms and environmental chemicals that represent a distinctive spectrum of antigenic specificities. Skin is subjected to physicochemical stresses such as irradiation with ultraviolet light that alter dramatically its immunologic properties. It is proposed that nature has provided skin with a unique collection of lymphoid cells, reticular cells, and organized lymphoid organs to deal with these special demands. Evidence in favor of the existence of skin-associated lymphoid tissues (SALT) includes (1) the cutaneous microenvironment is capable on its own of accepting, processing, and presenting nominal antigen; (2) strategically located peripheral lymph nodes are able to accept immunogenic signals derived from skin; (3) subsets of T lymphocytes display differential affinity for skin and its associated peripheral nodes; and (4) acquisition of this affinity by T cells is determined at least in part by differentiation signals received in situ from resident cutaneous cells. Responsibility for the establishment and integration of SALT rests with keratinocytes, Langerhans cells, and immunocompetent lymphocytes, each of which contributes uniquely to the synthesis. Together they provide skin with immune surveillance that effectively prejudices against the development of cutaneous neoplasms and persistent infection with intracellular pathogens. In patients who have been under long-term immunosuppressive therapy, the large majority of nonlymphoid malignancies arise within the skin, rather than other types of tissues. These data suggest that immune surveillance, once thought to be an immune defense operative in all somatic tissues, is a specialized immune function dedicated to the skin and mediated by SALT

3D cell printing of in vitro stabilized skin model and in vivo pre-vascularized skin patch using tissue-specific extracellular matrix bioink: A step towards advanced skin tissue engineering.

Science.gov (United States)

Kim, Byoung Soo; Kwon, Yang Woo; Kong, Jeong-Sik; Park, Gyu Tae; Gao, Ge; Han, Wonil; Kim, Moon-Bum; Lee, Hyungseok; Kim, Jae Ho; Cho, Dong-Woo

2018-06-01

3D cell-printing technique has been under spotlight as an appealing biofabrication platform due to its ability to precisely pattern living cells in pre-defined spatial locations. In skin tissue engineering, a major remaining challenge is to seek for a suitable source of bioink capable of supporting and stimulating printed cells for tissue development. However, current bioinks for skin printing rely on homogeneous biomaterials, which has several shortcomings such as insufficient mechanical properties and recapitulation of microenvironment. In this study, we investigated the capability of skin-derived extracellular matrix (S-dECM) bioink for 3D cell printing-based skin tissue engineering. S-dECM was for the first time formulated as a printable material and retained the major ECM compositions of skin as well as favorable growth factors and cytokines. This bioink was used to print a full thickness 3D human skin model. The matured 3D cell-printed skin tissue using S-dECM bioink was stabilized with minimal shrinkage, whereas the collagen-based skin tissue was significantly contracted during in vitro tissue culture. This physical stabilization and the tissue-specific microenvironment from our bioink improved epidermal organization, dermal ECM secretion, and barrier function. We further used this bioink to print 3D pre-vascularized skin patch able to promote in vivo wound healing. In vivo results revealed that endothelial progenitor cells (EPCs)-laden 3D-printed skin patch together with adipose-derived stem cells (ASCs) accelerates wound closure, re-epithelization, and neovascularization as well as blood flow. We envision that the results of this paper can provide an insightful step towards the next generation source for bioink manufacturing. Copyright © 2018 Elsevier Ltd. All rights reserved.

Skin Diseases Modeling using Combined Tissue Engineering and Microfluidic Technologies.

Science.gov (United States)

Mohammadi, Mohammad Hossein; Heidary Araghi, Behnaz; Beydaghi, Vahid; Geraili, Armin; Moradi, Farshid; Jafari, Parya; Janmaleki, Mohsen; Valente, Karolina Papera; Akbari, Mohsen; Sanati-Nezhad, Amir

2016-10-01

In recent years, both tissue engineering and microfluidics have significantly contributed in engineering of in vitro skin substitutes to test the penetration of chemicals or to replace damaged skins. Organ-on-chip platforms have been recently inspired by the integration of microfluidics and biomaterials in order to develop physiologically relevant disease models. However, the application of organ-on-chip on the development of skin disease models is still limited and needs to be further developed. The impact of tissue engineering, biomaterials and microfluidic platforms on the development of skin grafts and biomimetic in vitro skin models is reviewed. The integration of tissue engineering and microfluidics for the development of biomimetic skin-on-chip platforms is further discussed, not only to improve the performance of present skin models, but also for the development of novel skin disease platforms for drug screening processes. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Endoscopic Approach for Tissue Expansion for Different Cosmetic ...

African Journals Online (AJOL)

Background/Purpose: The use of tissue expanders in plastic and reconstruction surgery is now well established for large defects in adults & children. Tissue expansion is one of the reconstructive surgeon's alternatives in providing optimal tissue replacement when skin shortage is a major problem. Predesigned plan about ...

Sequential chimeric medial femoral condyle and anterolateral thigh flow-through flaps for one-stage reconstructions of composite bone and soft tissue defects: Report of three cases.

Science.gov (United States)

Henn, Dominic; Abouarab, Mohamed H; Hirche, Christoph; Hernekamp, Jochen F; Schmidt, Volker J; Kneser, Ulrich; Kremer, Thomas

2017-10-01

Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure. © 2017 Wiley Periodicals, Inc.

Free Boomerang-shaped Extended Rectus Abdominis Myocutaneous flap: The longest possible skin/myocutaneous free flap for soft tissue reconstruction of extremities.

Science.gov (United States)

Koul, Ashok R; Nahar, Sushil; Prabhu, Jagdish; Kale, Subhash M; Kumar, Praveen H P

2011-09-01

A soft tissue defect requiring flap cover which is longer than that provided by the conventional "long" free flaps like latissimus dorsi (LD) and anterolateral thigh (ALT) flap is a challenging problem. Often, in such a situation, a combination of flaps is required. Over the last 3 years, we have managed nine such defects successfully with a free "Boomerang-shaped" Extended Rectus Abdominis Myocutaneous (BERAM) flap. This flap is the slightly modified and "free" version of a similar flap described by Ian Taylor in 1983. This is a retrospective study of patients who underwent free BERAM flap reconstruction of soft tissue defects of extremity over the last 3 years. We also did a clinical study on 30 volunteers to compare the length of flap available using our design of BERAM flap with the maximum available flap length of LD and ALT flaps, using standard markings. Our clinical experience of nine cases combined with the results of our clinical study has confirmed that our design of BERAM flap consistently provides a flap length which is 32.6% longer than the standard LD flap and 42.2% longer than the standard ALT flap in adults. The difference is even more marked in children. The BERAM flap is consistently reliable as long as the distal end is not extended beyond the mid-axillary line. BERAM flap is simple in design, easy to harvest, reliable and provides the longest possible free skin/myocutaneous flap in the body. It is a useful new alternative for covering long soft tissue defects in the limbs.

Skin grafting and tissue replacement for treating foot ulcers in people with diabetes.

Science.gov (United States)

Santema, Trientje B; Poyck, Paul P C; Ubbink, Dirk T

2016-02-11

Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin substitutes can consist of bioengineered or artificial skin, autografts (taken from the patient), allografts (taken from another person) or xenografts (taken from animals). To determine the benefits and harms of skin grafting and tissue replacement for treating foot ulcers in people with diabetes. In April 2015 we searched: The Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trial registries to identify ongoing studies. We did not apply restrictions to language, date of publication or study setting. Randomised clinical trials (RCTs) of skin grafts or tissue replacements for treating foot ulcers in people with diabetes. Two review authors independently extracted data and assessed the quality of the included studies. We included seventeen studies with a total of 1655 randomised participants in this review. Risk of bias was variable among studies. Blinding of participants, personnel and outcome assessment was not possible in most trials because of obvious differences between the treatments. The lack of a blinded outcome assessor may have caused detection bias when ulcer healing was assessed. However, possible detection bias is hard to prevent due to the nature of the skin replacement products we assessed, and the fact that they are easily recognisable. Strikingly, nearly all studies (15/17) reported industry involvement; at least one of the authors was connected to a commercial organisation or the study was funded by a commercial organisation. In addition, the funnel plot for

Seromuscular Colonic Flap for Intrapelvic Soft-Tissue Coverage: A Reconstructive Option for Plastic Surgeons When Traditionally Used Flaps Are Not Available

Directory of Open Access Journals (Sweden)

Johnathon Aho

2015-01-01

Full Text Available Background. Reconstruction of intrapelvic defects can be a challenging problem in patients with limited regional muscle flap options and previously resected omentum. In such situations, alternative methods of mobilizing vascularized tissue may be required. Methods. A case of a patient that underwent pelvic extirpation for recurrent rectal cancer who had limited donor sites for flap reconstruction is presented. The mucosa was removed from a blind loop of colon, and a pedicled seromuscular flap based on the colonic mesentery was placed into the pelvis for vascularized soft-tissue coverage and elimination of dead space. Results. The postoperative course was only complicated by a small subcutaneous fluid collection beneath the sacrectomy skin incision, which was drained with radiological assistance. The patient recovered without any major postoperative complications. Conclusion. Seromuscular colonic flap is a useful option for soft-tissue coverage after pelvic extirpation and should be considered by plastic surgeons when other reconstruction options are not available.

Vaginal reconstruction

International Nuclear Information System (INIS)

Lesavoy, M.A.

1985-01-01

Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients

Determining the origin of cells in tissue engineered skin substitutes: a pilot study employing in situ hybridization.

Science.gov (United States)

Weber, Andreas Daniel; Pontiggia, Luca; Biedermann, Thomas; Schiestl, Clemens; Meuli, Martin; Reichmann, Ernst

2011-03-01

Definitive and high-quality coverage of large and, in particular, massive skin defects remains a significant challenge in burn as well as plastic and reconstructive surgery because of donor site shortage. A novel and promising approach to overcome these problems is tissue engineering of skin. Clearly, before eventual clinical application, engineered skin substitutes of human origin must be grafted and then evaluated in animal models. For the various tests to be conducted it is indispensable to be able to identify human cells as such in culture and also to distinguish between graft and recipient tissue after transplantation. Here we describe a tool to identify human cells in vitro and in vivo. In situ hybridization allows for the detection and localization of specific DNA or RNA sequences in morphologically preserved cells in culture or tissue sections, respectively. We used digoxigenin-labeled DNA probes corresponding to human-specific Alu repeats in order to identify human keratinocytes grown in culture together with rat cells, and also to label split and full thickness skin grafts of human origin after transplantation on immuno-incompetent rats. Digoxigenin-labeled DNA probing resulted in an intensive nuclear staining of human cells, both in culture and after transplantation onto recipient animals, while recipient animal cells (rat cells) did not stain. In situ hybridization using primate-specific Alu probes reliably allows distinguishing between cells of human and non-human origin both in culture as well as in histological sections. This method is an essential tool for those preclinical experiments (performed on non-primate animals) that must be conducted before novel tissue engineered skin substitutes might be introduced into clinical practice.

Split thickness skin graft for cervicovaginal reconstruction in congenital atresia of cervix.

Science.gov (United States)

Zhang, Xuyin; Han, Tiantian; Ding, Jingxin; Hua, Keqin

2015-10-01

To introduce a new technique that combines laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of the cervix. Video article introducing a new surgical technique. University hospital. A 16-year-old patient with congenital cervical atresia, vaginal dysgenesis, and ovarian endometrial cyst. An original technique of combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft for cervicovaginal reconstruction. A midline incision at the vaginal introitus was made, and a 9-cm canal was made between the bladder and the rectum using sharp and blunt dissection along the anatomic vaginal route, with the aid of laparoscopy to ensure correct orientation. A 14 × 12 cm split thickness skin graft was harvested from the right lateral thigh. By laparoscopy, the level of the lowest pole of the uterine cavity was exposed and the cervix was incised by shape dissection. The proximal segment of the harvested skin to the lower uterine segment was secured, and the distal segment was sutured with the upper margin of vulva vaginally. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. The patient gave consent to use the video in the article. The procedure was successfully completed. Since February 2013, our experiences of combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in 10 patients with congenital atresia of cervix were positive, with successful results and without complications or cervical, or vaginal stenosis. Our technique is feasible and safe for congenital atresia of cervix, with successful results and without complications or cervical or vaginal stenosis. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

In vitro prediction of in vivo skin damage associated with the wiping of dry tissue against skin.

Science.gov (United States)

Koenig, David W; Dvoracek, Barb; Vongsa, Rebecca

2013-02-01

The ideal gentle cleansing product is one that effectively removes soils while minimizing damage to the skin. Thus, measuring physical abrasion caused by cleansing tissues is critical to the continued development of gentle cleansing products. Current analysis of cleansing materials for skin gentleness is time consuming and requires expensive human subject testing. This report describes the development of a rapid and inexpensive bench assay for the assessment of skin abrasion caused by wiping. Coefficient of friction (COF) evaluations using bench methods were compared with results from clinical studies of repeated wiping and with confocal visualizations of excised skin. A Monitor/Slip and Friction instrument (model 32-06; TMI, Amityville, NY, USA) was used to measure tissue friction on simulated skin (Vitro-Skin, N19-5X; IMS, Milford, CT, USA). Clinical data from a 4-day repetitive forearm wiping study measuring transepidermal water loss (TEWL) in 30 subjects was compared with results from the bench top assay. In addition, excised skin samples were also treated using the COF bench assay and examined using confocal microscopy to visualize stratum corneum damage caused by wiping. Using the bench COF assay, we were able to distinguish between bath tissue codes by comparing average static friction value (ASFV) for the test codes, where lower ASFV indicated less abrasive tissue. The ASFV followed the same gentleness trend observed in the clinical study. Confocal microscopy of excised skin wiped with the same materials indicated stratum corneum damage consistent with the bench COF and clinical TEWL observations. We observed significant correlation between bench and clinical methods for measuring skin damage caused by wiping of skin with tissue. The bench method will facilitate rapid and inexpensive skin gentleness assessment of cleansing materials. © 2012 John Wiley & Sons A/S.

Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

Science.gov (United States)

Jaiswal, Rohit; Pu, Lee L Q

2013-04-01

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

Fabrication and characterization of scaffold from cadaver goat-lung tissue for skin tissue engineering applications.

Science.gov (United States)

Gupta, Sweta K; Dinda, Amit K; Potdar, Pravin D; Mishra, Narayan C

2013-10-01

The present study aims to fabricate scaffold from cadaver goat-lung tissue and evaluate it for skin tissue engineering applications. Decellularized goat-lung scaffold was fabricated by removing cells from cadaver goat-lung tissue enzymatically, to have cell-free 3D-architecture of natural extracellular matrix. DNA quantification assay and Hematoxylin and eosin staining confirmed the absence of cellular material in the decellularized lung-tissue. SEM analysis of decellularized scaffold shows the intrinsic porous structure of lung tissue with well-preserved pore-to-pore interconnectivity. FTIR analysis confirmed non-denaturation and well maintainance of collagenous protein structure of decellularized scaffold. MTT assay, SEM analysis and H&E staining of human skin-derived Mesenchymal Stem cell, seeded over the decellularized scaffold, confirms stem cell attachment, viability, biocompatibility and proliferation over the decellularized scaffold. Expression of Keratin18 gene, along with CD105, CD73 and CD44, by human skin-derived Mesenchymal Stem cells over decellularized scaffold signifies that the cells are viable, proliferating and migrating, and have maintained their critical cellular functions in the presence of scaffold. Thus, overall study proves the applicability of the goat-lung tissue derived decellularized scaffold for skin tissue engineering applications. Copyright © 2013 Elsevier B.V. All rights reserved.

Elemental composition of skin tissue by PIXE and INAA analyses

International Nuclear Information System (INIS)

Hollands, R.; Spyrou, N.M.

1997-01-01

Hypertrophic scars are a particular type of scar that can form after any type of dermal injury. They are unsightly, red, elevated above normal skin level, itchy and painful. At present no-one knows why these scars form. Due to the differences between scar tissue and normal skin it was decided to analyse skin tissue which at a later date would be compared to scar tissue. Spit skin graft (epidermis) samples as well as full thickness skin (epidermis to dermis) tissue were analysed using PIXE and RBS with a 2 MeV proton beam. The epidermis was compared to the dermis to see if there were any variations between the two. In all the samples P, S, Cl, K, Ca, Fe, and Cd were detected and in a majority of the samples Zn and Ba were found, using PIXE. It was found that, between the epidermis and dermis, there was an significant increase in P in the epidermis in both full thickness and split skin graft samples. Complementary elemental analysis was also performed using neutron activation, and Br, Na and Zn were detected. (author)

Future Prospects for Scaffolding Methods and Biomaterials in Skin Tissue Engineering: A Review.

Science.gov (United States)

Chaudhari, Atul A; Vig, Komal; Baganizi, Dieudonné Radé; Sahu, Rajnish; Dixit, Saurabh; Dennis, Vida; Singh, Shree Ram; Pillai, Shreekumar R

2016-11-25

Over centuries, the field of regenerative skin tissue engineering has had several advancements to facilitate faster wound healing and thereby restoration of skin. Skin tissue regeneration is mainly based on the use of suitable scaffold matrices. There are several scaffold types, such as porous, fibrous, microsphere, hydrogel, composite and acellular, etc., with discrete advantages and disadvantages. These scaffolds are either made up of highly biocompatible natural biomaterials, such as collagen, chitosan, etc., or synthetic materials, such as polycaprolactone (PCL), and poly-ethylene-glycol (PEG), etc. Composite scaffolds, which are a combination of natural or synthetic biomaterials, are highly biocompatible with improved tensile strength for effective skin tissue regeneration. Appropriate knowledge of the properties, advantages and disadvantages of various biomaterials and scaffolds will accelerate the production of suitable scaffolds for skin tissue regeneration applications. At the same time, emphasis on some of the leading challenges in the field of skin tissue engineering, such as cell interaction with scaffolds, faster cellular proliferation/differentiation, and vascularization of engineered tissues, is inevitable. In this review, we discuss various types of scaffolding approaches and biomaterials used in the field of skin tissue engineering and more importantly their future prospects in skin tissue regeneration efforts.

Comparison of tissue viability imaging and colorimetry: skin blanching.

Science.gov (United States)

Zhai, Hongbo; Chan, Heidi P; Farahmand, Sara; Nilsson, Gert E; Maibach, Howard I

2009-02-01

Operator-independent assessment of skin blanching is important in the development and evaluation of topically applied steroids. Spectroscopic instruments based on hand-held probes, however, include elements of operator dependence such as difference in applied pressure and probe misalignment, while laser Doppler-based methods are better suited for demonstration of skin vasodilatation than for vasoconstriction. To demonstrate the potential of the emerging technology of Tissue Viability Imaging (TiVi) in the objective and operator-independent assessment of skin blanching. The WheelsBridge TiVi600 Tissue Viability Imager was used for quantification of human skin blanching with the Minolta chromameter CR 200 as an independent colorimeter reference method. Desoximetasone gel 0.05% was applied topically on the volar side of the forearm under occlusion for 6 h in four healthy adults. In a separate study, the induction of blanching in the occlusion phase was mapped using a transparent occlusion cover. The relative uncertainty in the blanching estimate produced by the Tissue Viability Imager was about 5% and similar to that of the chromameter operated by a single user and taking the a(*) parameter as a measure of blanching. Estimation of skin blanching could also be performed in the presence of a transient paradoxical erythema, using the integrated TiVi software. The successive induction of skin blanching during the occlusion phase could readily be mapped by the Tissue Viability Imager. TiVi seems to be suitable for operator-independent and remote mapping of human skin blanching, eliminating the main disadvantages of methods based on hand-held probes.

The Boomerang-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of Circular Defect of Cervical Skin.

Science.gov (United States)

Azuma, Shuchi; Arikawa, Masaki; Miyamoto, Shimpei

2017-11-01

We report on a patient with a recurrence of oral cancer involving a cervical lymph node. The patient's postexcision cervical skin defect was nearly circular in shape, and the size was about 12 cm in diameter. The defect was successfully reconstructed with a boomerang-shaped pectoralis major musculocutaneous flap whose skin paddle included multiple intercostal perforators of the internal mammary vessels. This flap design is effective for reconstructing an extensive neck skin defect and enables primary closure of the donor site with minimal deformity.

Reconstructing in-vivo reflectance spectrum of pigmented skin lesion by Monte Carlo simulation

Science.gov (United States)

Wang, Shuang; He, Qingli; Zhao, Jianhua; Lui, Harvey; Zeng, Haishan

2012-03-01

In dermatology applications, diffuse reflectance spectroscopy has been extensively investigated as a promising tool for the noninvasive method to distinguish melanoma from benign pigmented skin lesion (nevus), which is concentrated with the skin chromophores like melanin and hemoglobin. We carried out a theoretical study to examine melanin distribution in human skin tissue and establish a practical optical model for further pigmented skin investigation. The theoretical simulation was using junctional nevus as an example. A multiple layer skin optical model was developed on established anatomy structures of skin, the published optical parameters of different skin layers, blood and melanin. Monte Carlo simulation was used to model the interaction between excitation light and skin tissue and rebuild the diffuse reflectance process from skin tissue. A testified methodology was adopted to determine melanin contents in human skin based on in vivo diffuse reflectance spectra. The rebuild diffuse reflectance spectra were investigated by adding melanin into different layers of the theoretical model. One of in vivo reflectance spectra from Junctional nevi and their surrounding normal skin was studied by compare the ratio between nevus and normal skin tissue in both the experimental and simulated diffuse reflectance spectra. The simulation result showed a good agreement with our clinical measurements, which indicated that our research method, including the spectral ratio method, skin optical model and modifying the melanin content in the model, could be applied in further theoretical simulation of pigmented skin lesions.

Free Boomerang-shaped Extended Rectus Abdominis Myocutaneous flap: The longest possible skin/myocutaneous free flap for soft tissue reconstruction of extremities

Directory of Open Access Journals (Sweden)

Ashok R Koul

2011-01-01

Full Text Available Background: A soft tissue defect requiring flap cover which is longer than that provided by the conventional "long" free flaps like latissimus dorsi (LD and anterolateral thigh (ALT flap is a challenging problem. Often, in such a situation, a combination of flaps is required. Over the last 3 years, we have managed nine such defects successfully with a free "Boomerang-shaped" Extended Rectus Abdominis Myocutaneous (BERAM flap. This flap is the slightly modified and "free" version of a similar flap described by Ian Taylor in 1983. Materials and Methods: This is a retrospective study of patients who underwent free BERAM flap reconstruction of soft tissue defects of extremity over the last 3 years. We also did a clinical study on 30 volunteers to compare the length of flap available using our design of BERAM flap with the maximum available flap length of LD and ALT flaps, using standard markings. Results: Our clinical experience of nine cases combined with the results of our clinical study has confirmed that our design of BERAM flap consistently provides a flap length which is 32.6% longer than the standard LD flap and 42.2% longer than the standard ALT flap in adults. The difference is even more marked in children. The BERAM flap is consistently reliable as long as the distal end is not extended beyond the mid-axillary line. Conclusion: BERAM flap is simple in design, easy to harvest, reliable and provides the longest possible free skin/myocutaneous flap in the body. It is a useful new alternative for covering long soft tissue defects in the limbs.

The Boomerang-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of Circular Defect of Cervical Skin

Directory of Open Access Journals (Sweden)

Shuchi Azuma, MD

2017-11-01

Full Text Available Summary:. We report on a patient with a recurrence of oral cancer involving a cervical lymph node. The patient’s postexcision cervical skin defect was nearly circular in shape, and the size was about 12 cm in diameter. The defect was successfully reconstructed with a boomerang-shaped pectoralis major musculocutaneous flap whose skin paddle included multiple intercostal perforators of the internal mammary vessels. This flap design is effective for reconstructing an extensive neck skin defect and enables primary closure of the donor site with minimal deformity.

Tissue engineering of ligaments for reconstructive surgery.

Science.gov (United States)

Hogan, MaCalus V; Kawakami, Yohei; Murawski, Christopher D; Fu, Freddie H

2015-05-01

The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. Level IV, systematic review of Level IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation

Directory of Open Access Journals (Sweden)

Laurenz Weitgasser

2017-01-01

Full Text Available Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

[Clinical study of full-thickness skin graft for reconstruction of completely defect nail unit].

Science.gov (United States)

Li, Wen-jun; Li, Chun; Zhu, Jin; Tian, Guang-lei; Chen, Shan-lin; Tian, Wen

2012-12-18

To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free full-thickness skin graft for the whole nail unit repair. Between Apr. 2010 and Mar. 2012, the method of free full-thickness skin graft was done for reconstruction of the completely nail unit defect in seven cases. There were 2 male and 5 female patients; the mean age of these patients at the time of surgery was 51.9 years (range: 7 to 70 years). The preoperative diagnoses included two cases of malignant melanoma, one of chronic infection, one of squamous cell carcinoma, two of subungual pigmentation and one of junctional nevus. There were 2 thumb lesions, 3 middle and 2 index finger lesions. Nail unit defect was in the range of 1.5 cm×2 cm to 2.5 cm × 3.5 cm and full thickness skin graft was harvested from the same medial side of upper arm (3 cases), forearm cubital fossa (1 case) and contralateral side of groin region (3 cases). All the patients were followed with an average follow-up time being 10 months. All the free skin graft taken was achieved with 100% in all the 7 cases, even in those patients whose partial cortical bone had been curetted. The skin graft was often bluish initially, and superficial blisters were always noticed within 1.5 months postoperatively and the survival skin graft was smooth eventually, and skin graft was adhered to the underlying bone tightly. There was no epidermal inclusion cyst and no residual nail formation. The skin donor sites were without complications. Aesthetic appearance was assessed by the surgeons and found no unacceptable for their patients. And all the patients were satisfied with the cosmetic appearance and active range of motion of their involved fingers, who did not express a desire to undergo any further of nail reconstruction. Free full-thickness skin grafting for reconstruction of the complete nail unit defect is a simple, safe and effective

Future Prospects for Scaffolding Methods and Biomaterials in Skin Tissue Engineering: A Review

Directory of Open Access Journals (Sweden)

Atul A. Chaudhari

2016-11-01

Full Text Available Over centuries, the field of regenerative skin tissue engineering has had several advancements to facilitate faster wound healing and thereby restoration of skin. Skin tissue regeneration is mainly based on the use of suitable scaffold matrices. There are several scaffold types, such as porous, fibrous, microsphere, hydrogel, composite and acellular, etc., with discrete advantages and disadvantages. These scaffolds are either made up of highly biocompatible natural biomaterials, such as collagen, chitosan, etc., or synthetic materials, such as polycaprolactone (PCL, and poly-ethylene-glycol (PEG, etc. Composite scaffolds, which are a combination of natural or synthetic biomaterials, are highly biocompatible with improved tensile strength for effective skin tissue regeneration. Appropriate knowledge of the properties, advantages and disadvantages of various biomaterials and scaffolds will accelerate the production of suitable scaffolds for skin tissue regeneration applications. At the same time, emphasis on some of the leading challenges in the field of skin tissue engineering, such as cell interaction with scaffolds, faster cellular proliferation/differentiation, and vascularization of engineered tissues, is inevitable. In this review, we discuss various types of scaffolding approaches and biomaterials used in the field of skin tissue engineering and more importantly their future prospects in skin tissue regeneration efforts.

Transport of beta-aminopropionitrile through intact skin or scar tissue

International Nuclear Information System (INIS)

Gibeault, J.D.; Cravens, R.B. Jr.; Chvapil, M.

1989-01-01

A lathyrogen, [ 14 C]aminopropionitrile (beta APN), was administered to 34 rats either in K-Y jelly or saline vehicles onto intact shaven skin or onto a healed splinted deep excision wound. The dynamics of beta APN transport and content in the skin or repair tissue was observed after 2, 5, 8, and 24 hr of topical administration. The repair tissue quickly absorbed the lathyrogen and reached maximum at the 2-hr sampling. The content of beta APN in the repair tissue was twice as high as that in K-Y jelly vehicle and remained high and stable for at least 24 hr only when beta APN was administered through a saline vehicle. The transport of beta APN through intact skin, irrespective of the vehicle tested, was slow and continuously increased. The study showed that almost 20% of the beta APN administered onto the wounded skin area was transported into the repair tissue within 2 hr. We suggest that, due to the absence of epidermal stratum corneum from the repair tissue, drugs, such as beta APN, penetrate quickly into the wound

Tissue engineering for urinary tract reconstruction and repair: Progress and prospect in China.

Science.gov (United States)

Zou, Qingsong; Fu, Qiang

2018-04-01

Several urinary tract pathologic conditions, such as strictures, cancer, and obliterations, require reconstructive plastic surgery. Reconstruction of the urinary tract is an intractable task for urologists due to insufficient autologous tissue. Limitations of autologous tissue application prompted urologists to investigate ideal substitutes. Tissue engineering is a new direction in these cases. Advances in tissue engineering over the last 2 decades may offer alternative approaches for the urinary tract reconstruction. The main components of tissue engineering include biomaterials and cells. Biomaterials can be used with or without cultured cells. This paper focuses on cell sources, biomaterials, and existing methods of tissue engineering for urinary tract reconstruction in China. The paper also details challenges and perspectives involved in urinary tract reconstruction.

Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures.

Science.gov (United States)

Pechevy, Lolita; Carloni, Raphael; Guerid, Samia; Vincent, Pierre-Luc; Toussoun, Gilles; Delay, Emmanuel

2017-06-01

In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Tissue engineered skin substitutes created by laser-assisted bioprinting form skin-like structures in the dorsal skin fold chamber in mice.

Directory of Open Access Journals (Sweden)

Stefanie Michael

Full Text Available Tissue engineering plays an important role in the production of skin equivalents for the therapy of chronic and especially burn wounds. Actually, there exists no (cellularized skin equivalent which might be able to satisfactorily mimic native skin. Here, we utilized a laser-assisted bioprinting (LaBP technique to create a fully cellularized skin substitute. The unique feature of LaBP is the possibility to position different cell types in an exact three-dimensional (3D spatial pattern. For the creation of the skin substitutes, we positioned fibroblasts and keratinocytes on top of a stabilizing matrix (Matriderm®. These skin constructs were subsequently tested in vivo, employing the dorsal skin fold chamber in nude mice. The transplants were placed into full-thickness skin wounds and were fully connected to the surrounding tissue when explanted after 11 days. The printed keratinocytes formed a multi-layered epidermis with beginning differentiation and stratum corneum. Proliferation of the keratinocytes was mainly detected in the suprabasal layers. In vitro controls, which were cultivated at the air-liquid-interface, also exhibited proliferative cells, but they were rather located in the whole epidermis. E-cadherin as a hint for adherens junctions and therefore tissue formation could be found in the epidermis in vivo as well as in vitro. In both conditions, the printed fibroblasts partly stayed on top of the underlying Matriderm® where they produced collagen, while part of them migrated into the Matriderm®. In the mice, some blood vessels could be found to grow from the wound bed and the wound edges in direction of the printed cells. In conclusion, we could show the successful 3D printing of a cell construct via LaBP and the subsequent tissue formation in vivo. These findings represent the prerequisite for the creation of a complex tissue like skin, consisting of different cell types in an intricate 3D pattern.

Analysis of human skin tissue by millimeter-wave reflectometry

NARCIS (Netherlands)

Smulders, P.F.M.

2013-01-01

Background/pupose: Millimeter-wave reflectometry is a potentially interesting technique to analyze the human skin in vivo in order to determine the water content locally in the skin. Purpose of this work is to investigate the possibility of skin-tissue differentiation. In addition, it addresses the

Skin and soft-tissue infec tions

African Journals Online (AJOL)

2010-06-01

Jun 1, 2010 ... Patients with skin and soft-tissue infections (SSTIs) often initially present to family physicians. ..... Nosocomial infections are often caused by MRSA or mixed .... site infections are good hand hygiene, good surgical technique.

The Ability of Tissue Engineered Skin Accelerating the Closure of Different Wound

Institute of Scientific and Technical Information of China (English)

无

2005-01-01

1 IntroductionIn the past several decades, a number of reseacher have described the principal efficacy of tissue engineered skin to promote wound healing of venous and diabetic ulcers. But the true value of tissue-engineered skin products in different wound care remains yet to be more clearly defined. In this trial, we analysis the effective of tissue-engineered skin (ActivSkin) in the management of burns, donor sites and ulcers, which were also the frequently injury caused with warfare, disaster and terror...

Reverse tissue expansion by liposuction deflation adopted for harvest of large sheet of full-thickness skin graft.

Science.gov (United States)

Ibrahim, A E; Debbas, C C; Dibo, S A; Atiyeh, B S; Abu-Sittah, G S; Isik, S

2012-06-30

Full-thickness skingraft is a valid option to release burn scar contractures with the main purpose of correcting the induced limitation in function and improve the disfiguring appearance of the scar. The main pitfall remains the limited availability of these grafts, especially when large sheets are needed. We present an application of a previously described technique known as reverse tissue expansion, which permits the harvesting of a large sheet of full thickness skin graft when needed. This method was adopted to release a burn scar contracture in a 32-yr-old man who sustained a 65% TBSA burn secondary to a gasoline tank explosion at the age of 7 yr followed by multiple reconstructive procedures. The patient presented with a disfiguring anterior neck contracture coupled to limited range of motion. Improvement of neck extension was contemplated using full-thickness skin graft harvested following reverse tissue expansion achieved by deflation liposuction of the donor site.

Reconstruction of massive full-thickness abdominal wall defect

DEFF Research Database (Denmark)

Aydin, Dogu; Paulsen, Ida Felbo; Bentzen, Vibeke Egerup

2016-01-01

We demonstrate that it is possible to use a nonabsorbable mesh for abdominal wall reconstruction after total wound rupture and successfully split-skin graft directly on the mesh. Sufficient granulation tissue formation prior to skin grafting was obtained with long-term use of negative pressure...

Oxidative stress and CCN1 protein in human skin connective tissue aging

Directory of Open Access Journals (Sweden)

Zhaoping Qin

2016-06-01

Full Text Available Reactive oxygen species (ROS is an important pathogenic factor involved in human aging. Human skin is a primary target of oxidative stress from ROS generated from both extrinsic and intrinsic sources, like ultraviolet irradiation (UV and endogenous oxidative metabolism. Oxidative stress causes the alterations of collagen-rich extracellular matrix (ECM, the hallmark of skin connective tissue aging. Age-related alteration of dermal collagenous ECM impairs skin structural integrity and creates a tissue microenvironment that promotes age-related skin diseases, such as poor wound healing and skin cancer. Here, we review recent advances in our understanding of oxidative stress and CCN1 protein (first member of CCN family proteins, a critical mediator of oxidative stress-induced skin connective tissue aging.

Uncovering of melanin fluorescence in human skin tissue

Science.gov (United States)

Scholz, Matthias; Stankovic, Goran; Seewald, Gunter; Leupold, Dieter

2007-07-01

Due to its extremely low fluorescence quantum yield, in the conventionally (one-photon) excited autofluorescence of skin tissue, melanin fluorescence is masked by several other endogenous and possibly also exogenous fluorophores (e.g. NADH, FAD, Porphyrins). A first step to enhance the melanin contribution had been realized by two-photon fs-pulse excitation in the red/near IR, based on the fact that melanin can be excited by stepwise two-photon absorption, whereas all other fluorophores in this spectral region allow only simultaneous two-photon excitation. Now, the next and decisive step has been realized: Using an extremely sensitive detection system, for the first time twophoton fluorescence of skin tissue excited with pulses in the ns-range could be measured. The motivation for this step was based on the fact that the population density of the fluorescent level resulting from a stepwise excitation has a different dependence of the pulse duration than that from a simultaneous excitation (Δt2 vs. Δt). Due to this strong discrimination between the fluorophores, practically pure melanin fluorescence can be obtained. Examples for in-vivo, ex-vivo as well as paraffin embedded skin tissue will be shown. The content of information with respect to early diagnosis of skin deseases will be discussed.

Tissue Banking: Current procedures, ethical consideration and ...

African Journals Online (AJOL)

Tissue banking provides safe and effective cells and tissues for transplantation in reconstruction surgery. Bone, amnion, skin, cartilage, heart valves and xenograft tissues are the most commonly used biological tissues. Acquisition of tissue is dependent on elaborate donor screening criteria based on medical and social ...

Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures.

Science.gov (United States)

Parrett, Brian M; Matros, Evan; Pribaz, Julian J; Orgill, Dennis P

2006-04-01

Open lower leg fractures with exposed bone or tendon continue to be challenging for plastic surgeons. Microvascular free-tissue transfer increases the ability to close wounds, transfer vascularized bone, and prevent amputation, yet remains a complex, invasive procedure with significant complication rates, donor-site morbidity, and failure rates. This review documents the changing treatment protocol in the authors' institution for these injuries. Two hundred ninety consecutive open tibia-fibula fractures over a 12-year period (1992 to 2003) were retrospectively reviewed and methods and outcomes were compared by grouping the fractures into 4-year intervals. The number of open lower extremity fractures increased, whereas the distribution of Gustilo grade I to III fractures remained unchanged. Overall, free-tissue transfer was performed less frequently and constituted 20 percent of reconstructions in period 1 (1992 to 1995), 11 percent in period 2 (1996 to 1999), and 5 percent in period 3 (2000 to 2003). For the most severe fractures, Gustilo grade III, free-flap reconstruction has decreased significantly, constituting 42 percent, 26 percent, and 11 percent of procedures in periods 1, 2, and 3, respectively. Local flaps for grade III fractures have remained relatively constant throughout the study. In contrast, local wound care for grade III fractures, including skin grafts, delayed primary closures, and secondary intention closures has significantly increased from 22 percent to 49 percent of reconstructions from periods 1 through 3. In 1997, the authors began to use the vacuum-assisted closure device and now use it in nearly half of all open fractures. Despite this trend, there has been no change in infection, amputation, or malunion/nonunion rates and a decrease in reoperation rate with at least 1-year follow-up. These results demonstrate a change in practice, with a trend down the reconstructive ladder, currently using fewer free flaps and more delayed closures and

Perforator based rectus free tissue transfer for head and neck reconstruction: New reconstructive advantages from an old friend.

Science.gov (United States)

Kang, Stephen Y; Spector, Matthew E; Chepeha, Douglas B

2017-11-01

To demonstrate three reconstructive advantages of the perforator based rectus free tissue transfer: long pedicle, customizable adipose tissue, and volume reconstruction without muscle atrophy within a contained space. Thirty patients with defects of the head and neck were reconstructed with the perforator based rectus free tissue transfer. Transplant success was 93%. Mean pedicle length was 13.4cm. Eleven patients (37%) had vessel-poor necks and the long pedicle provided by this transplant avoided the need for vein grafts in these patients. Adipose tissue was molded in 17 patients (57%). Twenty-five patients (83%) had defects within a contained space, such as the orbit, where it was critical to have a transplant that avoided muscle atrophy. The perforator based rectus free tissue transfer provides a long pedicle, moldable fat for flap customization, and is useful in reconstruction of defects within a contained space where volume loss due to muscle atrophy is prevented. Copyright © 2017 Elsevier Ltd. All rights reserved.

Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander.

Science.gov (United States)

Li, Qingfeng; Zan, Tao; Gu, Bin; Liu, Kai; Shen, Guoxiong; Xie, Yun; Weng, Rui

2009-01-01

Resurfacing of facial massive soft tissue defect is a formidable challenge because of the unique character of the region and the limitation of well-matched donor site. In this report, we introduce a technique for using the prefabricated cervicothoracic skin flap for facial resurfacing, in an attempt to meet the principle of flap selection in face reconstructive surgery for matching the color and texture, large dimension, and thinner thickness (MLT) of the recipient. Eleven patients with massive facial scars underwent resurfacing procedures with prefabricated cervicothoracic flaps. The vasculature of the lateral thigh fascial flap, including the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia, was used as the vascular carrier, and the pedicles of the fascial flap were anastomosed to either the superior thyroid or facial vessels in flap prefabrication. A tissue expander was placed beneath the fascial flap to enlarge the size and reduce the thickness of the flap. The average size of the harvested fascia flap was 6.5 x 11.7 cm. After a mean interval of 21.5 weeks, the expanders were filled to a mean volume of 1,685 ml. The sizes of the prefabricated skin flaps ranged from 12 x 15 cm to 15 x 32 cm. The prefabricated skin flaps were then transferred to the recipient site as pedicled flaps for facial resurfacing. All facial soft tissue defects were successfully covered by the flaps. The donor sites were primarily closed and healed without complications. Although varied degrees of venous congestion were developed after flap transfers, the marginal necrosis only occurred in two cases. The results in follow-up showed most resurfaced faces restored natural contour and regained emotional expression. MLT is the principle for flap selection in resurfacing of the massive facial soft tissue defect. Our experience in this series of patients demonstrated that the prefabricated cervicothoracic skin flap could be a reliable alternative

Management of complex pediatric laryngotracheal stenosis with skin graft reconstruction.

Science.gov (United States)

Bowe, Sarah N; Wentland, Carissa J; Sandhu, G S; Hartnick, Christopher J

2018-05-01

For pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production. A chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts. Patient history, bronchoscopic evaluation, intra-operative technique, post-operative management, treatment outcomes, and complications were noted. Harvesting and preparation of the split-thickness skin grafts (STSG) proceeded in a similar manner for each case. Stenting material varied based on the clinical scenario. Using this technique, our patient with a Type 3 glottic web achieved substantial improvement in exercise tolerance, as well as vocal strength and quality. In addition, our aphonic patient could vocalize for the first time since her laryngotracheal injury. Temporary endoluminal stenting with skin graft lining can reproduce epithelial continuity and provide "biological inhibition" to enhance the wound healing process. When previous reconstructive efforts have failed, use of STSG can be considered in the management of complex pediatric laryngotracheal stenosis. Copyright © 2018. Published by Elsevier B.V.

Reconstructive Surgery of Extensive Face and Neck Burn Scars Using Tissue Expanders

OpenAIRE

Ashab Yamin, Mohammad Reza; Mozafari, Naser; Mozafari, Mohadase; Razi, Zahra

2015-01-01

BACKGROUND Neck reconstruction is considered as one of the most important surgeries in cosmetic and reconstructive surgery.?The present study aimed to assess the results of reconstructive surgery of extensive face and neck burning scars using tissue expanders. METHODS This descriptive prospective study was conducted on 36 patients with extensive burning scars on the neck and face. Operation for tissue expander insertion was performed and tissue distension started two or three weeks later, dep...

The Nrf2-inducers tanshinone I and dihydrotanshinone protect human skin cells and reconstructed human skin against solar simulated UV☆

Science.gov (United States)

Tao, Shasha; Justiniano, Rebecca; Zhang, Donna D.; Wondrak, Georg T.

2013-01-01

Exposure to solar ultraviolet (UV) radiation is a causative factor in skin photocarcinogenesis and photoaging, and an urgent need exists for improved strategies for skin photoprotection. The redox-sensitive transcription factor Nrf2 (nuclear factor-E2-related factor 2), a master regulator of the cellular antioxidant defense against environmental electrophilic insult, has recently emerged as an important determinant of cutaneous damage from solar UV, and the concept of pharmacological activation of Nrf2 has attracted considerable attention as a novel approach to skin photoprotection. In this study, we examined feasibility of using tanshinones, a novel class of phenanthrenequinone-based cytoprotective Nrf2 inducers derived from the medicinal plant Salvia miltiorrhiza, for protection of cultured human skin cells and reconstructed human skin against solar simulated UV. Using a dual luciferase reporter assay in human Hs27 dermal fibroblasts pronounced transcriptional activation of Nrf2 by four major tanshinones [tanshinone I (T-I), dihydrotanshinone (DHT), tanshinone IIA (T-II-A) and cryptotanshinone (CT)] was detected. In fibroblasts, the more potent tanshinones T-I and DHT caused a significant increase in Nrf2 protein half-life via blockage of ubiquitination, ultimately resulting in upregulated expression of cytoprotective Nrf2 target genes (GCLC, NQO1) with the elevation of cellular glutathione levels. Similar tanshinone-induced changes were also observed in HaCaT keratinocytes. T-I and DHT pretreatment caused significant suppression of skin cell death induced by solar simulated UV and riboflavin-sensitized UVA. Moreover, feasibility of tanshinone-based cutaneous photoprotection was tested employing a human skin reconstruct exposed to solar simulated UV (80 mJ/cm2 UVB; 1.53 J/cm2 UVA). The occurrence of markers of epidermal solar insult (cleaved procaspase 3, pycnotic nuclei, eosinophilic cytoplasm, acellular cavities) was significantly attenuated in DHT

The Nrf2-inducers tanshinone I and dihydrotanshinone protect human skin cells and reconstructed human skin against solar simulated UV.

Science.gov (United States)

Tao, Shasha; Justiniano, Rebecca; Zhang, Donna D; Wondrak, Georg T

2013-01-01

Exposure to solar ultraviolet (UV) radiation is a causative factor in skin photocarcinogenesis and photoaging, and an urgent need exists for improved strategies for skin photoprotection. The redox-sensitive transcription factor Nrf2 (nuclear factor-E2-related factor 2), a master regulator of the cellular antioxidant defense against environmental electrophilic insult, has recently emerged as an important determinant of cutaneous damage from solar UV, and the concept of pharmacological activation of Nrf2 has attracted considerable attention as a novel approach to skin photoprotection. In this study, we examined feasibility of using tanshinones, a novel class of phenanthrenequinone-based cytoprotective Nrf2 inducers derived from the medicinal plant Salvia miltiorrhiza, for protection of cultured human skin cells and reconstructed human skin against solar simulated UV. Using a dual luciferase reporter assay in human Hs27 dermal fibroblasts pronounced transcriptional activation of Nrf2 by four major tanshinones [tanshinone I (T-I), dihydrotanshinone (DHT), tanshinone IIA (T-II-A) and cryptotanshinone (CT)] was detected. In fibroblasts, the more potent tanshinones T-I and DHT caused a significant increase in Nrf2 protein half-life via blockage of ubiquitination, ultimately resulting in upregulated expression of cytoprotective Nrf2 target genes (GCLC, NQO1) with the elevation of cellular glutathione levels. Similar tanshinone-induced changes were also observed in HaCaT keratinocytes. T-I and DHT pretreatment caused significant suppression of skin cell death induced by solar simulated UV and riboflavin-sensitized UVA. Moreover, feasibility of tanshinone-based cutaneous photoprotection was tested employing a human skin reconstruct exposed to solar simulated UV (80 mJ/cm(2) UVB; 1.53 J/cm(2) UVA). The occurrence of markers of epidermal solar insult (cleaved procaspase 3, pycnotic nuclei, eosinophilic cytoplasm, acellular cavities) was significantly attenuated in DHT

The Nrf2-inducers tanshinone I and dihydrotanshinone protect human skin cells and reconstructed human skin against solar simulated UV

Directory of Open Access Journals (Sweden)

Shasha Tao

2013-01-01

Full Text Available Exposure to solar ultraviolet (UV radiation is a causative factor in skin photocarcinogenesis and photoaging, and an urgent need exists for improved strategies for skin photoprotection. The redox-sensitive transcription factor Nrf2 (nuclear factor-E2-related factor 2, a master regulator of the cellular antioxidant defense against environmental electrophilic insult, has recently emerged as an important determinant of cutaneous damage from solar UV, and the concept of pharmacological activation of Nrf2 has attracted considerable attention as a novel approach to skin photoprotection. In this study, we examined feasibility of using tanshinones, a novel class of phenanthrenequinone-based cytoprotective Nrf2 inducers derived from the medicinal plant Salvia miltiorrhiza, for protection of cultured human skin cells and reconstructed human skin against solar simulated UV. Using a dual luciferase reporter assay in human Hs27 dermal fibroblasts pronounced transcriptional activation of Nrf2 by four major tanshinones [tanshinone I (T-I, dihydrotanshinone (DHT, tanshinone IIA (T-II-A and cryptotanshinone (CT] was detected. In fibroblasts, the more potent tanshinones T-I and DHT caused a significant increase in Nrf2 protein half-life via blockage of ubiquitination, ultimately resulting in upregulated expression of cytoprotective Nrf2 target genes (GCLC, NQO1 with the elevation of cellular glutathione levels. Similar tanshinone-induced changes were also observed in HaCaT keratinocytes. T-I and DHT pretreatment caused significant suppression of skin cell death induced by solar simulated UV and riboflavin-sensitized UVA. Moreover, feasibility of tanshinone-based cutaneous photoprotection was tested employing a human skin reconstruct exposed to solar simulated UV (80 mJ/cm2 UVB; 1.53 J/cm2 UVA. The occurrence of markers of epidermal solar insult (cleaved procaspase 3, pycnotic nuclei, eosinophilic cytoplasm, acellular cavities was significantly attenuated in DHT

Tissue banking for management of nuclear casualties

International Nuclear Information System (INIS)

Singh, Rita

2014-01-01

The proliferation of nuclear material and technology has made the acquisition and adversarial use more probable than ever. Devastating medical consequences would follow a nuclear detonation due to the thermal, blast and radiation effects of the weapon. Atomic explosions at Hiroshima and Nagasaki demonstrated the human agonies on vast scale. A full range of medical modalities are required to decrease the morbidity and mortality as a result of the use of nuclear weapons. Biological tissues from human donor like bone, skin, amniotic membrane and other soft tissues can be used for repair or reconstruction of the injured part of the body. Tissues from human donor can be processed and banked for orthopaedic, spinal, trauma and other surgical procedures. Processed tissues can be provided by the tissue banks and can be of great assistance in the treatment of injuries due to the nuclear weapon. The use of allograft tissue avoids the donor site morbidity and reduces the operating time, expense and trauma associated with the acquisition of autografts. Further, allografts have the added advantage of being available in large quantities. This has led to a global increase in allogeneic transplantation and development of tissue banking. The aim of the tissue bank is to provide a wide range of processed biological tissues free from any transmissible disease, that help to restore the growth and function of the damaged tissues. Skin dressings or skin substitutes like allograft skin, xenograft skin and amniotic membrane can be used for the treatment of thermal burns and radiation induced skin injuries. Bone allografts can be used for reconstructive approaches to the skeletal system. Tissue banking would thus ensure health care to the military personnel and population following a nuclear detonation. (author)

Imaging-guided two-photon excitation-emission-matrix measurements of human skin tissues

Science.gov (United States)

Yu, Yingqiu; Lee, Anthony M. D.; Wang, Hequn; Tang, Shuo; Zhao, Jianhua; Lui, Harvey; Zeng, Haishan

2012-07-01

There are increased interests on using multiphoton imaging and spectroscopy for skin tissue characterization and diagnosis. However, most studies have been done with just a few excitation wavelengths. Our objective is to perform a systematic study of the two-photon fluorescence (TPF) properties of skin fluorophores, normal skin, and diseased skin tissues. A nonlinear excitation-emission-matrix (EEM) spectroscopy system with multiphoton imaging guidance was constructed. A tunable femtosecond laser was used to vary excitation wavelengths from 730 to 920 nm for EEM data acquisition. EEM measurements were performed on excised fresh normal skin tissues, seborrheic keratosis tissue samples, and skin fluorophores including: NADH, FAD, keratin, melanin, collagen, and elastin. We found that in the stratum corneum and upper epidermis of normal skin, the cells have large sizes and the TPF originates from keratin. In the lower epidermis, cells are smaller and TPF is dominated by NADH contributions. In the dermis, TPF is dominated by elastin components. The depth resolved EEM measurements also demonstrated that keratin structure has intruded into the middle sublayers of the epidermal part of the seborrheic keratosis lesion. These results suggest that the imaging guided TPF EEM spectroscopy provides useful information for the development of multiphoton clinical devices for skin disease diagnosis.

3D skin surface reconstruction from a single image by merging global curvature and local texture using the guided filtering for 3D haptic palpation.

Science.gov (United States)

Lee, K; Kim, M; Kim, K

2018-05-11

Skin surface evaluation has been studied using various imaging techniques. However, all these studies had limited impact because they were performed using visual exam only. To improve on this scenario with haptic feedback, we propose 3D reconstruction of the skin surface using a single image. Unlike extant 3D skin surface reconstruction algorithms, we utilize the local texture and global curvature regions, combining the results for reconstruction. The first entails the reconstruction of global curvature, achieved by bilateral filtering that removes noise on the surface while maintaining the edge (ie, furrow) to obtain the overall curvature. The second entails the reconstruction of local texture, representing the fine wrinkles of the skin, using an advanced form of bilateral filtering. The final image is then composed by merging the two reconstructed images. We tested the curvature reconstruction part by comparing the resulting curvatures with measured values from real phantom objects while local texture reconstruction was verified by measuring skin surface roughness. Then, we showed the reconstructed result of our proposed algorithm via the reconstruction of various real skin surfaces. The experimental results demonstrate that our approach is a promising technology to reconstruct an accurate skin surface with a single skin image. We proposed 3D skin surface reconstruction using only a single camera. We highlighted the utility of global curvature, which has not been considered important in the past. Thus, we proposed a new method for 3D reconstruction that can be used for 3D haptic palpation, dividing the concepts of local and global regions. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Reconstruction of segmented human voxel phantoms for skin dosimetry

International Nuclear Information System (INIS)

Antunes, Paula C.G.; Siqueira, Paulo de Tarso D.; Yoriyaz, Helio; Fonseca, Gabriel P.; Reis, Gabriela; Furnari, Laura

2009-01-01

High-resolution medical images along with methods that simulate the interaction of radiation with matter, as the Monte Carlo radiation transport codes, have been widely used in medical physics procedures. These images provide the construction of realistic anatomical models, which after being coupled to these codes, may drive to better assessments of dose distributions on the patient. These anatomical models constructed from medical images are known as voxel phantoms (voxel - volume element of an image). Present day regular images are unsuitable to correctly perform skin dose distribution evaluations. This inability is due to improper skin discrimination in most of the current medical images, once its thickness stands below the resolution of the pixels that form the image. This paper proposes the voxel phantom reconstruction by subdividing and segmenting the elements that form the phantom. It is done in order to better discriminate the skin by assigning it more adequate thickness and actual location, allowing a better dosimetric evaluation of the skin. This task is an important issue in many radiotherapy procedures. Particular interest lays in Total Skin Irradiation (TSI) with electron beams, where skin dose evaluation stands as the treatment key point of the whole body irradiation. This radiotherapy procedure is under implementation at the Hospital das Clinicas da Universidade de Sao Paulo (HC-USP). (author)

Internal Mammary Vessels’ Impact on Abdominal Skin Perfusion in Free Abdominal Flap Breast Reconstruction

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Solveig Nergård, MD

2017-12-01

Conclusions:. Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days.

[NEW PROGRESS OF ACELLULAR FISH SKIN AS NOVEL TISSUE ENGINEERED SCAFFOLD].

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Wei, Xiaojuan; Wang, Nanping; He, Lan; Guo, Xiuyu; Gu, Qisheng

2016-11-08

To review the recent research progress of acellular fish skin as a tissue engineered scaffold, and to analyze the feasibility and risk management in clinical application. The research and development, application status of acellular fish skin as a tissue engineered scaffold were comprehensively analyzed, and then several key points were put forward. Acellular fish skin has a huge potential in clinical practice as novel acellular extracellular matrix, but there have been no related research reports up to now in China. As an emerging point of translational medicine, investigation of acellular fish skin is mainly focused on artificial skin, surgical patch, and wound dressings. Development of acellular fish skin-based new products is concerned to be clinical feasible and necessary, but a lot of applied basic researches should be carried out.

Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique

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Elisa Bellini

2017-01-01

Full Text Available Objective. Breast cancer, the most common malignancy in women, comprises 18% of all female cancers. Mastectomy is an essential intervention to save lives, but it can destroy one’s body image, causing both physical and psychological trauma. Reconstruction is an important step in restoring patient quality of life after the mutilating treatment. Material and Methods. Tissue expanders and implants are now commonly used in breast reconstruction. Autologous reconstruction allows a better aesthetic result; however, many patients prefer implant reconstruction due to the shorter operation time and lack of donor site morbidity. Moreover, this reconstruction strategy is safe and can be performed in patients with multiple health problems. Tissue-expander reconstruction is conventionally performed as a two-stage procedure starting immediately after mammary gland removal. Results. Mastectomy is a destructive but essential intervention for women with breast cancer. Tissue expansion breast reconstruction is a safe, reliable, and efficacious procedure with considerable psychological benefits since it provides a healthy body image. Conclusion. This article focuses on this surgical technique and how to achieve the best reconstruction possible.

One-stage reconstruction of soft tissue defects with the sandwich technique: Collagen-elastin dermal template and skin grafts

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Uwe Wollina

2011-01-01

Full Text Available Background : A full-thickness soft tissue defect closure often needs complex procedures. The use of dermal templates can be helpful in improving the outcome. Objective : The objective was to evaluate a sandwich technique combining the dermal collagen-elastin matrix with skin grafts in a one-stage procedure. Materials and Methods : Twenty-three patients with 27 wounds were enrolled in this prospective single-centre observational study. The mean age was 74.8 ± 17.2 years. Included were full-thickness defects with exposed bone, cartilage and/ or tendons. The dermal collagen-elastin matrix was applied onto the wound bed accomplished by skin transplants, i.e. ′sandwich′ transplantation. In six wounds, the transplants were treated with intermittent negative pressure therapy. Results : The size of defects was ≤875 cm 2 . The use of the dermal template resulted in a complete and stable granulation in 100% of wounds. Seventeen defects showed a complete closure and 19 achieved a complete granulation with an incomplete closure. There was a marked pain relief. No adverse events were noted due to the dermal template usage. Conclusions : Sandwich transplantation with the collagen-elastin matrix is a useful tool when dealing with full-thickness soft tissue defects with exposed bone, cartilage or tendons.

Radiation processing of biological tissues for nuclear disaster management

International Nuclear Information System (INIS)

Singh, Rita

2012-01-01

A number of surgical procedures require tissue substitutes to repair or replace damaged or diseased tissues. Biological tissues from human donor like bone, skin, amniotic membrane and other soft tissues can be used for repair or reconstruction of the injured part of the body. Tissues from human donor can be processed and banked for orthopaedic, spinal, trauma and other surgical procedures. Allograft tissues provide an excellent alternative to autografts. The use of allograft tissue avoids the donor site morbidity and reduces the operating time, expense and trauma associated with the acquisition of autografts. Further, allografts have the added advantage of being available in large quantities. This has led to a global increase in allogeneic transplantation and development of tissue banking. However, the risk of infectious disease transmission via tissue allografts is a major concern. Therefore, tissue allografts should be sterilized to make them safe for clinical use. Radiation processing has well appreciated technological advantages and is the most suitable method for sterilization of biological tissues. Radiation processed biological tissues can be provided by the tissue banks for the management of injuries due to a nuclear disaster. A nuclear detonation will result in a large number of casualties due to the heat, blast and radiation effects of the weapon. Skin dressings or skin substitutes like allograft skin, xenograft skin and amniotic membrane can be used for the treatment of thermal burns and radiation induced skin injuries. Bone grafts can be employed for repairing fracture defects, filling in destroyed regions of bone, management of open fractures and joint injuries. Radiation processed tissues have the potential to repair or reconstruct damaged tissues and can be of great assistance in the treatment of injuries due to the nuclear weapon. (author)

The tolerance of skin grafts to postoperative radiation therapy in patients with soft-tissue sarcoma

International Nuclear Information System (INIS)

Lawrence, W.T.; Zabell, A.; McDonald, H.D.

1986-01-01

During the last ten years at the National Cancer Institute, 11 patients have received 12 courses of postoperative adjuvant radiation therapy to skin grafts used for wound closure after the resection of soft-tissue sarcomas. The intervals between grafting and the initiation of radiation ranged between 3 and 20 weeks, and 4 patients received chemotherapy at the same time as their radiation. Ten of the 12 irradiated grafts remained intact after the completion of therapy. One graft had several small persistently ulcerated areas that required no further surgical treatment, and one graft required a musculocutaneous flap for reconstruction of a persistent large ulcer. Acute radiation effects on the grafted skin sometimes developed at slightly lower doses than usually seen with normal skin, but these acute effects necessitated a break in therapy on only five occasions. Concurrent chemotherapy and a relatively short interval between grafting and the initiation of radiation seemed to contribute to more severe radiation reactions. This experience indicates that postoperative adjuvant radiation therapy can be delivered to skin grafted areas without undue fear of complications, especially if the graft is allowed to heal adequately prior to initiating therapy and if chemotherapy is not given in conjunction with radiation

[Skin and Soft Tissue Infections Due to Corynebacterium ulcerans - Case Reports].

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Jenssen, Christian; Schwede, Ilona; Neumann, Volker; Pietsch, Cristine; Handrick, Werner

2017-10-01

History and clinical findings  We report on three patients suffering from skin and soft tissue infections of the legs due to toxigenic Corynebacterium ulcerans strains. In all three patients, there was a predisposition due to chronic diseases. Three patients had domestic animals (cat, dog) in their households. Investigations and diagnosis  A mixed bacterial flora including Corynebacterium ulcerans was found in wound swab samples. Diphtheric toxin was produced by the Corynebacterium ulcerans strains in all three cases. Treatment and course  In all three patients, successful handling of the skin and soft tissue infections was possible by combining local treatment with antibiotics. Diphtheria antitoxin was not administered in any case. Conclusion  Based on a review of the recent literature pathogenesis, clinical symptoms and signs, diagnostics and therapy of skin and soft tissue infections due to Corynebacterium ulcerans are discussed. Corynebacterium ulcerans should be considered as a potential cause of severe skin and soft tissue infections. Occupational or domestic animal contacts should be evaluated. © Georg Thieme Verlag KG Stuttgart · New York.

Tissue-Engineered Skin Substitute Enhances Wound Healing after Radiation Therapy.

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Busra, Mohd Fauzi bin Mh; Chowdhury, Shiplu Roy; bin Ismail, Fuad; bin Saim, Aminuddin; Idrus, Ruszymah Bt Hj

2016-03-01

When given in conjunction with surgery for treating cancer, radiation therapy may result in impaired wound healing, which, in turn, could cause skin ulcers. In this study, bilayer and monolayer autologous skin substitutes were used to treat an irradiated wound. A single dose of 30 Gy of linear electron beam radiation was applied to the hind limb of nude mice before creating the skin lesion (area of 78.6 mm). Monolayer tissue-engineered skin substitutes (MTESSs) were prepared by entrapping cultured keratinocytes in fibrin matrix, and bilayer tissue-engineered skin substitutes (BTESSs) were prepared by entrapping keratinocytes and fibroblasts in separate layers. Bilayer tissue-engineered skin substitute and MTESS were implanted to the wound area. Gross appearance and wound area were analyzed to evaluate wound healing efficiency. Skin regeneration and morphological appearance were observed via histological and electron microscopy. Protein expressions of transforming growth factor β1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and vascular endothelial growth factor (VEGF) in skin regeneration were evaluated by immunohistochemistry (IHC). Macroscopic observation revealed that at day 13, treatments with BTESS completely healed the irradiated wound, whereas wound sizes of 1.1 ± 0.05 and 6.8 ± 0.14 mm were measured in the MTESS-treated and untreated control groups, respectively. Hematoxylin-eosin (H&E) analysis showed formation of compact and organized epidermal and dermal layers in the BTESS-treated group, as compared with MTESS-treated and untreated control groups. Ultrastructural analysis indicates maturation of skin in BTESS-treated wound evidenced by formation of intermediate filament bundles in the dermal layer and low intercellular space in the epidermal layer. Expressions of TGF-β1, PDGF-BB, and VEGF were also higher in BTESS-treated wounds, compared with MTESS-treated wounds. These results indicate that BTESS is the preferred treatment for

RECONSTRUCTION OF FACIAL SKIN DEFECT BY VARIOUS FLAPS : OUR EXPERIENCE

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Atishkumar B.

2015-08-01

Full Text Available INTRODUCTION : Face represents complete personality of human being. Cosmetically it is very important part of a person especially for woman. There are many situations when due to disease or trauma, facial defect arises, which requires reconstruction by either local or distant surgical flaps . METHODS AND MATERIALS : In rural places, we come across many patients suffering from trauma and skin malignancy of face. These patients require reconstruction done esthetically with local flaps. Objective of this study is to share our exper ience of providing esthetically good results at our secondary referral care center. Hereby, we present case series of 14 patients operated at our institute. These patients were analyzed according to the age, sex, nature of injury and anatomical location of lesion on the face. All these patients were operated and reconstruction of defect was done with various local flaps best suited for respective lesion, under local anesthesia or sedation. Post - operative nature of wound was analyzed for flap viability or fl ap necrosis . RESULTS : Amongst them were 7 male and 7 female, ages ranging from 4 to 80 years. 7out of 14 patients were of basal cell carcinoma, 4 were due to trauma, 2 were due to dog bite and 1 case of recurrent pleomorphic adenoma at root of nose. All patients had excellent flap viability at end of 6 months and flap achieving almost similar color and contour as that of surrounding skin. CONCLUSION : Reconstruction of facial defects by local flaps is very easy and cost effective technique. This can be don e even at secondary referral care centre with minimal availability of facilities

′Sure closure′-skin stretching system, our clinical experience

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Subramania K

2005-01-01

Full Text Available Objective: In clinical practice of reconstructive surgery one of the problems one routinely comes across is skin and soft tissue defects, which require coverage. Coverage of such wounds requires primary/secondary closure, skin grafting or flaps. The objective of our clinical series was to assess the efficacy of sure closure skin stretching system for closure of defects which otherwise would have required major flap cover or skin grafting. Methods: Our series included five patients with different causes and types of wound defects namely: 1. Post-traumatic soft tissue defect on dorsum of hand. 2. Post fasciotomy wound on leg (anterolateral aspect. 3. Abdominal wound dehiscence following surgery for enterocutaneous fistula. 4. Leg soft tissue defect following dehiscence of fasciocutaneous flap. 5. Secondary defect following harvesting a lateral arm/forearm free flap. The device was applied to skin edges after preparing the wound under local anesthesia and the skin edges were brought together by turning the skin-stretching knob. After adequate approximation of the edges of the wound it was sutured by conventional suturing techniques. Results: All the wounds could be successfully closed using the skin stretching system in our series. The time taken for the closure ranged from 2 to 48 h. Conclusions: Sure closure skin stretching system is an effective device for closing some of the skin defects which otherwise would have required skin flaps or grafts. In all the patients wound closure could be achieved by this method and was carried out under local anesthesia. Use of this technique is simple and helps to reduce the morbidity and cost of treatment by allowing the reconstructive surgeon to avoid using major flaps or grafts.

Comet assay in reconstructed 3D human epidermal skin models—investigation of intra- and inter-laboratory reproducibility with coded chemicals

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Pfuhler, Stefan

2013-01-01

Reconstructed 3D human epidermal skin models are being used increasingly for safety testing of chemicals. Based on EpiDerm™ tissues, an assay was developed in which the tissues were topically exposed to test chemicals for 3h followed by cell isolation and assessment of DNA damage using the comet assay. Inter-laboratory reproducibility of the 3D skin comet assay was initially demonstrated using two model genotoxic carcinogens, methyl methane sulfonate (MMS) and 4-nitroquinoline-n-oxide, and the results showed good concordance among three different laboratories and with in vivo data. In Phase 2 of the project, intra- and inter-laboratory reproducibility was investigated with five coded compounds with different genotoxicity liability tested at three different laboratories. For the genotoxic carcinogens MMS and N-ethyl-N-nitrosourea, all laboratories reported a dose-related and statistically significant increase (P 30% cell loss), and the overall response was comparable in all laboratories despite some differences in doses tested. The results of the collaborative study for the coded compounds were generally reproducible among the laboratories involved and intra-laboratory reproducibility was also good. These data indicate that the comet assay in EpiDerm™ skin models is a promising model for the safety assessment of compounds with a dermal route of exposure. PMID:24150594

Complications of surgery for radiotherapy skin damage

International Nuclear Information System (INIS)

Rudolph, R.

1982-01-01

Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design

Conservative mastectomies and immediate reconstruction with the use of ADMs.

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Govshievich, Alexander; Somogyi, Ron B; Brown, Mitchell H

2015-12-01

In recent years, a novel approach to immediate breast reconstruction has been introduced with the advent of acellular dermal matrix (ADM). In the setting of conservative mastectomies where the native skin envelope is preserved, placement of ADM at the lower pole in continuity with the pectoralis major muscle (PMM) provides additional support, allowing direct-to-implant breast reconstruction. The following manuscript presents the senior author's experience with ADM-assisted reconstruction and provides a detailed description of surgical technique along with a comprehensive discussion of patient selection and potential complications. A retrospective chart review of patients undergoing direct-to-implant breast reconstruction following skin sparing or nipple sparing mastectomy with the use of ADM (AlloDerm; LifeCell Corp., Branchburg, USA) was conducted at Women's College Hospital in Toronto over a 5-year period [2008-2013]. Demographic data, previous radiation therapy and post-operative complications were recorded. A total of 72 patients representing 119 breasts were identified. Average follow-up was 16 months (range, 3-51 months). Twenty-seven complications were recorded for a complication rate of 22.7% (27/119). Complications included six cases of capsular contracture (Baker III/IV), five cases of red skin syndrome, four cases of rippling, three cases of dehiscence and two cases of seroma. Overall, direct-to-implant reconstruction was successfully completed in 97.5% of breasts (116/119). One case of infection was treated with explantation and conversion to autogenous reconstruction. Two breasts with tissue necrosis or dehiscence had the implants removed and replaced with tissue expanders. Overall reoperation rate was 9.7% (7/72 patients). ADM assisted direct-to-implant breast reconstruction has been shown to be a safe option for women who are candidates for skin sparing or nipple sparing mastectomies. Judicious patient selection, effective collaboration between the

Skin Perfusion Pressure Measurement to Assess Improvement in Peripheral Circulation after Arterial Reconstruction for Critical Limb Ischemia

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Watanabe, Yoshiko; Onozuka, Atsuko; Obitsu, Yukio; Komai, Hiroyoshi; Koizumi, Nobusato; Saiki, Naozumi; Shigematsu, Hiroshi

2011-01-01

Aim: To assess the utility of skin perfusion pressure (SPP) measurement in evaluating the outcome of vascular constructions for critical limb ischemia (CLI) patients. Methods: We retrospectively studied 19 lower limbs in 18 patients who underwent arterial reconstruction for CLI from whom SPP measurements had been obtained pre- and postoperatively between 2008 and 2010. Six limbs whose ulcers had healed postoperatively were classified into group H, 7 limbs whose ulcers had not healed into group U, and 6 limbs without ulcers into group N. SPP values were compared among these groups. Results: The preoperative SPP values in all groups were <30 mmHg, without significant differences among the groups. The SPP values in groups H and N significantly improved after operation, and those in group U were significantly lower than those in the other groups. Conclusions: SPP measurement before and after arterial reconstruction is useful to assess improvement in tissue circulation and to predict the likelihood of wound healing. An SPP value ≥30 mmHg was considered necessary for wound healing, supporting the findings of the few reports in the literature on the usefulness of SPP for assessing vascular reconstruction effects on ulcer wound healing. PMID:23555459

OWN EXPERIENCE OF LASER THERAPY FOR THE PREVENTION AND TREATMENT OF EARLY AND LATE RADIATION-INDUCED SKIN INJURIES IN PATIENTS WITH BREAST CANCER AFTER SIMULTANEOUS RECONSTRUCTIVE PLASTIC SURGERY

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S. I. Tkachev

2017-01-01

Full Text Available Low-energy laser radiation has a good anti-inflammatory and stimulating effect on the damaged tissues; therefore, it can be used for the prevention and treatment of both early and late radiation-induced skin injuries in patients receiving radiotherapy. So far, the effect of low-energy laser radiation in the prevention of radiation-induced skin damage remains poorly understood. This article presents a brief overview of the results obtained in the latest foreign studies as well as own experience of laser therapy for the prevention and treatment of both early and late radiation-induced skin injuries in patients with breast cancer after simultaneous reconstructive plastic surgery.

Magneto-acousto-electrical Measurement Based Electrical Conductivity Reconstruction for Tissues.

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Zhou, Yan; Ma, Qingyu; Guo, Gepu; Tu, Juan; Zhang, Dong

2018-05-01

Based on the interaction of ultrasonic excitation and magnetoelectrical induction, magneto-acousto-electrical (MAE) technology was demonstrated to have the capability of differentiating conductivity variations along the acoustic transmission. By applying the characteristics of the MAE voltage, a simplified algorithm of MAE measurement based conductivity reconstruction was developed. With the analyses of acoustic vibration, ultrasound propagation, Hall effect, and magnetoelectrical induction, theoretical and experimental studies of MAE measurement and conductivity reconstruction were performed. The formula of MAE voltage was derived and simplified for the transducer with strong directivity. MAE voltage was simulated for a three-layer gel phantom and the conductivity distribution was reconstructed using the modified Wiener inverse filter and Hilbert transform, which was also verified by experimental measurements. The experimental results are basically consistent with the simulations, and demonstrate that the wave packets of MAE voltage are generated at tissue interfaces with the amplitudes and vibration polarities representing the values and directions of conductivity variations. With the proposed algorithm, the amplitude and polarity of conductivity gradient can be restored and the conductivity distribution can also be reconstructed accurately. The favorable results demonstrate the feasibility of accurate conductivity reconstruction with improved spatial resolution using MAE measurement for tissues with conductivity variations, especially suitable for nondispersive tissues with abrupt conductivity changes. This study demonstrates that the MAE measurement based conductivity reconstruction algorithm can be applied as a new strategy for nondestructive real-time monitoring of conductivity variations in biomedical engineering.

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series.

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Ramanathan, Manikandhan; Sneha, Pendem; Parameswaran, Ananthnarayanan; Jayakumar, Naveen; Sailer, Hermann F

2014-12-01

Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion. To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts. 9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages. Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site. Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.

Point-of-care instrument for monitoring tissue health during skin graft repair

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Gurjar, R. S.; Seetamraju, M.; Zhang, J.; Feinberg, S. E.; Wolf, D. E.

2011-06-01

We have developed the necessary theoretical framework and the basic instrumental design parameters to enable mapping of subsurface blood dynamics and tissue oxygenation for patients undergoing skin graft procedures. This analysis forms the basis for developing a simple patch geometry, which can be used to map by diffuse optical techniques blood flow velocity and tissue oxygenation as a function of depth in subsurface tissue.skin graft, diffuse correlation analysis, oxygen saturation.

Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy.

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Verstappen, Ralph; Djedovic, Gabriel; Morandi, Evi Maria; Heiser, Dietmar; Rieger, Ulrich Michael; Bauer, Thomas

2018-03-01

A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

Reconstruction of voxel phantoms for skin dosimetry

International Nuclear Information System (INIS)

Antunes, Paula Cristina Guimaraes

2010-01-01

Radiotherapy is a therapeutic modality that utilizes ionizing radiation for the destruction of neoplastic human cells. One of the requirements for this treatment methodology success lays on the appropriate use of planning systems, which performs, among other information, the patient's dose distribution estimate. Nowadays, transport codes have been providing huge subsidies to these planning systems, once it enables specific and accurate patient organ and tissue dosimetry. The model utilized by these codes to describe the human anatomy in a realistic way is known as voxel phantoms, which are represented by discrete volume elements (voxels) directly associated to tomographic data. Nowadays, voxel phantoms doable of being inserted and processed by the transport code MCNP (Monte Carlo N-Particle) presents a 3-4 mm image resolution; however, such resolution limits some thin body structure discrimination, such as skin. In this context, this work proposes a calculus routine that discriminates this region with thickness and localization in the voxel phantoms similar to the real, leading to an accurate dosimetric skin dose assessment by the MCNP code. Moreover, this methodology consists in manipulating the voxel phantoms volume elements by segmenting and subdividing it in different skin thickness. In addition to validate the skin dose calculated data, a set of experimental evaluations with thermoluminescent dosimeters were performed in an anthropomorphic phantom. Due to significant differences observed on the dose distribution of several skin representations, it was found that is important to discriminate the skin thickness similar to the real. The presented methodology is useful to obtain an accurate skin dosimetric evaluation for several radiotherapy procedures, with particular interest on the electron beam radiotherapy, in which highlights the whole body irradiation therapy (TSET), a procedure under implementation at the Hospital das Clinicas da Faculdade de Medicina da

Low-intensity infrared lasers alter actin gene expression in skin and muscle tissue

International Nuclear Information System (INIS)

Fonseca, A S; Mencalha, A L; Campos, V M A; Ferreira-Machado, S C; Peregrino, A A F; Magalhães, L A G; Geller, M; Paoli, F

2013-01-01

The biostimulative effect of low-intensity lasers is the basis for treatment of diseases in soft tissues. However, data about the influence of biostimulative lasers on gene expression are still scarce. The aim of this work was to evaluate the effects of low-intensity infrared lasers on the expression of actin mRNA in skin and muscle tissue. Skin and muscle tissue of Wistar rats was exposed to low-intensity infrared laser radiation at different fluences and frequencies. One and 24 hours after laser exposure, tissue samples were withdrawn for total RNA extraction, cDNA synthesis and evaluation of actin gene expression by quantitative polymerase chain reaction. The data obtained show that laser radiation alters the expression of actin mRNA differently in skin and muscle tissue of Wistar rats depending of the fluence, frequency and time after exposure. The results could be useful for laser dosimetry, as well as to justify the therapeutic protocols for treatment of diseases of skin and muscle tissues based on low-intensity infrared laser radiation. (paper)

Oromandibular reconstruction with chimeric double-skin paddle flap based on peroneal vessel axis for synchronous opposite double oral cancer.

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Huang, Shih-Tsai; Liu, Wen-Chung; Chen, Lee-Wei; Yang, Kuo-Chung

2015-05-01

Synchronous double oral cancer represents the minority of cases of head and neck cancer. After tumor ablation, 2 separate oromandibular defects, even combined with a through-and-through oral defect, pose a serious reconstructive challenge. The ideal method for reconstruction remains controversial. Based on the peroneal vessel axis, a chimeric double-skin paddle peroneal fasciocutaneous or fibular osteomyocutaneous flap could be designed to accomplish the difficult reconstruction. Six male patients, each with 2 separate oromandibular defects after tumor ablation of synchronous double oral cancer, received double-skin paddle flap reconstruction with 3 peroneal fasciocutaneous and 3 fibular osteomyocutaneous flaps. All 6 flaps survived; however, complications included 1 skin paddle lost due to insufficient perfusion of a visible perforator, and 1 superficial necrosis occurring over the tip of a longer skin paddle. One postoperative intraoral infection and 1 donor site infection were also reported. During follow-up, 3 months later, 1 patient succumbed to local recurrence and bony metastasis. One patient developed a new cancer in the maxillary gingiva, and another had osteoradionecrosis 8 months later. Four patients gained acceptable cosmesis with good oral competence. A chimeric flap based on the peroneal artery could provide a segment of fibular bone, 1 or 2 skin paddles, and a cuff of the flexor hallucis longus muscle simultaneously. For 1-stage reconstruction of separate oromandibular defects after tumor ablation of synchronous double oral cancer, this design could provide all components at 1 transfer.

Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study.

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Craig, Elizabeth S; Clemens, Mark W; Koshy, John C; Wren, James; Hong, Zhang; Butler, Charles; Garvey, Patrick; Selber, Jesse; Kronowitz, Steven

2018-05-24

Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared between cohorts. Over ten years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1,370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0 and 16.7%, respectively (p <0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM. The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases.

Antibiotic susceptibility pattern and the prevalence of Staphylococcus aureus isolated from skin and soft tissue in Tehran Razi skin hospital (2014-15

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Zeynab Fagheei-Aghmiyuni

2017-06-01

Full Text Available Background: Staphylococcus aureus (S. aureus is the most common cause of skin and soft tissue infections. This study aimed to determine the prevalence of S. aureus isolated from skin and soft tissue and antibiotic susceptibility pattern among the patient hospitalized in Razi skin hospital (Tehran-Iran. Materials and Methods: This cross-sectional study was conducted on patients (n=400 with skin and soft tissue infections in Razi skin hospital. Sterilized swabs were used to collect the skin infection samples. S. aureus isolates were confirmed using biochemical tests (gram staining, catalase, coagulase, DNase test and manitol fermentation tests. Result: 51.3 %( 205 out of 400 of isolates were S. aureus. Ninety six (46.8% of isolates were methicillin and penicillin-resistant S. aureus. All of the isolates showed sensitivity to vancomycin, linezolid. 98% of the isolates were susceptible to daptomycin. One-hundred sixteen (56.6% isolates were multi- drug resistant. Conclusion: More than half of the skin and soft tissue infections were caused by S.aureus. More than 46 percent of the isolates were methicillin resistant. The highest resistance to penicillin was observed.

Reconstruction of Defects After Fournier Gangrene: A Systematic Review.

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Karian, Laurel S; Chung, Stella Y; Lee, Edward S

2015-01-01

Reconstruction of scrotal defects after Fournier gangrene is often achieved with skin grafts or flaps, but there is no general consensus on the best method of reconstruction or how to approach the exposed testicle. We systematically reviewed the literature addressing methods of reconstruction of Fournier defects after debridement. PubMed and Cochrane databases were searched from 1950 to 2013. Inclusion criteria were reconstruction for Fournier defects, patients 18 to 90 years old, and reconstructive complication rates reported as whole numbers or percentages. Exclusion criteria were studies focused on methods of debridement or other phases of care rather than reconstruction, studies with fewer than 5 male patients with Fournier defects, literature reviews, and articles not in English. The initial search yielded 982 studies, which was refined to 16 studies with a total pool of 425 patients. There were 25 (5.9%) patients with defects that healed by secondary intention, 44 (10.4%) with delayed primary closure, 36 (8.5%) with implantation of the testicle in a medial thigh pocket, 6 (1.4%) with loose wound approximation, 96 (22.6%) with skin grafts, 68 (16.0%) with scrotal advancement flaps, 128 (30.1%) with flaps, and 22 (5.2%) with flaps or skin grafts in combination with tissue adhesives. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft. A reconstructive algorithm is proposed. Skin grafting or flap reconstruction is recommended for defects larger than 50% of the scrotum or extending beyond the scrotum, whereas scrotal advancement flap reconstruction or healing by secondary intention is best for defects confined to less than 50% of the scrotum that cannot be closed

Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy

Directory of Open Access Journals (Sweden)

Ralph Verstappen

2018-03-01

Full Text Available Background A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. Methods All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. Results We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. Conclusions In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

Reconstructing Carotenoid-Based and Structural Coloration in Fossil Skin.

Science.gov (United States)

McNamara, Maria E; Orr, Patrick J; Kearns, Stuart L; Alcalá, Luis; Anadón, Pere; Peñalver, Enrique

2016-04-25

Evidence of original coloration in fossils provides insights into the visual communication strategies used by ancient animals and the functional evolution of coloration over time [1-7]. Hitherto, all reconstructions of the colors of reptile integument and the plumage of fossil birds and feathered dinosaurs have been of melanin-based coloration [1-6]. Extant animals also use other mechanisms for producing color [8], but these have not been identified in fossils. Here we report the first examples of carotenoid-based coloration in the fossil record, and of structural coloration in fossil integument. The fossil skin, from a 10 million-year-old colubrid snake from the Late Miocene Libros Lagerstätte (Teruel, Spain) [9, 10], preserves dermal pigment cells (chromatophores)-xanthophores, iridophores, and melanophores-in calcium phosphate. Comparison with chromatophore abundance and position in extant reptiles [11-15] indicates that the fossil snake was pale-colored in ventral regions; dorsal and lateral regions were green with brown-black and yellow-green transverse blotches. Such coloration most likely functioned in substrate matching and intraspecific signaling. Skin replicated in authigenic minerals is not uncommon in exceptionally preserved fossils [16, 17], and dermal pigment cells generate coloration in numerous reptile, amphibian, and fish taxa today [18]. Our discovery thus represents a new means by which to reconstruct the original coloration of exceptionally preserved fossil vertebrates. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fish collagen/alginate/chitooligosaccharides integrated scaffold for skin tissue regeneration application.

Science.gov (United States)

Chandika, Pathum; Ko, Seok-Chun; Oh, Gun-Woo; Heo, Seong-Yeong; Nguyen, Van-Tinh; Jeon, You-Jin; Lee, Bonggi; Jang, Chul Ho; Kim, GeunHyung; Park, Won Sun; Chang, Wonseok; Choi, Il-Whan; Jung, Won-Kyo

2015-11-01

An emerging paradigm in wound healing techniques is that a tissue-engineered skin substitute offers an alternative approach to create functional skin tissue. Here we developed a fish collagen/alginate (FCA) sponge scaffold that was functionalized by different molecular weights of chitooligosaccharides (COSs) with the use of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride as a cross-linking agent. The effects of cross-linking were analyzed by Fourier transform infrared spectroscopy. The results indicate that the homogeneous materials blending and cross-linking intensity were dependent on the molecular weights of COSs. The highly interconnected porous architecture with 160-260μm pore size and over 90% porosity and COS's MW driven swelling and retention capacity, tensile property and in vitro biodegradation behavior guaranteed the FCA/COS scaffolds for skin tissue engineering application. Further improvement of these properties enhanced the cytocompatibility of all the scaffolds, especially the scaffolds containing COSs with MW in the range of 1-3kDa (FCA/COS1) showed the best cytocompatibility. These physicochemical, mechanical, and biological properties suggest that the FCA/COS1 scaffold is a superior candidate that can be used for skin tissue regeneration. Copyright © 2015 Elsevier B.V. All rights reserved.

Tissue expansion and fluid absorption by skin tissue following intradermal injections through hollow microneedles

Science.gov (United States)

Shrestha, Pranav; Stoeber, Boris

2017-11-01

Hollow microneedles provide a promising alternative to conventional drug delivery techniques due to improved patient compliance and the dose sparing effect. The dynamics of fluid injected through hollow microneedles into skin, which is a heterogeneous and deformable porous medium, have not been investigated extensively in the past. We have introduced the use of Optical Coherence Tomography (OCT) for real-time visualization of fluid injections into excised porcine tissue. The results from ex-vivo experiments, including cross-sectional tissue images from OCT and pressure/flow-rate measurements, show a transient mode of high flow-rate into the tissue followed by a lower steady-state infusion rate. The injected fluid expands the underlying tissue and causes the external free surface of the skin to rise, forming a characteristic intradermal wheal. We have used OCT to visualize the evolution of tissue and free surface deformation, and advancement of the boundary between regions of expanding and stationary tissue. We will show the effect of different injection parameters such as fluid pressure, viscosity and microneedle retraction on the injected volume. This work has been supported through funding from the Collaborative Health Research Program by the Natural Science and Engineering Research Council of Canada and the Canadian Health Research Institute, and through the Canada Research Chairs program.

An Algorithmic Approach to Total Breast Reconstruction with Free Tissue Transfer

Directory of Open Access Journals (Sweden)

Seong Cheol Yu

2013-05-01

Full Text Available As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. Each flap comes with its own advantages and disadvantages related to tissue properties and donor-site morbidity. Currently, the problem is how to determine the most appropriate flap for a particular patient among those potential candidates. Based on a thorough review of the literature and accumulated experiences in the author’s institution, this article provides a logical approach to autologous breast reconstruction. The algorithms presented here can be helpful to customize breast reconstruction to individual patient needs.

Is there a need for smooth muscle cell transplantation in urethral reconstruction?

NARCIS (Netherlands)

Arenas da Silva, L.F.; Micol, L.; Tiemessen, D.; Kuppevelt, T.H. van; Frey, P.; Oosterwijk, E.; Geutjes, P.J.; Feitz, W.F.J.

2014-01-01

BACKGROUND: Hypospadias and urethral strictures are conditions requiring additional tissue for reconstruction. Due to a limited source of tissue, autologous skin and oral mucosa are frequently used. However, long-term follow-up studies demonstrated significant complications and diminished quality of

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap

Directory of Open Access Journals (Sweden)

Jefferson Lessa Soares de Macedo

Full Text Available ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

Gene expression changes with age in skin, adipose tissue, blood and brain.

Science.gov (United States)

Glass, Daniel; Viñuela, Ana; Davies, Matthew N; Ramasamy, Adaikalavan; Parts, Leopold; Knowles, David; Brown, Andrew A; Hedman, Asa K; Small, Kerrin S; Buil, Alfonso; Grundberg, Elin; Nica, Alexandra C; Di Meglio, Paola; Nestle, Frank O; Ryten, Mina; Durbin, Richard; McCarthy, Mark I; Deloukas, Panagiotis; Dermitzakis, Emmanouil T; Weale, Michael E; Bataille, Veronique; Spector, Tim D

2013-07-26

Previous studies have demonstrated that gene expression levels change with age. These changes are hypothesized to influence the aging rate of an individual. We analyzed gene expression changes with age in abdominal skin, subcutaneous adipose tissue and lymphoblastoid cell lines in 856 female twins in the age range of 39-85 years. Additionally, we investigated genotypic variants involved in genotype-by-age interactions to understand how the genomic regulation of gene expression alters with age. Using a linear mixed model, differential expression with age was identified in 1,672 genes in skin and 188 genes in adipose tissue. Only two genes expressed in lymphoblastoid cell lines showed significant changes with age. Genes significantly regulated by age were compared with expression profiles in 10 brain regions from 100 postmortem brains aged 16 to 83 years. We identified only one age-related gene common to the three tissues. There were 12 genes that showed differential expression with age in both skin and brain tissue and three common to adipose and brain tissues. Skin showed the most age-related gene expression changes of all the tissues investigated, with many of the genes being previously implicated in fatty acid metabolism, mitochondrial activity, cancer and splicing. A significant proportion of age-related changes in gene expression appear to be tissue-specific with only a few genes sharing an age effect in expression across tissues. More research is needed to improve our understanding of the genetic influences on aging and the relationship with age-related diseases.

Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers

International Nuclear Information System (INIS)

Duncan, M.J.; Manktelow, R.T.; Zuker, R.M.; Rosen, I.B.

1985-01-01

This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft

Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers

Energy Technology Data Exchange (ETDEWEB)

Duncan, M.J.; Manktelow, R.T.; Zuker, R.M.; Rosen, I.B.

1985-12-01

This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft.

Cervi cornus Colla (deer antler glue) induce epidermal differentiation in the reconstruction of skin equivalents.

Science.gov (United States)

Choi, H-R; Nam, K-M; Kim, D-S; Huh, C-H; Na, J-I; Park, K-C

2013-06-01

In the reconstruction of skin equivalents (SEs), keratinocyte differentiation is important because epidermal differentiation is closely related with barrier function. The aim of this study was to investigate the effects of Cervi cornus Colla (CCC) on the stem cell activity and epidermal differentiation in the reconstruction of skin equivalent. Four different models were constructed according to different composition of dermal substitute. Results showed similar morphologic findings when hyaluronic acid (HA) and/or CCC was added. But, immunohistochemical staining showed that p63 was significantly increased by addition of HA and/or CCC. Increased staining of integrin α6 and β1 was variably observed when HA and/or CCC was added to make dermal substitute. These finding showed that addition of HA and/or CCC may affect the stem cell activity in the reconstruction of skin. Furthermore, filaggrin expression was much increased when CCC was added. It showed that epidermal differentiation was significantly improved by addition of CCC. In conclusion, simultaneous presence of HA and CCC contributed to the stem cell activity and epidermal differentiation in the reconstruction of SE. Legislation in the EU prohibits marketing cosmetics and personal care products that contain constituents that have been examined through animal experiments. To avoid these limitations, SEs can be used for testing the safety or the efficacy of cosmetic ingredients. Therefore, our results showed that combined use of HA and CCC can be helpful for the reconstruction of SE with good stem cell activity and epidermal differentiation. © 2013 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Biomaterials and tissue engineering in reconstructive surgery

Indian Academy of Sciences (India)

In spite of some good successes and excellent materials, there are still serious limitations to the performance of implants today, and the paper explains these limitations and develops this theme in order to describe the recent innovations in tissue engineering, which involves a different approach to reconstruction of the body.

In vivo Molecular Evaluation of Guinea Pig Skin Incisions Healing after Surgical Suture and Laser Tissue Welding Using Raman Spectroscopy

Science.gov (United States)

Alimova, A.; Chakraverty, R.; Muthukattil, R.; Elder, S.; Katz, A.; Sriramoju, V.; Lipper, Stanley; Alfano, R. R.

2009-01-01

The healing process in guinea pig skin following surgical incisions was evaluated at the molecular level, in vivo, by the use of Raman spectroscopy. After the incisions were closed either by suturing or by laser tissue welding (LTW), differences in the respective Raman spectra were identified. The study determined that the ratio of the Raman peaks of the amide III (1247 cm−1) band to a peak at 1326 cm−1 (the superposition of elastin and keratin bands) can be used to evaluate the progression of wound healing. Conformational changes in the amide I band (1633 cm−1 to 1682 cm−1) and spectrum changes in the range of 1450 cm−1 to 1520 cm−1 were observed in LTW and sutured skin. The stages of the healing process of the guinea pig skin following LTW and suturing were evaluated by Raman spectroscopy, using histopathology as the gold standard. LTW skin demonstrated better healing than sutured skin, exhibiting minimal hyperkeratosis, minimal collagen deposition, near-normal surface contour, and minimal loss of dermal appendages. A wavelet decomposition-reconstruction baseline correction algorithm was employed to remove the fluorescence wing from the Raman spectra. PMID:19581109

[Reconstructive methods after Fournier gangrene].

Science.gov (United States)

Wallner, C; Behr, B; Ring, A; Mikhail, B D; Lehnhardt, M; Daigeler, A

2016-04-01

Fournier's gangrene is a variant of the necrotizing fasciitis restricted to the perineal and genital region. It presents as an acute life-threatening disease and demands rapid surgical debridement, resulting in large soft tissue defects. Various reconstructive methods have to be applied to reconstitute functionality and aesthetics. The objective of this work is to identify different reconstructive methods in the literature and compare them to our current concepts for reconstructing defects caused by Fournier gangrene. Analysis of the current literature and our reconstructive methods on Fournier gangrene. The Fournier gangrene is an emergency requiring rapid, calculated antibiotic treatment and radical surgical debridement. After the acute phase of the disease, appropriate reconstructive methods are indicated. The planning of the reconstruction of the defect depends on many factors, especially functional and aesthetic demands. Scrotal reconstruction requires a higher aesthetic and functional reconstructive degree than perineal cutaneous wounds. In general, thorough wound hygiene, proper pre-operative planning, and careful consideration of the patient's demands are essential for successful reconstruction. In the literature, various methods for reconstruction after Fournier gangrene are described. Reconstruction with a flap is required for a good functional result in complex regions as the scrotum and penis, while cutaneous wounds can be managed through skin grafting. Patient compliance and tissue demand are crucial factors in the decision-making process.

Storage Conditions of Skin Affect Tissue Structure and Subsequent in vitro Percutaneous Penetration

DEFF Research Database (Denmark)

Nielsen, Jesper Bo; Plasencia Gil, Maria Inés; Sørensen, Jens Ahm

2011-01-01

fluorescence microscopy) and in vitro percutaneous penetration of caffeine under four different storage conditions using skin samples from the same donors: fresh skin, skin kept at -20°C for 3 weeks (with or without the use of polyethylene glycol) and at -80°C. Our results show a correlation between increasing...... permeation of caffeine and tissue structural damage caused by the storage conditions, most so after skin storage at -80°C. The presented approach, which combines imaging techniques with studies on percutaneous penetration, enables the link between tissue damage at selected depths and penetration...

Quantification of Tissue Trauma following Insulin Pen Needle Insertions in Skin

DEFF Research Database (Denmark)

Jensen, Casper Bo; Larsen, Rasmus; Vestergaard, Jacob Schack

Objective: Within the field of pen needle development, most research on needle design revolves around mechanical tensile testing and patient statements. Only little has been published on the actual biological skin response to needle insertions. The objective of this study was to develop a computa......Objective: Within the field of pen needle development, most research on needle design revolves around mechanical tensile testing and patient statements. Only little has been published on the actual biological skin response to needle insertions. The objective of this study was to develop...... a computational method to quantify tissue trauma based on skin bleeding and immune response. Method: Two common sized pen needles of 28G (0.36mm) and 32G (0.23mm) were inserted into skin of sedated LYD pigs prior to termination. Four pigs were included and a total of 32 randomized needle insertions were conducted...... diameter. Conclusion: A computational and quantitative method has been developed to assess tissue trauma following insulin pen needle insertions. Application of the method is tested by conduction of a needle diameter study. The obtained quantitative measures of tissue trauma correlate positively to needle...

ORIGINAL ARTICLES Staphylococcus aureus skin and soft-tissue ...

African Journals Online (AJOL)

(MRSA) has become a key pathogen in skin and soft-tissue infections. (SSTIs). The emergence of ..... SSTI isolates; (iii) improved hospital infection control guidelines and practices to prevent .... So exposed in the field. And he'll never run off ...

[A case of iatrogenic scrotal elephantiasis: reconstruction of the scrotal purse and the cutaneous sleeve of the penis with local skin flaps].

Science.gov (United States)

Masia, D-R; Castus, P; Delia, G; Casoli, V; Martine, D

2008-02-01

Scrotal elephantiasis is a pathology of often unknown etiology. Symptomatology is characterized by an oedematius infiltration of skin and subcutaneous tissue, hard-bound aspect and purplished color. The scrotum, the penis and the perineal area are gradually affected. This pathology is very invalidating for the patient, on functional, sexual and aesthetic aspects. The authors present the case of a 58-year-old man with an enormous scrotal mass invading the penis and drowning the testicular elements, which were impossible to palpate. The aetiology was determined by exclusion and an iatrogenic origin following the cure of bilateral inguinal hernia was retained. Resection of the scrotal mass was performed. The reconstruction of the scrotal purse and the cutaneous sleeve of the penis were carried out using local flaps of the remaining healthy skin.

Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries.

Science.gov (United States)

Wu, Peng Sen; Matoo, Reshvin; Sun, Hong; Song, Li Yuan; Kikkawa, Don O; Lu, Wei

2017-02-01

Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries. Retrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48 h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months. The main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30-0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05-3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection. An early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft.

Science.gov (United States)

Dessy, Luca Andrea; Figus, Andrea; Fioramonti, Paolo; Mazzocchi, Marco; Scuderi, Nicolò

2010-05-01

Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone to delay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p<0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours

From Cell to Tissue Properties-Modeling Skin Electroporation With Pore and Local Transport Region Formation.

Science.gov (United States)

Dermol-Cerne, Janja; Miklavcic, Damijan

2018-02-01

Current models of tissue electroporation either describe tissue with its bulk properties or include cell level properties, but model only a few cells of simple shapes in low-volume fractions or are in two dimensions. We constructed a three-dimensional model of realistically shaped cells in realistic volume fractions. By using a 'unit cell' model, the equivalent dielectric properties of whole tissue could be calculated. We calculated the dielectric properties of electroporated skin. We modeled electroporation of single cells by pore formation on keratinocytes and on the papillary dermis which gave dielectric properties of the electroporated epidermis and papillary dermis. During skin electroporation, local transport regions are formed in the stratum corneum. We modeled local transport regions and increase in their radii or density which affected the dielectric properties of the stratum corneum. The final model of skin electroporation accurately describes measured electric current and voltage drop on the skin during electroporation with long low-voltage pulses. The model also accurately describes voltage drop on the skin during electroporation with short high-voltage pulses. However, our results indicate that during application of short high-voltage pulses additional processes may occur which increase the electric current. Our model connects the processes occurring at the level of cell membranes (pore formation), at the level of a skin layer (formation of local transport region in the stratum corneum) with the tissue (skin layers) and even level of organs (skin). Using a similar approach, electroporation of any tissue can be modeled, if the morphology of the tissue is known.

Tissue engineering of ligaments: a comparison of bone marrow stromal cells, anterior cruciate ligament, and skin fibroblasts as cell source.

Science.gov (United States)

Van Eijk, F; Saris, D B F; Riesle, J; Willems, W J; Van Blitterswijk, C A; Verbout, A J; Dhert, W J A

2004-01-01

Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell source for tissue engineering of ligaments. The aim of this study is to determine the optimal cell source for tissue engineering of the anterior cruciate ligament. Bone marrow stromal cells (BMSCs), ACL, and skin fibroblasts were seeded onto a resorbable suture material [poly(L-lactide/glycolide) multifilaments] at five different seeding densities, and cultured for up to 12 days. All cell types tested attached to the suture material, proliferated, and synthesized extracellular matrix rich in collagen type I. On day 12 the scaffolds seeded with BMSCs showed the highest DNA content (p engineered ligament.

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft.

Science.gov (United States)

Toft, Peter B

2016-01-01

To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft. All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort. Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.

Analytical model of diffuse reflectance spectrum of skin tissue

Energy Technology Data Exchange (ETDEWEB)

Lisenko, S A; Kugeiko, M M; Firago, V A [Belarusian State University, Minsk (Belarus); Sobchuk, A N [B.I. Stepanov Institute of Physics, National Academy of Sciences of Belarus, Minsk (Belarus)

2014-01-31

We have derived simple analytical expressions that enable highly accurate calculation of diffusely reflected light signals of skin in the spectral range from 450 to 800 nm at a distance from the region of delivery of exciting radiation. The expressions, taking into account the dependence of the detected signals on the refractive index, transport scattering coefficient, absorption coefficient and anisotropy factor of the medium, have been obtained in the approximation of a two-layer medium model (epidermis and dermis) for the same parameters of light scattering but different absorption coefficients of layers. Numerical experiments on the retrieval of the skin biophysical parameters from the diffuse reflectance spectra simulated by the Monte Carlo method show that commercially available fibre-optic spectrophotometers with a fixed distance between the radiation source and detector can reliably determine the concentration of bilirubin, oxy- and deoxyhaemoglobin in the dermis tissues and the tissue structure parameter characterising the size of its effective scatterers. We present the examples of quantitative analysis of the experimental data, confirming the correctness of estimates of biophysical parameters of skin using the obtained analytical expressions. (biophotonics)

Excellent Aesthetic and Functional Outcome After Fractionated Carbon Dioxide Laser Skin Graft Revision Surgery: Case Report and Review of Laser Skin Graft Revision Techniques.

Science.gov (United States)

Ho, Derek; Jagdeo, Jared

2015-11-01

Skin grafts are utilized in dermatology to reconstruct a defect secondary to surgery or trauma of the skin. Common indications for skin grafts include surgical removal of cutaneous malignancies, replacement of tissue after burns or lacerations, and hair transplantation in alopecia. Skin grafts may be cosmetically displeasing, functionally limiting, and significantly impact patient's quality-of-life. There is limited published data regarding skin graft revision to enhance aesthetics and function. Here, we present a case demonstrating excellent aesthetic and functional outcome after fractionated carbon dioxide (CO2) laser skin graft revision surgery and review of the medical literature on laser skin graft revision techniques.

Soft tissue engineering with micronized-gingival connective tissues.

Science.gov (United States)

Noda, Sawako; Sumita, Yoshinori; Ohba, Seigo; Yamamoto, Hideyuki; Asahina, Izumi

2018-01-01

The free gingival graft (FGG) and connective tissue graft (CTG) are currently considered to be the gold standards for keratinized gingival tissue reconstruction and augmentation. However, these procedures have some disadvantages in harvesting large grafts, such as donor-site morbidity as well as insufficient gingival width and thickness at the recipient site post-treatment. To solve these problems, we focused on an alternative strategy using micronized tissue transplantation (micro-graft). In this study, we first investigated whether transplantation of micronized gingival connective tissues (MGCTs) promotes skin wound healing. MGCTs (≤100 µm) were obtained by mincing a small piece (8 mm 3 ) of porcine keratinized gingiva using the RIGENERA system. The MGCTs were then transplanted to a full skin defect (5 mm in diameter) on the dorsal surface of immunodeficient mice after seeding to an atelocollagen matrix. Transplantations of atelocollagen matrixes with and without micronized dermis were employed as experimental controls. The results indicated that MGCTs markedly promote the vascularization and epithelialization of the defect area 14 days after transplantation compared to the experimental controls. After 21 days, complete wound closure with low contraction was obtained only in the MGCT grafts. Tracking analysis of transplanted MGCTs revealed that some mesenchymal cells derived from MGCTs can survive during healing and may function to assist in wound healing. We propose here that micro-grafting with MGCTs represents an alternative strategy for keratinized tissue reconstruction that is characterized by low morbidity and ready availability. © 2017 Wiley Periodicals, Inc.

CT Imaging of facial trauma. The role of different types of reconstruction. Part II - soft tissues

International Nuclear Information System (INIS)

Myga-Porosilo, J.; Sraga, W.; Borowiak, H.; Jackowska, Z.; Kluczewska, E.; Skrzelewski, S.

2011-01-01

Background: Injury to facial soft tissues as a complication of skeleton fractures is an important problem among patients with facial trauma. The aim of this work was to assess the value of multiplanar and three-dimensional (3D) reconstruction computed tomography (CT) images obtained by using multi-detector row technology in spiral data acquisition in patients with facial injuries of soft tissue. Material/Methods: Sixty-seven patients diagnosed with injury to the facial skeleton underwent a CT scan with the use of GE Hispeed Qx/i scanner. For each patient: a two-dimensional (2D) multiplanar reconstruction (MPR), maximum intensity projection (MIP), and 3D volume rendering (VR) were conducted. Post-injury lesions of soft tissues were assessed. During the assessment of the post-injury lesions of soft tissues, the following features were evaluated: Extra ocular muscle and fat tissue herniation through fractures in the medial and inferior orbital walls. Fluid in the sinuses and in the nasal cavity. Subcutaneous tissue emphysema. Results: For subcutaneous emphysema and sinus fluid imaging, both the axial and the 2D image reconstruction proved comparably effective. However, 2D reconstructions were superior to transverse plane images with regard to herniations into fractures of the inferior orbital wall. 3D reconstruction has no importance in diagnosing soft tissue injuries. Conclusions: Multiplanar CT reconstructions increase the effectiveness of imaging of orbital tissue herniations, especially in case of fractures in the inferior orbital wall. In suspected soft tissue herniations, as well as prior to surgical treatment, spiral CT with 2D multiplanar reconstructions should be the method of choice. (authors)

Human stem cells for craniomaxillofacial reconstruction.

Science.gov (United States)

Jalali, Morteza; Kirkpatrick, William Niall Alexander; Cameron, Malcolm Gregor; Pauklin, Siim; Vallier, Ludovic

2014-07-01

Human stem cell research represents an exceptional opportunity for regenerative medicine and the surgical reconstruction of the craniomaxillofacial complex. The correct architecture and function of the vastly diverse tissues of this important anatomical region are critical for life supportive processes, the delivery of senses, social interaction, and aesthetics. Craniomaxillofacial tissue loss is commonly associated with inflammatory responses of the surrounding tissue, significant scarring, disfigurement, and psychological sequelae as an inevitable consequence. The in vitro production of fully functional cells for skin, muscle, cartilage, bone, and neurovascular tissue formation from human stem cells, may one day provide novel materials for the reconstructive surgeon operating on patients with both hard and soft tissue deficit due to cancer, congenital disease, or trauma. However, the clinical translation of human stem cell technology, including the application of human pluripotent stem cells (hPSCs) in novel regenerative therapies, faces several hurdles that must be solved to permit safe and effective use in patients. The basic biology of hPSCs remains to be fully elucidated and concerns of tumorigenicity need to be addressed, prior to the development of cell transplantation treatments. Furthermore, functional comparison of in vitro generated tissue to their in vivo counterparts will be necessary for confirmation of maturity and suitability for application in reconstructive surgery. Here, we provide an overview of human stem cells in disease modeling, drug screening, and therapeutics, while also discussing the application of regenerative medicine for craniomaxillofacial tissue deficit and surgical reconstruction.

[Microbiological diagnosis of infections of the skin and soft tissues].

Science.gov (United States)

Burillo, Almudena; Moreno, Antonio; Salas, Carlos

2007-11-01

Skin and soft tissue infections are often seen in clinical practice, yet their microbiological diagnosis is among the most complex of laboratory tasks. The diagnosis of a skin and a soft tissue infection is generally based on clinical criteria and not microbiological results. A microbiological diagnosis is reserved for cases in which the etiology of infection is required, e.g., when the infection is particularly severe, when less common microorganisms are suspected as the causative agent (e.g. in immunocompromised patients), when response to antimicrobial treatment is poor, or when a longstanding wound does not heal within a reasonable period of time. We report the indications, sampling and processing techniques, and interpretation criteria for various culture types, including quantitative cultures from biopsy or tissue specimens and semiquantitative and qualitative cultures performed on all types of samples. For non-invasive samples taken from open wounds, application of the Q index to Gram stains is a cost-effective way to standardize sample quality assessment and interpretation of the pathogenic involvement of the different microorganisms isolated from cultures. All these issues are covered in the SEIMC microbiological procedure number 22: Diagnóstico microbiológico de las infecciones de piel y tejidos blandos (Microbiological diagnosis of infections of the skin and soft tissues) (2nd ed., 2006, www.seimc.org/protocolos/microbiologia).

Polyurethane Foam Wound Dressing Technique for Areola Skin Graft Stabilization and Nipple Protection After Nipple-Areola Reconstruction.

Science.gov (United States)

Satake, Toshihiko; Muto, Mayu; Nagashima, Yu; Haga, Shoko; Homma, Yuki; Nakasone, Reiko; Kadokura, Marina; Kou, Seiko; Fujimoto, Hiroshi; Maegawa, Jiro

2018-04-01

We describe a new wound management technique using a soft dressing material to stabilize the areola skin graft and protect the nipple after nipple-areola reconstruction at the final stage of breast reconstruction. We introduced a center-fenestrated multilayered hydrocellular polyurethane foam dressing material that provides adequate pressure and retains a moist environment for a smooth skin graft "take." Moreover, the reconstructed nipple can be monitored at any time through the fenestrated window for adequate blood circulation. Altogether, this simple and inexpensive wound dressing technique improves the clinical outcome. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Facial reconstruction--anatomical art or artistic anatomy?

Science.gov (United States)

Wilkinson, Caroline

2010-02-01

Facial reconstruction is employed in the context of forensic investigation and for creating three-dimensional portraits of people from the past, from ancient Egyptian mummies and bog bodies to digital animations of J. S. Bach. This paper considers a facial reconstruction method (commonly known as the Manchester method) associated with the depiction and identification of the deceased from skeletal remains. Issues of artistic licence and scientific rigour, in relation to soft tissue reconstruction, anatomical variation and skeletal assessment, are discussed. The need for artistic interpretation is greatest where only skeletal material is available, particularly for the morphology of the ears and mouth, and with the skin for an ageing adult. The greatest accuracy is possible when information is available from preserved soft tissue, from a portrait, or from a pathological condition or healed injury.

[Decellularized fish skin: characteristics that support tissue repair].

Science.gov (United States)

Magnússon, Skúli; Baldursson, Baldur Tumi; Kjartansson, Hilmar; Thorlacius, Guðný Ella; Axelsson, Ívar; Rolfsson, Óttar; Petersen, Pétur Henry; Sigurjónsson, Guðmundur Fertram

2015-12-01

Acellular fish skin of the Atlantic cod (Gadus morhua) is being used to treat chronic wounds. The prevalence of diabetes and the comorbidity of chronic wounds is increasing globally. The aim of the study was to assess the biocompatibility and biological characteristics of acellular fish skin, important for tissue repair. The structure of the acellular fish skin was examined with microscopy. Biocompatibility of the graft was conducted by a specialized certified laboratory. Protein extracts from the material were analyzed using gel electrophoresis. Cytokine levels were measured with an enzyme linked immunosorbent assay (ELISA). Angiogenic properties were assessed with a chick chorioallantoic membrane (chick CAM) assay. The structure of acellular fish skin is porous and the material is biocompatible. Electrophoresis revealed proteins around the size 115-130 kDa, indicative of collagens. The material did not have significant effect on IL-10, IL-12p40, IL-6 or TNF-α secretion from monocytes or macrophages. Acellular fish skin has significant effect on angiogenesis in the chick CAM assay. The acellular fish skin is not toxic and is not likely to promote inflammatory responses. The graft contains collagen I, promotes angiogenesis and supports cellular ingrowth. Compared to similar products made from mammalian sources, acellular fish skin does not confer a disease risk and contains more bioactive compounds, due to less severe processing.

Gingival Tissue Color Related With Facial Skin and Acrylic Resin ...

African Journals Online (AJOL)

The objective of this study is to determine the predominant gingival tissue colour in this environment; to assess the association of gingival tissue colour with gender and facial skin colour. Four hundred and thirty subjects that attended the Dental Centre, University College Hospital, Ibadan, who consented to participate in the ...

Tissue engineering skin: a paradigm shift in wound care.

Science.gov (United States)

Mason, C

2005-12-01

Tissue-engineered skin for the treatment of burns and ulcers is a clinical success, but making it commercially viable is more problematic. This article examines the industry, its techniques and suggests the way forward.

Skin Graft

OpenAIRE

Shimizu, Ruka; Kishi, Kazuo

2012-01-01

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use o...

Bipolar fracture dislocation of clavicle: A report of osteosynthesis and early soft tissue reconstruction

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Renaldi Prasetia

Full Text Available Introduction: Bipolar dislocation of the clavicle, also called bifocal or pan-articular dislocation or floating clavicle, is an uncommon traumatic injury. The injury of this case is also concomitant with distal third clavicle and coracoid fracture. This article aimed to report the experience of performing osteosynthesis and early soft tissue reconstruction on these injuries. Case report: We reported a case of bipolar clavicle fracture-dislocation in concomitant with coracoid fracture in a man, aged 32 years old, successfully treated 24 days after accident by fixation of both fractures and early simultaneous reconstruction of sternoclavicular- acromioclavicular-coracoclavicular joints. Discussion: These injuries are rare and capable of causing many complications if they are treated improperly. It is compulsory to carefully assess any fractured clavicle along its whole length, both clinically and radiologically. Various options, from non-operative to operative, have been reported to manage such of these cases. Early bony fixation and soft tissue reconstruction can correct the alignment of clavicle and recover the function of sterno-clavicular and acromio-clavicular- joints promptly. Conclusion: Fracture osteosynthesis and early soft tissue reconstruction can be regarded as an option treatment for bipolar fracture-dislocation of the clavicle to facilitate prompt treatment and early rehabilitation. Keywords: Bipolar dislocation, Floating clavicle, Early reconstruction, Soft tissue reconstruction

Reconstruction of oncologic defects of the eyelid, lips and ear

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Gill Paul

2007-12-01

Full Text Available Non melanomatous skin cancers constitute a major part of the cancers that occur in the face, especially in the darker skinned people. Surgical excision stays as the main modality of treatment in these giving very good cure rates. The major drawback of surgery is the resultant functional and esthetic deformity, which has been considerably reduced with proper application of reconstructive surgery principles. In order to achieve good outcome attention has to be given to understand the anatomy as well as tissue requirement at specific areas of the face. There is a great variation in the reconstructive methods in the different sites. This article reviews briefly the anatomy and methods of reconstruction available for the post cancer excisions involving the lips, eyelids and the auricle.

Establishment and function of tissue-resident innate lymphoid cells in the skin

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Jie Yang

2017-03-01

Full Text Available ABSTRACT Innate lymphoid cells (ILCs are a newly classified family of immune cells of the lymphoid lineage. While they could be found in both lymphoid organs and non-lymphoid tissues, ILCs are preferentially enriched in barrier tissues such as the skin, intestine, and lung where they could play important roles in maintenance of tissue integrity and function and protection against assaults of foreign agents. On the other hand, dysregulated activation of ILCs could contribute to tissue inflammatory diseases. In spite of recent progress towards understanding roles of ILCs in the health and disease, mechanisms regulating specific establishment, activation, and function of ILCs in barrier tissues are still poorly understood. We herein review the up-to-date understanding of tissue-specific relevance of ILCs. Particularly we will focus on resident ILCs of the skin, the outmost barrier tissue critical in protection against various foreign hazardous agents and maintenance of thermal and water balance. In addition, we will discuss remaining outstanding questions yet to be addressed.

Establishment and function of tissue-resident innate lymphoid cells in the skin.

Science.gov (United States)

Yang, Jie; Zhao, Luming; Xu, Ming; Xiong, Na

2017-07-01

Innate lymphoid cells (ILCs) are a newly classified family of immune cells of the lymphoid lineage. While they could be found in both lymphoid organs and non-lymphoid tissues, ILCs are preferentially enriched in barrier tissues such as the skin, intestine, and lung where they could play important roles in maintenance of tissue integrity and function and protection against assaults of foreign agents. On the other hand, dysregulated activation of ILCs could contribute to tissue inflammatory diseases. In spite of recent progress towards understanding roles of ILCs in the health and disease, mechanisms regulating specific establishment, activation, and function of ILCs in barrier tissues are still poorly understood. We herein review the up-to-date understanding of tissue-specific relevance of ILCs. Particularly we will focus on resident ILCs of the skin, the outmost barrier tissue critical in protection against various foreign hazardous agents and maintenance of thermal and water balance. In addition, we will discuss remaining outstanding questions yet to be addressed.

Optimizing aesthetic outcomes for breast reconstruction in patients with significant macromastia or ptosis

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Wojciech Dec

2018-06-01

Full Text Available Background: Achieving excellent aesthetic outcomes in reconstruction of large or ptotic breasts is especially challenging. Incorporating a Wise pattern into the mastectomy design is effective in reducing the excess breast skin, however it increases the risk of mastectomy skin necrosis. The aim of this study is to describe surgical maneuvers which optimize aesthetic outcomes, anticipate flap volume requirements, and limit mastectomy skin necrosis in autologous reconstruction in patients with macromastia and grade III ptosis. Methods: This is a retrospective review of operative and clinical records of patients who underwent unilateral or bilateral breast reconstruction with autologous tissue between August 2015 and May 2017. Patients were divided into macromastia and ptosis groups. Key surgical maneuvers for safely achieving aesthetically optimal results were identified. Results: A total of 29 breasts were successfully reconstructed in 19 patients with a Wise pattern mastectomy skin reduction. Free flap weights were similar in both groups, mastectomy weights were greater in the macromastia group, p < 0.05. Complications were limited to three cases of wound breakdown and one case of mastectomy skin necrosis. Total number of revision stages was reduced in unilateral reconstructions when a contralateral breast reduction or mastopexy was performed during the first stage. Conclusions: A Wise pattern can safely and effectively be incorporated into a mastectomy incision design in patients who are not candidates for a nipple sparing mastectomy. Optimal aesthetics are achieved with similar volume flaps for both macromastia and ptosis patients. In cases of unilateral breast reconstruction a contralateral breast reduction or mastopexy should be performed at the time of the immediate breast reconstruction. Keywords: Breast reconstruction, Aesthetic breast reconstruction, Macromastia breast reconstruction, Ptosis breast reconstruction

Photoprotection by pistachio bioactives in a 3-dimensional human skin equivalent tissue model.

Science.gov (United States)

Chen, C-Y Oliver; Smith, Avi; Liu, Yuntao; Du, Peng; Blumberg, Jeffrey B; Garlick, Jonathan

2017-09-01

Reactive oxygen species (ROS) generated during ultraviolet (UV) light exposure can induce skin damage and aging. Antioxidants can provide protection against oxidative injury to skin via "quenching" ROS. Using a validated 3-dimensional (3D) human skin equivalent (HSE) tissue model that closely mimics human skin, we examined whether pistachio antioxidants could protect HSE against UVA-induced damage. Lutein and γ-tocopherol are the predominant lipophilic antioxidants in pistachios; treatment with these compounds prior to UVA exposure protected against morphological changes to the epithelial and connective tissue compartments of HSE. Pistachio antioxidants preserved overall skin thickness and organization, as well as fibroblast morphology, in HSE exposed to UVA irradiation. However, this protection was not substantiated by the analysis of the proliferation of keratinocytes and apoptosis of fibroblasts. Additional studies are warranted to elucidate the basis of these discordant results and extend research into the potential role of pistachio bioactives promoting skin health.

Recovery of sensation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps after breast-conservative surgery and skin-sparing mastectomy.

Science.gov (United States)

Tomita, Koichi; Yano, Kenji; Hosokawa, Ko

2011-04-01

In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft.

Science.gov (United States)

Chi, Zhenglin; Chen, Yiheng; Chu, Tinggang; Gao, Weiyang; Li, Zhijie; Yan, Hede; Song, Yonghuan

2018-02-01

The conventional procedure of the sural neuro-fasciocutaneous flap enables the supply of blood and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may lead to some complications and influence the aesthetic appearance. We report modifications for a distally based sural neuro-fasciocutaneous perforator flap and a relaying flap for donor site closure without skin graft. Twelve patients undergoing the modified flap for foot and ankle reconstruction were included in this study between 2014 and 2016. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A Z-shape skin incision was performed to explore the perforator vessels and a relaying island perforator flap was used to close the donor site. All flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 15 cm. The diameter width of the pedicle ranged from 1.0 to 2.0 cm. A relaying perforator island flap was used in 10 cases for donor site closure and no skin graft was performed. There were no serious donor site complications. All patients were satisfied with the aesthetic outcome postoperatively at the final follow-up. The distally based sural neuro-fasciocutaneous perforator flap is considered a reliable method for foot and ankle reconstruction. The modification for flap pedicle and donor site closure method without skin graft should be recommended. Copyright © 2017. Published by Elsevier Ltd.

Determination of quantitative tissue composition by iterative reconstruction on 3D DECT volumes

Energy Technology Data Exchange (ETDEWEB)

Magnusson, Maria [Linkoeping Univ. (Sweden). Dept. of Electrical Engineering; Linkoeping Univ. (Sweden). Dept. of Medical and Health Sciences, Radiation Physics; Linkoeping Univ. (Sweden). Center for Medical Image Science and Visualization (CMIV); Malusek, Alexandr [Linkoeping Univ. (Sweden). Dept. of Medical and Health Sciences, Radiation Physics; Linkoeping Univ. (Sweden). Center for Medical Image Science and Visualization (CMIV); Nuclear Physics Institute AS CR, Prague (Czech Republic). Dept. of Radiation Dosimetry; Muhammad, Arif [Linkoeping Univ. (Sweden). Dept. of Medical and Health Sciences, Radiation Physics; Carlsson, Gudrun Alm [Linkoeping Univ. (Sweden). Dept. of Medical and Health Sciences, Radiation Physics; Linkoeping Univ. (Sweden). Center for Medical Image Science and Visualization (CMIV)

2011-07-01

Quantitative tissue classification using dual-energy CT has the potential to improve accuracy in radiation therapy dose planning as it provides more information about material composition of scanned objects than the currently used methods based on single-energy CT. One problem that hinders successful application of both single- and dual-energy CT is the presence of beam hardening and scatter artifacts in reconstructed data. Current pre- and post-correction methods used for image reconstruction often bias CT attenuation values and thus limit their applicability for quantitative tissue classification. Here we demonstrate simulation studies with a novel iterative algorithm that decomposes every soft tissue voxel into three base materials: water, protein, and adipose. The results demonstrate that beam hardening artifacts can effectively be removed and accurate estimation of mass fractions of each base material can be achieved. Our iterative algorithm starts with calculating parallel projections on two previously reconstructed DECT volumes reconstructed from fan-beam or helical projections with small conebeam angle. The parallel projections are then used in an iterative loop. Future developments include segmentation of soft and bone tissue and subsequent determination of bone composition. (orig.)

Current Concepts in Tissue Engineering: Skin and Wound.

Science.gov (United States)

Tenenhaus, Mayer; Rennekampff, Hans-Oliver

2016-09-01

Pure regenerative healing with little to no donor morbidity remains an elusive goal for both surgeon and patient. The ability to engineer and promote the development of like tissue holds so much promise, and efforts in this direction are slowly but steadily advancing. Products selected and reviewed reflect historical precedence and importance and focus on current clinically available products in use. Emerging technologies we anticipate will further expand our therapeutic options are introduced. The topic of tissue engineering is incredibly broad in scope, and as such the authors have focused their review on that of constructs specifically designed for skin and wound healing. A review of pertinent and current clinically related literature is included. Products such as biosynthetics, biologics, cellular promoting factors, and commercially available matrices can be routinely found in most modern health care centers. Although to date no complete regenerative or direct identical soft-tissue replacement exists, currently available commercial components have proven beneficial in augmenting and improving some types of wound healing scenarios. Cost, directed specificity, biocompatibility, and bioburden tolerance are just some of the impending challenges to adoption. Quality of life and in fact the ability to sustain life is dependent on our most complex and remarkable organ, skin. Although pure regenerative healing and engineered soft-tissue constructs elude us, surgeons and health care providers are slowly gaining comfort and experience with concepts and strategies to improve the healing of wounds.

Biohydrogels for the In Vitro Re-construction and In Situ Regeneration of Human Skin

Science.gov (United States)

Korkina, Liudmila; Kostyuk, Vladimir; Guerra, Liliana

Natural and synthetic biohydrogels are of great interest for the development of innovative medicinal and cosmetic products feasible for the treatment of numerous skin diseases and age-related changes in skin structure and function. Here, the characteristics of bio-resorbable hydrogels as scaffolds for the in vitro re-construction of temporary skin substitutes or full skin equivalents for further transplantation are reviewed. Another fast developing area of regenerative medicine is the in situ regeneration of human skin. The approach is mainly applicable to activate and facilitate the skin regeneration process and angiogenesis in chronic wounds with impaired healing. In this case, extracellular matrix resembling polymers are used to stimulate cell growth, adhesion, and movement. Better results could be achieved by activation of biocompatible hydrogels either with proteins (growth factors, adhesion molecules or/and cytokines) or with allogenic skin cells producing and releasing these molecules. Hydrogels are widely applied as carriers of low molecular weight substances with antioxidant, anti-inflammatory, anti-ageing, and wound healing action. Incorporation of these substances into hydrogels enhances their penetration through the skin barrier and prevents their destruction by oxidation. Potential roles of hydrogel-based products for modern dermatology and cosmetology are also discussed.

Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

DEFF Research Database (Denmark)

Boennelycke, M; Gräs, Søren; Lose, G

2013-01-01

Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

Scattered and Fluorescent Photon Track Reconstruction in a Biological Tissue

Directory of Open Access Journals (Sweden)

Maria N. Kholodtsova

2014-01-01

Full Text Available Appropriate analysis of biological tissue deep regions is important for tumor targeting. This paper is concentrated on photons’ paths analysis in such biotissue as brain, because optical probing depth of fluorescent and excitation radiation differs. A method for photon track reconstruction was developed. Images were captured focusing on the transparent wall close and parallel to the source fibres, placed in brain tissue phantoms. The images were processed to reconstruct the photons most probable paths between two fibres. Results were compared with Monte Carlo simulations and diffusion approximation of the radiative transfer equation. It was shown that the excitation radiation optical probing depth is twice more than for the fluorescent photons. The way of fluorescent radiation spreading was discussed. Because of fluorescent and excitation radiation spreads in different ways, and the effective anisotropy factor, geff, was proposed for fluorescent radiation. For the brain tissue phantoms it were found to be 0.62±0.05 and 0.66±0.05 for the irradiation wavelengths 532 nm and 632.8 nm, respectively. These calculations give more accurate information about the tumor location in biotissue. Reconstruction of photon paths allows fluorescent and excitation probing depths determination. The geff can be used as simplified parameter for calculations of fluorescence probing depth.

One-step breast reconstruction with polyurethane-covered implants after skin-sparing mastectomy.

Science.gov (United States)

Rancati, Alberto; Soderini, Alejandro; Dorr, Julio; Gercovich, Gustavo; Tessari, Luciano; Gonzalez, Eduardo

2013-12-01

Skin-sparing mastectomy (SSM) and immediate one-step breast reconstruction with implants has become an increasingly popular, effective treatment for selected patients with breast carcinoma. However, it is associated with high complication rates. Breast augmentation with polyurethane-covered implants (PCIs) has consistently had optimal short-term and long-term results with low rates of capsular contracture. The aim of this study was to evaluate the clinical and aesthetic outcomes of immediate one-step breast reconstruction with PCI after SSM in early breast cancer patients at a single institution. We reviewed the records of 221 consecutive breast cancer patients who underwent one-stage immediate reconstruction with PCI after SSM from 1995 through 2005. Patient and tumour characteristics, type of reconstruction, postoperative complications, aesthetic results and recurrence rate were analysed. The mean age of the patients was 52±11 years (range, 30-76; standard deviation (SD), 11). The American Joint Committee on Cancer (AJCC) pathologic stages were 0 (10%), I (63.3%) and II (26.7%). Thirty-nine (17.65%; confidence interval (CI)=13.04-23.1) of the 221 patients had complications; seven had prosthesis extrusion requiring an implant (five due to skin necrosis, one due to infection and one due to late haematoma). In six of these seven cases, the procedure was indicated for local recurrence after conservative breast surgery with adjunctive radiation therapy (rescue procedure). Thirty-two (14.4%) patients had minor complications: 12 had cutaneous rash, four had malpositioned implants and 16 had inadequate implant projection. At long-term follow-up, four (1.8%) patients had developed grade IV capsular contracture associated with postoperative radiation therapy. At a median follow-up of 98 months (range, 36-156), 14 (6.3%) patients had tumour recurrence and 12.2% had distant metastasis. Nineteen patients had died of cancer, and 192 (86.8%) remained disease free. One

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study.

Science.gov (United States)

Matsen, Cindy B; Mehrara, Babak; Eaton, Anne; Capko, Deborah; Berg, Anastasia; Stempel, Michelle; Van Zee, Kimberly J; Pusic, Andrea; King, Tari A; Cody, Hiram S; Pilewskie, Melissa; Cordeiro, Peter; Sclafani, Lisa; Plitas, George; Gemignani, Mary L; Disa, Joseph; El-Tamer, Mahmoud; Morrow, Monica

2016-01-01

Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.

Lobule separator prosthesis to prevent adhesion of reconstructed ear lobe

Directory of Open Access Journals (Sweden)

Lokendra Gupta

2016-01-01

Full Text Available An adhesion is a band of scar tissue that binds two parts of the tissue together, which develops when the body's repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Prevention of unwanted scar bands is of utmost importance to develop esthetic and healthy tissue. This article describes a technique to prevent the adhesion of the surgically reconstructed ear lobule with facial skin, using novel lobule separator prosthesis.

Nanofat grafting under a split-thickness skin graft for problematic wound management.

Science.gov (United States)

Kemaloğlu, Cemal Alper

2016-01-01

Obesity and certain medical disorders make the reconstruction of skin defects challenging. Different kind of procedure can be used for these defect, besides, skin grafting is one of the most common and simplest procedure. Fat grafting and stem cells which are located in the adipose tissue have been commonly used in plastic surgery for regeneration and rejuvenation purposes. To decrease graft failure rate we performed nanofat grafting under an autologous split-thickness skin graft in our patient who had a problematic wound. The case of a 35-year-old female patient with a traumatic skin defect on her left anterior crural region is described herein. After subsequent flap reconstruction, the result was disappointing and the defect size was widened. The defect was treated with combined grafting (nanofat grafting under an autologous split-thickness skin graft). At the 6 months follow-up assessment after combined grafting, the integrity of the skin graft was good with excellent pliability. Combined grafting for problematic wounds seems to be a useful technique for cases requiring reconstruction. The potential existence of stem cells may be responsible for the successful result in our patient.

Reconstruction for Skull Base Defect Using Fat-Containing Perifascial Areolar Tissue.

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Choi, Woo Young; Sung, Ki Wook; Kim, Young Seok; Hong, Jong Won; Roh, Tai Suk; Lew, Dae Hyun; Chang, Jong Hee; Lee, Kyu Sung

2017-06-01

Skull base reconstruction is a challenging task. The method depends on the anatomical complexity and size of the defect. We obtained tissue by harvesting fat-containing perifascial areolar tissue (PAT) for reconstruction of limited skull base defects and volume augmentation. We demonstrated the effective option for reconstruction of limited skull base defects and volume augmentation. From October 2013 to November 2015, 5 patients underwent operations using fat-containing PAT to fill the defect in skull base and/or perform volume replacement in the forehead. Perifascial areolar tissue with 5- to 10-mm fat thickness was harvested from the inguinal region. The fat-containing PAT was grafted to the defect contacting the vascularized wound bed. Patients were followed up in terms of their clinical symptoms and postoperative magnetic resonance imaging findings. Four patients were treated using fat-containing PAT after tumor resection. One patient was treated for a posttraumatic forehead depression deformity. The fat-containing PAT included 5- to 9-mm fat thickness in all cases. The mean size of grafted PAT was 65.6 cm (28-140 cm). The mean follow-up period was 18.6 months (12-31 months). There was no notable complication. There was no donor site morbidity. We can harvest PAT with fat easily and obtain the sufficient volume to treat the defect. It also could be used with other reconstructive method, such as a free flap or a regional flap to fill the left dead space. Therefore, fat-containing PAT could be additional options to reconstruction of skull base defect.

Creation of a Bioengineered Skin Flap Scaffold with a Perfusable Vascular Pedicle.

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Jank, Bernhard J; Goverman, Jeremy; Guyette, Jacques P; Charest, Jon M; Randolph, Mark; Gaudette, Glenn R; Gershlak, Joshua R; Purschke, Martin; Javorsky, Emilia; Nazarian, Rosalynn M; Leonard, David A; Cetrulo, Curtis L; Austen, William G; Ott, Harald C

2017-07-01

Full-thickness skin loss is a challenging problem due to limited reconstructive options, demanding 75 million surgical procedures annually in the United States. Autologous skin grafting is the gold standard treatment, but results in donor-site morbidity and poor aesthetics. Numerous skin substitutes are available on the market to date, however, none truly functions as full-thickness skin due to lack of a vascular network. The creation of an autologous full-thickness skin analogue with a vascular pedicle would result in a paradigm shift in the management of wounds and in reconstruction of full-thickness skin defects. To create a clinically relevant foundation, we generated an acellular skin flap scaffold (SFS) with a perfusable vascular pedicle of clinically relevant size by perfusion decellularization of porcine fasciocutaneous flaps. We then analyzed the yielded SFS for mechanical properties, biocompatibility, and regenerative potential in vitro and in vivo. Furthermore, we assessed the immunological response using an in vivo model. Finally, we recellularized the vascular compartment of an SFS and reconnected it to a recipient's blood supply to test for perfusability. Perfusion decellularization removed all cellular components with preservation of native extracellular matrix composition and architecture. Biaxial testing revealed preserved mechanical properties. Immunologic response and biocompatibility assessed via implantation and compared with native xenogenic skin and commercially available dermal substitutes revealed rapid neovascularization and complete tissue integration. Composition of infiltrating immune cells showed no evidence of allorejection and resembled the inflammatory phase of wound healing. Implantation into full-thickness skin defects demonstrated good tissue integration and skin regeneration without cicatrization. We have developed a protocol for the generation of an SFS of clinically relevant size, containing a vascular pedicle, which can be

Rapid intraoperative tissue expansion with Foley catheter in a challenging cripple Hypospadias

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Murat Cakmak

2015-06-01

Full Text Available ABSTRACTFailed hypospadiass cases may result in hypovascular, scarred penis with residual penile chordee and leave the patient with minimal residual skin for penile resurfacing and urethroplasty. Local tissue expansion has become a good alternative to provide skin for penis by using expanders however they require long periods of time for expansion. Besides, rapid tissue expansion was also described in different tissues. We used rapid intraoperative expansion technique by using a Foley catheter in a failed hypospadias case who had minimal residual skin secondary to infection and we concluded that rapid intraoperative tissue expansion with Foley catheter is an effective, feasible reconstructive method for easy dissection and penile resurfacing in failed hypospadiass cases.

Skin-Resident T Cells Drive Dermal Dendritic Cell Migration in Response to Tissue Self-Antigen.

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Ali, Niwa; Zirak, Bahar; Truong, Hong-An; Maurano, Megan M; Gratz, Iris K; Abbas, Abul K; Rosenblum, Michael D

2018-05-01

Migratory dendritic cell (DC) subsets deliver tissue Ags to draining lymph nodes (DLNs) to either initiate or inhibit T cell-mediated immune responses. The signals mediating DC migration in response to tissue self-antigen are largely unknown. Using a mouse model of inducible skin-specific self-antigen expression, we demonstrate that CD103 + dermal DCs (DDCs) rapidly migrate from skin to skin DLN (SDLNs) within the first 48 h after Ag expression. This window of time was characterized by the preferential activation of tissue-resident Ag-specific effector T cells (Teffs), with no concurrent activation of Ag-specific Teffs in SDLNs. Using genetic deletion and adoptive transfer approaches, we show that activation of skin-resident Teffs is required to drive CD103 + DDC migration in response to tissue self-antigen and this Batf3-dependent DC population is necessary to mount a fulminant autoimmune response in skin. Conversely, activation of Ag-specific Teffs in SDLNs played no role in DDC migration. Our studies reveal a crucial role for skin-resident T cell-derived signals, originating at the site of self-antigen expression, to drive DDC migration during the elicitation phase of an autoimmune response. Copyright © 2018 by The American Association of Immunologists, Inc.

Iatrogenic Pneumothorax as a Complication to Delayed Breast Reconstruction With Tissue Expander—A Case Report

DEFF Research Database (Denmark)

Willert, Cecilie Balslev; Bredgaard, Rikke

2017-01-01

Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen as a complicat......Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen...... as a complication to the operation. Literature is sparse; hence, the only study is by Schneider et al who found an incidence of 0.55%. The study focused on immediate reconstruction only and did not report the percentage of irradiated patients. We present a unique case of iatrogenic pneumothorax in a previously...

Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing.

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Lazzeri, Davide; Su, Weijie; Qian, Yunliang; Messmer, Caroline; Agostini, Tommaso; Spinelli, Giuseppe; Marcus, Jeffrey R; Levin, L Scott; Zenn, Micheal R; Zhang, Yi Xin

2013-05-01

The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues. A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect. Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months. Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

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Jiajun Feng

2016-03-01

Full Text Available BackgroundThe aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.MethodsWe analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.ResultsThe average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.ConclusionsThis approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

Handheld skin printer: in situ formation of planar biomaterials and tissues.

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Hakimi, Navid; Cheng, Richard; Leng, Lian; Sotoudehfar, Mohammad; Ba, Phoenix Qing; Bakhtyar, Nazihah; Amini-Nik, Saeid; Jeschke, Marc G; Günther, Axel

2018-05-15

We present a handheld skin printer that enables the in situ formation of biomaterial and skin tissue sheets of different homogeneous and architected compositions. When manually positioned above a target surface, the compact instrument (weight <0.8 kg) conformally deposits a biomaterial or tissue sheet from a microfluidic cartridge. Consistent sheet formation is achieved by coordinating the flow rates at which bioink and cross-linker solution are delivered, with the speed at which a pair of rollers actively translate the cartridge along the surface. We demonstrate compatibility with dermal and epidermal cells embedded in ionically cross-linkable biomaterials (e.g., alginate), and enzymatically cross-linkable proteins (e.g., fibrin), as well as their mixtures with collagen type I and hyaluronic acid. Upon rapid crosslinking, biomaterial and skin cell-laden sheets of consistent thickness, width and composition were obtained. Sheets deposited onto horizontal, agarose-coated surfaces were used for physical and in vitro characterization. Proof-of-principle demonstrations for the in situ formation of biomaterial sheets in murine and porcine excisional wound models illustrate the capacity of depositing onto inclined and compliant wound surfaces that are subject to respiratory motion. We expect the presented work will enable the in situ delivery of a wide range of different cells, biomaterials, and tissue adhesives, as well as the in situ fabrication of spatially organized biomaterials, tissues, and biohybrid structures.

Quantitatively characterizing microstructural variations of skin tissues during ultraviolet radiation damaging process based on Mueller matrix polarimetry

Science.gov (United States)

Sheng, Wei; He, Honghui; Dong, Yang; Ma, Hui

2018-02-01

As one of the most fundamental features of light, polarization can be used to develop imaging techniques which can provide insight into the optical and structural properties of tissues. Especially, the Mueller matrix polarimetry is suitable to detect the changes in collagen and elastic fibres, which are the main compositions of skin tissue. Here we demonstrate a novel quantitative, non-contact and in situ technique to monitor the microstructural variations of skin tissue during ultraviolet radiation (UVR) induced photoaging based on Mueller matrix polarimetry. Specifically, we measure the twodimensional (2D) backscattering Mueller matrices of nude mouse skin samples, then calculate and analyze the Mueller matrix derived parameters during the skin photoaging and self-repairing processes. To induce three-day skin photoaging, the back skin of each mouse is irradiated with UVR (0.05J/cm2) for five minutes per day. After UVR, the microstructures of the nude mouse skin are damaged. During the process of UV damage, we measure the backscattering Mueller matrices of the mouse skin samples and examine the relationship between the Mueller matrix parameters and the microstructural variations of skin tissue quantitatively. The comparisons between the UVR damaged groups with and without sunscreens show that the Mueller matrix derived parameters are potential indicators for fibrous microstructure variation in skin tissue. The pathological examinations and Monte Carlo simulations confirm the relationship between the values of Mueller matrix parameters and the changes of fibrous structures. Combined with smart phones or wearable devices, this technique may have a good application prospect in the fields of cosmetics and dermatological health.

Modeling skin cooling using optical windows and cryogens during laser induced hyperthermia in a multilayer vascularized tissue

International Nuclear Information System (INIS)

Singh, Rupesh; Das, Koushik; Okajima, Junnosuke; Maruyama, Shigenao; Mishra, Subhash C.

2015-01-01

This article deals with the spatial and the temporal evolution of tissue temperature during skin surface cooled laser induced hyperthermia. Three different skin surface cooling methodologies viz., optical window contact cooling, cryogenic spray cooling and cryogen cooled optical window contact cooling are considered. Sapphire, yttrium aluminum garnet, lithium tantalate, and magnesium oxide doped lithium niobate are the considered optical windows. The cryogens considered are liquid CO_2 and R1234yf. Heat transfer in the multilayer skin tissue embedded with thermally significant blood vessels pairs is modeled using the Pennes and Weinbaum–Jiji bioheat equations. Weinbaum–Jiji bioheat equation is used for the vascularized tissue. Laser transport in the tissue is modeled using the radiative transfer equation. Axial and radial (skin surface) temperature distributions for different combinations of optical windows and cryogens are analyzed. Liquid CO_2 cooled yttrium aluminum garnet is found to be the best surface cooling mechanism. - Highlights: • Skin surface cooled laser induced hyperthermia is studied. • A multi-layer 2-D cylindrical tissue geometry is considered. • Both Pennes and Weinbaum–Jiji bioheat models are considered. • Laser transport in the tissue is modeled using discrete ordinate method. • Results for 4 optical windows and 2 cryogens for skin cooling are presented.

Current status of tissue engineering applied to bladder reconstruction in humans.

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Gasanz, C; Raventós, C; Morote, J

2018-01-11

Bladder reconstruction is performed to replace or expand the bladder. The intestine is used in standard clinical practice for tissue in this procedure. The complications of bladder reconstruction range from those of intestinal resection to those resulting from the continuous contact of urine with tissue not prepared for this contact. In this article, we describe and classify the various biomaterials and cell cultures used in bladder tissue engineering and reviews the studies performed with humans. We conducted a review of literature published in the PubMed database between 1950 and 2017, following the principles of the PRISM declaration. Numerous in vitro and animal model studies have been conducted, but only 18 experiments have been performed with humans, with a total of 169 patients. The current evidence suggests that an acellular matrix, a synthetic polymer with urothelial and autologous smooth muscle cells attached in vitro or stem cells would be the most practical approach for experimental bladder reconstruction. Bladder replacement or expansion without using intestinal tissue is still a challenge, despite progress in the manufacture of biomaterials and the development of cell therapy. Well-designed studies with large numbers of patients and long follow-up times are needed to establish an effective clinical translation and standardisation of the check-up functional tests. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparison of structure and organization of cutaneous lipids in a reconstructed skin model and human skin: spectroscopic imaging and chromatographic profiling.

Science.gov (United States)

Tfayli, Ali; Bonnier, Franck; Farhane, Zeineb; Libong, Danielle; Byrne, Hugh J; Baillet-Guffroy, Arlette

2014-06-01

The use of animals for scientific research is increasingly restricted by legislation, increasing the demand for human skin models. These constructs present comparable bulk lipid content to human skin. However, their permeability is significantly higher, limiting their applicability as models of barrier function, although the molecular origins of this reduced barrier function remain unclear. This study analyses the stratum corneum (SC) of one such commercially available reconstructed skin model (RSM) compared with human SC by spectroscopic imaging and chromatographic profiling. Total lipid composition was compared by chromatographic analysis (HPLC). Raman spectroscopy was used to evaluate the conformational order, lateral packing and distribution of lipids in the surface and skin/RSM sections. Although HPLC indicates that all SC lipid classes are present, significant differences are observed in ceramide profiles. Raman imaging demonstrated that the RSM lipids are distributed in a non-continuous matrix, providing a better understanding of the limited barrier function. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Feasibility of the Use of RapiGraft and Skin Grafting in Reconstructive Surgery

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Jung Dug Yang

2016-09-01

Full Text Available BackgroundSkin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute.MethodsThis prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A, and RapiGraft and split-thickness skin grafting were used on the other side (group B. All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS, a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months.ResultsThe skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082. Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all. However, the groups did not differ significantly in pliability (P=0.155.ConclusionsThe present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

Evaluation of Perfusion and Thermal Parameters of Skin Tissue Using Cold Provocation and Thermographic Measurements

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Strąkowska Maria

2016-09-01

Full Text Available Measurement of the perfusion coefficient and thermal parameters of skin tissue using dynamic thermography is presented in this paper. A novel approach based on cold provocation and thermal modelling of skin tissue is presented. The measurement was performed on a person’s forearm using a special cooling device equipped with the Peltier module. The proposed method first cools the skin, and then measures the changes of its temperature matching the measurement results with a heat transfer model to estimate the skin perfusion and other thermal parameters. In order to assess correctness of the proposed approach, the uncertainty analysis was performed.

Skin color and tissue thickness effects on transmittance, reflectance, and skin temperature when using 635 and 808 nm lasers in low intensity therapeutics.

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Souza-Barros, Leanna; Dhaidan, Ghaith; Maunula, Mikko; Solomon, Vaeda; Gabison, Sharon; Lilge, Lothar; Nussbaum, Ethne L

2018-04-01

To examine the role of skin color and tissue thickness on transmittance, reflectance, and skin heating using red and infrared laser light. Forty volunteers were measured for skin color and skin-fold thickness at a standardized site near the elbow. Transmittance, reflectance and skin temperature were recorded for energy doses of 2, 6, 9, and 12 Joules using 635 nm (36 mW) and 808 nm (40 mW) wavelength laser diodes with irradiances within American National Standards Institute safety guidelines (4.88 mm diameter, 0.192 W/cm 2 and 4.88 mm diameter, 0.214 W/cm 2 , respectively). The key factors affecting reflectance to an important degree were skin color and wavelength. However, the skin color effects were different for the two wavelengths: reflectance decreased for darker skin with a greater decrease for red light than near infrared light. Transmittance was greater using 808 nm compared with 635 nm. However, the effect was partly lost when the skin was dark rather than light, and was increasingly lost as tissue thickness increased. Dose had an increasing effect on temperature (0.7-1.6°C across the 6, 9, and 12 J doses); any effects of wavelength, skin color, and tissue thickness were insignificant compared to dose effects. Subjects themselves were not aware of the increased skin temperature. Transmittance and reflectance changes as a function of energy were very small and likely of no clinical significance. Absorption did not change with higher energy doses and increasing temperature. Skin color and skin thickness affect transmittance and reflectance of laser light and must be accounted for when selecting energy dose to ensure therapeutic effectiveness at the target tissue. Skin heating appears not to be a concern when using 635 and 808 nm lasers at energy doses of up to 12 J and irradiance within American National Standards Institute standards. Photobiomodulation therapy should never exceed the American National Standards Institute

[Reconstruction of combined skin and bilateral artey defects at palmar side of fingers by free posterior interrosseous artery flap in a bridge fashion].

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Xu, Bao-cheng; Liang, Gang; Chen, Fu-sheng

2012-05-01

To investigate the feasibility and therapeutic effect of free posterior interrosseous artery flap in a bridge fashion for combined skin and bilateral artery defects at palmar side of fingers. 6 cases with combined skin and bilateral artery defects at palmar side of fingers were treated with long-pedicled free posterior interrosseous artery flap in a bridge fashion. The flap size ranged from 3.5 cm x 2.0 cm to 6.5 em x 3.0 cm. The wounds at donor sites were closed directly. All the 6 flaps survived completely without any complication, and the wounds healed primarily. The blood supply and vein drainage in all the 6 fingers were normal. 4 cases were followed up for 1-12 months (average, 7 months). Satisfactory cosmetic and functional results were achieved. The flaps looked a little bit thicker than the surrounding tissue. The long-pedicled free posterior interrosseous artery flap in a bridge fashion is a good option for reconstruction of the combined skin and bilateral artery defects at palmar side of fingers in one stage.

The effect of keratinocytes on the biomechanical characteristics and pore microstructure of tissue engineered skin using deep dermal fibroblasts.

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Varkey, Mathew; Ding, Jie; Tredget, Edward E

2014-12-01

Fibrosis affects most organs, it results in replacement of normal parenchymal tissue with collagen-rich extracellular matrix, which compromises tissue architecture and ultimately causes loss of function of the affected organ. Biochemical pathways that contribute to fibrosis have been extensively studied, but the role of biomechanical signaling in fibrosis is not clearly understood. In this study, we assessed the effect keratinocytes have on the biomechanical characteristics and pore microstructure of tissue engineered skin made with superficial or deep dermal fibroblasts in order to determine any biomaterial-mediated anti-fibrotic influences on tissue engineered skin. Tissue engineered skin with deep dermal fibroblasts and keratinocytes were found to be less stiff and contracted and had reduced number of myofibroblasts and lower expression of matrix crosslinking factors compared to matrices with deep fibroblasts alone. However, there were no such differences between tissue engineered skin with superficial fibroblasts and keratinocytes and matrices with superficial fibroblasts alone. Also, tissue engineered skin with deep fibroblasts and keratinocytes had smaller pores compared to those with superficial fibroblasts and keratinocytes; pore size of tissue engineered skin with deep fibroblasts and keratinocytes were not different from those matrices with deep fibroblasts alone. A better understanding of biomechanical characteristics and pore microstructure of tissue engineered skin may prove beneficial in promoting normal wound healing over pathologic healing. Copyright © 2014 Elsevier Ltd. All rights reserved.

Eyelid skin as a potential site for drug delivery to conjunctiva and ocular tissues.

Science.gov (United States)

See, Gerard Lee; Sagesaka, Ayano; Sugasawa, Satoko; Todo, Hiroaki; Sugibayashi, Kenji

2017-11-25

The feasibility of topical application onto the (lower) eyelid skin to deliver hydrophilic and lipophilic compounds into the conjunctiva and ocular tissues was evaluated by comparing with conventional eye drop application. Skin permeation and the concentration of several model compounds, and skin impedance were determined utilizing eyelid skin from hairless rats, as well as abdominal skin in the same animals for comparison. In vitro static diffusion cells were used to assess the skin permeation in order to provide key insights into the relationship between the skin sites and drugs. The obtained results revealed that drug permeation through the eyelid skin was much higher than that through abdominal skin regardless of the drug lipophilicity. Specifically, diclofenac sodium salt and tranilast exhibited approximately 6-fold and 11-fold higher permeability coefficients, respectively, through eyelid skin compared with abdominal skin. Histomorphological evaluation and in vivo distribution of model fluorescent dyes were also examined in the conjunctiva and skin after eyelid administration by conventional microscope and confocal laser scanning microscope analyses. The result revealed that eyelid skin has a thinner stratum corneum, thereby showing lower impedance, which could be the reason for the higher drug permeation through eyelid skin. Comparative evaluation of lipophilic and hydrophilic model compounds administered via the eyelid skin over 8h revealed stronger fluorescence intensity in the skin and surrounding tissues compared with eye drop administration. These results suggested that the (lower) eyelid skin is valuable as a prospective site for ophthalmic medicines. Copyright © 2017 Elsevier B.V. All rights reserved.

Spectra from 2.5-15 μm of tissue phantom materials, optical clearing agents and ex vivo human skin: implications for depth profiling of human skin

International Nuclear Information System (INIS)

Viator, John A; Choi, Bernard; Peavy, George M; Kimel, Sol; Nelson, J Stuart

2003-01-01

Infrared measurements have been used to profile or image biological tissue, including human skin. Usually, analysis of such measurements has assumed that infrared absorption is due to water and collagen. Such an assumption may be reasonable for soft tissue, but introduction of exogenous agents into skin or the measurement of tissue phantoms has raised the question of their infrared absorption spectrum. We used Fourier transform infrared spectroscopy in attenuated total reflection mode to measure the infrared absorption spectra, in the range of 2-15 μm, of water, polyacrylamide, Intralipid, collagen gels, four hyperosmotic clearing agents (glycerol, 1,3-butylene glycol, trimethylolpropane, Topicare TM ), and ex vivo human stratum corneum and dermis. The absorption spectra of the phantom materials were similar to that of water, although additional structure was noted in the range of 6-10 μm. The absorption spectra of the clearing agents were more complex, with molecular absorption bands dominating between 6 and 12 μm. Dermis was similar to water, with collagen structure evident in the 6-10 μm range. Stratum corneum had a significantly lower absorption than dermis due to a lower content of water. These results suggest that the assumption of water-dominated absorption in the 2.5-6 μm range is valid. At longer wavelengths, clearing agent absorption spectra differ significantly from the water spectrum. This spectral information can be used in pulsed photothermal radiometry or utilized in the interpretation of reconstructions in which a constant μ ir is used. In such cases, overestimating μ ir will underestimate chromophore depth and vice versa, although the effect is dependent on actual chromophore depth. (note)

Tissue-engineering as an adjunct to pelvic reconstructive surgery

DEFF Research Database (Denmark)

Jangö, Hanna

of pelvic organ prolapse (POP) are warranted. Traditional native tissue repair may be associated with poor long-term outcome and augmentation with permanent polypropylene meshes is associated with frequent and severe adverse effects. Tissue-engineering is a regenerative strategy that aims at creating...... functional tissue using stem cells, scaffolds and trophic factors. The aim of this thesis was to investigate the potential adjunctive use of a tissue-engineering technique for pelvic reconstructive surgery using two synthetic biodegradable materials; methoxypolyethyleneglycol-poly(lactic-co-glycolic acid......) (MPEG-PLGA) and electrospun polycaprolactone (PCL) - with or without seeded muscle stem cells in the form of autologous fresh muscle fiber fragments (MFFs).To simulate different POP repair scenarios different animal models were used. In Study 1 and 2, MPEG-PLGA was evaluated in a native tissue repair...

Facial reconstruction – anatomical art or artistic anatomy?

Science.gov (United States)

Wilkinson, Caroline

2010-01-01

Facial reconstruction is employed in the context of forensic investigation and for creating three-dimensional portraits of people from the past, from ancient Egyptian mummies and bog bodies to digital animations of J. S. Bach. This paper considers a facial reconstruction method (commonly known as the Manchester method) associated with the depiction and identification of the deceased from skeletal remains. Issues of artistic licence and scientific rigour, in relation to soft tissue reconstruction, anatomical variation and skeletal assessment, are discussed. The need for artistic interpretation is greatest where only skeletal material is available, particularly for the morphology of the ears and mouth, and with the skin for an ageing adult. The greatest accuracy is possible when information is available from preserved soft tissue, from a portrait, or from a pathological condition or healed injury. PMID:20447245

The use of ex vivo human skin tissue for genotoxicity testing

Energy Technology Data Exchange (ETDEWEB)

Reus, Astrid A.; Usta, Mustafa [TNO Triskelion BV, Utrechtseweg 48, 3704 HE, Zeist (Netherlands); Krul, Cyrille A.M., E-mail: cyrille.krul@tno.nl [TNO, Utrechtseweg 48, 3704 HE Zeist (Netherlands)

2012-06-01

As a result of the chemical legislation concerning the registration, evaluation, authorization and restriction of chemicals (REACH), and the Seventh Amendment to the Cosmetics Directive, which prohibits animal testing in Europe for cosmetics, alternative methods for safety evaluation of chemicals are urgently needed. Current in vitro genotoxicity assays are not sufficiently predictive for the in vivo situation, resulting in an unacceptably high number of misleading positives. For many chemicals and ingredients of personal care products the skin is the first site of contact, but there are no in vitro genotoxicity assays available in the skin for additional evaluation of positive or equivocal responses observed in regulatory in vitro genotoxicity assays. In the present study ex vivo human skin tissue obtained from surgery was used for genotoxicity evaluation of chemicals by using the comet assay. Fresh ex vivo human skin tissue was cultured in an air–liquid interface and topically exposed to 20 chemicals, including true positive, misleading positive and true negative genotoxins. Based on the results obtained in the present study, the sensitivity, specificity and accuracy of the ex vivo skin comet assay to predict in vivo genotoxicity were 89%, 90% and 89%, respectively. Donor and experimental variability were mainly reflected in the magnitude of the response and not the difference between the presence and absence of a genotoxic response. The present study indicates that human skin obtained from surgery is a promising and robust model for safety evaluation of chemicals that are in direct contact with the skin. -- Highlights: ► We use human skin obtained from surgery for genotoxicity evaluation of chemicals. ► We use the comet assay as parameter for genotoxicity in ex vivo human skin. ► Sensitivity, specificity and accuracy to predict in vivo genotoxins are determined. ► Sensitivity, specificity and accuracy are 89%, 90% and 90%, respectively. ► The method

The use of ex vivo human skin tissue for genotoxicity testing

International Nuclear Information System (INIS)

Reus, Astrid A.; Usta, Mustafa; Krul, Cyrille A.M.

2012-01-01

As a result of the chemical legislation concerning the registration, evaluation, authorization and restriction of chemicals (REACH), and the Seventh Amendment to the Cosmetics Directive, which prohibits animal testing in Europe for cosmetics, alternative methods for safety evaluation of chemicals are urgently needed. Current in vitro genotoxicity assays are not sufficiently predictive for the in vivo situation, resulting in an unacceptably high number of misleading positives. For many chemicals and ingredients of personal care products the skin is the first site of contact, but there are no in vitro genotoxicity assays available in the skin for additional evaluation of positive or equivocal responses observed in regulatory in vitro genotoxicity assays. In the present study ex vivo human skin tissue obtained from surgery was used for genotoxicity evaluation of chemicals by using the comet assay. Fresh ex vivo human skin tissue was cultured in an air–liquid interface and topically exposed to 20 chemicals, including true positive, misleading positive and true negative genotoxins. Based on the results obtained in the present study, the sensitivity, specificity and accuracy of the ex vivo skin comet assay to predict in vivo genotoxicity were 89%, 90% and 89%, respectively. Donor and experimental variability were mainly reflected in the magnitude of the response and not the difference between the presence and absence of a genotoxic response. The present study indicates that human skin obtained from surgery is a promising and robust model for safety evaluation of chemicals that are in direct contact with the skin. -- Highlights: ► We use human skin obtained from surgery for genotoxicity evaluation of chemicals. ► We use the comet assay as parameter for genotoxicity in ex vivo human skin. ► Sensitivity, specificity and accuracy to predict in vivo genotoxins are determined. ► Sensitivity, specificity and accuracy are 89%, 90% and 90%, respectively. ► The method

Partial medial second toe pulp free flap and dermal substitute with skin graft for salvage reconstruction of a complete skin envelope degloving of the small finger.

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Calafat, V; Strugarek, C; Montoya-Faivre, D; Dap, F; Dautel, G

2018-04-04

Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Noninvasive imaging of human skin hemodynamics using a digital red-green-blue camera

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Nishidate, Izumi; Tanaka, Noriyuki; Kawase, Tatsuya; Maeda, Takaaki; Yuasa, Tomonori; Aizu, Yoshihisa; Yuasa, Tetsuya; Niizeki, Kyuichi

2011-08-01

In order to visualize human skin hemodynamics, we investigated a method that is specifically developed for the visualization of concentrations of oxygenated blood, deoxygenated blood, and melanin in skin tissue from digital RGB color images. Images of total blood concentration and oxygen saturation can also be reconstructed from the results of oxygenated and deoxygenated blood. Experiments using tissue-like agar gel phantoms demonstrated the ability of the developed method to quantitatively visualize the transition from an oxygenated blood to a deoxygenated blood in dermis. In vivo imaging of the chromophore concentrations and tissue oxygen saturation in the skin of the human hand are performed for 14 subjects during upper limb occlusion at 50 and 250 mm Hg. The response of the total blood concentration in the skin acquired by this method and forearm volume changes obtained from the conventional strain-gauge plethysmograph were comparable during the upper arm occlusion at pressures of both 50 and 250 mm Hg. The results presented in the present paper indicate the possibility of visualizing the hemodynamics of subsurface skin tissue.

3D prostate histology image reconstruction: Quantifying the impact of tissue deformation and histology section location

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Eli Gibson

2013-01-01

Full Text Available Background: Guidelines for localizing prostate cancer on imaging are ideally informed by registered post-prostatectomy histology. 3D histology reconstruction methods can support this by reintroducing 3D spatial information lost during histology processing. The need to register small, high-grade foci drives a need for high accuracy. Accurate 3D reconstruction method design is impacted by the answers to the following central questions of this work. (1 How does prostate tissue deform during histology processing? (2 What spatial misalignment of the tissue sections is induced by microtome cutting? (3 How does the choice of reconstruction model affect histology reconstruction accuracy? Materials and Methods: Histology, paraffin block face and magnetic resonance images were acquired for 18 whole mid-gland tissue slices from six prostates. 7-15 homologous landmarks were identified on each image. Tissue deformation due to histology processing was characterized using the target registration error (TRE after landmark-based registration under four deformation models (rigid, similarity, affine and thin-plate-spline [TPS]. The misalignment of histology sections from the front faces of tissue slices was quantified using manually identified landmarks. The impact of reconstruction models on the TRE after landmark-based reconstruction was measured under eight reconstruction models comprising one of four deformation models with and without constraining histology images to the tissue slice front faces. Results: Isotropic scaling improved the mean TRE by 0.8-1.0 mm (all results reported as 95% confidence intervals, while skew or TPS deformation improved the mean TRE by <0.1 mm. The mean misalignment was 1.1-1.9΀ (angle and 0.9-1.3 mm (depth. Using isotropic scaling, the front face constraint raised the mean TRE by 0.6-0.8 mm. Conclusions: For sub-millimeter accuracy, 3D reconstruction models should not constrain histology images to the tissue slice front faces and

Determination of the axial and circumferential mechanical properties of the skin tissue using experimental testing and constitutive modeling.

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Karimi, Alireza; Navidbakhsh, Mahdi; Haghighatnama, Maedeh; Haghi, Afsaneh Motevalli

2015-01-01

The skin, being a multi-layered material, is responsible for protecting the human body from the mechanical, bacterial, and viral insults. The skin tissue may display different mechanical properties according to the anatomical locations of a body. However, these mechanical properties in different anatomical regions and at different loading directions (axial and circumferential) of the mice body to date have not been determined. In this study, the axial and circumferential loads were imposed on the mice skin samples. The elastic modulus and maximum stress of the skin tissues were measured before the failure occurred. The nonlinear mechanical behavior of the skin tissues was also computationally investigated through a suitable constitutive equation. Hyperelastic material model was calibrated using the experimental data. Regardless of the anatomic locations of the mice body, the results revealed significantly different mechanical properties in the axial and circumferential directions and, consequently, the mice skin tissue behaves like a pure anisotropic material. The highest elastic modulus was observed in the back skin under the circumferential direction (6.67 MPa), while the lowest one was seen in the abdomen skin under circumferential loading (0.80 MPa). The Ogden material model was narrowly captured the nonlinear mechanical response of the skin at different loading directions. The results help to understand the isotropic/anisotropic mechanical behavior of the skin tissue at different anatomical locations. They also have implications for a diversity of disciplines, i.e., dermatology, cosmetics industry, clinical decision making, and clinical intervention.

Tissue - engineering as an adjunct to pelvic reconstructive surgery.

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Jangö, Hanna

2017-08-01

This PhD-thesis is based on animal studies and comprises three original papers and unpublished data. The studies were con-ducted during my employment as a research fellow at the Department of Obstetrics and Gynecology, Herlev University Hospital, Denmark. New strategies for surgical reconstruction of pelvic organ pro-lapse (POP) are warranted. Traditional native tissue repair may be associated with poor long-term outcome and augmentation with permanent polypropylene meshes is associated with frequent and severe adverse effects. Tissue-engineering is a regenerative strategy that aims at creating functional tissue using stem cells, scaffolds and trophic factors. The aim of this thesis was to investigate the potential adjunctive use of a tissue-engineering technique for pelvic reconstructive surgery using two synthetic biodegradable materials; methoxypolyethyleneglycol-poly(lacticco-glycolic acid) (MPEG-PLGA) and electrospun polycaprolactone (PCL) - with or without seeded muscle stem cells in the form of autologous fresh muscle fiber fragments (MFFs). To simulate different POP repair scenarios different animal models were used. In Study 1 and 2, MPEG-PLGA was evaluated in a native tissue re-pair model and a partial defect model of the rat abdominal wall. We found that the scaffold was fully degraded after eight weeks. Cells from added MFFs could be traced and had resulted in the formation of new striated muscle fibers. Also, biomechanical changes were found in the groups with added MFFs. In Study 3, the long-term degradable electrospun PCL scaffold was evaluated in three rat abdominal wall models representing different loads on the scaffold. Surprisingly, cells from the MFFs did not survive. After eight weeks, a marked inflammatory foreign-body response was observed with numerous giant cells located between and around the PCL fibers which appeared not to be degraded. This response caused a considerable increase in the thickness of the mesh, resulting in a neotissue

Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases.

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Sharaf, Basel; Xue, Amy; Solari, Mario G; Boa, Olivier; Liu, Jun; Hanasono, Matthew M; Skoracki, Roman; Yu, Peirong; Selber, Jesse C

2017-01-01

Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.

Unexpected complication associated with balneotherapy: Skin and soft tissue infection

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Alım, Bülent; Bostancı, Fahrettin; Servi, M. Alperen; Ćetinel, Sinan; Bingöl, M. Ozan

2017-04-01

Balneotherapy cure is an ongoing process, but patients can benefit most when cure is complete. For these reason, patients should be closely monitored and necessary precautions should be taken in terms of the complications that may occur in order to prevent the interruption or discontinuation of balneotherapy. Here, we wanted to represent a case that developed left leg soft tissue infection during the application of balneotherapy and because of this reason we stopped the balneotherapy As a result, when balneotherapy is planned for patients with risk factors such as diabetes and obesity, frequent examination of the skin and the application of skin moisturizers will be beneficial to prevent itching and skin dryness.

Novel wearable-type biometric devices based on skin tissue optics with multispectral LED-photodiode matrix

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Jo, Young Chang; Kim, Hae Na; Kang, Jae Hwan; Hong, Hyuck Ki; Choi, Yeon Shik; Jung, Suk Won; Kim, Sung Phil

2017-04-01

In this study, we examined the possibility of using a multispectral skin photomatrix (MSP) module as a novel biometric device. The MSP device measures optical patterns of the wrist skin tissue. Optical patterns consist of 2 × 8 photocurrent intensities of photodiode arrays, which are generated by optical transmission and diffuse reflection of photons from LED light sources with variable wavelengths into the wrist skin tissue. Optical patterns detected by the MSP device provide information on both the surface and subsurface characteristics of the human skin tissue. We found that in the 21 subjects we studied, they showed their unique characteristics, as determined using several wavelengths of light. The experimental results show that the best personal identification accuracy can be acquired using a combination of infrared light and yellow light. This novel biometric device, the MSP module, exhibited an excellent false acceptance rate (FAR) of 0.3% and a false rejection rate (FRR) of 0.0%, which are better than those of commercialized biometric devices such as a fingerprint biometric system. From these experimental results, we found that people exhibit unique optical patterns of their inner-wrist skin tissue and this uniqueness could be used for developing novel high-accuracy personal identification devices.

Scrotal Reconstruction with a Pedicled Gracilis Muscle Flap after ...

African Journals Online (AJOL)

Several scrotal reconstructive options are available including split thickness skin grafts, scrotal advancement flaps, local fasciocutaneous, muscle or myocutaneous flaps, and free tissue transfer. We report a case of a 34 year old African male who presented as a referral from a district hospital with a scrotal defect and ...

Tissue Expander Overfilling: Achieving New Dimensions of Customization in Breast Reconstruction.

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Treiser, Matthew D; Lahair, Tracy; Carty, Matthew J

2016-02-01

Overfill of tissue expanders is a commonly used modality to achieve customized dimensions in breast reconstruction. Little formal study of the dynamics of hyperexpansion of these devices has been performed to date, however. Overfill trials were performed using both Natrelle 133 MV and Mentor 8200 tissue expanders of indicated capacities ranging from 250 to 800 mL. Each expander was initially filled to its indicated capacity with normal water and then injected in regular increments to 400% overfill. Measurements of each expander's width, height, and projection were made at indicated capacity and with each successive incremental overfill injection, and these results were then recorded, collated, and analyzed. Over the first 50% overfill, all expanders demonstrated a logarithmic increase in projection (mean increase, 143 ± 9%) while maintaining essentially stable base dimensions. Overfill levels in excess of 50% were accompanied by linear increases in height, width, and projection, during which projection approached, but never equaled, base dimensions. Stress versus strain analyses demonstrated nonlinear biomechanical dynamics during the first 50% overfill, followed by standard elastic dynamics up to 400% overfill. At no point during the study, did expander tensions outstrip elastic properties, thereby explaining the lack of device rupture. Through overfilling, tunable geometries of tissue expanders can be accessed that may provide for increasing customization of reconstructions, particularly at overfill volumes up to 50% over indicated capacity. This study should serve to guide tissue expander selection and fill volumes that surgeons may implement in obtaining ideal reconstructed breast shapes.

Soft tissue augmentation in skin of color: market growth, available fillers, and successful techniques.

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Burgess, Cheryl M

2007-01-01

In recent years, people of color have become an increasingly important market force for the cosmetics industry. Product lines have been expanded to accommodate a broader spectrum of skin colors and marketing strategies have been specialized in order to target specific ethnic populations. In addition, it is predicted that people with pigmented skin will eventually comprise a majority of the domestic and international population during the 21st century. Not surprisingly, people of color are increasingly seeking out products and procedures to fight the effects of aging, including an increase in surgical and nonsurgical cosmetic procedures. Among nonsurgical procedures, soft tissue augmentation has experienced dramatic growth. Today, clinicians are performing more and more of these procedures in people of color. As a result of these shifts in the cosmetics industry, clinicians performing soft tissue augmentation require increased expertise in the treatment of ethnic skin. This article reviews the important differences that exist between the appearance of the aging faces of Caucasians and people of color. In addition, soft tissue augmentation strategies and injection techniques that are specific to skin of color are discussed.

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

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Zhi Yang Ng

2017-03-01

Full Text Available BackgroundUpper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity.MethodsA literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974. Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s employed, and postoperative follow-up and functional outcomes (when available.ResultsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years. Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation.ConclusionsWith the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

The role of subcutaneous tissue stiffness on microneedle performance in a representative in vitro model of skin.

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Moronkeji, K; Todd, S; Dawidowska, I; Barrett, S D; Akhtar, R

2017-11-10

There has been growing interest in the mechanical behaviour of skin due to the rapid development of microneedle devices for drug delivery applications into skin. However, most in vitro experimentation studies that are used to evaluate microneedle performance do not consider the biomechanical properties of skin or that of the subcutaneous layers. In this study, a representative experimental model of skin was developed which was comprised of subcutaneous and muscle mimics. Neonatal porcine skin from the abdominal and back regions was used, with gelatine gels of differing water content (67, 80, 88 and 96%) to represent the subcutaneous tissue, and a type of ballistic gelatine, Perma-Gel®, as a muscle mimic. Dynamic nanoindentation was used to characterize the mechanical properties of each of these layers. A custom-developed impact test rig was used to apply dense polymethylmethacrylate (PMMA) microneedles to the skin models in a controlled and repeatable way with quantification of the insertion force and velocity. Image analysis methods were used to measure penetration depth and area of the breach caused by microneedle penetration following staining and optical imaging. The nanoindentation tests demonstrated that the tissue mimics matched expected values for subcutaneous and muscle tissue, and that the compliance of the subcutaneous mimics increased linearly with water content. The abdominal skin was thinner and less stiff as compared to back skin. The maximum force decreased with gel water content in the abdominal skin but not in the back skin. Overall, larger and deeper perforations were found in the skin models with increasing water content. These data demonstrate the importance of subcutaneous tissue on microneedle performance and the need for representative skin models in microneedle technology development. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Effect of implant vs. tissue reconstruction on cancer specific survival varies by axillary lymph node status in breast cancer patients.

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Qian Ouyang

Full Text Available To compare the breast cancer-specific survival (BCSS between patients who underwent tissue or implant reconstruction after mastectomy.We used the database from Surveillance, Epidemiology, and End Results (SEER registries and compared the BCSS between patients who underwent tissue and implant reconstruction after mastectomy. Cox-regression models were fitted, adjusting for known clinicopathological features. The interaction between the reconstruction types (tissue/implant and nodal status (N-stage was investigated.A total of 6,426 patients with a median age of 50 years were included. With a median follow up of 100 months, the 10-year cumulative BCSS and non-BCSS were 85.1% and 95.4%, respectively. Patients who underwent tissue reconstruction had tumors with a higher T-stage, N-stage, and tumor grade and tended to be ER/PR-negative compared to those who received implant reconstruction. In univariate analysis, implant-reconstruction was associated with a 2.4% increase (P = 0.003 in the BCSS compared with tissue-reconstruction. After adjusting for significant risk factors of the BCSS (suggested by univariate analysis and stratifying based on the N-stage, there was only an association between the reconstruction type and the BCSS for the N2-3 patients (10-year BCSS of implant vs. tissue-reconstruction: 68.7% and 59.0%, P = 0.004. The 10-year BCSS rates of implant vs. tissue-reconstruction were 91.7% and 91.8% in N0 patients (P>0.05 and 84.5% and 84.4% in N1 patients (P>0.05, respectively.The implant (vs. tissue reconstruction after mastectomy was associated with an improved BCSS in N2-3 breast cancer patients but not in N0-1 patients. A well-designed, prospective study is needed to further confirm these findings.

Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case.

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Townsend, F I; Ralphs, S C; Coronado, G; Sweet, D C; Ward, J; Bloch, C P

2012-01-01

To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts. Ex vivo experimental study and a single clinical case report. Four canine cadavers and a single clinical case. Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample. The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens. The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.

Collagen-chitosan scaffold - Lauric acid plasticizer for skin tissue engineering on burn cases

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Widiyanti, Prihartini; Setyadi, Ewing Dian; Rudyardjo, Djony Izak

2017-02-01

The prevalence of burns in the world is more than 800 cases per one million people each year and this is the second highest cause of death due to trauma after traffic accident. Many studies are turning to skin substitute methods of tissue engineering. The purpose of this study is to determine the composition of the collagen, chitosan, and lauric acid scaffold, as well as knowing the results of the characterization of the scaffold. The synthesis of chitosan collagen lauric acid scaffold as a skin tissue was engineered using freeze dried method. Results from making of collagen chitosan lauric acid scaffold was characterized physically, biologically and mechanically by SEM, cytotoxicity, biodegradation, and tensile strength. From the morphology test, the result obtained is that pore diameter size ranges from 94.11 to 140.1 µm for samples A,B,C,D, which are in the range of normal pore size 63-150 µm, while sample E has value below the standard which is about 37.87 to 47.36 µm. From cytotoxicity assay, the result obtained is the percentage value of living cells between 20.11 to 21.51%. This value is below 50% the standard value of living cells. Incompatibility is made possible because of human error mainly the replication of washing process over the standard. Degradation testing obtained values of 19.44% - 40% by weight which are degraded during the 7 days of observation. Tensile test results obtained a range of values of 0.192 - 3.53 MPa. Only sample A (3.53 MPa) and B (1.935 MPa) meet the standard values of skin tissue scaffold that is 1-24 MPa. Based on the results of the characteristics of this study, composite chitosan collagen scaffold with lauric acid plasticizer has a potential candidate for skin tissue engineering for skin burns cases.

Measurement of DNA biomarkers for the safety of tissue-engineered medical products, using artificial skin as a model.

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Rodriguez, Henry; O'Connell, Catherine; Barker, Peter E; Atha, Donald H; Jaruga, Pawel; Birincioglu, Mustafa; Marino, Michael; McAndrew, Patricia; Dizdaroglu, Miral

2004-01-01

To test the hypothesis that the process of tissue engineering introduces genetic damage to tissue-engineered medical products, we employed the use of five state-of-the-art measurement technologies to measure a series of DNA biomarkers in commercially available tissue-engineered skin as a model. DNA was extracted from the skin and compared with DNA from cultured human neonatal control cells (dermal fibroblasts and epidermal keratinocytes) and adult human fibroblasts from a 55-year-old donor and a 96-year-old donor. To determine whether tissue engineering caused oxidative DNA damage, gas chromatography/isotope-dilution mass spectrometry and liquid chromatography/isotope-dilution mass spectrometry were used to measure six oxidatively modified DNA bases as biomarkers. Normal endogenous levels of the modified DNA biomarkers were not elevated in tissue-engineered skin when compared with control cells. Next, denaturing high-performance liquid chromatography and capillary electrophoresis-single strand conformation polymorphism were used to measure genetic mutations. Specifically, the TP53 tumor suppressor gene was screened for mutations, because it is the most commonly mutated gene in skin cancer. The tissue-engineered skin was found to be free of TP53 mutations at the level of sensitivity of these measurement technologies. Lastly, fluorescence in situ hybridization was employed to measure the loss of Y chromosome, which is associated with excessive cell passage and aging. Loss of Y chromosome was not detected in the tissue-engineered skin and cultured neonatal cells used as controls. In this study, we have demonstrated that tissue engineering (for TestSkin II) does not introduce genetic damage above the limits of detection of the state-of-the-art technologies used. This work explores the standard for measuring genetic damage that could be introduced during production of novel tissue-engineered products. More importantly, this exploratory work addresses technological

In vivo evaluation of wound bed reaction and graft performance after cold skin graft storage: new targets for skin tissue engineering.

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Knapik, Alicia; Kornmann, Kai; Kerl, Katrin; Calcagni, Maurizio; Schmidt, Christian A; Vollmar, Brigitte; Giovanoli, Pietro; Lindenblatt, Nicole

2014-01-01

Surplus harvested skin grafts are routinely stored at 4 to 6°C in saline for several days in plastic surgery. The purpose of this study was to evaluate the influence of storage on human skin graft performance in an in vivo intravital microscopic setting after transplantation. Freshly harvested human full-thickness skin grafts and split-thickness skin grafts (STSGs) after storage of 0, 3, or 7 days in moist saline at 4 to 6°C were transplanted into the modified dorsal skinfold chamber, and intravital microscopy was performed to evaluate vessel morphology and angiogenic change of the wound bed. The chamber tissue was harvested 10 days after transplantation for evaluation of tissue integrity and inflammation (hematoxylin and eosin) as well as for immunohistochemistry (human CD31, murine CD31, Ki67, Tdt-mediated dUTP-biotin nick-end labelling). Intravital microscopy results showed no differences in the host angiogenic response between fresh and preserved grafts. However, STSGs and full-thickness skin grafts exhibited a trend toward different timing and strength in capillary widening and capillary bud formation. Preservation had no influence on graft quality before transplantation, but fresh STSGs showed better quality 10 days after transplantation than 7-day preserved grafts. Proliferation and apoptosis as well as host capillary in-growth and graft capillary degeneration were equal in all groups. These results indicate that cells may activate protective mechanisms under cold conditions, allowing them to maintain function and morphology. However, rewarming may disclose underlying tissue damage. These findings could be translated to a new approach for the design of full-thickness skin substitutes.

Skin cancer risk in autoimmune connective tissue diseases.

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Kostaki, D; Antonini, A; Peris, K; Fargnoli, M C

2014-10-01

Cutaneous malignancies have been significantly associated with autoimmune connective tissue diseases (ACTDs). This review focuses on the current state of knowledge on skin cancer risk in the most prevalent ACTDs in dermatology including lupus erythematosus, scleroderma, dermatomyositis and Sjögren syndrome. Potential pathogenetic mechanisms for the association between ACTDs and malignancy involve disease-related impairment of immune system, sustained cutaneous inflammation, drug-associated immune suppression and increased susceptibility to acquired viral infections. An additional causal role might be played by environmental factors such as UV exposure and smoking. The occurrence of skin cancer can have a profound impact on the already compromised quality of life of ACTD patients. Therefore, effective screening and monitoring strategies are essential for ACTD patients as early detection and prompt therapeutic intervention can reduce morbidity and mortality in these patients.

Fournier gangrene: a review of 41 patients and strategies for reconstruction.

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Chen, Shih-Yi; Fu, Ju-Peng; Wang, Chih-Hsin; Lee, Tzu-Peng; Chen, Shyi-Gen

2010-06-01

Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.

Combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of cervix.

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Zhang, Xuyin; Han, Tiantian; Ding, Jingxin; Hua, Keqin

2015-01-01

The aim of this study was to introduce a new technique which is combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of cervix and to evaluate the feasibility and the safety of it. This is a prospective observational study of 10 patients with congenital atresia of cervix who underwent combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft for cervicovaginal reconstruction from February 2013 to August 2014 in our hospital. All of the surgical procedures were carried out by the same operation team. Patient data were collected including operating time, estimated blood loss, hospital stay post-surgery, complications, total cost, and median vaginal length at 3 month, resumption of menstruation, vaginal stenosis and stricture of the cervix postoperatively. The operative procedure lasted 237±46 (175-380) min. The estimated blood loss was 160±76 (50-300) ml. The hospital stay post-surgery was 12±2 (9-18) days. None of the patients had complications or required a blood transfusion. The mean total cost was $3352±1025. The average vaginal length at 3 month was 8.3±1.1 (8-10) cm. All patients had resumption of menstruation. The patients were followed for a mean of 5±2 (1-10) months. Cervical or vaginal stenosis did not occur in any of the patients. Our experiences of combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in10 patients with congenital atresia of cervix were positive, with successful results and without complications, and cervical or vaginal stenosis.

Scrotal dartos-fascio-myo-cutaneous flaps for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap

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Alessandro Innocenti, MD

2016-01-01

Discussion and conclusion: Various techniques are available for penile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar. Dartos-fascio-myo-cutaneous flap is a single stage procedure that is easy and safe to perform. It can provide satisfactory cosmetic and functional results, offering a large amount of tissue, with minimal donor site morbidity.

Approach to skin and soft tissue infections in non-HIV immunocompromised hosts.

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Burke, Victoria E; Lopez, Fred A

2017-08-01

Skin and soft tissue infections are frequent contributors to morbidity and mortality in the immunocompromised host. This article reviews the changing epidemiology and clinical manifestations of the most common cutaneous pathogens in non-HIV immunocompromised hosts, including patients with solid organ transplants, stem cell transplants, solid tumors, hematologic malignancies, and receiving chronic immunosuppressive therapy for inflammatory disorders. Defects in the innate or adaptive immune response can predispose the immunocompromised host to certain cutaneous infections in a predictive fashion. Cutaneous lesions in patients with neutrophil defects are commonly due to bacteria, Candida, or invasive molds. Skin lesions in patients with cellular or humoral immunodeficiencies can be due to encapsulated bacteria, Nocardia, mycobacteria, endemic fungal infections, herpesviruses, or parasites. Skin lesions may reflect primary inoculation or, more commonly, disseminated infection. Tissue samples for microscopy, culture, and histopathology are critical to making an accurate diagnosis given the nonspecific and heterogeneous appearance of these skin lesions due to a blunted immune response. As the population of non-HIV immunosuppressed hosts expands with advances in medical therapies, the frequency and variety of cutaneous diseases in these hosts will increase.

Dynamic skin deformation simulation using musculoskeletal model and soft tissue dynamics

Institute of Scientific and Technical Information of China (English)

Akihiko Murai; Q. Youn Hong; Katsu Yamane; Jessica K. Hodgins

2017-01-01

Deformation of skin and muscle is essential for bringing an animated character to life. This deformation is difficult to animate in a realistic fashion using traditional techniques because of the subtlety of the skin deformations that must move appropriately for the character design. In this paper, we present an algorithm that generates natural, dynamic, and detailed skin deformation (movement and jiggle) from joint angle data sequences. The algorithm has two steps: identification of parameters for a quasi-static muscle deformation model, and simulation of skin deformation. In the identification step, we identify the model parameters using a musculoskeletal model and a short sequence of skin deformation data captured via a dense marker set. The simulation step first uses the quasi-static muscle deformation model to obtain the quasi-static muscle shape at each frame of the given motion sequence (slow jump). Dynamic skin deformation is then computed by simulating the passive muscle and soft tissue dynamics modeled as a mass–spring–damper system. Having obtained the model parameters, we can simulate dynamic skin deformations for subjects with similar body types from new motion data. We demonstrate our method by creating skin deformations for muscle co-contraction and external impacts from four different behaviors captured as skeletal motion capture data. Experimental results show that the simulated skin deformations are quantitatively and qualitatively similar to measured actual skin deformations.

Dynamic skin deformation simulation using musculoskeletal model and soft tissue dynamics

Institute of Scientific and Technical Information of China (English)

Akihiko Murai; Q.Youn Hong; Katsu Yamane; Jessica K.Hodgins

2017-01-01

Deformation of skin and muscle is essential for bringing an animated character to life. This deformation is difficult to animate in a realistic fashion using traditional techniques because of the subtlety of the skin deformations that must move appropriately for the character design. In this paper, we present an algorithm that generates natural, dynamic, and detailed skin deformation(movement and jiggle) from joint angle data sequences. The algorithm has two steps: identification of parameters for a quasi-static muscle deformation model, and simulation of skin deformation. In the identification step, we identify the model parameters using a musculoskeletal model and a short sequence of skin deformation data captured via a dense marker set. The simulation step first uses the quasi-static muscle deformation model to obtain the quasi-static muscle shape at each frame of the given motion sequence(slow jump). Dynamic skin deformation is then computed by simulating the passive muscle and soft tissue dynamics modeled as a mass–spring–damper system. Having obtained the model parameters, we can simulate dynamic skin deformations for subjects with similar body types from new motion data. We demonstrate our method by creating skin deformations for muscle co-contraction and external impacts from four different behaviors captured as skeletal motion capture data. Experimental results show that the simulated skin deformations are quantitatively and qualitatively similar to measured actual skin deformations.

Recent advances in head and neck cancer reconstruction

Directory of Open Access Journals (Sweden)

Prabha Yadav

2014-01-01

Full Text Available Treatment of cancer is race against time! Following radical excision, breathing, speech, mastication and swallowing are hampered. Face is invariably involved. Beside functional normalcy, excellent cosmetic restoration is necessary for patient′s life quality. Primary wound healing, quick resumption of adequate oral intake, prompt initiation of chemo-radiotherapy has direct bearing on cure. Primary reconstruction with pedicle or free flap is the choice of treatment in most protocols. Composite defects are requiring bone, muscle and skin restrict choice of donor site and may have shortfalls in aesthetic and functional requirements. To improve further newer, and newer modalities are being developed and used to give best aesthetic and functions. Navigation, use of three-dimensional imaging, stereo lithic model and custom made implant for reconstruction are recommended as they promise improvement in aesthetics. Robotic surgeries allow access for resection of tumours and reconstruction with free flap in deep oropharynx obviating need of doing mandibulotomy. Researchers in stem cell and tissue engineering are looking forward to regenerating tissues and avoid the need of autologous tissue flaps. Desired tissue combination across counter may be available in the future. Excellent immunosuppressant drugs have made it possible to reconstruct composite facial anatomical units with allotransplant in a single surgery, along sensory and motor recovery! Mythological heterogenic head transplant like clone Ganesha, will be a reality in the near future!!

Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location.

Science.gov (United States)

Ooi, Adrian Sh; Kanapathy, Muholan; Ong, Yee Siang; Tan, Kok Chai; Tan, Bien Keem

2015-11-01

Scalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage. A retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted. Forty-one patients were included in this study. The majority of defects aesthetic outcome while minimising complications and repeat procedures.

Marine-derived biological macromolecule-based biomaterials for wound healing and skin tissue regeneration.

Science.gov (United States)

Chandika, Pathum; Ko, Seok-Chun; Jung, Won-Kyo

2015-01-01

Wound healing is a complex biological process that depends on the wound condition, the patient's health, and the physicochemical support given through external materials. The development of bioactive molecules and engineered tissue substitutes to provide physiochemical support to enhance the wound healing process plays a key role in advancing wound-care management. Thus, identification of ideal molecules in wound treatment is still in progress. The discovery of natural products that contain ideal molecules for skin tissue regeneration has been greatly advanced by exploration of the marine bioenvironment. Consequently, tremendously diverse marine organisms have become a great source of numerous biological macromolecules that can be used to develop tissue-engineered substitutes with wound healing properties. This review summarizes the wound healing process, the properties of macromolecules from marine organisms, and the involvement of these molecules in skin tissue regeneration applications. Copyright © 2015 Elsevier B.V. All rights reserved.

Flap reconstruction for soft-tissue defects with exposed hardware following deep infection after internal fixation of ankle fractures.

Science.gov (United States)

Ovaska, Mikko T; Madanat, Rami; Tukiainen, Erkki; Pulliainen, Lea; Sintonen, Harri; Mäkinen, Tatu J

2014-12-01

The aim of the present study was to determine the outcome for patients treated with flap reconstruction following deep ankle fracture infection with exposed hardware. Out of 3041 consecutive ankle fracture operations in 3030 patients from 2006 to 2011, we identified 56 patients requiring flap reconstruction following deep infection. Thirty-two of these patients could be examined at a follow-up visit. Olerud-Molander Ankle (OMA) score, 15D score, Numeric Rating Scale (NRS), and clinical examination were used to assess the outcome. A total of 58 flap reconstructions were performed in 56 patients with a mean age of 57 years (range 25–93 years) and mean follow-up time of 52 months. The most commonly used reconstruction was a distally based peroneus brevis muscle flap with a split-thickness skin graft. A microvascular free flap was required in only one patient. 22 (39%) patients required subsequent surgical interventions because of a flap-related complication. With flap reconstruction, hardware could eventually be salvaged in 53% of patients with a non-consolidated fracture. The mean OMA score was fair or poor in 53% of the patients, and only 56% had recovered their pre-injury level of function. Half of the patients had shoe wear limitations. The 15D score showed a significantly poorer health-related quality of life compared to an age-standardised sample of the general population. The mean pain NRS was 2.1 (range 0–6), and the mean satisfaction NRS was 6.6 (range 0–10). Our study showed that successful treatment of a soft-tissue defect with exposed hardware following ankle fracture infections can be achieved with local flaps. Despite eventual reconstructive success, complications are common. Patients perceive a poorer health-related quality of life, have shoe wear limitations, and only half of them achieve their pre-injury level of function.

Maxillofacial osseous reconstruction using the angular branch of the thoracodorsal vessels.

LENUS (Irish Health Repository)

Dolderer, Jürgen H

2010-09-01

Mandibular and maxillary resections can produce complex three-dimensional defects requiring skeletal, soft tissue, and epithelial reconstruction. The subscapular vascular axis offers a source of skin, bone, and muscle on a single pedicle for microvascular flap transfer. We reviewed four cases where the subscapular vascular pedicle was used as a source of tissue for complex facial reconstructions in maxillofacial defects. Reconstruction of these complex defects was performed with a latissimus dorsi muscle or myocutaneous flap in combination with the lateral border of the scapula, harvested on the angular branch of the thoracodorsal vessels. There were three cases of maxillectomy and one case of partial mandibulectomy for malignant tumors. In each case, the angular branch of the thoracodorsal artery supplied 6 to 8 cm of the lateral border of the scapula and a latissimus dorsi myocutaneous flap was used for soft tissue reconstruction. Follow-up ranged from 9 months to 3 years and in all cases there was successful bony union. Shoulder movement was normal. This series encourages the further use of subscapular axis flaps as flexible sources of combined myocutaneous and osseous flaps on a single vascular pedicle in cases of complex maxillofacial reconstruction.

Low-level lasers affect uncoupling protein gene expression in skin and skeletal muscle tissues

International Nuclear Information System (INIS)

Canuto, K S; Sergio, L P S; Mencalha, A L; Fonseca, A S; Paoli, F

2016-01-01

Wavelength, frequency, power, fluence, and emission mode determine the photophysical, photochemical, and photobiological responses of biological tissues to low-level lasers. Free radicals are involved in these responses acting as second messengers in intracellular signaling processes. Irradiated cells present defenses against these chemical species to avoid unwanted effects, such as uncoupling proteins (UCPs), which are part of protective mechanisms and minimize the effects of free radical generation in mitochondria. In this work UCP2 and UCP3 mRNA gene relative expression in the skin and skeletal muscle tissues of Wistar rats exposed to low-level red and infrared lasers was evaluated. Samples of the skin and skeletal muscle tissue of Wistar rats exposed to low-level red and infrared lasers were withdrawn for total RNA extraction, cDNA synthesis, and the evaluation of gene expression by quantitative polymerase chain reaction. UCP2 and UCP3 mRNA expression was differently altered in skin and skeletal muscle tissues exposed to lasers in a wavelength-dependent effect, with the UCP3 mRNA expression dose-dependent. Alteration on UCP gene expression could be part of the biostimulation effect and is necessary to make cells exposed to red and infrared low-level lasers more resistant or capable of adapting in damaged tissues or diseases. (paper)

One-stage Pelnac Reconstruction in Full-thickness Skin Defects with Bone or Tendon Exposure

Directory of Open Access Journals (Sweden)

Xianghong Lou, MS

2018-03-01

Full Text Available Summary:. Dermal regeneration template, such as Integra and Pelnac, was originally designed for treating large area burn injury by inducing regeneration of dermis. To date, it has been widely applied in various acute and chronic wound sites. The present study demonstrated that application of artificial dermis alone induced 1-stage wound healing for wounds with bone or tendon exposure that should usually be repaired by flap surgery. Eight patients who presented with skin defects with bone and/or tendon exposure were treated by 1-stage Pelnac approach. All wounds healed within 20 weeks without skin graft or flap surgery. The wound area was reconstructed by nearly normal skin structure and linear scar. In the case of scalp defect, evidence of hair follicle cell migration and regeneration during healing process was observed. Thereby, the 1-stage Pelnac reconstitution can be considered as a novel method for inducing regrowth of epidermis and hair follicles to cure large full-thickness skin defect with bone and tendon exposure in 1 stage.

3D imaging of cleared human skin biopsies using light-sheet microscopy: A new way to visualize in-depth skin structure.

Science.gov (United States)

Abadie, S; Jardet, C; Colombelli, J; Chaput, B; David, A; Grolleau, J-L; Bedos, P; Lobjois, V; Descargues, P; Rouquette, J

2018-05-01

Human skin is composed of the superimposition of tissue layers of various thicknesses and components. Histological staining of skin sections is the benchmark approach to analyse the organization and integrity of human skin biopsies; however, this approach does not allow 3D tissue visualization. Alternatively, confocal or two-photon microscopy is an effective approach to perform fluorescent-based 3D imaging. However, owing to light scattering, these methods display limited light penetration in depth. The objectives of this study were therefore to combine optical clearing and light-sheet fluorescence microscopy (LSFM) to perform in-depth optical sectioning of 5 mm-thick human skin biopsies and generate 3D images of entire human skin biopsies. A benzyl alcohol and benzyl benzoate solution was used to successfully optically clear entire formalin fixed human skin biopsies, making them transparent. In-depth optical sectioning was performed with LSFM on the basis of tissue-autofluorescence observations. 3D image analysis of optical sections generated with LSFM was performed by using the Amira ® software. This new approach allowed us to observe in situ the different layers and compartments of human skin, such as the stratum corneum, the dermis and epidermal appendages. With this approach, we easily performed 3D reconstruction to visualise an entire human skin biopsy. Finally, we demonstrated that this method is useful to visualise and quantify histological anomalies, such as epidermal hyperplasia. The combination of optical clearing and LSFM has new applications in dermatology and dermatological research by allowing 3D visualization and analysis of whole human skin biopsies. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Soft Tissue Coverage of the Hand and Upper Extremity: The Reconstructive Elevator.

Science.gov (United States)

Miller, Erin Anne; Friedrich, Jeffrey

2016-07-01

Soft tissue reconstruction of the upper extremity is a complex topic because every defect has multiple potential solutions. Whereas the often-cited reconstructive ladder advised selection of the simplest reconstruction of the defect, the newer concept of the reconstructive elevator allows freedom to choose a more complex reconstruction to account for specialized function and aesthetic outcome. An algorithm for assessment of the defect is presented and demonstrated in this review, using 6 case examples to highlight key concepts. Representative flaps are presented and a discussion of functional and aesthetic outcomes is undertaken to provide a framework for achieving the patient's and surgeon's goals of reconstruction. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Design of a tissue oxygenation monitor and verification on human skin

Science.gov (United States)

Liu, Hongyuan; Kohl-Bareis, Matthias; Huang, Xiabing

2011-07-01

We report the design of a tissue oxygen and temperature monitor. The non-invasive, fibre based device monitors tissue haemoglobin (Hb) and oxygen saturation (SO2) and is based on white-light reflectance spectroscopy.Visible light with wavelengths in the 500 - 650nm range is utilized. The spectroscopic algorithm takes into account the tissue scattering and melanin absorption for the calculation of tissue haemoglobin concentration and oxygen saturation. The monitor can probe superficial layers of tissue with a high spatial resolution (mm3) and a high temporal resolution (40 Hz). It provides an accurate measurement with the accuracy of SO2 at 2 % and high reliability with less than 2 % variation of continuous SO2 measurement over 12 hours. It can also form a modular system when used in conjunction with a laser Doppler monitor, enabling simultaneous measurements of Hb, SO2 and blood flow. We found experimentally that the influence of the source-detector separation on the haemoglobin parameters is small. This finding is discussed by Monte Carlo simulations for the depth sensitivity profile. The influence of probe pressure and the skin pigmentation on the measurement parameters are assessed before in vivo experimental data is presented. The combination with laser Doppler flowmetry demonstrates the importance of a measurement of both the haemoglobin and the blood flow parameters for a full description of blood tissue perfusion. This is discussed in experimental data on human skin during cuff occlusion and after hyperemisation by a pharmacological cream. Strong correlation is observed between tissue oxygen (Hb and SO2) and blood flow measurements.

Biocomposite nanofibrous strategies for the controlled release of biomolecules for skin tissue regeneration

Directory of Open Access Journals (Sweden)

Gandhimathi C

2014-10-01

Full Text Available Chinnasamy Gandhimathi,1 Jayarama Reddy Venugopal,2 Velmurugan Bhaarathy,2 Seeram Ramakrishna,2 Srinivasan Dinesh Kumar1 1Cellular and Molecular Epigenetics Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; 2Center for Nanofibers and Nanotechnology, Nanoscience and Nanotechnology Initiative, Faculty of Engineering, National University of Singapore, Singapore Abstract: Nanotechnology and tissue engineering have enabled engineering of nanostructured strategies to meet the current challenges in skin tissue regeneration. Electrospinning technology creates porous nanofibrous scaffolds to mimic extracellular matrix of the native tissues. The present study was performed to gain some insights into the applications of poly(L-lactic acid-co-poly-(ε-caprolactone (PLACL/silk fibroin (SF/vitamin E (VE/curcumin (Cur nanofibrous scaffolds and to assess their potential for being used as substrates for the culture of human dermal fibroblasts for skin tissue engineering. PLACL/SF/VE/Cur nanofibrous scaffolds were fabricated by electrospinning and characterized by fiber morphology, membrane porosity, wettability, mechanical strength, and chemical properties by Fourier transform infrared (FTIR analysis. Human dermal fibroblasts were cultured on these scaffolds, and the cell scaffold interactions were analyzed by cell proliferation, cell morphology, secretion of collagen, expression of F-actin, and 5-chloromethylfluorescein diacetate (CMFDA dye. The electrospun nanofiber diameter was obtained between 198±4 nm and 332±13 nm for PLACL, PLACL/SF, PLACL/SF/VE, and PLACL/SF/VE/Cur nanofibrous scaffolds. FTIR analysis showed the presence of the amide groups I, II, and III, and a porosity of up to 92% obtained on these nanofibrous scaffolds. The results showed that the fibroblast proliferation, cell morphology, F-actin, CMFDA dye expression, and secretion of collagen were significantly increased in PLACL/SF/VE/Cur when compared

Enhancement of keratinocyte performance in the production of tissue-engineered skin using a low-calcium medium.

Science.gov (United States)

Hernon, Catherine A; Harrison, Caroline A; Thornton, Daniel J A; MacNeil, Sheila

2007-01-01

The success of laboratory-expanded autologous keratinocytes for the treatment of severe burn injuries is often compromised by their lack of dermal remnants and failure to establish a secure dermo-epidermal junction on the wound bed. We have developed a tissue-engineered skin substitute for in vivo use, based on a sterilized donor human dermis seeded with autologous keratinocytes and fibroblasts. However, culture rates are currently too slow for clinical use in acute burns. Our aim in this study was to increase the rate of production of tissue-engineered skin. Two approaches were explored: one using a commercial low-calcium media and the other supplementing well-established media for keratinocyte culture with the calcium-chelating agent ethylene glutamine tetra-acetic acid (EGTA). Using commercial low-calcium media for both the initial cell culture and subsequent culture of tissue-engineered skin did not produce tissue suitable for clinical use. However, it was possible to enhance the initial proliferation of keratinocytes and to increase their horizontal migration in tissue-engineered skin by supplementing established culture medium with 0.04 mM EGTA without sacrificing epidermal attachment and differentiation. Enhancement of keratinocyte migration with EGTA was also maximal in the absence of fibroblasts or basement membrane.

Tissue-engineered skin preserving the potential of epithelial cells to differentiate into hair after grafting.

Science.gov (United States)

Larouche, Danielle; Cuffley, Kristine; Paquet, Claudie; Germain, Lucie

2011-03-01

The aim of this study was to evaluate whether tissue-engineered skin produced in vitro was able to sustain growth of hair follicles in vitro and after grafting. Different tissues were designed. Dissociated newborn mouse keratinocytes or newborn mouse hair buds (HBs) were added onto dermal constructs consisting of a tissue-engineered cell-derived matrix elaborated from either newborn mouse or adult human fibroblasts cultured with ascorbic acid. After 7-21 days of maturation at the air-liquid interface, no hair was noticed in vitro. Epidermal differentiation was observed in all tissue-engineered skin. However, human fibroblast-derived tissue-engineered dermis (hD) promoted a thicker epidermis than mouse fibroblast-derived tissue-engineered dermis (mD). In association with mD, HBs developed epithelial cyst-like inclusions presenting outer root sheath-like attributes. In contrast, epidermoid cyst-like inclusions lined by a stratified squamous epithelium were present in tissues composed of HBs and hD. After grafting, pilo-sebaceous units formed and hair grew in skin elaborated from HBs cultured 10-26 days submerged in culture medium in association with mD. However, the number of normal hair follicles decreased with longer culture time. This hair-forming capacity after grafting was not observed in tissues composed of hD overlaid with HBs. These results demonstrate that epithelial stem cells can be kept in vitro in a permissive tissue-engineered dermal environment without losing their potential to induce hair growth after grafting.

Tissue responses to fractional transient heating with sinusoidal heat flux condition on skin surface.

Science.gov (United States)

Ezzat, Magdy A; El-Bary, Alaa A; Al-Sowayan, Noorah S

2016-10-01

A fractional model of Bioheat equation for describing quantitatively the thermal responses of skin tissue under sinusoidal heat flux conditions on skin surface is given. Laplace transform technique is used to obtain the solution in a closed form. The resulting formulation is applied to one-dimensional application to investigate the temperature distribution in skin with instantaneous surface heating for different cases. According to the numerical results and its graphs, conclusion about the fractional bioheat transfer equation has been constructed. Sensitivity analysis is performed to explore the thermal effects of various control parameters on tissue temperature. The comparisons are made with the results obtained in the case of the absence of time-fractional order. © 2016 Japanese Society of Animal Science. © 2016 Japanese Society of Animal Science.

Skin graft influence in human tissue radiated in nude mice regeneration

International Nuclear Information System (INIS)

Miranda, Jurandir Tomaz de

2016-01-01

Over the last few years it has increased the interest in the human skin grafts radio sterilized for application mainly in extensive and deep burns. Because these grafts quickly grip and present antigenic lower potential, compared with other treatments used. The purpose of this study was to evaluate the histoarchitecture of human skin grafts irradiated with doses 25 kGy, 50 kGy and non-irradiated during the repair tissue process in nude mice submitted by skin grafting in the dorsal region. Three groups of animals received irradiated human skin grafts (25 kGy and 50 kGy) and non-irradiated and were euthanized on the 3 rd , 7 th and 21 th day after the surgery. Indeed, routine histologic procedures, tissue samples were stained with hematoxylin and eosin (HE) for quantification of keratinocytes, fibroblasts, immune cells and blood vessels and immunofluorescence (IF) was performed to determine the expression human collagen type I and collagen type I and III mouse. Therefore, quantification of both the cells and the collagen types was performed by image analysis using Image-Pro Plus 6.0 software. Histologic results demonstrated at a dose of 25 kGy that human skin irradiation when grafted influences the increase in the number of cells in wound site over time and it provides better dispersion of these cells. In addition, on the 21 st day, three groups of animals with human skin graft were embedded part of the graft in the healing process. On the other hand, the group not irradiated showed greater incorporation of the graft (43 %), but less production of collagen type III mouse (22 %). Since the groups irradiated skin graft showed lower graft incorporation (6 and 15%), but with greater production of collagen type III mice (35 % and 28 % to 25 kGy and 50 kGy, respectively). In conclusion, this study presented that the group irradiated to 25 kGy and it has a higher cell proliferation and vessel formation, and better remodeling of the healing area. (author)

A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures

Directory of Open Access Journals (Sweden)

Tae Joon Choi

2016-01-01

Full Text Available Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

Preauricular full-thickness skin grafting in medial canthal reconstruction

Directory of Open Access Journals (Sweden)

Rafael Corredor-Osorio

2018-02-01

Full Text Available Basal cell carcinoma in medial canthal is a surgical challenge to oculoplastic surgeon. We report a case an 80 –year-old woman who presented with a vegetative tumor in the right inferior medial canthus that increased slowly in size over the past two years. An excisional biopsy from the tumor was suggestive of a basal cell carcinoma. A full-thickness excision of the tumor within the oncologic safety limits, was performed. A wide range of reconstruction techniques should be customized to the individual patient. In this case, the use of a preauricular full. Thickness skin graft was a favorable option, without complications, and with acceptable functional and cosmetic results. The aim of the treatment is to restore anatomy, functional and cosmetic of the patients.

Comparison of Reconstructive Outcomes in Breast Cancer Patients With Preexisting Subpectoral Implants: Implant-Sparing Mastectomy With Delayed Implant Exchange Versus Immediate Tissue Expander Reconstruction.

Science.gov (United States)

Parabkaharan, Sangeetha; Melody, Megan; Trotta, Rose; Lleshi, Amina; Sun, Weihong; Smith, Paul D; Khakpour, Nazanin; Dayicioglu, Deniz

2016-06-01

Women who have undergone prior augmentation mammoplasty represent a unique subset of breast cancer patients with several options available for breast reconstruction. We performed a single institution review of surgical outcomes of breast reconstruction performed in patients with breast cancer with prior history of subpectoral breast augmentation. Institutional review board-approved retrospective review was conducted among patients with previously mentioned criteria treated at our institution between 2000 and 2014. Reconstructions were grouped into 2 categories as follows: (1) removal of preexisting subpectoral implant during mastectomy with immediate tissue expander placement and (2) implant-sparing mastectomy followed by delayed exchange to a larger implant. We reviewed demographics, tumor features, and reconstruction outcomes of these groups. Fifty-three patients had preexisting subpectoral implants. Of the 63 breast reconstructions performed, 18 (28.6%) had immediate tissue expander placed and 45 (71.4%) had implant-sparing mastectomy followed by delayed implant exchange. The groups were comparable based on age, body mass index, cancer type, tumor grade, TNM stage at presentation, and hormonal receptor status. No significant difference was noted between tumor margins or subsequent recurrence, mastectomy specimen weight, removed implant volume, volume of implant placed during reconstruction, or time from mastectomy to final implant placement. Rates of complications were significantly higher in the tissue expander group compared to the implant-sparing mastectomy group 7 (38.9%) versus 4 (8.9%) (P = 0.005). Implant-sparing mastectomy with delayed implant exchange in patients with preexisting subpectoral implants is safe and has fewer complications compared to tissue expander placement. There was no difference noted in the final volume of implant placed, time interval for final implant placement, or tumor margins.

Soft tissue reconstruction for calcaneal fractures or osteomyelitis.

Science.gov (United States)

Attinger, C; Cooper, P

2001-01-01

A systematic approach of the surgical management of a calcaneal fracture can minimize the potential of soft tissue complications. When reducing a closed calcaneal fracture, the incision used affects the postoperative complications. The L-shaped incision with the horizontal limb lying on the lateral glabrous junction ensures maximum blood flow to either side of the incision. Whether or not the wound can be closed primarily depends on the preexisting edema, the lost calcaneal height, and the delay between the fracture and reduction (Fig. 20). The wrinkle test is a good indicator that the incision can be closed primarily if the amount of height restored is minimal. If the edema is too great, steps should be taken to reduce it sufficiently to allow successful wound closure. If the wound, after reduction, is too wide to allow primary closure, an ADM flap laterally or an AHM flap medially should be used. For larger defects, a free flap should be considered. The three important steps to reconstruction of soft tissue defects around the calcaneus include good blood supply, a infection-free wound, and the simplest soft tissue reconstructive option that covers the wound successfully. Adequate blood supply can be determined by the use of Doppler. If the supply is inadequate, revascularization is necessary before proceeding. Achieving a clean wound requires aggressive debridement, intravenous antibiotics, and good wound care. Adjuncts that can help in achieving a clean wound include topical antibiotics (silver sulfadiazine), the VAC, and hyperbaric oxygen. Osteomyelitis has to be treated aggressively. Any suspicious bone has to be removed. Only clean, healthy, bleeding bone is left behind. Antibiotic beads can be useful when there is doubt as to whether the cancellous bone is infection-free. The beads are not a substitute for good debridement, however. Soft tissue reconstruction ranges from delayed primary closure to the use of microsurgical free flaps (Fig. 21). When bone or

Approaches to improve angiogenesis in tissue-engineered skin.

Science.gov (United States)

Sahota, Parbinder S; Burn, J Lance; Brown, Nicola J; MacNeil, Sheila

2004-01-01

A problem with tissue-engineered skin is clinical failure due to delays in vascularization. The aim of this study was to explore a number of simple strategies to improve angiogenesis/vascularization using a tissue-engineered model of skin to which small vessel human dermal microvascular endothelial cells were added. For the majority of these studies, a modified Guirguis chamber was used, which allowed the investigation of several variables within the same experiment using the same human dermis; cell type, angiogenic growth factors, the influence of keratinocytes and fibroblasts, mechanical penetration of the human dermis, the site of endothelial cell addition, and the influence of hypoxia were all examined. A qualitative scoring system was used to assess the impact of these factors on the penetration of endothelial cells throughout the dermis. Similar results were achieved using freshly isolated small vessel human dermal microvascular endothelial cells or an endothelial cell line and a minimum cell seeding density was identified. Cell penetration was not influenced by the addition of angiogenic growth factors (vascular endothelial growth factor and basic fibroblast growth factor); similarly, including epidermal keratinocytes or dermal fibroblasts did not encourage endothelial cell entry, and neither did mechanical introduction of holes throughout the dermis. Two factors were identified that significantly enhanced endothelial cell penetration into the dermis: hypoxia and the site of endothelial cell addition. Endothelial cells added from the papillary surface entered into the dermis much more effectively than when cells were added to the reticular surface of the dermis. We conclude that this model is valuable in improving our understanding of how to enhance vascularization of tissue-engineered grafts.

Biomechanical Comparison of an Intramedullary and Extramedullary Free-Tissue Graft Reconstruction of the Acromioclavicular Joint Complex

Science.gov (United States)

Garg, Rishi; Javidan, Pooya; Lee, Thay Q.

2013-01-01

Background Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique. Methods Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min. Results Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05). Conclusions Intramedullary reconstruction of the AC joint provides greater stability in the

Raman spectroscopic analysis of human skin tissue sections ex-vivo: evaluation of the effects of tissue processing and dewaxing

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Ali, Syed M.; Bonnier, Franck; Tfayli, Ali; Lambkin, Helen; Flynn, Kathleen; McDonagh, Vincent; Healy, Claragh; Clive Lee, T.; Lyng, Fiona M.; Byrne, Hugh J.

2013-06-01

Raman spectroscopy coupled with K-means clustering analysis (KMCA) is employed to elucidate the biochemical structure of human skin tissue sections and the effects of tissue processing. Both hand and thigh sections of human cadavers were analyzed in their unprocessed and formalin-fixed, paraffin-processed (FFPP), and subsequently dewaxed forms. In unprocessed sections, KMCA reveals clear differentiation of the stratum corneum (SC), intermediate underlying epithelium, and dermal layers for sections from both anatomical sites. The SC is seen to be relatively rich in lipidic content; the spectrum of the subjacent layers is strongly influenced by the presence of melanin, while that of the dermis is dominated by the characteristics of collagen. For a given anatomical site, little difference in layer structure and biochemistry is observed between samples from different cadavers. However, the hand and thigh sections are consistently differentiated for all cadavers, largely based on lipidic profiles. In dewaxed FFPP samples, while the SC, intermediate, and dermal layers are clearly differentiated by KMCA of Raman maps of tissue sections, the lipidic contributions to the spectra are significantly reduced, with the result that respective skin layers from different anatomical sites become indistinguishable. While efficient at removing the fixing wax, the tissue processing also efficiently removes the structurally similar lipidic components of the skin layers. In studies of dermatological processes in which lipids play an important role, such as wound healing, dewaxed samples are therefore not appropriate. Removal of the lipids does however accentuate the spectral features of the cellular and protein components, which may be more appropriate for retrospective analysis of disease progression and biochemical analysis using tissue banks.

Bipolar fracture dislocation of clavicle: A report of osteosynthesis and early soft tissue reconstruction.

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Prasetia, Renaldi; Rasyid, Hermawan Nagar

2017-01-01

Bipolar dislocation of the clavicle, also called bifocal or pan-articular dislocation or floating clavicle, is an uncommon traumatic injury. The injury of this case is also concomitant with distal third clavicle and coracoid fracture. This article aimed to report the experience of performing osteosynthesis and early soft tissue reconstruction on these injuries. We reported a case of bipolar clavicle fracture-dislocation in concomitant with coracoid fracture in a man, aged 32 years old, successfully treated 24days after accident by fixation of both fractures and early simultaneous reconstruction of sternoclavicular- acromioclavicular-coracoclavicular joints. These injuries are rare and capable of causing many complications if they are treated improperly. It is compulsory to carefully assess any fractured clavicle along its whole length, both clinically and radiologically. Various options, from non-operative to operative, have been reported to manage such of these cases. Early bony fixation and soft tissue reconstruction can correct the alignment of clavicle and recover the function of sterno-clavicular and acromio-clavicular- joints promptly. Fracture osteosynthesis and early soft tissue reconstruction can be regarded as an option treatment for bipolar fracture-dislocation of the clavicle to facilitate prompt treatment and early rehabilitation. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

[Reconstruction of the ear in the burns patient].

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Carrillo-Córdova, Jorge Raúl; Jiménez Murat, Yusef; Apellaniz-Campo, Armando; Bracho-Olvera, Hazel; Carrillo Esper, Raúl

Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Facial soft tissue thickness database of Gujarati population for forensic craniofacial reconstruction

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Anand Lodha

2016-06-01

Full Text Available The forensic facial reconstruction is a scientific art to construct the ante-mortem face from the human skull. The facial recognition is made by reconstructing the contours of the facial soft tissue thickness (FSTT.These FSTT data are essential for probable face reconstruction but the data of FSTT at particular anthropological landmarks differ in various ethnic groups. Until now several works have been reported on different population but no study exists in which the FSTT of a Gujarati population has been measured. The aim of this study is to compile a set of soft tissue depth data of Gujarati population of India to add to existing literature on FSTT. Computed tomography (CT-scan has been utilized to measure the 25 different FSTT landmarks of 324 male and 165 female. Present study shows significant differences in certain FSTT of Gujarati population from that of other populations. Our compiled data set of FSTT for the Gujarati population is important in understanding craniofacial characteristics of the Gujarati population and potentially be helpful in forensic identification.

Immediate Reconstruction of a Soft-Tissue Defect in a Burn Patient whit a Peroforator-Based Propeller Flap: A Case Report

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Burhan Özalp

2017-06-01

Full Text Available Soft tissue reconstruction of the distal lower leg is a challenging issue for plastic surgeons. Immediate coverage of exposed anatomical structures with soft tissue after trauma prevents these structures from being infected, and this is very important for burn patients. Free flaps have recently been accepted as the gold-standard technique for ankle and foot reconstruction; however, this is changing with the increasing popularity of the perforator flaps. Today, perforator flaps are commonly performed for the reconstruction of the soft-tissue defects across the body. In this report, we want to present the reconstruction of a soft-tissue defect case using perforator-based propeller flap in a burn patient for immediate reconstruction. A 45-year-old male patient had a soft-tissue defect over the medial side of the ankle and foot due to a high-voltage electrical burn. The exposed bone tissue was covered with a propeller flap of 15×6 cm size, without any circulation problems during the postoperative period. In conclusion, we want to state that perforator-based propeller flaps are reliable, successful, and effective techniques for the immediate reconstruction of distal leg and foot. These flaps can be easily performed without requiring any microsurgical technique thus, they can be commonly performed by most of the plastic surgeons.

Single stage reconstruction of complex anterior urethral strictures

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Deepak Dubey

2001-01-01

Full Text Available Purpose: Single stage reconstruction of long, com-plex urethral strictures is technically demanding and may require the use of more than one tissue transfer technique. We describe our experience in the manage-ment of such strictures with a variety of urethroplasty techniques. Materials and Methods: Between 1989 and 1999, 25 men (mean age 38.5 years underwent single stage re-construction of panurethral, multiple segment or focally dense strictures [mean length 11.2 cm (range 8-17 cm]. 8 patients had combined substitution urethroplasty with a circumpenile fasciocutaneous flap and a free graft of bladder/buccal mucosa or tunica vaginalis . flap. In 10 patients a single tissue transfer technique was used. 3 patients underwent an augmented roof/floor strip ure-throplasty with a penile skin flap. 4 patients with multi-ple segment strictures (separate pendulous and bulbar underwent distal onlay flap and proximal anastomotic urethroplasty. Results: The median ,follow-up was 46.5 months (range 6-88 months. The mean postoperative flow rate improved to 22.5 ml/sec. 2 patients developed fistulae requiring repair. Recurrent stricture developed in 5 (20.8% patients, of which 2 were managed with visual internal urethrotomy, 2 with anastomotic urethroplasty and 1 with a two-stage procedure. Pseudodiverticulum and post-void dribbling were seen in 6 (25% patients. Conclusions: Successful outcome of single stage re-construction of long complex strictures can be achieved with a combination of various tissue transfer methods. The urologist who has a thorough knowledge of penile skin and urethral vascular anatomy and a wide array of substitution techniques in his armamentarium can un-dertake approach to such strictures.

The properties of connective tissue membrane and pig skin as raw materials for cooked sausage.

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Puolanne, E; Ruusunen, M

1981-09-01

Pig skin and epimysial membrane from young bulls were comminuted in a colloid grinder and mixed with water and additives. The resultant mixture was heated in a water bath to give an internal temperature of 72°C, and centrifuged while still hot. Such variations in the amount of water added, the salt content, the phosphate content and the pH value as are possible in cooked sausage heated to over 65°C during processing did not cause marked changes in the amount of water bound by the connective tissues, the amount of dissolved protein or the gel strength of the liquid released from the connective tissues. As the temperature rose the amount of bound water dropped, but the amount of dissolved protein and the gel strength increased. The liquid released from the connective tissue membranes formed a gel at 32°C and re-melted at 49°C. For pig skin, the corresponding temperatures were 23°C and 47°C. On the basis of this study it appears that connective tissue may be important for the water-binding capacity and firmness of cold sausage. The connective tissue membranes obtained from young bulls and pig skin are of roughly equal value in this respect, although the gel formed from connective tissue membrane is tougher. Copyright © 1981. Published by Elsevier Ltd.

Evaluation of the role of the cyclooxygenase signaling pathway during inflammation in skin and muscle tissues of ball pythons (Python regius).

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Sadler, Ryan A; Schumacher, Juergen P; Rathore, Kusum; Newkirk, Kim M; Cole, Grayson; Seibert, Rachel; Cekanova, Maria

2016-05-01

OBJECTIVE To determine degrees of production of cyclooxygenase (COX)-1 and -2 and other mediators of inflammation in noninflamed and inflamed skin and muscle tissues in ball pythons (Python regius). ANIMALS 6 healthy adult male ball pythons. PROCEDURES Biopsy specimens of noninflamed skin and muscle tissue were collected from anesthetized snakes on day 0. A 2-cm skin and muscle incision was then made 5 cm distal to the biopsy sites with a CO2 laser to induce inflammation. On day 7, biopsy specimens of skin and muscle tissues were collected from the incision sites. Inflamed and noninflamed tissue specimens were evaluated for production of COX-1, COX-2, phosphorylated protein kinase B (AKT), total AKT, nuclear factor κ-light-chain-enhancer of activated B cells, phosphorylated extracellular receptor kinases (ERKs) 1 and 2, and total ERK proteins by western blot analysis. Histologic evaluation was performed on H&E-stained tissue sections. RESULTS All biopsy specimens of inflamed skin and muscle tissues had higher histologic inflammation scores than did specimens of noninflamed tissue. Inflamed skin specimens had significantly greater production of COX-1 and phosphorylated ERK than did noninflamed skin specimens. Inflamed muscle specimens had significantly greater production of phosphorylated ERK and phosphorylated AKT, significantly lower production of COX-1, and no difference in production of COX-2, compared with production in noninflamed muscle specimens. CONCLUSIONS AND CLINICAL RELEVANCE Production of COX-1, but not COX-2, was significantly greater in inflamed versus noninflamed skin specimens from ball pythons. Additional research into the reptilian COX signaling pathway is warranted.

Reconstruction with vascularized composite tissue in patients with excessive injury following surgery and irradiation

International Nuclear Information System (INIS)

Serafin, D.; DeLand, M.; Lesesne, C.B.; Smith, P.J.; Noell, K.T.; Georgiade, N.

1982-01-01

The biological effects of a single high dose of radiation are examined. Both cellular injury and repair are reviewed during early, intermediate, and late phases. Anticipated composite tissue morbidity is detailed for therapeutic radiation doses administered to the head and neck, breast and thorax, and perineum. Patients who demonstrated excessive time-dose fractionation values were irradiated with lower x-ray energies. Those in whom there was an overlap of treatment fields presented a serious challenge to the reconstructive surgeon. Judicious selection of well-vascularized composite tissue outside the portals of irradiation, preferably with a long vascular pedicle, facilitated reconstruction. When possible, both donor and recipient vasculature should be outside the irradiated area to ensure uninterrupted blood flow to the transferred or transplanted tissue

Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal-based perforator free flaps.

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Tran, Bao Ngoc N; Fadayomi, Ayotunde; Lin, Samuel J; Singhal, Dhruv; Lee, Bernard T

2017-09-01

Two staged tissue expander-implant with acellular dermal matrix (TE/I + ADM) and deep inferior epigastric perforator (DIEP) flap are the most common implant and autologous methods of reconstruction in the U.S. Implant-based techniques are disproportionally more popular, partially due to its presumed cost effectiveness. We performed a comprehensive cost analysis to compare TE/I + ADM and DIEP flap. A comparative cost analysis of TE/I + ADM and DIEP flap was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of complications including cellulitis, seroma, skin necrosis, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using published studies from 2010 to 2016. Average actual cost for successful TE/I + ADM and DIEP flap were $13 304.55 and $10 237.13, respectively. Incorporating pooled complication data from published literature resulted in an increase in cost to $13 963.46 for TE/I + ADM and $12 624.29 for DIEP flap. The expected costs for successful TE/I + ADM and DIEP flap were $9700.35 and $8644.23, which are lower than the actual costs. DIEP flap breast reconstruction incurs lower costs compared to TE/I + ADM. These costs are lower at baseline and when additional costs from pooled complications are incorporated. © 2017 Wiley Periodicals, Inc.

Skin and Soft Tissue Infections (Patera Foot) in Immigrants, Spain

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Ternavasio-de la Vega, Hugo-Guillermo; Ángel-Moreno, Alfonso; Hernández-Cabrera, Michele; Pisos-Álamo, Elena; Bolaños-Rivero, Margarita; Carranza-Rodriguez, Cristina; Calderín-Ortega, Antonio; Pérez-Arellano, José-Luis

2009-01-01

An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats (pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis. PMID:19331742

Cellulose/poly-(m-phenylene isophthalamide) porous film as a tissue-engineered skin bioconstruct

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Lee, Jae Woong; Han, Sung Soo; Zo, Sum Mi; Choi, Soon Mo

2018-06-01

Regarding the porous structure, coagulated cellulose may not provide sufficient voids for cell proliferation, resulting in tissue growth. For this reason, it was blended with poly(m-phenylene isophthalamide) (PMIA), which could produce a porous structure in the resulting construct. The aim of this study was to confirm the potential of a novel cellulose/PMIA porous film as a tissue-engineered bioconstruct for impaired skin. The films were fabricated by a coagulation process added with a peel-off method, and the structural, mechanical properties were characterized by Fourier transform infrared spectroscopy, thermogravimetric analysis, and capillary flow porometry. CRL-2310 human keratinocytes were used to determine the biocompatibility of the prepared films. The attachment and proliferation of cells were investigated by scanning electron microscopy, DAPI staining, and a cell viability assay. The results show that cellulose/PMIA porous films have potential use as wound matrices for skin tissue genesis.

Skin penetration and tissue permeation after topical administration of diclofenac.

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Hagen, Martina; Baker, Mark

2017-09-01

Topical delivery of drugs is an alternative to oral administration, often with similar efficacy but potentially a more favorable tolerability profile. However, topical formulations need to be able to penetrate the skin and permeate to the target areas in quantities sufficient to exert a therapeutic effect. Many factors can affect this process, including the physicochemical properties of the drug, the formulation used, and the site and mode of application. It is believed that measurement of drug concentrations at the sites of action may be an indicator of their likely efficacy. This review addresses these issues, with reference to topically administered diclofenac in osteoarthritis. Articles relevant to this review were identified after a systematic search of Medline and Embase, using the key words "diclofenac", "topical administration" and "osteoarthritis" in the search strategy. The sparse data available indicate that topical diclofenac can penetrate and permeate to deeper tissues, with a lower plasma to tissue ratio than oral diclofenac. The tissue diclofenac levels after topical delivery are sustained over time (at least several hours). However, there is not enough data to establish how diclofenac levels in the joint compare with IC 50 levels (50% of the maximum inhibition of prostaglandin synthesis) established following oral administration. After topical application, diclofenac can penetrate the skin and permeate to deeper tissues, where it reaches a concentration that appears to be sufficient to exert a therapeutic effect. More robust methods are required for in vivo characterization to better estimate the clinical efficacy of topically applied drugs.

[Cartilage tissue reconstruction by the polymer biomaterials--early macroscopic and histological results].

Science.gov (United States)

Scierski, Wojciech; Polok, Aleksandra; Namysłowski, Grzegorz; Nozyński, Jerzy; Turecka, Lucyna; Urbaniec, Natalia; Pamuła, Elzbieta

2009-09-01

The surgical treatment of large cartilage defects in the region of head and neck is often impossible because of the atrophy of surrounding tissues and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. For many years the suitable synthetic material for the cartilage defects reconstruction has been searched for. Was to evaluate two different biomaterials with proper mechanical and biological features for the cartilage replacement. Two type of biomaterials in this study were used: resorbable polymer - poly(L-lactide-co-glycolide) (PLG) acting as a supportive matrix. A thin layer of sodium hyaluronate (Hyal) was also deposited on the surface as well in the pore walls of PLG scaffolds in order to provide biologically active molecules promoting differentiation and regeneration of the tissue. The studies were performed on the 50 animals--rabbits divided into 2 groups. The animals were operated in the general anaesthesia. The incision was done along the edge of the rabbit's auricle. Perichondrium and cartilage of the auricle on the surface 4 x 3 cm were prepared. Subperichondrically 1 x 1 cm fragment of the cartilage was removed by the scissors. This fragment was then replaced by the biomaterials: PLG in first group of 25 rabbits and PLG-Hyal in second group 25 rabbits. The tissues were sutured with polyglycolide Safil 3-0. The animals obtained Enrofloxacin for three days after the operation. Then 1, 4 and 12 weeks after the surgery the animals were painlessly euthanized by an overdose of Morbital. Implants and surrounding tissues were excised and observed macroscopically and using an optical microscope. In all the observation periods we observed proper macroscopic healing process of biomaterials. We didn't stated strong inflammatory process and necrosis around the implanted biomaterials. The histological and macroscopic examinations indicated that both materials developed in this study have

Boomerang flap reconstruction for the breast.

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Baumholtz, Michael A; Al-Shunnar, Buthainah M; Dabb, Richard W

2002-07-01

The boomerang-shaped latissimus dorsi musculocutaneous flap for breast reconstruction offers a stable platform for breast reconstruction. It allows for maximal aesthetic results with minimal complications. The authors describe a skin paddle to obtain a larger volume than either the traditional elliptical skin paddle or the extended latissimus flap. There are three specific advantages to the boomerang design: large volume, conical shape (often lacking in the traditional skin paddle), and an acceptable donor scar. Thirty-eight flaps were performed. No reconstruction interfered with patient's ongoing oncological regimen. The most common complication was seroma, which is consistent with other latissimus reconstructions.

Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients.

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Aveta, Achille; Casati, Paolo

2008-01-01

Facial injuries are often accompanied by soft tissue injuries. The complexity of these injuries is represented by the potential for loss of relationships between the functional and the aesthetic subunits of the head. Most reviews of craniofacial trauma have concentrated on fractures. With this article, we want to emphasize the importance of early aesthetic reconstruction of the face in polytrauma patients. We present 13 patients with soft tissue injuries of the face, treated in our emergency department in the 'day one surgery", without "second look"procedures. The final result always restored a sense of normalcy to the face. The face is the first most visible part of the human anatomy, so, in emergency, surgeons must pay special attention also to the reconstruction of the face, in polytrauma patients.

Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging.

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Nakajima, H; Minabe, T; Imanishi, N

1998-09-01

To develop new types of surgical flaps that utilize portions of the skin and subcutaneous tissue (e.g., a thin flap or an adipofascial flap), three-dimensional investigation of the vasculature in the skin and subcutaneous tissue has been anticipated. In the present study, total-body arterial injection and three-dimensional imaging of the arteries by computer graphics were performed. The full-thickness skin and subcutaneous adipofascial tissue samples, which were obtained from fresh human cadavers injected with radio-opaque medium, were divided into three distinct layers. Angiograms of each layer were introduced into a personal computer to construct three-dimensional images. On a computer monitor, each artery was shown color-coded according to the three portions: the deep adipofascial layer, superficial adipofascial layer, and dermis. Three-dimensional computerized images of each artery in the skin and subcutaneous tissue revealed the components of each vascular plexus and permitted their classification into six types. The distribution of types in the body correlated with the tissue mobility of each area. Clinically, appreciation of the three-dimensional structure of the arteries allowed the development of several new kinds of flaps.

Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III.

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Blok, J L; Spoo, J R; Leeman, F W J; Jonkman, M F; Horváth, B

2015-02-01

Surgery is the only curative treatment for removal of the persistent sinus tracts in the skin that are characteristic of severe hidradenitis suppurativa (HS). Complete resection of the affected tissue by wide excision is currently regarded as the preferred surgical technique in these cases. However, relatively large amounts of healthy tissue are removed with this method and suitable skin-tissue-saving techniques aiming at creating less-extensive surgical defects are therefore needed in severe HS. We describe a skin-tissue-saving surgical technique for HS Hurley stage II-III disease: the Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP) procedure. In contrast to wide excisions that generally reach into the deep subcutaneous fat, the fat is maximally spared with the STEEP procedure by performing successive tangential excisions of lesional tissue until the epithelialized bottom of the sinus tracts has been reached. From here, secondary intention healing can occur. In addition, fibrotic tissue is completely removed in the same manner as this also serves as a source of recurrence. This tissue-sparing technique results in low recurrence rates, high patient satisfaction with relatively short healing times and favourable cosmetic outcomes without contractures. © 2014 European Academy of Dermatology and Venereology.

Burn Scar Reconstruction of the Neck with FTSG Obtained from Lower Abdominal Skin

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Sadrollah Motamed

2011-05-01

Full Text Available Burns account for a significant proportion of injuries, and of these the face, neck, and anterior torso are commonly affected. Burn scars remain a lasting reminder of the insult both for the patient and the outside world. There is little doubt that the change in appearance and the limitation imposed by a burn scar contribute to negative body image. Treatment of hypertrophic scars in the neck has been quite challenging if there is no intact tissue for local flaps. So application of full-thickness skin grafts could be of great value. We applied full-thickness grafts obtained from lower abdominal skin for treatment of severe neck contractures in four patients when other treatment modalities such as local flaps could not be used. Full-thickness skin graft of the neck is a safe and reliable treatment option with fairly good functional and aesthetic results. It has little donor site morbidity in spite of providing a large surface area of full-thickness skin.

Refractive indices of human skin tissues at eight wavelengths and estimated dispersion relations between 300 and 1600 nm

International Nuclear Information System (INIS)

Ding Huafeng; Lu, Jun Q; Wooden, William A; Kragel, Peter J; Hu Xinhua

2006-01-01

The refractive index of human skin tissues is an important parameter in characterizing the optical response of the skin. We extended a previously developed method of coherent reflectance curve measurement to determine the in vitro values of the complex refractive indices of epidermal and dermal tissues from fresh human skin samples at eight wavelengths between 325 and 1557 nm. Based on these results, dispersion relations of the real refractive index have been obtained and compared in the same spectral region

Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

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Iglesias, Martin; Gonzalez-Chapa, Diego R

2013-08-01

Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the

Pedicled Instep Flap and Tibial Nerve Reconstruction in a Cynomolgus Monkey [Macaca fascicularis

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Ruth Weiss

2016-01-01

Full Text Available A male cynomolgus monkey experienced extensive soft tissue trauma to the right caudal calf area. Some weeks after complete healing of the original wounds, the monkey developed a chronic pressure sore on plantar surface of the heel of its right foot. A loss of sensitivity in the sole of the foot was hypothesized. The skin defect was closed by a medial sensate pedicled instep flap followed by counter transplantation of a full thickness graft from the interdigital webspace. The integrity of the tibial nerve was revised and reconstructed by means of the turnover flap technique. Both procedures were successful. This is an uncommon case in an exotic veterinary patient as it demonstrates a reconstructive skin flap procedure for the treatment of a chronic, denervated wound in combination with the successful reconstruction of 2.5 cm gap in the tibial nerve.

In Vitro Evaluation of a Biomedical-Grade Bilayer Chitosan Porous Skin Regenerating Template as a Potential Dermal Scaffold in Skin Tissue Engineering

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Chin Keong Lim

2011-01-01

Full Text Available Chitosan is a copolymer of N-acetylglucosamine and glucosamine. A bilayer chitosan porous skin regenerating template (CPSRT has been developed for skin tissue engineering. The pore size of the CPSRT was assessed using a scanning electron microscopy (SEM. The in vitro cytocompatibility of the CPSRT was tested on primary human epidermal keratinocyte (pHEK cultures by measuring lactate dehydrogenase (LDH levels and skin irritation by western blot analysis of the interleukin-8 (IL-8 and tumor necrosis factor-α (TNF-α secretions. The ability of the CPSRT to support cell ingrowth was evaluated by seeding primary human dermal fibroblasts (pHDFs on the scaffold, staining the cells with live/dead stain, and imaging the construct by confocal microscopy (CLSM. The CPSRT with pore sizes ranging from 50 to 150 μm was cytocompatible because it did not provoke the additional production of IL-8 and TNF-α by pHEK cultures. Cultured pHDFs were able to penetrate the CPSRT and had increased in number on day 14. In conclusion, the CPSRT serves as an ideal template for skin tissue engineering.

[CLINICAL APPLICATION AND EXPERIENCE IN RECONSTRUCTION OF SOFT TISSUE DEFECTS FOLLOWING MALIGNANT TUMOR REMOVAL OF LIMBS USING PERFORATOR PROPELLER FLAPS].

Science.gov (United States)

Zhu, Shan; Liu, Yuanbo; Yu, Shengji; Zang, Mengqing; Zhao, Zhenguo; Xu, Libin; Zhang, Xinxin; Chen, Bo; Ding, Qiang

2016-01-01

To explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps. Between July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm x 3 cm to 30 cm x 13 cm in size) were used to reconstruct defects (from 4 cm x 4 cm to 24 cm x 16 cm in size). The potential source arteries included the femoral artery (n = 2), profunda femoral artery (n = 3), superficial circumflex iliac artery (n = 1), lateral circumflex femoral artery (n = 6), superior lateral genicular artery (n = 2), peroneal artery (n = 2), anterior tibial artery (n = 1), brachial artery (n = 4), and radial artery (n = 1). The remaining one was a free style perforator flap. Partial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100 degrees respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site. For patients with malignant

Automation of 3D reconstruction of neural tissue from large volume of conventional serial section transmission electron micrographs.

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Mishchenko, Yuriy

2009-01-30

We describe an approach for automation of the process of reconstruction of neural tissue from serial section transmission electron micrographs. Such reconstructions require 3D segmentation of individual neuronal processes (axons and dendrites) performed in densely packed neuropil. We first detect neuronal cell profiles in each image in a stack of serial micrographs with multi-scale ridge detector. Short breaks in detected boundaries are interpolated using anisotropic contour completion formulated in fuzzy-logic framework. Detected profiles from adjacent sections are linked together based on cues such as shape similarity and image texture. Thus obtained 3D segmentation is validated by human operators in computer-guided proofreading process. Our approach makes possible reconstructions of neural tissue at final rate of about 5 microm3/manh, as determined primarily by the speed of proofreading. To date we have applied this approach to reconstruct few blocks of neural tissue from different regions of rat brain totaling over 1000microm3, and used these to evaluate reconstruction speed, quality, error rates, and presence of ambiguous locations in neuropil ssTEM imaging data.

Optimization of CT image reconstruction algorithms for the lung tissue research consortium (LTRC)

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McCollough, Cynthia; Zhang, Jie; Bruesewitz, Michael; Bartholmai, Brian

2006-03-01

To create a repository of clinical data, CT images and tissue samples and to more clearly understand the pathogenetic features of pulmonary fibrosis and emphysema, the National Heart, Lung, and Blood Institute (NHLBI) launched a cooperative effort known as the Lung Tissue Resource Consortium (LTRC). The CT images for the LTRC effort must contain accurate CT numbers in order to characterize tissues, and must have high-spatial resolution to show fine anatomic structures. This study was performed to optimize the CT image reconstruction algorithms to achieve these criteria. Quantitative analyses of phantom and clinical images were conducted. The ACR CT accreditation phantom containing five regions of distinct CT attenuations (CT numbers of approximately -1000 HU, -80 HU, 0 HU, 130 HU and 900 HU), and a high-contrast spatial resolution test pattern, was scanned using CT systems from two manufacturers (General Electric (GE) Healthcare and Siemens Medical Solutions). Phantom images were reconstructed using all relevant reconstruction algorithms. Mean CT numbers and image noise (standard deviation) were measured and compared for the five materials. Clinical high-resolution chest CT images acquired on a GE CT system for a patient with diffuse lung disease were reconstructed using BONE and STANDARD algorithms and evaluated by a thoracic radiologist in terms of image quality and disease extent. The clinical BONE images were processed with a 3 x 3 x 3 median filter to simulate a thicker slice reconstructed in smoother algorithms, which have traditionally been proven to provide an accurate estimation of emphysema extent in the lungs. Using a threshold technique, the volume of emphysema (defined as the percentage of lung voxels having a CT number lower than -950 HU) was computed for the STANDARD, BONE, and BONE filtered. The CT numbers measured in the ACR CT Phantom images were accurate for all reconstruction kernels for both manufacturers. As expected, visual evaluation of the

Tissue-Engineered Solutions in Plastic and Reconstructive Surgery: Principles and Practice

Science.gov (United States)

Al-Himdani, Sarah; Jessop, Zita M.; Al-Sabah, Ayesha; Combellack, Emman; Ibrahim, Amel; Doak, Shareen H.; Hart, Andrew M.; Archer, Charles W.; Thornton, Catherine A.; Whitaker, Iain S.

2017-01-01

Recent advances in microsurgery, imaging, and transplantation have led to significant refinements in autologous reconstructive options; however, the morbidity of donor sites remains. This would be eliminated by successful clinical translation of tissue-engineered solutions into surgical practice. Plastic surgeons are uniquely placed to be intrinsically involved in the research and development of laboratory engineered tissues and their subsequent use. In this article, we present an overview of the field of tissue engineering, with the practicing plastic surgeon in mind. The Medical Research Council states that regenerative medicine and tissue engineering “holds the promise of revolutionizing patient care in the twenty-first century.” The UK government highlighted regenerative medicine as one of the key eight great technologies in their industrial strategy worthy of significant investment. The long-term aim of successful biomanufacture to repair composite defects depends on interdisciplinary collaboration between cell biologists, material scientists, engineers, and associated medical specialties; however currently, there is a current lack of coordination in the field as a whole. Barriers to translation are deep rooted at the basic science level, manifested by a lack of consensus on the ideal cell source, scaffold, molecular cues, and environment and manufacturing strategy. There is also insufficient understanding of the long-term safety and durability of tissue-engineered constructs. This review aims to highlight that individualized approaches to the field are not adequate, and research collaboratives will be essential to bring together differing areas of expertise to expedite future clinical translation. The use of tissue engineering in reconstructive surgery would result in a paradigm shift but it is important to maintain realistic expectations. It is generally accepted that it takes 20–30 years from the start of basic science research to clinical utility

Tissue-Engineered Solutions in Plastic and Reconstructive Surgery: Principles and Practice.

Science.gov (United States)

Al-Himdani, Sarah; Jessop, Zita M; Al-Sabah, Ayesha; Combellack, Emman; Ibrahim, Amel; Doak, Shareen H; Hart, Andrew M; Archer, Charles W; Thornton, Catherine A; Whitaker, Iain S

2017-01-01

Recent advances in microsurgery, imaging, and transplantation have led to significant refinements in autologous reconstructive options; however, the morbidity of donor sites remains. This would be eliminated by successful clinical translation of tissue-engineered solutions into surgical practice. Plastic surgeons are uniquely placed to be intrinsically involved in the research and development of laboratory engineered tissues and their subsequent use. In this article, we present an overview of the field of tissue engineering, with the practicing plastic surgeon in mind. The Medical Research Council states that regenerative medicine and tissue engineering "holds the promise of revolutionizing patient care in the twenty-first century." The UK government highlighted regenerative medicine as one of the key eight great technologies in their industrial strategy worthy of significant investment. The long-term aim of successful biomanufacture to repair composite defects depends on interdisciplinary collaboration between cell biologists, material scientists, engineers, and associated medical specialties; however currently, there is a current lack of coordination in the field as a whole. Barriers to translation are deep rooted at the basic science level, manifested by a lack of consensus on the ideal cell source, scaffold, molecular cues, and environment and manufacturing strategy. There is also insufficient understanding of the long-term safety and durability of tissue-engineered constructs. This review aims to highlight that individualized approaches to the field are not adequate, and research collaboratives will be essential to bring together differing areas of expertise to expedite future clinical translation. The use of tissue engineering in reconstructive surgery would result in a paradigm shift but it is important to maintain realistic expectations. It is generally accepted that it takes 20-30 years from the start of basic science research to clinical utility

Using polypropylene mesh graft for soft-tissue reconstruction in internal hemipelvectomy: a case report

Directory of Open Access Journals (Sweden)

Asavamongkolkul Apichat

2012-06-01

Full Text Available Abstract We report the case of a patient with chondrosarcoma involving the right pelvis and contralateral pubic area in a 45-year-old male who underwent an extensive internal hemipelvectomy without bony reconstruction. We demonstrate the technique of using polypropylene mesh graft for soft-tissue reconstruction. Follow-up at 7.5 years showed a good oncological and functional outcome.

Synthesis of highly interconnected 3D scaffold from Arothron stellatus skin collagen for tissue engineering application.

Science.gov (United States)

Ramanathan, Giriprasath; Singaravelu, Sivakumar; Raja, M D; Sivagnanam, Uma Tiruchirapalli

2015-11-01

The substrate which is avidly used for tissue engineering applications should have good mechanical and biocompatible properties, and all these parameters are often considered as essential for dermal reformation. Highly interconnected three dimensional (3D) wound dressing material with enhanced structural integrity was synthesized from Arothron stellatus fish skin (AsFS) collagen for tissue engineering applications. The synthesized 3D collagen sponge (COL-SPG) was further characterized by different physicochemical methods. The scanning electron microscopy analysis of the material demonstrated that well interconnected pores with homogeneous microstructure on the surface aids higher swelling index and that the material also possessed good mechanical properties with a Young's modulus of 0.89±0.2 MPa. Biocompatibility of the 3D COL-SPG showed 92% growth for both NIH 3T3 fibroblasts and keratinocytes. Overall, the study revealed that synthesized 3D COL-SPG from fish skin will act as a promising wound dressing in skin tissue engineering. Copyright © 2015 Elsevier Ltd. All rights reserved.

Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction.

Science.gov (United States)

Iida, Takuya; Takushima, Akihiko; Asato, Hirotaka; Harii, Kiyonori

2006-01-01

We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.

Evaluation of peripheral vasodilative indices in skin tissue of type 1 diabetic rats by use of RGB images

Science.gov (United States)

Tanaka, Noriyuki; Nishidate, Izumi; Nakano, Kazuya; Aizu, Yoshihisa; Niizeki, Kyuichi

2016-04-01

We investigated a method to evaluate the arterial inflow and the venous capacitance in the skin tissue of streptozotocin-induced type 1 diabetic rats from RGB digital color images. The arterial inflow and the venous capacitance in the dorsal reversed McFarlane skin flap are calculated based on the responses of change in the total blood concentration to occlusion of blood flow to and from the flap tissues at a pressure of 50 mmHg. The arterial inflow and the venous capacitance in the skin flap tissue were significantly reduced in type 1 diabetic rat group compared with the non-diabetic rat group. The results of the present study indicate the possibility of using the proposed method for evaluating the peripheral vascular dysfunctions in diabetes mellitus.

Discrimination between basal cell carcinoma and hair follicles in skin tissue sections by Raman micro-spectroscopy

Science.gov (United States)

Larraona-Puy, M.; Ghita, A.; Zoladek, A.; Perkins, W.; Varma, S.; Leach, I. H.; Koloydenko, A. A.; Williams, H.; Notingher, I.

2011-05-01

Skin cancer is the most common human malignancy and basal cell carcinoma (BCC) represents approximately 80% of the non-melanoma cases. Current methods of treatment require histopathological evaluation of the tissues by qualified personnel. However, this method is subjective and in some cases BCC can be confused with other structures in healthy skin, including hair follicles. In this preliminary study, we investigated the potential of Raman micro-spectroscopy (RMS) to discriminate between hair follicles and BCC in skin tissue sections excised during Mohs micrographic surgery (MMS). Imaging and diagnosis of skin sections was automatically generated using ' a priori'-built spectral model based on LDA. This model had 90 ± 9% sensitivity and 85 ± 9% specificity for discrimination of BCC from dermis and epidermis. The model used selected Raman bands corresponding to the largest spectral differences between the Raman spectra of BCC and the normal skin regions, associated mainly with nucleic acids and collagen type I. Raman spectra corresponding to the epidermis regions of the hair follicles were found to be closer to those of healthy epidermis rather than BCC. Comparison between Raman spectral images and the gold standard haematoxylin and eosin (H&E) histopathology diagnosis showed good agreement. Some hair follicle regions were misclassified as BCC; regions corresponded mainly to the outermost layer of hair follicle (basal cells) which are expected to have higher nucleic acid concentration. This preliminary study shows the ability of RMS to distinguish between BCC and other tissue structures associated to healthy skin which can be confused with BCC due to their similar morphology.

Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions.

Science.gov (United States)

Zhong, Toni; Antony, Anu; Cordeiro, Peter

2009-05-01

Numerous techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction (NAR). A common setback, however, is the diminution of projection over time; this phenomenon is particularly evident following implant based breast reconstruction. The purpose of this report was thus to evaluate surgical outcomes and long-term nipple projection with the use of "modified skate flap" technique in exclusively implant based postmastectomy reconstructions. A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with 2-staged tissue expander/implant reconstructions followed by NAR using the modified skate flap technique performed by the senior author (P.C.) were identified in a prospectively maintained breast reconstruction database. Only patients with a minimum of 1-year follow-up were included in the study. Patients with a history of irradiation to the breast were excluded from nipple projection assessment. Clinical outcome measurements included long-term nipple projection as well as incidence of complications from the NAR procedure using the modified skate flap technique. Over the 15-year study period, 475 patients underwent 2-staged tissue expander/implant reconstruction followed by NAR using the modified skate flap technique. Of these, there was a total of 292 patients with the minimum requirement of 1-year follow-up post NAR (61% follow-up rate). The total number of reconstructed nipple areolar complexes evaluated in this series was 422 (130 bilateral and 162 unilateral NAR). Forty patients (28 unilateral and 12 bilateral NAR) who received radiation to their breasts were excluded from nipple projection assessment. At a median follow-up of 44 months (range: 12-84 months), mean nipple projection was 2.5 mm (range: 1-4 mm). Minor complications occurred in 7.2% of the patients (n = 292). Skin graft donor site dehiscence was the most common complication (3.1%) followed by partial skin

Expanding the applications of Cadaveric skin - the properties and uses of an acellular dermal matrix

International Nuclear Information System (INIS)

Greenleaf, G.; Livesey, S.

1999-01-01

The ability to transplant organs and tissues has been one of the most significant advances of modern medicine. The availability of cadaveric allograft skin has greatly facilitated the practice of aggressive, early excision of massive burn injuries. Due to its ultimate rejection however, the role of allograft skin has historically been limited to that of a temporary wound dressing. Development of an acellular dermal allograft has greatly expanded the applications for donated human skin. AlloDerm(r) preserved dermal graft (LifeCell, The Woodlands, TX) is prepared via ionic separation of allograft skin followed by detergent removal of antigenic cells. Acellular dermal grafts are then cryoprotected and freeze-dried. The process maintains the structural integrity of the extracellular matrix and preserves the biochemical composition of the basement membrane. The resultant immunologically inert allograft can be used in a variety of applications. In burn injuries, lack of an adequate dermal component at either the donor or wound site may result in complications including contraction, delayed healing, hypertrophic scarring and keloid formation. Utilizing allogenic dermis eliminates the need for autologous dermis at the wound site and minimizes donor site trauma by allowing procurement of ultra-thin (0.006 ) autografts. Expanding the scope of traditional uses for allograft skin, acellular dermal grafts have been successfully utilized in a variety of procedures including duraplasty, orbital reconstruction, and hemia repar. In periodontal surgery, allograft tissue eliminates the need for painful palatal autografts and has been used to increase attached gingiva and reduce gingival recession. Resorption of autologous grafts or extrusion of synthetic material often hampers repair or reconstruction of soft tissue deficits. Transplantation of acellular allograft dermis provides a biochemically and structurally intact matrix, which persists and is ultimately repopulated with

Genital reconstruction in exstrophy patients

Directory of Open Access Journals (Sweden)

R B Nerli

2012-01-01

Full Text Available Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36 showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional

High resolution in-vivo imaging of skin with full field optical coherence tomography

Science.gov (United States)

Dalimier, E.; Bruhat, Alexis; Grieve, K.; Harms, F.; Martins, F.; Boccara, C.

2014-03-01

Full-field OCT (FFOCT) has the ability to provide en-face images with a very good axial sectioning as well as a very high transverse resolution (about 1 microns in all directions). Therefore it offers the possibility to visualize biological tissues with very high resolution both on the axial native view, and on vertical reconstructed sections. Here we investigated the potential dermatological applications of in-vivo skin imaging with FFOCT. A commercial FFOCT device was adapted for the in-vivo acquisition of stacks of images on the arm, hand and finger. Several subjects of different benign and pathological skin conditions were tested. The images allowed measurement of the stratum corneum and epidermis thicknesses, measurement of the stratum corneum refractive index, size measurement and count of the keratinocytes, visualization of the dermal-epidermal junction, and visualization of the melanin granules and of the melanocytes. Skins with different pigmentations could be discriminated and skin pathologies such as eczema could be identified. The very high resolution offered by FFOCT both on axial native images and vertical reconstructed sections allows for the visualization and measurement of a set of parameters useful for cosmetology and dermatology. In particular, FFOCT is a potential tool for the understanding and monitoring of skin hydration and pigmentation, as well as skin inflammation.

Delayed reconstruction of mangled lower extremities: soft tissue management

OpenAIRE

Tiftikçioğlu, Yiğit Özer; Erçin, Burak Sercan; Erdem, Mehmet; Biçer, Ahmet; Özkayın, Nadir; Özek, Cüneyt

2018-01-01

Objectives: This study aims to propose a new, practical and versatile algorithm for the management of traumatic lower limb soft tissue wounds for patients who did not undergo early reconstruction.Materials and methods: A total of 81 patients (54 males, 27 females; mean age 37.1 years; range 11 to 64 years) managed due to complex lower limb injuries at our institution between January 2008 and December 2012 were analyzed retrospectively in this study. Age and gender of the patients, type of tra...

Importance of banked tissues in the management of mass nuclear casualties

International Nuclear Information System (INIS)

Singh, Rita; Bhatnagar, P.K.

2009-01-01

Nuclear detonations are the most devastating of the weapons of mass destruction. There will be large number of casualties on detonation of nuclear weapon. Biological tissues like bone, skin, amniotic membrane and other soft tissues can be used for repair or reconstruction of the injured part of the body. Tissues from human donor can be processed and banked for orthopaedic, spinal, trauma and other surgical procedures. Radiation technology is used to sterilize the tissues to make them safe for clinical use. This paper highlights the importance of such banked tissues in the management of the casualties. (author)

Preliminary observations on differences in the Raman spectra of cancerous and noncancerous cells and connective tissue of human skin

Science.gov (United States)

Short, Michael A.; Lui, Harvey; McLean, David I.; Zeng, Haishan; Alajlan, Abdulmajeed; Chen, Michael X.

2005-04-01

A less invasive method of reliably detecting skin cancers is required. Raman spectroscopy is just one of several spectroscopic methods that look promising, but are not yet sufficiently reliable. More information is needed on how and why the Raman spectra of cancerous skin tissue is different from its normal counterpart. We have used confocal micro-Raman spectroscopy with a spatial resolution of about a micron to obtain spectra of unstained thin sections of human skin. We found that there were clear differences in the Raman spectra between cancerous and non-cancerous tissue both in cells and in the connective tissue. The DNA contribution to the spectra was generally stronger in malignant cells than normal ones. In regions of the dermis far away from the tumor one obtains the usual collagen spectra of normal skin, but adjacent to the tumor the spectra no longer appeared to be those of native collagen.

A quantitative and non-contact technique to characterise microstructural variations of skin tissues during photo-damaging process based on Mueller matrix polarimetry.

Science.gov (United States)

Dong, Yang; He, Honghui; Sheng, Wei; Wu, Jian; Ma, Hui

2017-10-31

Skin tissue consists of collagen and elastic fibres, which are highly susceptible to damage when exposed to ultraviolet radiation (UVR), leading to skin aging and cancer. However, a lack of non-invasive detection methods makes determining the degree of UVR damage to skin in real time difficult. As one of the fundamental features of light, polarization can be used to develop imaging techniques capable of providing structural information about tissues. In particular, Mueller matrix polarimetry is suitable for detecting changes in collagen and elastic fibres. Here, we demonstrate a novel, quantitative, non-contact and in situ technique based on Mueller matrix polarimetry for monitoring the microstructural changes of skin tissues during UVR-induced photo-damaging. We measured the Mueller matrices of nude mouse skin samples, then analysed the transformed parameters to characterise microstructural changes during the skin photo-damaging and self-repairing processes. Comparisons between samples with and without the application of a sunscreen showed that the Mueller matrix-derived parameters are potential indicators for fibrous microstructure in skin tissues. Histological examination and Monte Carlo simulations confirmed the relationship between the Mueller matrix parameters and changes to fibrous structures. This technique paves the way for non-contact evaluation of skin structure in cosmetics and dermatological health.

The use of dermal autograft as an adjunct to breast reconstruction with tissue expanders.

Science.gov (United States)

Rinker, Brian

2012-12-01

Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV.

Investigation of the effect of hydration on dermal collagen in ex vivo human skin tissue using second harmonic generation microscopy

Science.gov (United States)

Samatham, Ravikant; Wang, Nicholas K.; Jacques, Steven L.

2016-02-01

Effect of hydration on the dermal collagen structure in human skin was investigated using second harmonic generation microscopy. Dog ears from the Mohs micrographic surgery department were procured for the study. Skin samples with subject aged between 58-90 years old were used in the study. Three dimensional Multiphoton (Two-photon and backward SHG) control data was acquired from the skin samples. After the control measurement, the skin tissue was either soaked in deionized water for 2 hours (Hydration) or kept at room temperature for 2 hours (Desiccation), and SHG data was acquired. The data was normalized for changes in laser power and detector gain. The collagen signal per unit volume from the dermis was calculated. The desiccated skin tissue gave higher backward SHG compared to respective control tissue, while hydration sample gave a lower backward SHG. The collagen signal decreased with increase in hydration of the dermal collagen. Hydration affected the packing of the collagen fibrils causing a change in the backward SHG signal. In this study, the use of multiphoton microscopy to study the effect of hydration on dermal structure was demonstrated in ex vivo tissue.

Mueller matrix polarimetry for characterizing microstructural variation of nude mouse skin during tissue optical clearing.

Science.gov (United States)

Chen, Dongsheng; Zeng, Nan; Xie, Qiaolin; He, Honghui; Tuchin, Valery V; Ma, Hui

2017-08-01

We investigate the polarization features corresponding to changes in the microstructure of nude mouse skin during immersion in a glycerol solution. By comparing the Mueller matrix imaging experiments and Monte Carlo simulations, we examine in detail how the Mueller matrix elements vary with the immersion time. The results indicate that the polarization features represented by Mueller matrix elements m22&m33&m44 and the absolute values of m34&m43 are sensitive to the immersion time. To gain a deeper insight on how the microstructures of the skin vary during the tissue optical clearing (TOC), we set up a sphere-cylinder birefringence model (SCBM) of the skin and carry on simulations corresponding to different TOC mechanisms. The good agreement between the experimental and simulated results confirm that Mueller matrix imaging combined with Monte Carlo simulation is potentially a powerful tool for revealing microscopic features of biological tissues.

Validation of the 3D Skin Comet assay using full thickness skin models: Transferability and reproducibility.

Science.gov (United States)

Reisinger, Kerstin; Blatz, Veronika; Brinkmann, Joep; Downs, Thomas R; Fischer, Anja; Henkler, Frank; Hoffmann, Sebastian; Krul, Cyrille; Liebsch, Manfred; Luch, Andreas; Pirow, Ralph; Reus, Astrid A; Schulz, Markus; Pfuhler, Stefan

2018-03-01

Recently revised OECD Testing Guidelines highlight the importance of considering the first site-of-contact when investigating the genotoxic hazard. Thus far, only in vivo approaches are available to address the dermal route of exposure. The 3D Skin Comet and Reconstructed Skin Micronucleus (RSMN) assays intend to close this gap in the in vitro genotoxicity toolbox by investigating DNA damage after topical application. This represents the most relevant route of exposure for a variety of compounds found in household products, cosmetics, and industrial chemicals. The comet assay methodology is able to detect both chromosomal damage and DNA lesions that may give rise to gene mutations, thereby complementing the RSMN which detects only chromosomal damage. Here, the comet assay was adapted to two reconstructed full thickness human skin models: the EpiDerm™- and Phenion ® Full-Thickness Skin Models. First, tissue-specific protocols for the isolation of single cells and the general comet assay were transferred to European and US-American laboratories. After establishment of the assay, the protocol was then further optimized with appropriate cytotoxicity measurements and the use of aphidicolin, a DNA repair inhibitor, to improve the assay's sensitivity. In the first phase of an ongoing validation study eight chemicals were tested in three laboratories each using the Phenion ® Full-Thickness Skin Model, informing several validation modules. Ultimately, the 3D Skin Comet assay demonstrated a high predictive capacity and good intra- and inter-laboratory reproducibility with four laboratories reaching a 100% predictivity and the fifth yielding 70%. The data are intended to demonstrate the use of the 3D Skin Comet assay as a new in vitro tool for following up on positive findings from the standard in vitro genotoxicity test battery for dermally applied chemicals, ultimately helping to drive the regulatory acceptance of the assay. To expand the database, the validation will

The Effects of Low Dose Irradiation on Inflammatory Response Proteins in a 3D Reconstituted Human Skin Tissue Model

Energy Technology Data Exchange (ETDEWEB)

Varnum, Susan M.; Springer, David L.; Chaffee, Mary E.; Lien, Katie A.; Webb-Robertson, Bobbie-Jo M.; Waters, Katrina M.; Sacksteder, Colette A.

2012-12-01

Skin responses to moderate and high doses of ionizing radiation include the induction of DNA repair, apoptosis, and stress response pathways. Additionally, numerous studies indicate that radiation exposure leads to inflammatory responses in skin cells and tissue. However, the inflammatory response of skin tissue to low dose radiation (<10 cGy) is poorly understood. In order to address this, we have utilized a reconstituted human skin tissue model (MatTek EpiDerm FT) and assessed changes in 23 cytokines twenty-four and forty eight hours following treatment of skin with either 3 or 10 cGy low-dose of radiation. Three cytokines, IFN-γ, IL-2, MIP-1α, were significantly altered in response to low dose radiation. In contrast, seven cytokines were significantly altered in response to a high radiation dose of 200 cGy (IL-2, IL-10, IL-13, IFN-γ, MIP-1α, TNF α, and VEGF) or the tumor promoter 12-O-tetradecanoylphorbol 13-acetate (G-CSF, GM-CSF, IL-1α, IL-8, MIP-1α, MIP-1β, RANTES). Additionally, radiation induced inflammation appears to have a distinct cytokine response relative to the non-radiation induced stressor, TPA. Overall, these results indicate that there are subtle changes in the inflammatory protein levels following exposure to low dose radiation and this response is a sub-set of what is seen following a high dose in a human skin tissue model.

Chimeric Human Skin Substitute Tissue: A Novel Treatment Option for the Delivery of Autologous Keratinocytes.

Science.gov (United States)

Rasmussen, Cathy A; Allen-Hoffmann, B Lynn

2012-04-01

For patients suffering from catastrophic burns, few treatment options are available. Chimeric coculture of patient-derived autologous cells with a "carrier" cell source of allogeneic keratinocytes has been proposed as a means to address the complex clinical problem of severe skin loss. Currently, autologous keratinocytes are harvested, cultured, and expanded to form graftable epidermal sheets. However, epidermal sheets are thin, are extremely fragile, and do not possess barrier function, which only develops as skin stratifies and matures. Grafting is typically delayed for up to 4 weeks to propagate a sufficient quantity of the patient's cells for application to wound sites. Fully stratified chimeric bioengineered skin substitutes could not only provide immediate wound coverage and restore barrier function, but would simultaneously deliver autologous keratinocytes to wounds. The ideal allogeneic cell source for this application would be an abundant supply of clinically evaluated, nontumorigenic, pathogen-free, human keratinocytes. To evaluate this potential cell-based therapy, mixed populations of a green fluorescent protein-labeled neonatal human keratinocyte cell line (NIKS) and unlabeled primary keratinocytes were used to model the allogeneic and autologous components of chimeric monolayer and organotypic cultures. Relatively few autologous keratinocytes may be required to produce fully stratified chimeric skin substitute tissue substantially composed of autologous keratinocyte-derived regions. The need for few autologous cells interspersed within an allogeneic "carrier" cell population may decrease cell expansion time, reducing the time to patient application. This study provides proof of concept for utilizing NIKS keratinocytes as the allogeneic carrier for the generation of bioengineered chimeric skin substitute tissues capable of providing immediate wound coverage while simultaneously supplying autologous human cells for tissue regeneration.

Redox proteomic evaluation of oxidative modification and recovery in a 3D reconstituted human skin tissue model exposed to UVB.

Science.gov (United States)

Dyer, J M; Haines, S R; Thomas, A; Wang, W; Walls, R J; Clerens, S; Harland, D P

2017-04-01

Exposure to UV in humans resulting in sunburn triggers a complex series of events that are a mix of immediate and delayed damage mediation and healing. While studies on the effects of UV exposure on DNA damage and repair have been reported, changes in the oxidative modification of skin proteins are poorly understood at the molecular level, despite the important role played by structural proteins in skin tissue, and the effect of the integrity of these proteins on skin appearance and health. Proteomic molecular mapping of oxidation was here applied to try to enhance understanding of skin damage and recovery from oxidative damage and UVB exposure. A redox proteomic-based approach was applied to evaluating skin protein modification when exposed to varying doses of UVB after initial oxidative stress, via tracking changes in protein oxidation during the healing process in vitro using a full-thickness reconstituted human skin tissue model. Bioassays and structural evaluation confirmed that our cultured skin tissues underwent a normal physiological response to UVB exposure. A set of potential skin marker peptides was generated, for use in tracking skin protein oxidative modification. Exposure to UVB after thermal oxidative stress was found to result in higher levels of skin protein oxidation than a non-irradiated control for up to seven days after exposure. Recovery of the skin proteins from oxidative stress, as assessed by the overall protein oxidation levels, was found to be impaired by UVB exposure. Oxidative modification was largely observed in skin structural proteins. Exposure of skin proteins to UVB exacerbates oxidative damage to structural skin proteins, with higher exposure levels leading to increasingly impaired recovery from this damage. This has potential implications for the functional performance of the proteins and inter-related skin health and cosmetic appearance. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Soft-tissue imaging with C-arm cone-beam CT using statistical reconstruction

International Nuclear Information System (INIS)

Wang, Adam S; Stayman, J Webster; Otake, Yoshito; Siewerdsen, Jeffrey H; Kleinszig, Gerhard; Vogt, Sebastian; Gallia, Gary L; Khanna, A Jay

2014-01-01

The potential for statistical image reconstruction methods such as penalized-likelihood (PL) to improve C-arm cone-beam CT (CBCT) soft-tissue visualization for intraoperative imaging over conventional filtered backprojection (FBP) is assessed in this work by making a fair comparison in relation to soft-tissue performance. A prototype mobile C-arm was used to scan anthropomorphic head and abdomen phantoms as well as a cadaveric torso at doses substantially lower than typical values in diagnostic CT, and the effects of dose reduction via tube current reduction and sparse sampling were also compared. Matched spatial resolution between PL and FBP was determined by the edge spread function of low-contrast (∼40–80 HU) spheres in the phantoms, which were representative of soft-tissue imaging tasks. PL using the non-quadratic Huber penalty was found to substantially reduce noise relative to FBP, especially at lower spatial resolution where PL provides a contrast-to-noise ratio increase up to 1.4–2.2× over FBP at 50% dose reduction across all objects. Comparison of sampling strategies indicates that soft-tissue imaging benefits from fully sampled acquisitions at dose above ∼1.7 mGy and benefits from 50% sparsity at dose below ∼1.0 mGy. Therefore, an appropriate sampling strategy along with the improved low-contrast visualization offered by statistical reconstruction demonstrates the potential for extending intraoperative C-arm CBCT to applications in soft-tissue interventions in neurosurgery as well as thoracic and abdominal surgeries by overcoming conventional tradeoffs in noise, spatial resolution, and dose. (paper)

Soft Tissue Reconstruction following Hemipelvectomy: Eight-Year Experience and Literature Review

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A. Z. Mat Saad

2012-01-01

Results. Thirteen patients were included with median age of 39 years (range 13–78 of which all had advanced tumour with stage IIb (54% and Stage III (46%. External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. Conclusions. Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.

The use of allodermis prepared from Euro skin bank to prepare autologous tissue engineered skin for clinical use.

Science.gov (United States)

Deshpande, P; Ralston, D R; MacNeil, S

2013-09-01

Over the past two decades a range of 3D models for human skin have been described. Some include native collagen and intrinsic basement membrane proteins and fibroblasts, others are based on xenogeneic collagen or synthetic supports often without fibroblasts. The aim of this study was to look at the influence of media calcium, basement membrane and fibroblasts on the quality of 3D tissue engineered skin produced using human de-epidermized acellular dermis. In this study we deliberately used Euro skin as the source of the donor dermis to examine to what extent this could provide an effective dermal substrate for producing 3D skin for clinical use. Keratinocytes were cultured in the presence and absence of fibroblasts and both with and without basement membrane on decellularized dermis at calcium concentrations ranging from 250μM to 1.6mM over a period of 14 days. Results showed the formation of a well attached epithelium with many of the features of normal skin in the presence of a basement membrane. This was largely independent of the presence of fibroblasts and not greatly influenced by the concentration of calcium in the media. However there was a clear requirement for physiological levels of calcium in the formation of a stratified epithelium in the absence of a basement membrane. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Total Maxillary Reconstruction Using a Double-Barreled and Double Skin Paddle Fibular Flap after Total Maxillectomy

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Miguel de la Parra

2013-11-01

Full Text Available Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence.

Total Maxillary Reconstruction Using a Double-Barreled and Double Skin Paddle Fibular Flap after Total Maxillectomy

Science.gov (United States)

Sanchez, Gerardo; Lopez, Jaime; Perez, Adrian; Naal, Norberto

2013-01-01

Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence. PMID:24286054

Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

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Apresh Singla, MBBS, MSc

2017-07-01

Full Text Available Background:. Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM and with a vertical inframammary incision. Methods:. A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive. Patient, operative and treatment variables were extracted. All patients with viable mastectomy skin flaps intraoperatively and at least 5 mm of subcutaneous tissue were eligible except for patients who were deemed too slim by the senior surgeon preoperatively and thus at risk of implant visibility or skin rippling. Results:. There were 26 patients (bilateral n = 12 and unilateral n = 14 eligible for analysis, with a median long-term follow-up of 51.5 months. The majority of complications were classified as minor affecting 46.2% of the cohort (n = 12. There were 20 episodes of complications overall. The most frequent episodes were contour defects (x = 5, minor seroma (x = 4, and malrotation and minor infection (x = 3. There was 1 episode of capsular contracture. Conclusion:. Skin-sparing mastectomy with immediate subcutaneous silicon implant reconstruction with a vertical incision and without the need for mesh or ADM is an acceptable and safe treatment option. Accurate patient selection and skin flap viability is the key to achieving optimal outcomes with this approach.

Surgical Reconstruction of Lower Face Degloving.

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Faria, Paulo Esteves Pinto; de Souza Carvalho, Abrahão Cavalcante Gomes; Masalskas, Bárbara; Chihara, Letícia; Sant'Ana, Eduardo; Filho, Osvaldo Magro

2016-10-01

One of the most impressive soft tissue injuries is the facial degloving, normally associated with industrial machines and traffic accidents. This injury is characterized by the separation of the skin and cartilage from the bones, compromising the soft tissues correlated in the trauma area, nerves, and blood vessels. A 28-year-old patient, male, was referred to Araçatuba's Santa Casa Hospital, after a motorcycle accident, hitting his face on the sidewalk. The patient was conscious, oriented, denying fainting and unconsciousness during the accident, and complaining of pain in the nasal region of the face. The suture of wounds was performed using 5-0 absorbable sutures for muscle planes, and reconstruction of the septum and nasal cartilages. The skin was sutured with interrupted stitches using 6-0 nylon. After reducing the edema, a slight increase in alar base was observed. Subsequently, the alar base cinch suture was performed aiming to bring the alar bases to a measure of 34.0 mm in diameter. As a conclusion, the knowledge of the anatomy of the region involved, the healing of tissues, and suture techniques for the facial region process were critical to the successful treatment. The evaluation of the alar base in degloving cases can involve aesthetic features.

Viability of permanent PMMA spacer with combined free fasciocutaneous tissue transfer for failed charcot reconstruction: A 38 month prospective case report

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Tammer Elmarsafi

Full Text Available Introduction: Charcot Neuroarthropathy is a complex lower extremity pathology which predisposes the afflicted limb to ulcerations, osteomyelitis, and risk of major amputation. Charcot Neuroarthropathy often requires osseous reconstruction, which can be complicated with osteomyelitis and hardware infection. When soft tissue and osseous deficits must be concomitantly addressed, the use of PMMA spacers can be combined with free tissue transfers. Presentation of case: 71 year old Caucasian male with Diabetic Charcot Neuroarthopathy underwent osseous reconstruction with internal hardware. The surgical site was complicated by acute infection, osteomyelitis, exposed hardware requiring removal, and multiple surgical débridement. The degree of soft tissue and osseous deficit post-débridement required complex reconstruction. Discussion: The osseous deficit was addressed with the use of a permanent PMMA cement spacer. The soft tissue deficit was reconstructed with a free tissue transfer. This case report demonstrates the long term viability and utility of the use of permanent cement spacers when combined with free tissue transfer for closure of complex diabetic foot wounds. This case is an example of a multidisciplinary team approach to limb salvage with successful long term outcome; a plantigrade stable functional foot in an ambulatory highly active patient. Follow up time since initial intervention was 38 months. Conclusion: The use of a permanent PMMA cement spacer does not preclude free tissue transfer in complex host lower extremity reconstruction. A multidisciplinary team approach is a vital component to successful salvage outcomes. Keywords: Diabetes, Charcot neuroarthropathy, Ulcer, Cement spacer, Free tissue transfer, Osteomyelitis

Artificial skin in perspective: concepts and applications.

Science.gov (United States)

Brohem, Carla A; Cardeal, Laura B da Silva; Tiago, Manoela; Soengas, María S; Barros, Silvia B de Moraes; Maria-Engler, Silvya S

2011-02-01

Skin, the largest organ of the human body, is organized into an elaborate layered structure consisting mainly of the outermost epidermis and the underlying dermis. A subcutaneous adipose-storing hypodermis layer and various appendages such as hair follicles, sweat glands, sebaceous glands, nerves, lymphatics, and blood vessels are also present in the skin. These multiple components of the skin ensure survival by carrying out critical functions such as protection, thermoregulation, excretion, absorption, metabolic functions, sensation, evaporation management, and aesthetics. The study of how these biological functions are performed is critical to our understanding of basic skin biology such as regulation of pigmentation and wound repair. Impairment of any of these functions may lead to pathogenic alterations, including skin cancers. Therefore, the development of genetically controlled and well characterized skin models can have important implications, not only for scientists and physicians, but also for manufacturers, consumers, governing regulatory boards and animal welfare organizations. As cells making up human skin tissue grow within an organized three-dimensional (3D) matrix surrounded by neighboring cells, standard monolayer (2D) cell cultures do not recapitulate the physiological architecture of the skin. Several types of human skin recombinants, also called artificial skin, that provide this critical 3D structure have now been reconstructed in vitro. This review contemplates the use of these organotypic skin models in different applications, including substitutes to animal testing. © 2010 John Wiley & Sons A/S.

Vacuum-assisted closure downgrades reconstructive demands in high-risk patients with severe lower extremity injuries.

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Kakagia, D; Karadimas, E; Drosos, G; Ververidis, A; Kazakos, D; Lazarides, M; Verettas, D

2009-01-01

Primary soft tissue reconstruction in complex leg injuries is mandatory in order to protect exposed tissues; however, it may be precluded by the patient's clinical status or by local wound conditions. This retrospective study aims to evaluate the use of negative pressure as an adjunct to delayed soft tissue reconstruction in patients with complex lower limb trauma. Forty-two patients with 49 complex lower limb injuries were treated with Vacuum assisted closure (VAC) 48 hours after bone fixation, vascular repair and surgical debridement. Wound swab cultures were obtained before and after every VAC application. Duration of therapy, wound flora, final reconstructive technique required, outcome and follow-up period were retrieved from medical records. Twenty-four male and eighteen female patients were recruited, with a mean age of 47 years. All were treated with VAC therapy for 15-42 days. Reconstruction was delayed due to the patients' critical condition, advanced age, medical co-morbidities, heavily exuding wounds and questionable viability of soft tissues. Patients were followed up for 90-895 days. Two wounds healed spontaneously, 6 were managed with delayed direct suture, 31 with split thickness skin grafts and 9 required local cutaneous, fasciocutaneous or muscular flaps. One patient died due to fat embolism. Wound bacterial flora progressively decreased in all but one patient. Scar formation was aesthetically acceptable by the patients while function depended on the initial injury. Negative pressure is a safe and effective adjunct to delayed soft tissue reconstruction in high-risk patients with severe lower extremity injuries, minimizing reconstructive requirements and therefore postoperative morbidity.

Unit Advancement Flap for Lower Lip Reconstruction.

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Ogino, Akihiro; Onishi, Kiyoshi; Okada, Emi; Nakamichi, Miho

2018-05-01

Lower lip reconstruction requires consideration of esthetic and functional outcome in selecting a surgical procedure, and reconstruction with local tissue is useful. The authors reconstructed full-thickness defects with a unit advancement flap. Reconstruction was performed using this method in 4 patients with lower lip squamous cell carcinoma in whom tumor resection with preservation of the mouth angle was possible. The lower lip resection width was 30 to 45 mm, accounting for 50% to 68% of the entire width of the lower lip. The flap was prepared by lateral extension from above the mental unit and matched with the potential wrinkle line of the lower lip in order to design a unit morphology surrounded by the anterior margin of the depressor labii inferioris muscle. It was elevated as a full-thickness flap composed of the orbicularis oris muscle, skin, and mucosa of the residual lower lip from the bilateral sides, and advanced to the defect. Flap transfer was adjusted by small triangular resection of the skin on the lateral side of the mental unit. The postoperative scar was inconspicuous in all patients and there was no impairment of the mouth opening-closing or articulation functions. This was a relatively simple surgical procedure. A blood supply of the flap was stable, and continuity of the orbicularis oris muscle was reconstructed by transferred the residual lower lip advancement flap from the bilateral sides. The postoperative mouth opening-closing function was sufficient, and dentures could be placed from an early phase in elderly patients. The postoperative scar was consistent with the lip unit morphology, being esthetically superior. This procedure may be applicable for reconstruction of defects approximately 1/3 to 2/3 the width of the lower lip where the mouth angle is preserved.

Thermal interaction of short-pulsed laser focused beams with skin tissues

International Nuclear Information System (INIS)

Jiao Jian; Guo Zhixiong

2009-01-01

Time-dependent thermal interaction is developed in a skin tissue cylinder subjected to the irradiation of a train of short laser pulses. The skin embedded with a small tumor is stratified as three layers: epidermis, dermis and subcutaneous fat with different optical, thermal and physiological properties. The laser beam is focused to the tumor site by an objective lens for thermal therapy. The ultrafast radiation heat transfer of the focused beam is simulated by the transient discrete ordinates method. The transient Pennes bio-heat equation is solved numerically by the finite volume method with alternating direction implicit scheme. Emphasis is placed on the characterization of the focused beam propagation and absorption and the temperature rise in the focal spot. The effects of the focal spot size and location, the laser power, and the bio-heat equation are investigated. Comparisons with collimated irradiation are conducted. The focused beam can penetrate a greater depth and produce higher temperature rise at the target area, and thus reduce the possibility of thermal damage to the surrounding healthy tissue. It is ideal for killing cancerous cells and small tumors.

Thermal interaction of short-pulsed laser focused beams with skin tissues

Energy Technology Data Exchange (ETDEWEB)

Jiao Jian; Guo Zhixiong [Department of Mechanical and Aerospace Engineering, Rutgers, State University of New Jersey, Piscataway, NJ 08854 (United States)], E-mail: guo@jove.rutgers.edu

2009-07-07

Time-dependent thermal interaction is developed in a skin tissue cylinder subjected to the irradiation of a train of short laser pulses. The skin embedded with a small tumor is stratified as three layers: epidermis, dermis and subcutaneous fat with different optical, thermal and physiological properties. The laser beam is focused to the tumor site by an objective lens for thermal therapy. The ultrafast radiation heat transfer of the focused beam is simulated by the transient discrete ordinates method. The transient Pennes bio-heat equation is solved numerically by the finite volume method with alternating direction implicit scheme. Emphasis is placed on the characterization of the focused beam propagation and absorption and the temperature rise in the focal spot. The effects of the focal spot size and location, the laser power, and the bio-heat equation are investigated. Comparisons with collimated irradiation are conducted. The focused beam can penetrate a greater depth and produce higher temperature rise at the target area, and thus reduce the possibility of thermal damage to the surrounding healthy tissue. It is ideal for killing cancerous cells and small tumors.

Design, Manufacturing, and In Vitro Testing of a Patient-Specific Shape-Memory Expander for Nose Reconstruction With Forehead Flap Technique.

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Borghi, Alessandro; Rodgers, Will; Schievano, Silvia; Ponniah, Allan; O'Hara, Justine; Jeelani, Owase; Dunaway, David

2016-01-01

Forehead skin is widely acknowledged as a good donor site for total nasal reconstruction, thanks to its matching color, texture, and abundant vascularity. The forehead flap technique uses an axial pattern flap forehead skin to replace missing nasal tissue. To increase the amount of available tissue and reduce the size of the tissue defect after flap mobilization, tissue expanders may be used. Although this is a relatively established technique, limitations include reduced moldability of the forehead skin (which is thicker than the nasal skin), and the need for multiple sessions of expansion to achieve a sufficient yield to close the forehead.Shape-memory metals, such as nitinol, can be programmed to "remember" complex shapes. In this work, the methodology for producing a prototype of nitinol tissue expander able to mold the skin in a predetermined patient-specific skin shape is described. A realistic nose mold was manufactured using metal rapid prototyping; nitinol sheet and mesh were molded into nose-shape constructs, having hyperelastic as well as shape-memory capability. Computed tomography scanning was performed to assess the ability of the structure to regain its shape after phase transformation upon cooling within 2% of initial dimensions. The prototypes were implanted in a pig forehead to test its ability to impose a nose shape to the forehead skin.The shape-memory properties of nitinol offer the possibility of producing bespoke tissue expanders able to deliver complex, precisely designed skin envelopes. The hyperelastic properties of nitinol allow constant preprogrammed expansion forces to be generated throughout the expansion process.

Excision of Oral Submucous Fibrosis and Reconstruction with Full Thickness Skin Graft: A Case Study and Review of the Literature

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Alshadwi, Ahmad; Bhatia, Ishwar

2012-01-01

Oral submucous fibrosis is a chronic debilitating disease characterized by gradually increasing fibrosis of the oral cavity and pharynx, mainly the buccal mucosa, resulting in trismus. The highest incidence of oral submucous fibrosis is seen in South India due to various deleterious habits. In spite of the numerous medical modalities employed in the management of oral submucous fibrosis, occasionally surgical intervention becomes inevitable. Various surgical approaches have been used to reconstruct the surgical defects following excision of fibrous bands. Full thickness skin grafts have been described in the literature with variable outcomes. In the present study a 38-year-old male presented with severe oral submucous fibrosis of the buccal mucosa, which was successfully treated and reconstructed using full thickness skin graft with stable functional result after one year of treatment. An integrated review of the literature regarding etiology, histopathology, diagnostic, and treatment modalities of the disease follows. PMID:23304568

Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects

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Thalaivirithan Margabandu Balakrishnan

2017-01-01

Full Text Available Introduction: Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. Aim: This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Patients and Methods: 22 patients (16 were males and 6 were females were involved in this study between period of January 2012 and December 2016.We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. Results: All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. Conclusion: With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region.

Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report.

Science.gov (United States)

Hayashida, Kenji; Saijo, Hiroto; Fujioka, Masaki

2018-01-01

We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects. © 2016 Wiley Periodicals, Inc.

Two-dimensional Tissue Image Reconstruction Based on Magnetic Field Data

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J. Dedkova

2012-09-01

Full Text Available This paper introduces new possibilities within two-dimensional reconstruction of internal conductivity distribution. In addition to the electric field inside the given object, the injected current causes a magnetic field which can be measured either outside the object by means of a Hall probe or inside the object through magnetic resonance imaging. The Magnetic Resonance method, together with Electrical impedance tomography (MREIT, is well known as a bio-imaging modality providing cross-sectional conductivity images with a good spatial resolution from the measurements of internal magnetic flux density produced by externally injected currents. A new algorithm for the conductivity reconstruction, which utilizes the internal current information with respect to corresponding boundary conditions and the external magnetic field, was developed. A series of computer simulations has been conducted to assess the performance of the proposed algorithm within the process of estimating electrical conductivity changes in the lungs, heart, and brain tissues captured in two-dimensional piecewise homogeneous chest and head models. The reconstructed conductivity distribution using the proposed method is compared with that using a conventional method based on Electrical Impedance Tomography (EIT. The acquired experience is discussed and the direction of further research is proposed.

Tissue engineering strategies for alveolar cleft reconstruction: a systematic review of the literature

NARCIS (Netherlands)

Janssen, N.G.; Weijs, W.L.J.; Koole, R.A.; Rosenberg, A.J.; Meijer, G.J.

2014-01-01

OBJECTIVES: To date, a great number of tissue engineering strategies have been suggested for alveolar cleft reconstruction; however, autologous bone grafting seems to remain the golden standard. MATERIALS AND METHODS: A systematic review of the literature was conducted in order to evaluate the

Tissue differences in fragile X mosaics: Mosaicism in blood cells may differ greatly from skin

Energy Technology Data Exchange (ETDEWEB)

Dobkin, C.S.; Nolin, S.L.; Cohen, I. [NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY (United States)] [and others

1996-08-09

The fragile X mutation is diagnosed from the structure of the FMR1 gene in blood cell DNA. An estimated 12 to 41% of affected males are mosaics who carry both a {open_quotes}full mutation{close_quotes} allele from which there is no gene expression and a {open_quotes}premutation{close_quotes} allele which has normal gene expression. We compared the DNA in blood cells and skin fibroblasts from four mosaic fragile X males to see if there was a difference in the relative amounts of premutation and full mutation alleles within the tissues of these individuals. Two of these males showed striking differences in the ratio of premutation to full mutation in different tissues while the other two showed only slight differences. These observations conform with the widely accepted hypothesis that the fragile X CGG repeat is unstable in somatic tissue during early embryogenesis. Accordingly, the mosaicism in brain and skin, which are both ectodermal in origin, may be similar to each other but different from blood which is not ectodermal in origin. Thus, the ratio of full mutation to premutation allele in skin fibroblasts might be a better indicator of psychological impairment than the ratio in blood cells. 24 refs., 4 figs., 1 tab.

The effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

Science.gov (United States)

Källman, Ulrika; Engström, Maria; Bergstrand, Sara; Ek, Anna-Christina; Fredrikson, Mats; Lindberg, Lars-Göran; Lindgren, Margareta

2015-03-01

Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored. To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents. From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30° supine tilt and 0° supine positions and over the trochanter major in 30° lateral and 90° lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry. Interface pressure was significantly higher in the 0° supine and 90° lateral positions than in 30° supine tilt and 30° lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30° supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions. The 30° supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial. © The Author(s) 2014.

Free Vastus Intermedius Muscle Flap: A Successful Alternative for Complex Reconstruction of the Neurocranium in Preoperated Patients.

Science.gov (United States)

Horn, Dominik; Freudlsperger, Christian; Berger, Moritz; Freier, Kolja; Ristow, Oliver; Hoffmann, Jürgen; Sakowitz, Oliver; Engel, Michael

2017-07-01

The reconstruction of large cranial and scalp defects is a surgical and esthetic challenge. Single autologous tissue transfer can be insufficient due to the defect size and the anatomic complexity of the recipient site. Alloplastic patient-specific preformed implants can be used to recover hard tissue defects of the neurocranium. Nevertheless, for long-term success adequate soft tissue support is required. In this brief clinical study, the authors describe calvarian reconstruction in a 33-year-old patient with wound healing disorder after an initial resection of ependymoma. The patient suffered from osteonecrosis and wound breakdown in the fronto-parietal region. An alloplastic polymethylmethacrylate implant for hard tissue support was manufactured based on 3-dimensional visualization of a computed tomography scan. After the resection of remaining pathologic bone from earlier surgical procedures, the alloplastic implant was inserted to achieve functional coverage of the brain. Due to anatomic variation of donor site vessels during anterolateral thigh flap preparation, the authors performed a vastus intermedius free flap as a new muscular flap for craniofacial reconstruction. The authors achieved excellent functional and esthetic results. The muscular vastus intermedius free flap in combination with a split skin graft proves to be a new alternative to the anterolateral thigh flap for soft tissue reconstruction of the neurocranium.

Chimeric superficial temporal artery based skin and temporal fascia flap plus temporalis muscle flap - An alternative to free flap for suprastructure maxillectomy with external skin defect

Directory of Open Access Journals (Sweden)

Dushyant Jaiswal

2011-01-01

Full Text Available Flaps from temporal region have been used for mid face, orbital and peri-orbital reconstruction. The knowledge of the vascular anatomy of the region helps to dissect and harvest the muscle/fascia/skin/combined tissue flaps from that region depending upon the requirement. Suprastructure maxillectomy defects are usually covered with free flaps to fill the cavity. Here we report an innovative idea in which a patient with a supra structure maxillectomy with external skin defect was covered with chimeric flap based on the parietal and frontal branches of superficial temporal artery and the temporalis muscle flap based on deep temporal artery.

Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction?

Science.gov (United States)

Ibrahim, Ahmed M S; Koolen, Pieter G L; Ganor, Oren; Markarian, Mark K; Tobias, Adam M; Lee, Bernard T; Lin, Samuel J; Mureau, Marc A M

2015-06-01

The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons. Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability. When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement. Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the

SU-F-T-517: Determining the Tissue Equivalence of a Brass Mesh Bolus in a Reconstructed Chest Wall Irradiation

Energy Technology Data Exchange (ETDEWEB)

Shekel, E; Epstein, D; Levin, D [Dept of radiotherapy, Assuta Medical Centers, Tel Aviv (Israel)

2016-06-15

Purpose: To determine the tissue equivalence of a brass mesh bolus (RPD) in the setting of a reconstructed chest wall irradiation Methods: We measured breast skin dose delivered by a tangential field plan on an anthropomorphic phantom using Mosfet and nanoDot (Landauer) dosimeters in five different locations on the breast. We also measured skin dose using no bolus, 5mm and 10 mm superflab bolus. In the Eclipse treatment planning system (Varian, Palo Alto, CA) we calculated skin dose for different bolus thicknesses, ranging from 0 to 10 mm, in order to evaluate which calculation best matches the brass mesh measurements, as the brass mesh cannot be simulated due to artefacts.Finally, we measured depth dose behavior with the brass mesh bolus to verify that the bolus does not affect the dose to the breast itself beyond the build-up region. Results: Mosfet and nanoDot measurements were consistent with each other.As expected, skin dose measurements with no bolus had the least agreement with Eclipse calculation, while measurements for 5 and 10 mm agreed well with the calculation despite the difficulty in conforming superflab bolus to the breast contour. For the brass mesh the best agreement was for 3 mm bolus Eclipse calculation. For Mosfets, the average measurement was 90.8% of the expected dose, and for nanoDots 88.33% compared to 83.34%, 88.64% and 93.94% (2,3 and 5 mm bolus calculation respectively).The brass mesh bolus increased skin dose by approximately 25% but there was no dose increase beyond the build-up region. Conclusion: Brass mesh bolus is most equivalent to a 3 mm bolus, and does not affect the dose beyond the build-up region. The brass mesh cannot be directly calculated in Eclipse, hence a 3mm bolus calculation is a good reflection of the dose response to the brass mesh bolus.

Skin tightening.

Science.gov (United States)

Woolery-Lloyd, Heather; Kammer, Jenna N

2011-01-01

Skin tightening describes the treatment of skin laxity via radiofrequency (RF), ultrasound, or light-based devices. Skin laxity on the face is manifested by progressive loss of skin elasticity, loosening of the connective tissue framework, and deepening of skin folds. This results in prominence of submandibular and submental tissues. Genetic factors (chronological aging) and extrinsic factors (ultraviolet radiation) both contribute to skin laxity. There are many RF, ultrasound, and light-based devices directed at treating skin laxity. All of these devices target and heat the dermis to induce collagen contraction. Heating of the dermis causes collagen denaturation and immediate collagen contraction in addition to long-term collagen remodeling. Via RF, light, or ultrasound, these skin tightening devices deliver heat to the dermis to create new collagen and induce skin tightening. This chapter will provide an overview of the various skin tightening devices. Copyright © 2011 S. Karger AG, Basel.

A two-layered forward model of tissue for electrical impedance tomography

International Nuclear Information System (INIS)

Kulkarni, Rujuta; Saulnier, Gary J; Kao, Tzu-Jen; Newell, Jonathan C; Boverman, Gregory; Isaacson, David

2009-01-01

Electrical impedance tomography is being explored as a technique to detect breast cancer, exploiting the differences in admittivity between normal tissue and tumors. In this paper, the geometry is modeled as an infinite half space under a hand-held probe. A forward solution and a reconstruction algorithm for this geometry were developed previously by Mueller et al (1999 IEEE Trans. Biomed. Eng. 46 1379). In this paper, we present a different approach which uses the decomposition of the forward solution into its Fourier components to obtain the forward solution and the reconstructions. The two approaches are compared in terms of the forward solutions and the reconstructions of experimental tank data. We also introduce a two-layered model to incorporate the presence of the skin that surrounds the body area being imaged. We demonstrate an improvement in the reconstruction of a target in a layered medium using this layered model with finite difference simulated data. We then extend the application of our layered model to human subject data and estimate the skin and the tissue admittivities for data collected on the human abdomen using an ultrasound-like hand-held EIT probe. Lastly, we show that for this set of human subject data, the layered model yields an improvement in predicting the measured voltages of around 81% for the lowest temporal frequency (3 kHz) and around 61% for the highest temporal frequency (1 MHz) applied when compared to the homogeneous model

3D Printing of Scaffold for Cells Delivery: Advances in Skin Tissue Engineering

Directory of Open Access Journals (Sweden)

Deepti Singh

2016-01-01

Full Text Available Injury or damage to tissue and organs is a major health problem, resulting in about half of the world’s annual healthcare expenditure every year. Advances in the fields of stem cells (SCs and biomaterials processing have provided a tremendous leap for researchers to manipulate the dynamics between these two, and obtain a skin substitute that can completely heal the wounded areas. Although wound healing needs a coordinated interplay between cells, extracellular proteins and growth factors, the most important players in this process are the endogenous SCs, which activate the repair cascade by recruiting cells from different sites. Extra cellular matrix (ECM proteins are activated by these SCs, which in turn aid in cellular migrations and finally secretion of growth factors that can seal and heal the wounds. The interaction between ECM proteins and SCs helps the skin to sustain the rigors of everyday activity, and in an attempt to attain this level of functionality in artificial three-dimensional (3D constructs, tissue engineered biomaterials are fabricated using more advanced techniques such as bioprinting and laser assisted printing of the organs. This review provides a concise summary of the most recent advances that have been made in the area of polymer bio-fabrication using 3D bio printing used for encapsulating stem cells for skin regeneration. The focus of this review is to describe, in detail, the role of 3D architecture and arrangement of cells within this system that can heal wounds and aid in skin regeneration.

Xenobiotic-metabolizing enzymes in the skin of rat, mouse, pig, guinea pig, man, and in human skin models.

Science.gov (United States)

Oesch, F; Fabian, E; Guth, K; Landsiedel, R

2014-12-01

The exposure of the skin to medical drugs, skin care products, cosmetics, and other chemicals renders information on xenobiotic-metabolizing enzymes (XME) in the skin highly interesting. Since the use of freshly excised human skin for experimental investigations meets with ethical and practical limitations, information on XME in models comes in the focus including non-human mammalian species and in vitro skin models. This review attempts to summarize the information available in the open scientific literature on XME in the skin of human, rat, mouse, guinea pig, and pig as well as human primary skin cells, human cell lines, and reconstructed human skin models. The most salient outcome is that much more research on cutaneous XME is needed for solid metabolism-dependent efficacy and safety predictions, and the cutaneous metabolism comparisons have to be viewed with caution. Keeping this fully in mind at least with respect to some cutaneous XME, some models may tentatively be considered to approximate reasonable closeness to human skin. For dermal absorption and for skin irritation among many contributing XME, esterase activity is of special importance, which in pig skin, some human cell lines, and reconstructed skin models appears reasonably close to human skin. With respect to genotoxicity and sensitization, activating XME are not yet judgeable, but reactive metabolite-reducing XME in primary human keratinocytes and several reconstructed human skin models appear reasonably close to human skin. For a more detailed delineation and discussion of the severe limitations see the "Overview and Conclusions" section in the end of this review.

Changing the Paradigm in Medial Canthal Reconstruction: The Bridge Principle and the Croissant-Like Keystone Island Perforator Flap as An Alternative for Medium Size Soft Tissue Defects in Internal Canthus Reconstruction.

Science.gov (United States)

Kostopoulos, Epameinondas; Agiannidis, Christos; Konofaos, Petros; Kotsakis, Ioannis; Hatzigianni, Panagiota; Georgopoulos, Gerasimos; Papadatou, Zoe; Konstantinidou, Chara; Champsas, Gregorios; Papadopoulos, Othon; Casoli, Vincent

2018-03-08

Medial canthus is a common area of skin cancer prevalence. Defects in this region represent a challenging reconstructive task. The nasal version of keystone perforator island flap (KPIF) has proven its versatility. The aim of the present study was to expand its utilization in the neighbor medial canthus area. A modified croissant-like KPIF (CKPIF) was used resolving inner convexity-related problems. The presence of procerus in the glabella area, bridging a surface from nasalis up to the frontalis, changed the traditional dissecting flap technique. Thus, the authors introduce the bridge principle, which consists of the indirect transfer of the flap to the defect site through a muscular "bridge" (the procerus). The authors report their experience in medial canthal reconstruction combining a modified KPIF with a new dissecting "principle." From November 2016 to July 2017, a series of patients presenting soft tissue defects of various dimensions in the medial canthus, secondary to tumor extirpation, sustained reconstruction with a CKPIF dissected with the bridge principle. A total of 15 patients were treated with this new technique. Their mean age was 75.3 years. The mean size of the defect was 2.08 cm (length) × 1.5 cm (width). All flaps survived without any sign of venous congestion. A transient epiphora presented in 4 patients (4/15 or 26.6%), which was subsided 2 months later. A new approach following a novel paradigm was introduced to resolve an old problem. Initial outcomes are encouraging. However, longer series are needed to extract definitive and safer conclusion.

[Progress in application of 3D bioprinting in cartilage regeneration and reconstruction for tissue engineering].

Science.gov (United States)

Liao, Junlin; Wang, Shaohua; Chen, Jia; Xie, Hongju; Zhou, Jianda

2017-02-28

Three-dimensional (3D) bioprinting provides an advanced technology for tissue engineering and regenerative medicine because of its ability to produce the models or organs with higher precision and more suitable for human body. It has been successfully used to produce a variety of cartilage scaffold materials. In addition, 3D bioprinter can directly to print tissue and organs with live chondrocytes. In conclusion, 3D bioprinting may have broad prospect for cartilage regeneration and reconstruction in tissue engineering.

Use of HPLC/UPLC-spectrophotometry for detection of formazan in in vitro Reconstructed human Tissue (RhT)-based test methods employing the MTT-reduction assay to expand their applicability to strongly coloured test chemicals.

Science.gov (United States)

Alépée, N; Barroso, J; De Smedt, A; De Wever, B; Hibatallah, J; Klaric, M; Mewes, K R; Millet, M; Pfannenbecker, U; Tailhardat, M; Templier, M; McNamee, P

2015-06-01

A number of in vitro test methods using Reconstructed human Tissues (RhT) are regulatory accepted for evaluation of skin corrosion/irritation. In such methods, test chemical corrosion/irritation potential is determined by measuring tissue viability using the photometric MTT-reduction assay. A known limitation of this assay is possible interference of strongly coloured test chemicals with measurement of formazan by absorbance (OD). To address this, Cosmetics Europe evaluated use of HPLC/UPLC-spectrophotometry as an alternative formazan measurement system. Using the approach recommended by the FDA guidance for validation of bio-analytical methods, three independent laboratories established and qualified their HPLC/UPLC-spectrophotometry systems to reproducibly measure formazan from tissue extracts. Up to 26 chemicals were then tested in RhT test systems for eye/skin irritation and skin corrosion. Results support that: (1) HPLC/UPLC-spectrophotometry formazan measurement is highly reproducible; (2) formazan measurement by HPLC/UPLC-spectrophotometry and OD gave almost identical tissue viabilities for test chemicals not exhibiting colour interference nor direct MTT reduction; (3) independent of the test system used, HPLC/UPLC-spectrophotometry can measure formazan for strongly coloured test chemicals when this is not possible by absorbance only. It is therefore recommended that HPLC/UPLC-spectrophotometry to measure formazan be included in the procedures of in vitro RhT-based test methods, irrespective of the test system used and the toxicity endpoint evaluated to extend the applicability of these test methods to strongly coloured chemicals. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cannabinoid CB2 Receptors Contribute to Upregulation of β-endorphin in Inflamed Skin Tissues by Electroacupuncture

Directory of Open Access Journals (Sweden)

Su Tang-feng

2011-12-01

Full Text Available Abstract Background Electroacupuncture (EA can produce analgesia by increasing the β-endorphin level and activation of peripheral μ-opioid receptors in inflamed tissues. Endogenous cannabinoids and peripheral cannabinoid CB2 receptors (CB2Rs are also involved in the antinociceptive effect of EA on inflammatory pain. However, little is known about how peripheral CB2Rs interact with the endogenous opioid system at the inflammatory site and how this interaction contributes to the antinociceptive effect of EA on inflammatory pain. In this study, we determined the role of peripheral CB2Rs in the effects of EA on the expression of β-endorphin in inflamed skin tissues and inflammatory pain. Results Inflammatory pain was induced by injection of complete Freund's adjuvant into the left hindpaw of rats. Thermal hyperalgesia was tested with a radiant heat stimulus, and mechanical allodynia was quantified using von Frey filaments. The mRNA level of POMC and protein level of β-endorphin were quantified by real-time PCR and Western blotting, respectively. The β-endorphin-containing keratinocytes and immune cells in the inflamed skin tissues were detected by double-immunofluorescence labeling. The CB2R agonist AM1241 or EA significantly reduced thermal hyperalgesia and mechanical allodynia, whereas the selective μ-opioid receptor antagonist β-funaltrexamine significantly attenuated the antinociceptive effect produced by them. AM1241 or EA significantly increased the mRNA level of POMC and the protein level of β-endorphin in inflamed skin tissues, and these effects were significantly attenuated by pretreatment with the CB2R antagonist AM630. AM1241 or EA also significantly increased the percentage of β-endorphin-immunoreactive keratinocytes, macrophages, and T-lymphocytes in inflamed skin tissues, and these effects were blocked by AM630. Conclusions EA and CB2R stimulation reduce inflammatory pain through activation of μ-opioid receptors. EA increases

Tissue repair genes: the TiRe database and its implication for skin wound healing.

Science.gov (United States)

Yanai, Hagai; Budovsky, Arie; Tacutu, Robi; Barzilay, Thomer; Abramovich, Amir; Ziesche, Rolf; Fraifeld, Vadim E

2016-04-19

Wound healing is an inherent feature of any multicellular organism and recent years have brought about a huge amount of data regarding regular and abnormal tissue repair. Despite the accumulated knowledge, modulation of wound healing is still a major biomedical challenge, especially in advanced ages. In order to collect and systematically organize what we know about the key players in wound healing, we created the TiRe (Tissue Repair) database, an online collection of genes and proteins that were shown to directly affect skin wound healing. To date, TiRe contains 397 entries for four organisms: Mus musculus, Rattus norvegicus, Sus domesticus, and Homo sapiens. Analysis of the TiRe dataset of skin wound healing-associated genes showed that skin wound healing genes are (i) over-conserved among vertebrates, but are under-conserved in invertebrates; (ii) enriched in extracellular and immuno-inflammatory genes; and display (iii) high interconnectivity and connectivity to other proteins. The latter may provide potential therapeutic targets. In addition, a slower or faster skin wound healing is indicative of an aging or longevity phenotype only when assessed in advanced ages, but not in the young. In the long run, we aim for TiRe to be a one-station resource that provides researchers and clinicians with the essential data needed for a better understanding of the mechanisms of wound healing, designing new experiments, and the development of new therapeutic strategies. TiRe is freely available online at http://www.tiredb.org.

Influence of low-energy laser radiation on normal skin and certain tumor tissues

Energy Technology Data Exchange (ETDEWEB)

Pletnev, S.D.; Karpenko, O.M.

For some years, the authors' Institute has studied the influence of various types of low-energy laser radiation on normal tissue and the growth of tumors. Radiation at 3 and 30 J/cm/sup 2/ causes an increase in biological activity of various cell elements, manifested as an increase in mitotic activity of the cells in the basal layer of the epidermis, conglomeration of chromatin in the cell nuclei and an increase in degranulation of fat cells in the process of their migration to the reticular layer. Also noted was an increase in content of fibroblastic and lymphohistocytic elements in the dermis, as well as an increase in collagenization of connective tissue. It was found that irradiation of the skin by helium-neon, cadmium-helium and nitrogen lasers before and after grafting of the cells of various tumors modifies the course of the tumor process. This effect is apparently related to the fact that systematic irradiation results in changes creating a favorable background for survival and proliferation of tumor cells in the skin tissue medium. The changes facilitate an increase in survival and growth of both pigmented and nonpigmented tumors. Low power radiation stimulates the activity of the cells or cell structures; medium power stimulates their activity; high power suppresses activity.

Interaction of dermatologically relevant nanoparticles with skin cells and skin

Directory of Open Access Journals (Sweden)

Annika Vogt

2014-12-01

Full Text Available The investigation of nanoparticle interactions with tissues is complex. High levels of standardization, ideally testing of different material types in the same biological model, and combinations of sensitive imaging and detection methods are required. Here, we present our studies on nanoparticle interactions with skin, skin cells, and biological media. Silica, titanium dioxide and silver particles were chosen as representative examples for different types of skin exposure to nanomaterials, e.g., unintended environmental exposure (silica versus intended exposure through application of sunscreen (titanium dioxide or antiseptics (silver. Because each particle type exhibits specific physicochemical properties, we were able to apply different combinations of methods to examine skin penetration and cellular uptake, including optical microscopy, electron microscopy, X-ray microscopy on cells and tissue sections, flow cytometry of isolated skin cells as well as Raman microscopy on whole tissue blocks. In order to assess the biological relevance of such findings, cell viability and free radical production were monitored on cells and in whole tissue samples. The combination of technologies and the joint discussion of results enabled us to look at nanoparticle–skin interactions and the biological relevance of our findings from different angles.

Influence of skin surface roughness degree on energy characteristics of light scattered by a biological tissue

Science.gov (United States)

Barun, V. V.; Ivanov, A. P.

2017-05-01

We present the results of modelling of photometric characteristics of light in soft tissues illuminated by a parallel beam along the normal to the surface, obtained with allowance for the skin roughness parameters and the angular structure of radiation approaching the surface from within the tissue. The depth structure of the fluence rate and the spectra of the diffuse reflection of light by the tissue in the interval of wavelengths 300 - 1000 nm are considered. We discuss the influence of the tilt angle variance of rough surface microelements and light refraction on the studied characteristics. It is shown that these factors lead to the reduction of the radiation flux only in the near-surface tissue layer and practically do not affect the depth of light penetration into the tissue. On the other hand, the degree of the surface roughness and the conditions of its illumination from within the tissue essentially affect the coefficient of diffuse reflection of light and lead to its considerable growth compared to the cases of a smooth interface and completely diffuse illumination, often considered to simplify the theoretical problem solution. The role of the roughness of skin surface is assessed in application to the solution of different direct and inverse problems of biomedical optics.

Patient skin dosimetry in interventional cardiology in the Czech Republic

International Nuclear Information System (INIS)

Sukupova, L.; Novak, L.; Kala, P.; Cervinka, P.; Stasek, J.

2011-01-01

In this study, skin dosimetry of patients undergoing interventional cardiology procedures is presented. Three hospitals were included. Two methods were used for skin dosimetry-radiochromic dosimetry films and reconstruction of skin dose distribution based on examination protocol. Maximum skin doses (MSD) obtained from both methods were compared for 175 patients. For patients for whom the film MSD was >1 Gy, the reconstruction MSD differed from the film MSD in the range of ± 50 % for 83 % of patients. For remaining patients, the difference was higher and it was caused by longer fluoroscopy time. For 59 patients for whom the cumulative dose was known, the cumulative dose was compared with the film MSD. Skin dosimetry with radiochromic films is more accurate than the reconstruction method, but films do not include X-ray fields from lateral projections whilst reconstructions do. (authors)

The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defects. A validity study of 34 patients

NARCIS (Netherlands)

C.M.E. Contant; A.N. van Geel (Albert); B. van der Holt (Bronno); T. Wiggers (Theo)

1996-01-01

textabstractThe aim of this study was to evaluate retrospectively the results of pedicled omentoplasty and split skin graft (POSSG) in reconstructing (full thickness) chest wall defects, and to define its role as a palliative procedure for local symptom control. Thirty-four patients with recurrent

A case of radiation-induced skin cancer of the neck

International Nuclear Information System (INIS)

Matsushita, Tetsuya; Susuki, Takeo; Kikui, Tomoko; Masada, Yoshiko; Tahara, Shinya.

1994-01-01

The authors discuss the case of radiation-induced skin cancer of the neck in a 76-year-old woman who had undergone irradiation of tubercular lymphadenitis of the cervix while in her low teens. Some fifty years later, a squamous cell carcinoma developed in the irradiated region and in due course deeply invaded the sternocleidomastoidous muscle. Thus, a radical neck dissection was performed and the tumor and the lymph tissue removed en bloc, after which reconstruction was accomplished by using a latissimus dorsi musculocutaneous flap. With regard to the lessons learned from treating this case, three points are considered important and are listed below. When treating radiation-induced skin cancer patients, the head and neck regions should be examined in detail for the presence of other tumors. The excision of the skin surrounding the tumor should be as wide as possible, so as to remove skin that may have been also over-subjected to irradiation. The remaining skin surrounding the defect left by the excision is atrophic and thin. (author)

Tumors of the skin and soft tissues

Energy Technology Data Exchange (ETDEWEB)

Weller, R.E.

1991-10-01

The majority of the body surface is covered by the skin. Many internal disorders are reflected in the condition of the skin. One of the major functions of the skin is protection of the other organ systems from a variety of environmental insults. In this role, the skin itself is exposed to factors that can ultimately cause chronic diseases and cancer. Since it is relatively easy to recognize skin abnormalities, most skin cancers are brought to professional attention sooner than other types of cancer. However, due to the close resemblance between many skin neoplasms and noncancerous dermatologic disorders, these neoplasms may be mistreated for months or even years. In veterinary oncology, as in human medicine, most cancers can be effectively treated or cured following an accurate diagnosis. Once diagnosed, skin neoplasms should be aggressively treated. If causal factors are known, exposure to these factors should be limited through removal of the agent (for chemical carcinogens) or limiting exposure to the agent (for other carcinogens such as sunlight). 10 tabs. (MHB)

Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

Directory of Open Access Journals (Sweden)

Fabio Caviggioli

2014-01-01

Full Text Available Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT. Negative Pressure Wound Therapy (NPWT, instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity

Energy Technology Data Exchange (ETDEWEB)

Magerkurth, Olaf [Dept. of Radiology, Hospital Baden, Baden (Switzerland); Girish, Gandikota; Jacobson, Jon A.; Kim, Sung Moon; Brigido, Monica; Dong, Qian; Jamadar, David A. [Dept. of Radiology, University of Michigan Hospitals, Ann Arbor (United States)

2015-02-15

MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

Simulation study of melanoma detection in human skin tissues by laser-generated surface acoustic waves.

Science.gov (United States)

Chen, Kun; Fu, Xing; Dorantes-Gonzalez, Dante J; Lu, Zimo; Li, Tingting; Li, Yanning; Wu, Sen; Hu, Xiaotang

2014-01-01

Air pollution has been correlated to an increasing number of cases of human skin diseases in recent years. However, the investigation of human skin tissues has received only limited attention, to the point that there are not yet satisfactory modern detection technologies to accurately, noninvasively, and rapidly diagnose human skin at epidermis and dermis levels. In order to detect and analyze severe skin diseases such as melanoma, a finite element method (FEM) simulation study of the application of the laser-generated surface acoustic wave (LSAW) technique is developed. A three-layer human skin model is built, where LSAW’s are generated and propagated, and their effects in the skin medium with melanoma are analyzed. Frequency domain analysis is used as a main tool to investigate such issues as minimum detectable size of melanoma, filtering spectra from noise and from computational irregularities, as well as on how the FEM model meshing size and computational capabilities influence the accuracy of the results. Based on the aforementioned aspects, the analysis of the signals under the scrutiny of the phase velocity dispersion curve is verified to be a reliable, a sensitive, and a promising approach for detecting and characterizing melanoma in human skin.

Simulation study of melanoma detection in human skin tissues by laser-generated surface acoustic waves

Science.gov (United States)

Chen, Kun; Fu, Xing; Dorantes-Gonzalez, Dante J.; Lu, Zimo; Li, Tingting; Li, Yanning; Wu, Sen; Hu, Xiaotang

2014-07-01

Air pollution has been correlated to an increasing number of cases of human skin diseases in recent years. However, the investigation of human skin tissues has received only limited attention, to the point that there are not yet satisfactory modern detection technologies to accurately, noninvasively, and rapidly diagnose human skin at epidermis and dermis levels. In order to detect and analyze severe skin diseases such as melanoma, a finite element method (FEM) simulation study of the application of the laser-generated surface acoustic wave (LSAW) technique is developed. A three-layer human skin model is built, where LSAW's are generated and propagated, and their effects in the skin medium with melanoma are analyzed. Frequency domain analysis is used as a main tool to investigate such issues as minimum detectable size of melanoma, filtering spectra from noise and from computational irregularities, as well as on how the FEM model meshing size and computational capabilities influence the accuracy of the results. Based on the aforementioned aspects, the analysis of the signals under the scrutiny of the phase velocity dispersion curve is verified to be a reliable, a sensitive, and a promising approach for detecting and characterizing melanoma in human skin.

Using Non-Invasive Multi-Spectral Imaging to Quantitatively Assess Tissue Vasculature

Energy Technology Data Exchange (ETDEWEB)

Vogel, A; Chernomordik, V; Riley, J; Hassan, M; Amyot, F; Dasgeb, B; Demos, S G; Pursley, R; Little, R; Yarchoan, R; Tao, Y; Gandjbakhche, A H

2007-10-04

This research describes a non-invasive, non-contact method used to quantitatively analyze the functional characteristics of tissue. Multi-spectral images collected at several near-infrared wavelengths are input into a mathematical optical skin model that considers the contributions from different analytes in the epidermis and dermis skin layers. Through a reconstruction algorithm, we can quantify the percent of blood in a given area of tissue and the fraction of that blood that is oxygenated. Imaging normal tissue confirms previously reported values for the percent of blood in tissue and the percent of blood that is oxygenated in tissue and surrounding vasculature, for the normal state and when ischemia is induced. This methodology has been applied to assess vascular Kaposi's sarcoma lesions and the surrounding tissue before and during experimental therapies. The multi-spectral imaging technique has been combined with laser Doppler imaging to gain additional information. Results indicate that these techniques are able to provide quantitative and functional information about tissue changes during experimental drug therapy and investigate progression of disease before changes are visibly apparent, suggesting a potential for them to be used as complementary imaging techniques to clinical assessment.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study

International Nuclear Information System (INIS)

Kaewlai, R.; Digumarthy, S.R.; Smith, B.L.; Corben, A.D.; Austen, W.G.; Shepard, J.-A.O.; Sharma, A.

2010-01-01

Aim: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. Materials and methods: Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. Results: There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). Conclusion: IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study

Energy Technology Data Exchange (ETDEWEB)

Kaewlai, R., E-mail: rathachai@gmail.co [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Digumarthy, S.R. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Smith, B.L. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Corben, A.D. [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Austen, W.G. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Shepard, J.-A.O.; Sharma, A. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

2010-06-15

Aim: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. Materials and methods: Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. Results: There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). Conclusion: IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.

A TRAM flap design refinement for use in delayed breast reconstruction.

LENUS (Irish Health Repository)

Patel, A J K

2009-09-01

Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author\\'s hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.

Prevalence of Methicillin Resistant Staphylococcus aureus in pyogenic community and hospital acquired skin and soft tissues infections

International Nuclear Information System (INIS)

Ahmad, M. K.; Asrar, A.

2014-01-01

Objective: To determine the percentage and frequency of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections. Methods: The descriptive cross-sectional study was conducted at the Dermatology Department of Combined Military Hospital, Abbottabad, from June 2009 to March 2010, and comprised 144 community-acquired and 54 hospital-acquired skin and soft tissue infections. Pus swabs from the infected lesions one from each individual were sent to laboratory for culture and sensitivity tests. Methicillin resistance was detected by 1 (mu) g oxacillin disk. Organisms were labelled methicillin-resistant once the inhibition zone for oxocillin was less than 10 mm. Data analysis was done by using SPSS 20. Results: Of the 198 patients in the study, 98(49.5%) were males and 100(50.5%) were females, with an overall mean age of 33.7+-14.8144 years. There were 144(72.72%) community-acquired infections and 54(27.27%) had hospital-acquired infections. Community-acquired Methicillin Resistant Staphylococcus aureus numbered 40(27.8%) and hospital-acquired ones numbered 26(48.1%). Conclusion: Prevalence of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections was high. (author)

Histological case-control study of peeling-induced skin changes by different peeling agents in surgically subcutaneous undermined skin flaps in facelift patients.

Science.gov (United States)

Gonser, P; Kaestner, S; Jaminet, P; Kaye, K

2017-11-01

A histological evaluation of peeling-induced skin changes in subcutaneous undermined preauricular facial skin flaps of nine patients was performed. There were three treatment groups: Trichloroacetic acid (TCA) 25%, TCA 40% and phenol/croton oil; one group served as control. Two independent evaluators determined the epidermal and dermal thickness and the depth of necrosis (micrometre). The percentual tissue damage due to the peeling was calculated, and a one-sample t-test for statistical significance was performed. On the basis of the histomorphological changes, peeling depth was classified as superficial, superficial-partial, deep-partial and full thickness chemical burn. The histological results revealed a progression of wound depth for different peeling agents without full thickness necrosis. TCA peels of up to 40% can be safely applied on subcutaneous undermined facial skin flaps without impairing the vascular patency, producing a predictable chemical burn, whereas deep peels such as phenol/croton oil peels should not be applied on subcutaneous undermined skin so as to not produce skin slough or necrosis by impairing vascular patency. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

International Nuclear Information System (INIS)

Reefy, Sara; Patani, Neill; Anderson, Anne; Burgoyne, Gwyne; Osman, Hisham; Mokbel, Kefah

2010-01-01

The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated. 137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), LD flap alone (n = 1) or implant alone (n = 51), for early BC (n = 130) or prophylaxis (n = 7). Nipple reconstruction was performed in 69 patients, using the trefoil local flap technique (n = 61), nipple sharing (n = 6), skin graft (n = 1) and Monocryl mesh (n = 1). Thirty patients underwent contra-lateral procedures to enhance symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. A linear visual analogue scale was used to assess patient satisfaction with surgical outcome, ranging from 0 (not satisfied) to 10 (most satisfied). After a median follow-up of 36 months (range = 6-101 months) there were no local recurrences. Overall breast cancer specific survival was 99.2%, 8 patients developed distant disease and 1 died of metastatic BC. There were no cases of partial or total LD flap loss. Morbidities included infection, requiring implant removal in 2 patients and 1 patient developed marginal ischaemia of the skin envelope. Chemotherapy was delayed in 1 patient due to infection. Significant capsule formation, requiring capsulotomy, was observed in 85% of patients who had either post-mastectomy radiotherapy (PMR) or prior radiotherapy (RT) compared with 13% for those who had not received RT. The outcome questionnaire was completed by 82 (64.6%) of 127 patients with a median satisfaction score of 9 (range = 5-10). SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin

Photon migration in non-scattering tissue and the effects on image reconstruction

Science.gov (United States)

Dehghani, H.; Delpy, D. T.; Arridge, S. R.

1999-12-01

Photon propagation in tissue can be calculated using the relationship described by the transport equation. For scattering tissue this relationship is often simplified and expressed in terms of the diffusion approximation. This approximation, however, is not valid for non-scattering regions, for example cerebrospinal fluid (CSF) below the skull. This study looks at the effects of a thin clear layer in a simple model representing the head and examines its effect on image reconstruction. Specifically, boundary photon intensities (total number of photons exiting at a point on the boundary due to a source input at another point on the boundary) are calculated using the transport equation and compared with data calculated using the diffusion approximation for both non-scattering and scattering regions. The effect of non-scattering regions on the calculated boundary photon intensities is presented together with the advantages and restrictions of the transport code used. Reconstructed images are then presented where the forward problem is solved using the transport equation for a simple two-dimensional system containing a non-scattering ring and the inverse problem is solved using the diffusion approximation to the transport equation.

Photon migration in non-scattering tissue and the effects on image reconstruction