Comparison of vertical and extended vertical rectus abdominis myocutaneous flaps. An anatomical study.

The extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap could be insufficient. To compare the dimensions of VRAM and eVRAM flaps an anatomical study was performed. Ten VRAM and ten eVRAM flaps were dissected in ten fresh adult cadavers. Length, width and volume of all the flaps were measured. Length and volume were significantly larger in eVRAM flap compared to VRAM flap (36.55 cm vs. 30.15, p=.005; and 315.5 vs. 244 mL, p=.012, respectively). No differences were observed in flap width. The eVRAM flap could be a better option than traditional VRAM for reconstruction of big pelviperineal defects when bulkier tissue, larger skin paddle and/or longer arch of rotation are needed for reconstruction.

Increased Expression of Galectin-3 in Skin Fibrosis: Evidence from In Vitro and In Vivo Studies.

Skin fibrosis is a hallmark of a wide array of dermatological diseases which can greatly impact the patients' quality of life. Galectin-3 (GAL-3) has emerged as a central regulator of tissue fibrosis, playing an important pro-fibrotic role in numerous organs. Various studies are highlighting its importance as a skin fibrotic diseases biomarker; however, there is a need for further studies that clarify its role. This paper aims to ascertain whether the expression of GAL-3 is increased in relevant in vitro and in vivo models of skin fibrosis. We studied the role of GAL-3 in vitro using normal human dermal fibroblasts (NHDF) and fibrocytes. In addition, we used a skin fibrosis murine model (BALB/c mice) and human biopsies of healthy or keloid tissue. GAL-3 expression was analyzed using real time PCR, Western blot and immunostaining techniques. We report a significantly increased expression of GAL-3 in NHDF and fibrocytes cell cultures following stimulation with transforming growth factor ß1 (TGFß1). In vivo, GAL-3 expression was increased in a murine model of systemic sclerosis and in human keloid biopsies. In sum, this study underlines the involvement of GAL-3 in skin fibrosis using several models of the disease and highlights its role as a relevant target.

Using a V-Y Advance Flap for Alar Rim Defect After Human Bite: A Case Report.

A human bite is a traumatic injury that often occurs in the recipient's nasal area. In this report, we describe the case of a 38-year-old man who was bitten by his roommate and sustained an alar rim defect. After reviewing the literature and professional recommendations for managing human bite wounds in the nasal area, we found both were unclear as to whether it is best to implement primary reconstruction or to defer reconstruction to a later date. We utilized a V-Y flap for secondary reconstruction in our patient.

Using Free Arterialized Venous Flaps for Reconstructing Hand Defects.

Hand and digit soft tissue defects are quite common and frequently require specialized reconstruction. When local flaps cannot be used to reconstruct a soft tissue defect, free flaps must be utilized. To overcome tissue volume and discrepancies in vessel diameter, arterialized venous free flaps from the forearm may provide an acceptable alternative. When using arterialized venous free flaps, surgeons should implement shunt restriction procedures to enhance flap viability.

Soft-Tissue Sarcoma as a Potential Differential Diagnosis of an Exophytic Soft-Tissue Mass: A Case Report.

The detection of a soft-tissue mass requires a detailed and conscientious examination to make a definitive diagnosis and propose appropriate treatment strategies. Benign mesenchymal tumors occur more frequently than malignant tumors. However, because of their aggressive growth and poor prognosis, sarcomas must always be considered as a potential differential diagnosis. To make a formal diagnosis and plan appropriate surgical treatment, the surgeon should obtain cross-sectional imaging studies and biopsies.

Atypical Presentation of a Marjolin Ulcer After a Burn: A Case Report.

The development of a nonhealing ulcer on a chronic wound or scar should raise suspicions of the plastic surgeon or nurse regarding the potential for malignant degeneration to a Marjolin ulcer. Occasionally, a Marjolin ulcer may present as exophytic granulation tissue within a scar. Most Marjolin ulcers are well-differentiated injuries; however, because of their aggressive nature and poor prognosis, to ensure surgical success, diagnosis of Marjolin ulcer should be confirmed and treatment initiated as soon as possible.

Use of Amniotic Membrane as a Biological Dressing for the Treatment of Torpid Venous Ulcers: A Case Report.

Chronic venous disease manifested as ulcers in the lower limb is a highly prevalent pathology in our population. Antiseptics and dressings designed to improve epithelialization are often used to cure the ulcer during outpatient therapy. Despite careful management, sometimes ulcers do not respond to treatment. In this report, we discuss the antiseptic and potentially immunomodulatory effects of the amniotic membrane as a biological dressing for the treatment of venous ulcers refractory to conventional therapy.

Contact allergy to isothiazolinones epidemic: Current situation.

BACKGROUND: Since 2009, an increasing number of published cases of allergic contact dermatitis (ACD) from isothiazolinones in Europe was observed, amounting to an epidemic. However, only few studies have assessed the current situation after changes in European regulation. OBJECTIVES: To analyze the incidence of isothiazolinone-related ACD in our area in the last decade. METHODS: A retrospective study analyzed all patients patch tested in the allergy unit in a tertiary hospital in Spain between January 2010 and June 2019. Positive patch-test reactions to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and/or MI alone were recorded. RESULTS: A total of 243 patients (9.55%) with positive patch-test reactions to MCI/MI and/or MI alone among 2544 consecutively patch-tested patients were recorded. An initial increase in the prevalence of MCI/MI allergy was observed, from 4.5% in 2010 reaching a peak in 2015, which was followed by a significant decrease until July 2019 with 3.1% prevalence in 2019. CONCLUSIONS: As shown in our data, regulatory interventions have resulted in a dramatic decrease in the prevalence of MCI and MI ACD, reaching a pre-epidemic level of 3.1% in 2019.

Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: A cross-sectional cohort study.

BACKGROUND/OBJECTIVES: Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. METHODS: Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). RESULTS: A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. CONCLUSIONS: Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.