Novel Application of Cultured Epithelial Autografts (CEA) with Expanded Mesh Skin Grafting Over an Artificial Dermis or Dermal Wound Bed Preparation.

Cultured epithelial autografts (CEA) with highly expanded mesh skin grafts were used for extensive adult burns covering more than 30% of the total body surface area. A prospective study on eight patients assessed subjective and objective findings up to a 12-month follow-up. The results of wound healing for over 1:6 mesh plus CEA, gap 1:6 mesh plus CEA, and 1:3 mesh were compared at 3, 6, and 12 months using extensibility, viscoelasticity, color, and transepidermal water loss by a generalized estimating equation (GEE) or generalized linear mixed model (GLMM). No significant differences were observed among the paired treatments at any time point. At 6 and 12 months, over 1:6 mesh plus CEA achieved significantly better expert evaluation scores by the Vancouver and Manchester Scar Scales (p < 0.01). Extended skin grafting plus CEA minimizes donor resources and the quality of scars is equal or similar to that with conventional low extended mesh slit-thickness skin grafting such as 1:3 mesh. A longitudinal analysis of scars may further clarify the molecular changes of scar formation and pathogenesis.

Pseudoaneurysm and Arteriovenous Fistula in the Radial Artery after Cardiac Catheterization: A Case Report.

We report the case of a 71-year-old man who was experiencing a gradually worsening, dull pain and a cold sensation in his right hand. Three months earlier, he underwent a percutaneous coronary intervention for angina pectoris using a transradial approach in his right wrist and developed an arteriovenous fistula (AVF), a complication of percutaneous coronary intervention. Ultrasonography and computed tomography revealed a pseudoaneurysm and an AVF that were reducing the blood flow in his right hand. We observed that the pseudoaneurysm and the AVF were close to the bifurcation of the superficial palmar artery (SPA) and that the superficial palmar arch had radial artery superiority. Because we thought it was important to maintain the blood flow of the SPA branch, we excised the pseudoaneurysm, sutured the artery directly via microsurgery, and ligated the arteriovenous shunt. After the operation, the patient's symptoms were alleviated. Computed tomography showed that the blood flow in his right hand was improved and that his right SPA branch from the radial artery was directly fed to the index finger. Because the blood circulation in the hand is dual dominant but with many anatomical variations, we believe that it is important to preserve the blood flow of the SPA in postcatheterization pseudoaneurysm and AVF repair.

Necrotising fasciitis and myositis that originated from gastrointestinal bacterial infection: two fatal cases.

We present two cases of aggressive myofasciitis after gastrointestinal infections. The first patient developed necrosis of the legs over 5 days and he died on the 20th day. Vibrio vulnificus was cultured. The second patient developed bullae on his thigh and he died the next day. Streptococcus pyogenes was cultured.