Ultrastructural changes of vascular smooth muscle cells and resistance to vasospasm treatment in femoral arteries of an arteriosclerotic rat model.

The objective of this study was to establish an animal model of arteriosclerosis for assessing vasospasm and to investigate the relationship between arteriosclerosis and vasospasm. Twelve-week-old male Sprague-Dawley rats were fed a diet supplemented with adenine and vitamin D (adenine/vitD). Body weight, blood, and femoral artery histopathology were assessed at 2, 4, and 6 weeks. Change in the femoral artery was examined by transmission electron microscope (TEM). Vasospasm was induced by administering epinephrine extravascularly into the femoral artery and released by the treatment with lidocaine as a vasodilator. During this period, the extravascular diameter and blood flow were measured. The rats in the adenine/vitD group developed renal dysfunction, uremia, hyperphosphatemia, and elevated serum alkaline phosphatase. Histological and TEM analyses of the femoral arteries in the treated rats revealed the degeneration of elastic fibers and extensive calcification of the tunica media and intima. Vascular smooth muscles were degenerated and osteoblasts were developed, resulting in calcified arteriosclerosis. Vasospasm in arteriosclerotic arteries was detected; however, vasodilation as well as an increase in the blood flow was not observed. This study revealed the development of vasospasm in the femoral arteries of the arteriosclerotic rats and, a conventional vasodilator did not release the vasospasm.

Simple and efficient method for consecutive inactivation-cryopreservation of porcine skin grafts.

We previously reported that inactivation treatment by high hydrostatic pressurization (HHP) has potential utility as a novel skin regeneration therapy for various skin tumors. In this study, we evaluated whether glycerol-cryopreservation could be applied in order to preserve inactivated skin by HHP using a porcine model. Twenty full-thickness skin grafts (1.5 × 1.5 cm) were prepared from a minipig. The skin samples were inactivated by the HHP in normal saline or glycerol/fructose solution, followed by cryopreservation for 5 weeks at - 80 °C in each same solution. Another 10 grafts immediately after inactivation were prepared as non-cryopreserved controls. Nine grafts in each group were randomly implanted on the fascia of a host pig and removed at 1, 4 and 11 weeks after grafting. All grafts showed engraftment macroscopically. Hematoxylin eosin staining showed the cellular components in all areas of the dermis at 4 and 11 weeks after grafting, and immunohistochemical staining for CD31 showed the presence of capillaries in the grafts in all groups. The surface and cross-sectional areas of grafts in the normal saline solution cryopreserved group decreased between 1 and 11 weeks, whereas these areas in the glycerol cryopreserved group did not decrease significantly. Glycerol cryopreservation may therefore be a simple and efficient method for preserving porcine skin inactivated by HHP.

Efficacy of Gelatin Hydrogel Impregnated With Concentrated Platelet Lysate in Murine Wound Healing.

BACKGROUND: The efficacy of a gelatin hydrogel (GH) sheet impregnated with platelet-rich plasma in full-thickness wound healing has been reported. Human platelet lysate is another potential natural product for use in wound healing. The present study examined the effects of a GH sheet impregnated with concentrated freeze-dried platelet lysate on wound healing after storage for 9 mo. MATERIALS AND METHODS: Platelet concentrates were subjected to three freeze-thaw cycles and freeze-dried then preserved at 4°C. Reconstitution with saline was then performed to produce 1-fold (hPL1), 2-fold (hPL2), and 3-fold (hPL3) concentrations of preserved platelet lysate. Full-thickness wounds were made on the back of male C57Bl6J/Jcl mice. Wounds were treated with saline, hPL1, or a GH sheet impregnated with saline, hPL1, hPL2, or hPL3. Histologic examinations using hematoxylin-eosin, Azan, and anti-CD31 staining were performed on days 4, 7, and 14 to assess neoepithelialization and granulation tissue and capillary formation. RESULTS: This study showed that the GH sheet itself or the simple administration of hPL1 did not accelerate the healing process. However, the GH sheet impregnated with hPL1 accelerated the granulation tissue formation to some extent, and the GH sheet impregnated with hPL2 or hPL3 clearly accelerated the capillary formation and the granulation tissue formation. In addition, the GH sheet impregnated with hPL3 had the longest epithelium formation. CONCLUSIONS: A GH sheet impregnated with long-term preserved 2-fold or 3-fold concentrated platelet lysate enhances the wound healing process.

A case report of the first application of culture epithelial autograft (JACE®) for giant congenital melanocytic nevus after its approval in Japan.

In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for use in the treatment of giant congenital melanocytic nevus (GCMN) in 2016. We herein report the results of the application of JACE® after curettage and Q-switched ruby laser therapy. The current patient was the first patient with GCMN to be treated with JACE® since its approval. A 3-month-old girl had a hairy GCMN of 9.5 cm in diameter from her cheek to her temple on the left side of her face. We first performed curettage of the nevus on the temple and applied irradiation using a Q-switched ruby laser; however, erosion relapsed at 2 months after first surgery. After preparing JACE®, we performed curettage a second time at 7 months with irradiation of a Q-switched ruby laser and the application of the CEA. The CEA took successfully and the wound was completely epithelized at 1 week after grafting. Re-pigmentation is an important issue that remains to be solved; however, overcoming this would allow for a deeper abrasion or more intense laser irradiation to be performed in cases in which CEA will be subsequently applied.

Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems.

Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. It holds promise for clinical use in areas such as wound healing and regenerative medicine, including bone regeneration. This study characterized the composition of PRP produced by seven commercially available separation systems (JP200, GLO PRP, Magellan Autologous Platelet Separator System, KYOCERA Medical PRP Kit, SELPHYL, MyCells, and Dr. Shin's System THROMBO KIT) to evaluate the platelet, white blood cell, red blood cell, and growth factor concentrations, as well as platelet-derived growth factor-AB (PDGF-AB), transforming growth factor beta-1 (TGF-ß1), and vascular endothelial growth factor (VEGF) concentrations. PRP prepared using the Magellan Autologous Platelet Separator System and the KYOCERA Medical PRP Kit contained the highest platelet concentrations. The mean PDGF-AB concentration of activated PRP was the highest from JP200, followed by the KYOCERA Medical PRP Kit, Magellan Autologous Platelet Separator System, MyCells, and GLO PRP. TGF-ß1 and VEGF concentrations varied greatly among individual samples, and there was almost no significant difference among the different systems, unlike for PDGF. The SELPHYL system produced PRP with low concentrations of both platelets and growth factors. Commercial PRP separation systems vary widely, and familiarity with their individual advantages is important to extend their clinical application to a wide variety of conditions.

En bloc resection of a large bilateral vulvar lipoma through a caesarean scar: A case report.

Large bilateral symmetrical vulvar tumors are rare. A 30-year-old multiparous Asian woman presented with severe discomfort during urination and intercourse owing to a large bilateral symmetrical lipoma in the labia majora. En bloc resection through a pre-existing Caesarean scar achieved good cosmetic and symptomatic results. This alternative and unique approach may be helpful in similar rare cases.

Activation of cell adhesion and migration is an early event of platelet-rich plasma (PRP)-dependent stimulation of human adipose-derived stem/stromal cells.

Stem cell therapy is a promising treatment in regenerative medicine. Human adipose-derived stem/stromal cells (hASCs), a type of mesenchymal stem cell, are easy to harvest. In plastic and aesthetic surgery, hASC may be applied in the treatment of fat grafting, wound healing, and scar remodeling. Platelet-rich plasma (PRP) contains various growth factors, including platelet-derived growth factor (PDGF), which accelerates wound healing. We previously reported that PRP promotes the proliferation of hASC via multiple signaling pathways, and we evaluated the effect of PRP on the stimulation of hASC adhesion and migration, leading to the proliferation of these cells. When hASCs were treated with PRP, AKT, ERK1/2, paxillin and RhoA were rapidly activated. PRP treatment led to the formation of F-actin stress fibers. Strong signals for integrin ß1, paxillin and RhoA at the cell periphery of RPR-treated cells indicated focal adhesion. PRP promoted cell adhesion and movement of hASC, compared with the control group. Imatinib, an inhibitor of the PDGF receptor tyrosine kinase, inhibited the promotion of PRP-dependent cell migration. PDGF treatment of hASCs also stimulated cell adhesion and migration but to a lesser extent than PRP treatment. PRP promoted the adhesion and the migration of hASC, mediated by the activation of AKT in the integrin signaling pathway. PRP treatment was more effective than PDGF treatment in enhancing cell migration. Thus, the ability of PRPs to promote migration of hASC to enhance cell growth is evident.

A novel intervention for wound bed preparation in severe extremity trauma: Highly concentrated carbon dioxide bathing.

Introduction: In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and Methods: The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. Results: We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. Conclusions: Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.

Twenty-minute harvesting of flow-through type vastus lateralis muscle flap significantly reduces the need for a temporary intravascular shunt in the treatment of severe upper extremity trauma in civilian patients.

For the reconstruction of severe upper extremity trauma involving arterial injury in civilian patients, it is generally recommended that the revascularization time be shortened using a temporary intravascular shunt (TIVS). However, if a flow-through type vastus lateralis muscle (VLm) flap can be harvested in 20 minutes and bypassed at the obstructed ischemic zone within 30 minutes, blood flow can be restored as quickly or more quickly than when using a TIVS, eliminating the need for a TIVS. This procedure was applied in the reconstruction of 3 cases of severe extremity trauma with vascular injury. The mean age was 69.7 years. Surgery was started an average of 2.93 hours from the onset. The average flap harvest time was 0.33 hours. The average time to revascularization from flap harvest was 1.33 hours, the average total operation time was 6.43 hours, and all upper extremities were salvaged. No cases showed ischemia-reperfusion injury or severe muscle contracture. The flow-through-type VLm flap can be applicable as a bypass graft for a 20 cm defect at any region distal to the elbow. In addition, harvesting the flap attached to blood-rich muscle not only controls the infection of contaminated wounds through the filling of dead space, but also has the potential to replace damaged muscle or tendon tissue. Even though TIVS placement is currently used extensively in this field of treatment, its role could be significantly reduced if a flow-through-type VLm flap can be harvested within 20 minutes.

Functional and cosmetic reconstruction of palmar heat press injury following wound bed preparation combined with artificial highly concentrated carbon dioxide bathing: A case report.

Background: The effect of artificial highly concentrated carbon dioxide bathing on heat-press-injured wounds has been clinically observed. Case presentation: A 46-year-old male patient with a heat press injury of the right palmar region achieved complete necrotic tissue removal and sufficient granulation of the skin graft by continuous hand bathing in a solution containing highly concentrated carbon dioxide for four weeks. The patient successfully underwent a full-thickness skin graft from the plantar to the palmar region, and his right hand function improved to the extent that it did not interfere with daily life. Conclusions: Heat press injuries are often refractory to treatment owing to the synergistic effects of heat and crush injuries. Highly concentrated carbon dioxide bathing has long been known to increase skin and muscle blood flow, and its clinical applications in ischemic limbs, skin ulcers, and osteomyelitis have already been reported. In this case, the results suggest an effect of improved blood flow leading to maturation of the graft bed at the heat-press injury site. Lay Summary: Highly concentrated carbon dioxide bathing is not only clinically applicable to ischemic extremities, skin ulcers, and osteomyelitis, due to increased cutaneous and muscular blood flow, but also to the reliable debridement of heat press injury wounds and the granulation of graft beds. We successfully used this novel combination of procedures to establish a graft bed with a good blood flow despite the deep heat press injury occurring in the palmar region, leading to an excellent functional recovery. The cost per procedure is low, at about $1(USD), making it a wound care option that should be considered from a healthcare economic perspective.

Beneficial Impact of "Supercharged" Pectoralis Major Musculocutaneous Flap With Indocyanine Green Angiography on Reconstruction in a Patient at High Risk for Necrosis.

Background: The pectoralis major musculocutaneous (PMMC) flap is a versatile and commonly used technique for reconstruction of the head and neck in patients at high risk in free tissue transfer procedures. In this report, a "supercharged" PMMC flap, in which the lateral thoracic artery was cut, preserved, and anastomosed to the cervical vessels, was developed to stabilize blood flow. Methods: The supercharged PMMC flap was introduced in a patient who was at high risk for partial necrosis of the flap and underwent surgery for reconstruction of the tongue. Intraoperative perfusion monitoring using laser-assisted indocyanine green angiography (ICGA) was also performed to verify the status of blood flow in the flap. Results: ICGA monitoring of blood flow in the flap revealed instability. Subsequently, a supercharged PMMC flap was applied, which prevented partial necrosis of the flap. Conclusions: Combined with ICGA, a supercharged PMMC flap contributed to successful reconstruction in a patient at high risk for necrosis of the flap region.

Exercise significantly increases plasma adrenaline and oxidized low-density lipoprotein in normal healthy subjects but not in persons with spinal cord injury.

OBJECTIVES: To compare plasma concentrations of oxidized low-density lipoprotein (oxLDL) and adrenaline during exercise between persons with spinal cord injury (SCI) and able-bodied (AB) individuals. DESIGN: Randomized controlled study. SETTING: Human laboratory at a medical university. PARTICIPANTS: Persons with SCI (n=7) and AB individuals (n=9). INTERVENTION: Two-hour arm crank ergometer exercise at 60% maximum oxygen consumption. MAIN OUTCOME MEASURES: Plasma oxLDL and adrenaline levels. RESULTS: Exercise significantly increased plasma adrenaline levels in AB persons (mean ± SD: rest, 45.4±32.2 pg/mL; exercise, 200.9±113.7 pg/mL; P<.05) and persons with SCI; however; the magnitude of the increase in those with SCI was attenuated (mean ± SD: rest, 45.4±14.0 pg/mL; exercise, 83.0±55.8 pg/mL; P<.05). Exercise also significantly increased plasma oxLDL levels in AB persons (mean ± SD: rest, 102.2±30.2 U/L; exercise, 179.7±60.0 U/L; P<.05), but not in persons with SCI (mean ± SD: rest, 124.3±66.0 U/L; exercise, 138.9±59.5 U/L). CONCLUSIONS: The results suggest that increases in plasma adrenaline levels during exercise contribute to the increase in plasma oxLDL levels.

Functional Reconstruction for Severe Heat Press Injury of the Proper Digits Using Immediate Preserved Subdermal Vascular Network Skin Graft: A Case Report.

The patient was a 57-year-old woman who suffered third-degree burns to the dorsal side of her left fingers (non-dominant hand) when it was caught in a press machine heated to 200°C while she was cleaning clothes. At 20 hours after the injury, the necrotic tissue was excised and covered with a preserved subdermal vascular network (PSVN) skin graft, which allowed the patient to regain a very good hand function. Even for severe heat press injuries of the hand, the combination of immediate surgical intervention, a thick skin graft with PSVN, and early rehabilitation from the first postoperative week leads to good functional and cosmetic reconstruction outcomes.

The anatomic classification of the anophthalmic eye socket (Types 0-V): A high-level taxonomy classification system.

Eyelid and orbital deformities caused by various defects, such as tumor resection and trauma, whether congenital or acquired, are extremely complex and atypical. Several classifications systems for these anophthalmic conditions have been developed, but none have proven suitable for determining the ideal reconstructive surgical strategy. We therefore designed a novel system known as the Anatomic Classification of the Anophthalmic Eye Socket (Types 0-V) for optimum reconstruction of anophthalmic socket deformities focusing on eyelid and orbital defects. Type 0 is an eyelid defect type, in which only the eyelid is defective; Type I is a phthisis bulbi type, in which the anatomical eyeball is preserved, but the visual function is lost; Type II is a substitution type involving filling with implant packing after evisceration or enucleation; Type III is an enucleation type involving enucleation of the ophthalmus; Type IV is an exenteration (incomplete) type involving exenteration while saving the eyelids; and Type V is an exenteration (complete) type involving exenteration including eyelid defects. Using this classification system, it will be possible to standardize reconstructive procedures of the anophthalmic socket.

Giant sebaceous nevus occupying half of the head associated with sebaceous carcinoma, apocrine adenocarcinoma, and basal cell carcinoma: A case report.

We herein report a 57-year-old man afflicted with multiple malignant tumors arising from a giant sebaceous nevus on his left parieto-temporal scalp and neck. The upper eyelid was resected in all layers, and the auricle was resected as well, leaving part of the external auricular cartilage; the parotid gland area was also resected over the parotid fascia. The lost part of the left eyebrow was reconstructed using an anterior forehead skin flap, and the residual defect was covered with skin graft and expanded scalp flap. This is probably the first case report of giant sebaceous nevus associated with three malignancies: sebaceous carcinoma, apocrine adenocarcinoma, and basal cell carcinoma.

Reduction and fixation of comminuted fractures of the midface by using a Hoffman-type external fixator: A case report.

Internal fixation using plates remains the gold standard for facial fracture fixation. External wound fixators are rarely used. In the present study, we successfully treated multiple comminuted facial fractures with midfacial depressions by using a Hoffman-type external fixator and achieved good functional and cosmetic results. Internal fixation using plates is sometimes problematic in comminuted facial fractures, such as those associated with high-energy trauma. Depending on the fracture pattern, a Hoffman-type external fixator, which is a single pillar type of external fixator, can be effective.

A stylized two-stage debridement strategy using an electric dermatome and a Versajet™ hydrosurgery system for deep axillary burns.

Treatment of axillary contracture after extensive deep burns is a serious clinical challenge. Various surgical intervention for releasing contracture using skin grafts, flaps and artificial skin have been used, but no consensus on the optimal treatment has been obtained. A standardized two-stage debridement strategy using an electric dermatome (for eschar) and the Versajet™ hydrosurgery system (for slough) can be an appropriate debridement strategy that provides reliable wound bed preparation in cases of for axillary deep burns. Using this approach focus on management of acute axillary burns, it is possible to avoid engraftment failure and prevent contracture caused by prolonged infection. This treatment strategy can be standardized and can be performed easily, even by non-experts.

Osteolytic metatarsal osteomyelitis regenerated by combined treatment of artificial carbon dioxide foot bathing and povidone-iodine sugar ointment: a case report.

BACKGROUND: In recent years, the number of patients with ischemic skin ulcers due to diabetes mellitus and arteriosclerosis obliterans are increasing. Accordingly, endovascular therapy, drugs, and various wound dressings have been developed and applied to diabetic foot ulcers, and negative-pressure wound therapy, which often requires expensive and burdensome procedures for medical personnel, has also become popular. So simple and minimal invasive home treatment by the patient or their caregiver is required. CASE PRESENTATION: The present patient (77 years old, male, Asian) had developed left sole ulcers with draining pus that were resistant to conventional treatment, and he suffered from gait disturbance. We report a case of metatarsal osteomyelitis in a patient with diabetes mellitus and arteriosclerosis obliterans, in whom artificial carbon dioxide foot bathing and povidone-iodine sugar ointment were used continuously to promote bone and joint regeneration, and skin ulcer healing. CONCLUSIONS: A simple therapeutic intervention with artificial carbon dioxide foot bathing and povidone-iodine sugar ointment can improve not only ischemic skin ulcers, but also the bone and joint regeneration of ischemic limbs. This therapy can lead to a reduction in healthcare costs for a huge number of diabetic patients.

A novel technique for forehead and eyebrow reconstruction using a temporal hairline flap combined with a free forearm flap: a report of two cases.

We herein report a novel technique for managing large forehead skin defects that include the eyebrows and upper eyelid. Case 1 was of a 55-year-old woman with an eccrine carcinoma (T2N0M0) at the right forehead, resulting in a skin defect 15 cm in diameter. Case 2 was of an 81-year-old man with a malignant peripheral nerve sheath tumor (T1a N0M0) at the left forehead, resulting in a skin defect 18 cm in diameter. A pedicled temporal hairline flap and free forearm flap were combined and placed on the defect, and good eyebrows and forehead morphology was ultimately achieved.

Reconstruction of extra-large severe punching hole injury in the palm: A case report.

A 48-year-old man sustained a severe punching hole injury of 8 cm in diameter on the palm of his left hand using a punching instrument (for making the bottom of drink cans), and his middle and ring fingers were almost amputated. A flow-through type immediate ALT (anterolateral thigh) flap was used to bypass the distal blood flow and a titanium plate for mandibular reconstruction and plantar glabrous skin were used to preserve the floating amputated fingers. As there has been no report of reconstruction of a punching hole in the palmar region that exceeds 8 cm in diameter, this report is novel and educational.