Multifaceted role of hair follicle dermal cells in bioengineered skins.

BACKGROUND: The method of generating bioengineered skin constructs was pioneered several decades ago; nowadays these constructs are used regularly for the treatment of severe burns and nonhealing wounds. Commonly, these constructs are comprised of skin fibroblasts within a collagen scaffold, forming the skin dermis, and stratified keratinocytes overlying this, forming the skin epidermis. In the past decade there has been a surge of interest in bioengineered skins, with researchers seeking alternative cell sources, or scaffolds, from which constructs can be established, and for more biomimetic equivalents with skin appendages. OBJECTIVES: To evaluate whether human hair follicle dermal cells can act as an alternative cell source for engineering the dermal component of engineered skin constructs. METHODS: We established in vitro skin constructs by incorporating into the collagenous dermal compartment: (i) primary interfollicular dermal fibroblasts, (ii) hair follicle dermal papilla cells or (iii) hair follicle dermal sheath cells. In vivo skins were established by mixing dermal cells and keratinocytes in chambers on top of immunologically compromised mice. RESULTS: All fibroblast subtypes were capable of supporting growth of overlying epithelial cells, both in vitro and in vivo. However, we found hair follicle dermal sheath cells to be superior to fibroblasts in their capacity to influence the establishment of a basal lamina. CONCLUSIONS: Human hair follicle dermal cells can be readily interchanged with interfollicular fibroblasts and used as an alternative cell source for establishing the dermal component of engineered skin both in vitro and in vivo.

Erythromycin sclerotherapy in the management of seroma.

Post-operative seroma can present the clinician and patient with a chronic and difficult problem. The authors present their experience of managing refractory seroma with the antibiotic erythromycin, administered for its properties as a sclerosant. The technique was found, in a series of patients, to be effective, simple and without serious complications.

Inguinal lymphadenectomy combined with staging endoscopic pelvic node sampling for stage III melanoma.

Elective pelvic lymphadenectomy is one of the enduring controversies in the management of Stage III melanoma of the groin. It can provide valuable staging information but concerns remain over the possibility of increased morbidity without the benefit of increased survival. Endoscopic lymphadenectomy of the pelvic nodes is an established procedure in the management of urological and gynaecological malignancy but is relatively novel in the management of metastatic melanoma. An endoscopic approach reduces the risks suggested to be associated with the open procedure while still providing the clinician with the benefit of improved staging information. The authors present their experience of a combined procedure in a series of eight patients undertaken between January 2005 and May 2006 at the Exeter Melanoma Unit. One patient was discovered to harbour occult pelvic nodal metastases, despite a negative pre-operative CT scan. While no complications were directly attributable to the endoscopic procedure, the only major complication was post-operative lymphoedema which occurred in one case. The authors' experience suggests a combined procedure is both feasible and safe in the Plastic Surgery Department setting for the management of Stage III melanoma of the groin. This is the first documented UK experience of this technique.

Nodal metastatic melanoma in the neck of a 4-year-old girl after diagnosis of Spitz nevus of the cheek.

A 4-year-old girl was referred to the plastic surgery unit with metastatic malignant melanoma diagnosed in a cervical lymph node. She had previously undergone excision of a Spitz nevus of the cheek at age 18 months. The management of this patient is discussed along with a review of the literature relating to Spitz nevi and malignant melanoma in childhood.