Hyperbaric oxygen treatment in bilateral orchiopexy and post-circumcision haematoma in a thrombocytopenic patient with Noonan syndrome.

Hyperbaric oxygen treatment (HBOT) can be utilised for necrotising soft tissue infections, clostridial myonecrosis (gas gangrene), crush injuries, acute traumatic ischaemia, delayed wound healing, and compromised skin grafts. Our case was a 17-month-old male patient with Noonan syndrome, idiopathic thrombocytopenic purpura, and bilateral undescended testicles. Haematoma and oedema developed in the scrotum and penis the day after bilateral orchiopexy and circumcision. Ischaemic appearances were observed on the penile and scrotal skin on the second postoperative day. Enoxaparin sodium and fresh frozen plasma were started on the recommendation of haematology. Hyperbaric oxygen treatment was initiated considering the possibility of tissue necrosis. We observed rapid healing within five days. We present this case to emphasise that HBOT may be considered as an additional treatment option in patients with similar conditions. To our knowledge, no similar cases have been reported in the literature.

The effects of combined application of autogenous fibroblast cell culture and full-tissue skin graft (FTSG) on wound healing and contraction in full-thickness tissue defects.

INTRODUCTION: This study investigates the effects of culture grown fibroblasts on contraction and dermal regeneration when used concurrently with full-thickness skin graft (FTSG) in full-thickness wounds. MATERIALS AND METHODS: Fourteen Sprague-Dawley male rats were divided into two groups. In the first group, wound contraction was evaluated visually. Two full thickness tissue defects were produced on the back of the seven rats. The skin harvested from these areas was prepared as a full-thickness graft and sutured back to their original beds. Just before the last suture, autogenous fibroblast suspension was applied between the graft and the bed in area 1, and area 2 served as control. The surface area of grafts were calculated and compared with "Image J" program. In the second group, contraction and dermal regeneration were evaluated histologically. Three full-thickness tissue defects were produced on the back of seven rats. Area 1 and 2 were prepared as described above and area 3 was left to secondary healing. On the 14th and 30th days, punch biopsies were harvested from the center of the areas 1-3. Preparations were examined under light microscopy. RESULTS: Wound contraction was significantly less in area 1 on day 14 (p<0.01). Histologically neovascularization, fibroblast density and collagen synthesis were more evident in cultured fibroblast applied areas on day 14. However epithelialization did not show any difference between areas both on days 14 and 30. On day 30, area 1 still a higher degree of fibroblast intensity than the other areas but neovascularization and collagen synthesis were not different than the other areas. CONCLUSION: According to the data obtained from the study, cultured fibroblasts, particularly with a dermal support, do not regress when transplanted to a living tissue. They contribute to the wound healing process; reduce the contraction of the wound; and support collagen synthesis and neovascularization.