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Silver nanoparticle dressings have gained popularity recently as a way to treat challenging wounds. Notwithstanding the properties of Ag-NPS (silver nanoparticles) described by several articles, there is a lack of clinical studies that guide healthcare professionals to specific and conscious use. In this case series, Ag-NPS dressing was tested on a randomized group of 10 patients with complex wounds requiring conservative treatment. Each case was analysed, recording the patient's history, the peculiar characteristics and the progressive changes in the wound. The wound bed and the quality of the peri-wound skin improved and a decrease in signs of infection was observed. The application of the dressing was simple and comfortable for the patient and it was appreciated for its sealing ability. A few capacity restrictions showed up: those should be read as elements to improve the indications for this peculiar dressing. The thin tissue matrix of the Ag-NPS dressing does not allow for massive absorption and also performs poorly in reducing little exudate. The reduction in wound width is also limited: reconstructive surgery was required in half of the enrolled patients to achieve wound healing.
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Queimaduras , Nanopartículas Metálicas , Prata , Humanos , Bandagens , Queimaduras/tratamento farmacológico , Nanopartículas Metálicas/uso terapêutico , Prata/uso terapêutico , CicatrizaçãoRESUMO
Monocyte chemoattractant protein-1 (MCP1) is one of the most powerful pro-inflammatory chemokines. However, its signaling is pivotal in driving injured axon and muscle regeneration. We previously reported that MCP1 is more strongly upregulated in the nervous system of slow-progressing than fast-progressing SOD1G93A mice, the latter showing a poor immune response and eventual massive nerve and muscle degeneration. To assess the MCP1-mediated therapeutic role, we boosted the chemokine along the motor unit of the two SOD1G93A models through a single intramuscular injection of a scAAV9 vector engineered with the Mcp1 gene. We provided direct evidence underlying the pivotal role of the immune response in driving skeletal muscle regeneration and thus the speed of ALS progression. The comparative study performed in fast- and slow-progressing SOD1G93A mice spotlights the nature and temporal activation of the inflammatory response as limiting factors to preserve the periphery and interfere with the disease course. In addition, we recorded a novel pleiotropic role of MCP1 in promoting peripheral axon regeneration and modulating neuroinflammation, ultimately preventing neurodegeneration. Altogether, these observations highlight the immune response as a key determinant for disease variability and proffer a reasonable explanation for the failure of systemic immunomodulatory treatments, suggesting new potential strategies to hamper ALS progression.
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Esclerose Lateral Amiotrófica , Esclerose Lateral Amiotrófica/genética , Esclerose Lateral Amiotrófica/terapia , Animais , Axônios , Modelos Animais de Doenças , Imunidade , Camundongos , Camundongos Transgênicos , Músculo Esquelético , Regeneração Nervosa , Superóxido Dismutase/genética , Superóxido Dismutase-1/genéticaRESUMO
Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.
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Coinfecção , Intertrigo , Dermatopatias , Humanos , Adulto , Coinfecção/complicações , Intertrigo/diagnóstico , Intertrigo/etiologia , Intertrigo/terapia , Pele , Higiene da PeleRESUMO
BACKGROUND: Due to the high demand of post-bariatric surgeries, the number of litigation cases is rapidly growing. Even if surgical mistakes still represent one of the main causes of medico-legal issues, many disputes depend on what happens in the post-operative course. In this article we analyzed the litigation cases that occurred in our Plastic Surgery Department, the current literature about medico-legal disputes and the importance of the doctor-patient relationship. PATIENTS AND METHODS: The medical records of 788 post-bariatric surgeries, the post-operative complications and the related litigation cases from January 2015 to December 2019 were collected, analyzed and compared. RESULTS: We performed 380 abdominoplasties, 28 torsoplasties, 65 breast reductions, 99 mastopexies, 94 brachioplasties, 52 thighplasties, 65 liposuctions and 5 facelifts between 2015 and 2019. Eight patients complained of medical issues and claimed for litigation. Despite in all cases the judges highlighted the risk of consent misinterpretation, the payout was granted only in one case. CONCLUSION: Post-bariatric patients often mistake their preoperative condition and consider body contouring procedures as an aesthetic surgery treatment. Patients should be therefore clearly informed about the complexity of body contouring procedures after massive weight loss, which should never be compared to aesthetic surgery. Surgeons should always promote the communication with their patients and build a strong and trustworthy relationship. This attitude will allow to deal more easily with complications and, in the worst situations, with medico-legal litigations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abdominoplastia , Cirurgia Bariátrica , Contorno Corporal , Lipectomia , Cirurgia Plástica , Humanos , Relações Médico-Paciente , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Abdominoplastia/métodos , Contorno Corporal/métodosRESUMO
BACKGROUND: Due to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty. PATIENTS AND METHODS: 26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated. RESULTS: None of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery. CONCLUSION: The piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Cirurgia Bariátrica , Bariatria , Tratamento de Ferimentos com Pressão Negativa , Obesidade Mórbida , Cirurgia Bariátrica/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Obesidade Mórbida/cirurgiaRESUMO
OBJECTIVE: Fluorescence biomodulation (FB), a form of photobiomodulation (PBM) that is also known as low energy level light (LELL), has become an increasingly used clinical tool to induce wound healing in wounds that remain recalcitrant to treatment. In a real-life clinical setting, the aim of the EUREKA (EvalUation of Real-lifE use of Klox biophotonic system in chronic wound mAnagement) study was to confirm the efficacy and safety of LumiHeal, a system based on FB, in the treatment of chronic wounds such as venous leg ulcers (VLUs), diabetic foot ulcers (DFUs) and pressure ulcers (PUs). The effects of this FB system on the modulation of wound healing in chronic ulcers through FB induction were previously examined in an interim analysis of this study. METHOD: A multicenter, prospective, observational, uncontrolled trial in 12 clinical sites in Italy. The wound was cleansed with saline and a 2mm thick layer of a chromophore gel was applied to the affected area in a biweekly regimen. The area was then illuminated with the LED activator for five minutes at a distance of 5cm. Treatment was used in combination with standard of care specific to each type of chronic wound (VLU, DFU, PU). Wound area evaluation was assessed using the Silhouette Imaging System and quality of life (QoL) with the Cardiff Wound Impact Schedule (CWIS). A seven-point evaluation of the clinicans' view was also examined. RESULTS: We enrolled 100 subjects, with the final analysis including 99 patients/ulcers consisting of 52 VLUs, 32 DFUs and 15 PUs. Total wound closure at the end of the study was achieved in 47 patients by aetiology: 26 VLUs (50% of VLUs); 16 DFUs (50% of DFUs); and five PUs (33.3% of PUs). The mean wound area regression at last study assessment was significant for VLUs (41.0%; p<0.001) and DFUs (52.4%; p<0.001). After four weeks of treatment, it was possible to significantly predict if the ulcer would respond (defined as a decrease of wound size) to the study treatment. Adherence was high (95.2%) and no related serious adverse events were reported during the study. QoL significantly improved, with an increase of 15.4% of the total score, using the CWIS (p<0.001). CONCLUSION: The study confirmed a positive efficacy profile of the FB system in inducing the wound healing process in three different types of hard-to-heal chronic wounds. The treatment was shown to be safe and well tolerated by the patients, with a significant improvement in patient QoL. This approach offers an effective modality for the treatment of hard-to-heal chronic ulcers.
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Doença Crônica/terapia , Pé Diabético/terapia , Fluorescência , Terapia com Luz de Baixa Intensidade/métodos , Úlcera por Pressão/terapia , Úlcera Varicosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , CicatrizaçãoRESUMO
BACKGROUNDS: Obese patients, mainly females, feel uncomfortable and unsatisfied with their physical appearance; they have a wrong perception of their image and consequently diminish their self-esteem, sometimes showing difficulties in functional areas such as work, relationship, social activity. Beside health concerns, improving their appearance and body image are often common motives for weight loss in obese individuals and after weight loss about 30% of bariatric surgery patients undergo plastic surgical correction of excessive skin. The authors investigated psychological and psychiatric traits in post-bariatric patients undergoing body-contouring surgery to underline the strong correlation between psychiatry and obesity and avoid unsatisfactory results in post-bariatric patients. METHODS: The Mini International Neuropsychiatric Interview, Beck Depression Inventory II, Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder Tridimensional Personality Questionnaire, Body Uneasiness Test, Barratt Impulsiveness Scale 11, and Binge Eating Scale were performed in 36 post-bariatric patients looking for plastic surgery and 21 controls, similar for clinical features, not seeking shape remodelling. RESULTS: Much different psychiatric pathology characterizes cases, including current body dysmorphic disorder and previous major depression and anxiety disorders, impulsivity, binging and body uneasiness are other common traits. CONCLUSIONS: In post-obesity rehabilitation, a strong collaboration between the plastic surgeon and psychiatrist is recommended to reduce the number of non-compliant patients. Preoperative psychological assessment of the body-contouring patient should be a central part of the initial plastic surgery consultation, as it should be for all plastic surgery patients. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Cirurgia Bariátrica/efeitos adversos , Transtornos Dismórficos Corporais/cirurgia , Imagem Corporal/psicologia , Obesidade Mórbida/cirurgia , Cirurgia Plástica/métodos , Adaptação Psicológica , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/psicologia , Transtornos Dismórficos Corporais/etiologia , Transtornos Dismórficos Corporais/fisiopatologia , Índice de Massa Corporal , Estudos de Casos e Controles , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Obesidade Mórbida/diagnóstico , Cuidados Pré-Operatórios/métodos , Autoimagem , Estresse Psicológico , Redução de Peso , Adulto JovemRESUMO
Purpose The purpose of this study is to examine the activity of collagenase from cultures of Vibrio alginolyticus as in vitro as in biological samples and to evaluate clinical perspectives of this product about the treatment of fibroproliferative diseases like Dupuytren's contracture. Methods The experimental part of the study has been divided in 2 stages. In the first stage, the collagenase has been produced in laboratory, assessing its purity, verifying the in vitro degradation of collagen by the enzyme and measuring the size of the fragments; in the second part, an experimental injection into samples of fibrous cord typical of Dupuytren's disease has been performed in vitro. For the injection we used only collagenase, or collagenase after having subjected them to 2 types of mechanical stress or a collagenase combined with ethylenediamine tetra-acetic acid. Considering that the human samples have been treated in vitro, our institution does not require a specific informed consent. Results It appeared evident that the collagenase obtained from Vibrio alginolyticus (nonpathogenic bacterium) is highly pure (>98%) and does not contain nonspecific protease. The collagenase from Vibrio alginolyticus therefore has an excellent degradative capacity against the collagen and this activity takes on a dose- and time-dependent behavior. The collagenase from Vibrio alginolyticus does not act negatively on cell survival and collagen peptides obtained may provide a better proliferative stimulus compared to controls. Conclusions The collagenase from Vibrio alginolyticus, given its obvious ability in vitro and biological samples, could be an option in the nonsurgical treatment of Dupuytren's disease. Level of evidence Level III, therapeutic.
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Colagenases/administração & dosagem , Contratura de Dupuytren/terapia , Vibrio alginolyticus/enzimologia , Humanos , Técnicas In Vitro , Injeções Intralesionais , Estudos de Amostragem , Sensibilidade e EspecificidadeRESUMO
Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology, characterized by the presence of multiple, symmetrical, noncapsulated lipomas, mostly in the neck and upper trunk. To date, there is no effective medical treatment of MSL. Surgical treatment is based on 2 options, namely, lipectomy and/or liposuction. In this retrospective study, we compare traditional lipectomy with ultrasound-assisted liposuction. Our initial experience demonstrates that the ultrasound-assisted liposuction procedure can be applied to patients with MSL, allowing simultaneous treatment of multiple areas in a single session and the removal of a substantial amount of fat, thus improving aesthetic results. If lipomas are circumscribed and isolated, traditional lipectomy is probably to be preferred.
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Lipectomia/métodos , Lipomatose Simétrica Múltipla/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Feminino , Humanos , Lipomatose Simétrica Múltipla/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Once believed to be completely inert implants, Silicon Breast Implants (SBIs) have been shown to be able to induce a chronic inflammatory response in the body which can lead to a variety of possible manifestations ranging from the most common capsular contraction to rarer conditions such as malignancies and autoimmune diseases. Among the latter, new syndromes have been consistently recognized: Breast Implant Illness (BII) and autoimmunity/autoinflammatory syndrome induced by adjuvants (ASIA syndrome/Shoenfeld's Syndrome). The pathophysiological mechanisms underlying such syndromes are not yet clear and the overlap they show with other common conditions have sparked an important debate in the scientific community regarding their existence and their cause-effect relationship with SBIs. In this article Professor Cohen Tervaert and Professor Bassetto, leading experts in the field, are going to present arguments in favor and against such causal relationship according to the latest scientific evidence. Professor Cohen Tervaert is going to demonstrate how the evidence available is enough to prove a causal relationship as defined by the Bradford Hill's criteria. Professor Bassetto is going to highlight how the many biases that afflict the available evidence prevent us from drawing such conclusions. Professor Shoenfeld is going to moderate the discussion with its insightful conclusions.
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Doenças Autoimunes , Implantes de Mama , Humanos , Implantes de Mama/efeitos adversos , Autoimunidade , Inflamação/complicações , SíndromeRESUMO
BACKGROUND: NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In 2017, a new ROCF-CC was introduced at the practice of the authors of the current manuscript for adjunctive management of patients with wounds with thick exudate and/or nonviable tissue and in cases in which surgical debridement is not available or not appropriate. OBJECTIVE: To compare the efficacy of NPWTi-d with ROCF-CC dressing (treatment) vs NPWTi-d with ROCF-V dressing (control). MATERIALS AND METHODS: An observational retrospective cohort study of hospital records of patients with VLUs treated with NPWTi-d who received ROCF-CC dressings (n = 11) vs standard ROCF-V dressings (n = 11) was conducted. NPWTi-d was chosen to promote wound healing in VLUs that were not fully responsive to advanced dressings and/or compression bandage. Solution dwell time was 10 minutes, followed by 2.5-hour NPWT cycles at -125 mm Hg. Dressings were changed every 72 hours. RESULTS: Overall, mean ± SD duration of therapy and hospital length of stay were shorter in the treatment group vs the control group (duration of therapy, 8.63 days ± 7.05 vs 11.72 days ± 17.41, respectively; P = .05, and length of stay, 9.9 days ± 2.98 vs 12.81 days ± 4.26, respectively; P = .08), but these differences were not statistically significant. Mean wound area reduction was greater in the treatment group than in the control group (14.63 cm2 ± 13.24 and 10.72 cm2 ± 14.06, respectively; P = .51), but this was not significant. CONCLUSION: ROCF-CC dressings were a useful tool in assisting wound bed preparation and reducing time to skin graft closure in this series of complex VLUs.
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Bandagens , Tratamento de Ferimentos com Pressão Negativa , Cicatrização , Humanos , Tratamento de Ferimentos com Pressão Negativa/métodos , Estudos Retrospectivos , Cicatrização/fisiologia , Masculino , Feminino , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso , Úlcera Varicosa/terapiaRESUMO
Composite graft is a useful tool for the reconstruction of specific facial aesthetic subunits with a single surgical stage. This technique, when successful, gives optimal results in the reconstruction of small defects of nose, ear, eyelid and lips. The aim of this work is to optimize the attachment of composite grafts in the reconstruction of small complex facial defects by combining it with Fluorescent Light Energy (FLE) during the healing process of the graft. The beneficial effects of photobiomodulation (PBM) on wound healing might be attributed to anti-inflammatory signaling, cell proliferation, protein synthesis, and decreased bacterial infection. We previously experienced rewarding achievements using Photonic energy in the treatment of burns, non-healing wounds and pathological scars. Therefore, we chose to exploit the potential of bioluminescent energy to maximize aesthetical and functional results, enhancing the formation of new vascular connections and modulating both inflammatory and scarring processes. From the 2nd postoperative day, the patients were locally treated with 5 FLE sessions every (48/72 h) 2 or 3 days. We evaluated results in terms of time for engraftment, quality of the scarring, infective complications and morbidity of the donor site. Graft survival is subject to many factors, both local and systemic. To overcome these issues, various methods have been studied and described. We here report the successful reconstruction of full-thickness defects of the free margin of the nasal alar rim and the central portion of the inferior lip with a composite graft. These results were highly encouraging if compared with the literature. By analyzing our small cohort, we demonstrated how new technologies may push this traditional reconstructive procedure beyond their old boundaries: overcoming an increased size demand or a potential infective wound environment.
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AIM: Dynavisc® is a novel surgical product made of carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) designed to reduce post-surgical adhesions in tendons surgery. A multicenter retrospective cohort study was performed to investigate the clinical safety and efficacy of the Dynavisc® gel in reducing post-surgical adhesions after flexor tenolysis in zone 2. MATERIAL OF STUDY: Thirty-one patients suffering from stiff finger after flexor tendon repairs in zone 2 treated with standard release with (18 Dynavisc®-treated group) or without (13 controls) anti-adhesion gel application into the flexor tendon sheath and around the site of the tenolysis, were collected in five different hand surgery units. Safety profile and functional outcomes (based on TAM test and the The Quick-DASH questionnaire) were examined from patients' charts and analyzed. RESULTS: The application of Dynavisc® posed no safety concerns and it was not related to any additional complication. The Dynavisc®-treated group showed greater progressive improvement of TAM value in all visits with superior TAM value at T(90) and T(180) compared to the control group. DISCUSSION: Tendon adhesions are the main cause of flexor tendon surgery failure. Multiple strategies (i.e. robust tendon repair, early rehabilitation and lubricant or barrier agents) have been proposed to minimize their formation. Among different products described in the literature Dynavisc® showed a significant role in limiting adhesions formation in a recent experimental study. CONCLUSIONS: This clinical study confirm the safety of Dynavisc® gel application in hand surgery demonstrating its potential long-term benefits after flexor tendon tenolysis. KEY WORDS: Flexor Tendon Repair, Tendon Adhesions, Tenolysis.
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Antifibróticos , Carboximetilcelulose Sódica , Cicatriz , Polietilenoglicóis , Tendões , Aderências Teciduais , Humanos , Cicatriz/etiologia , Cicatriz/prevenção & controle , Estudos Retrospectivos , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/complicações , Tendões/cirurgia , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Carboximetilcelulose Sódica/administração & dosagem , Carboximetilcelulose Sódica/uso terapêutico , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/uso terapêutico , Antifibróticos/administração & dosagem , Antifibróticos/uso terapêutico , Combinação de Medicamentos , GéisRESUMO
INTRODUCTION: The presence of debris covering a wound surface significantly impedes progression toward closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical wound solutions is a versatile tool that can be applied to various wound types to promote wound healing. At the University Hospital of Padova in Padova, Italy, NPWTi-d has been incorporated into wound management plans that include debridement and antibiotic therapy, as necessary, for a diverse population of patients with open wounds, including acute, chronic, and infected wounds. OBJECTIVE: A retrospective analysis of 100 patients (53 male, 47 female; age range, 22-95 years) who underwent NPWTi-d was performed, and key healing outcomes observed in subgroups differentiated by sex, wound etiology, initial wound size, and topical instillation solution were reported. MATERIALS AND METHODS: Wound types included vascular ulcers, surgical wounds, dehiscences, and trauma; anatomic location of the wounds varied. Negative pressure wound therapy with instillation (0.05% sodium hypochlorite, normal saline, or 0.25% acetic acid) was implemented with a dwell time of 3 minutes to 10 minutes, followed by a negative pressure cycle length of 2 hours to 3.5 hours at -75 mm Hg to -125 mm Hg. Dressings were changed approximately every 3 days. RESULTS: After a median of 11 days (range, 1-35 days), the wound surface area significantly decreased (P <.0001), percentage of infected wounds declined from 72% to 46%, and wound closure was attained in 91% of cases. A significant reduction in wound surface area was detected in both sexes, small- and medium-sized wounds, vascular ulcers, surgical wounds, dehiscences, trauma wounds, and pressure ulcers (P <.05). This effect was detected in wounds regardless of topical instillation solution (P <.0001). CONCLUSIONS: This study showed that NPWTi-d is a valuable treatment option in a variety of circumstances and can help the clinician achieve a range of therapy goals based on individual patient needs.
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BACKGROUND: Chronic ulcers represent a challenge for healthcare professionals and a large expense for national health care systems for their difficulty in achieving complete healing and for their high incidence of recurrence. With the progressive aging of the general population, the incidence of these injuries will only increase, further affecting the public health budget, hence the need to find new strategies for their management. The purpose of this study was to share the experience of the Complex Operational Unit of Plastic Surgery of the University Hospital of Padua with fluorescent light energy therapy, outlining its role in the treatment of chronic ulcers in the daily use outside the previous EUREKA study. METHODS: In this case series study, we enrolled 15 patients with chronic ulcers of any etiology between January 2018 and July 2019 and we treated them using fluorescence light energy. We evaluated efficacy and safety endpoints reporting data in excel files completed by medical staff during the study. RESULTS: The study confirms the effectiveness of fluorescent light energy inducing chronic ulcer healing, regardless of etiology, or at least preparing the lesions for a skin graft closure surgery. The system showed a low rate of complications established by patient adherence to treatment. Patients also reported a reduction in pain both at home and during outpatient dressings. CONCLUSION: Based on our experience, fluorescent light energy shows an excellent safety and efficacy profile in chronic ulcers no more responsive to traditional dressings and/or surgery.
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INTRODUCTION: The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds. MATERIALS AND METHODS: In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples. RESULTS: Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms. CONCLUSIONS: The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
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Queimaduras , Queimaduras/terapia , Humanos , Projetos Piloto , Pele/lesões , Lesões dos Tecidos Moles , CicatrizaçãoRESUMO
Since their first appearance, breast prostheses have been criticized as being both responsible for and giving rise to systemic disease. The literature contains many reports on the subject, and theories were controversial from the 1980s to the 2000s. The aim of this review was to gather together the most important studies on breast prostheses and systemic disease, with particular attention to connective tissue disease (CTD), in order to verify any relationship between silicone breast implants and the occurrence of pathologies.
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Implantes de Mama/efeitos adversos , Implantes de Mama/estatística & dados numéricos , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/etiologia , Feminino , Humanos , PrevalênciaRESUMO
BACKGROUND: Periprosthetic capsules are a common reaction of the body to silicone or polyurethane breast implants. The aim of this study was to evaluate similarities and differences in the histological features of periprosthetic capsules surrounding silicone implants and polyurethane foam-coated implants and to correlate those features with the age of the implants. METHODS: Tissues were studied from 41 periprosthetic capsules surrounding textured prostheses and from 20 capsules surrounding polyurethane foam-coated implants. For each sample we evaluated synovial metaplasia, density of collagen fibers or fibrosis, orientation of collagen fibers, and foreign body reaction (granulomatous reaction). RESULTS: Synovial metaplasia was seen in the capsular tissue from both types of implant, but more so from capsules surrounding polyurethane implants more than 5 years old. The density and orientation of the collagen fibers and the foreign body reaction were very similar for the two types of implant.
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Implantes de Mama , Mama/patologia , Materiais Revestidos Biocompatíveis , Granuloma de Corpo Estranho/patologia , Poliuretanos , Silicones , Adulto , Colágeno/análise , Feminino , Humanos , Metaplasia , Pessoa de Meia-Idade , Propriedades de Superfície , Membrana Sinovial/patologiaRESUMO
Cutaneous Lupus Erithematosus is one of the most common manifestation of Systemic Lupus Erithematosus and can be featured by the onset of cutaneous vasculitis which can bring to skin ulcers, expecially on the extremities. The "common" aetiopathogenesis can be summarized as following: 1) an antiself response to the endothelial cells which brings to frequent ischemic or thrombotic episodes, 2) the drugs therapy; recently authors have been demostrated a correlation between Metalloproteinase Matrix (MMP) and Cutaneous LES. Here we present the case of a 33 y.o. woman affected by a rheumatic disorder, which has developed a chronic ulcer on her left leg. After several and different unsuccessful approaches, as homologous and autologous skin graft, and considering both the refusal of other surgery even if enhanced by Negative Pressure Therapy and the compromised vascularization which contraindicated the use of flaps, we decided to use a dressing based on the TLC-NOSF (Technology Lipido-Colloid plus Nano-Oligo Saccharide Factor) protease inhibitor, a metalloproteinase regulator. The dressing was changed 2 times/week for the first 2 months and 1 time/week for other 2 months. The ulcer became smaller at every session and we obtained a full coverage at 4th month. KEY WORDS: Nano-oligo saccharide factor, Wound.