A Retrospective Self-Controlled Study Evaluating the Prophylactic Effects of CACIPLIQ20 on Postsurgical Scars.

Background: CACIPLIQ20 (OTR3, Paris, France) is a medical device used for the treatment of chronic skin ulcers. It contains a heparan sulfate mimetic that accelerates tissue healing by stabilizing matrix proteins and protecting heparin-binding growth factors. In humans, an open self-controlled study suggested that the topical application of CACIPLIQ20 optimizes skin healing following surgery. Objectives: To expand previous findings using a different CACIPLIQ20 administration regimen. Methods: Twenty-four females were referred for breast-reduction surgery. Each patient had their own control with 1 CACIPLIQ20-treated and 1 saline-treated control breast. The treated side (right or left) was randomly assigned by the operating surgeon. Scar appearance was assessed by 6 independent raters using a global visual scar comparison scale based on scar photographs. All raters were blinded toward the CACIPLIQ20-treated side. Results: The follow-up period following surgery ranged from 1 to 12 months with a median follow-up of 6 months. Overall, there was a mean improvement of 15.2% (SD = 26.7) in favor of CACIPLIQ20 (P = .016). On the CACIPLIQ20-treated side, the mean score per patient was above 20% in 11 patients and above 30% improvement in 8 cases. In contrast, only 3 patients were considered improved by at least 20% on the control side and only 1 above 30%. A comparison of different application regimens suggested that the best trend was obtained with a single administration of CACIPLIQ20 at Day 0. Conclusions: In conclusion, CACIPLIQ20 could represent an interesting scar prophylactic therapy, based on a single administration at the time of surgery, and without any known adverse effects.

RGTA® or ReGeneraTing Agents mimic heparan sulfate in regenerative medicine: from concept to curing patients.

The importance of extracellular matrix (ECM) integrity in maintaining normal tissue function is highlighted by numerous pathologies and situations of acute and chronic injury associated with dysregulation or destruction of ECM components. Heparan sulfate (HS) is a key component of the ECM, where it fulfils important functions associated with tissue homeostasis. Its degradation following tissue injury disrupts this delicate equilibrium and may impair the wound healing process. ReGeneraTing Agents (RGTA®s) are polysaccharides specifically designed to replace degraded HS in injured tissues. The unique properties of RGTA® (resistance to degradation, binding and protection of ECM structural and signaling proteins, like HS) permit the reconstruction of the ECM, restoring both structural and biochemical functions to this essential substrate, and facilitating the processes of tissue repair and regeneration. Here, we review 25 years of research surrounding this HS mimic, supporting the mode of action, pre-clinical studies and therapeutic efficacy of RGTA® in the clinic, and discuss the potential of RGTA® in new branches of regenerative medicine.

Placement of Absorbable Dermal Staples in Mammaplasty and Abdominoplasty: A 12-Month Prospective Study of 60 Patients.

BACKGROUND: The duration to close an incision is an important consideration in plastic surgery. The placement of Insorb absorbable subcuticular staples (Insorb, Incisive Surgical, Plymouth, MN) may allow for a decreased closure time compared with other modalities. OBJECTIVES: The authors evaluated the utility of Insorb staples for the closure of mammaplasty and abdominoplasty incisions. METHODS: Sixty patients who underwent anterior abdominal dermatolipectomy, total circular abdominal dermatolipectomy, bilateral breast reduction, or bilateral mastopexy were evaluated in a prospective study. Dermal closure was achieved on 1 side of each patient with Insorb absorbable staples and on the other with absorbable monofilament sutures. Scar quality, pruritus, and pain were scored according to a modified Vancouver Scar Scale (mVSS) at 1, 6, and 12 months postoperatively. RESULTS: Closure with absorbable staples was approximately 7-fold faster than closure with absorbable sutures for all surgical procedures. No significant differences in mVSS scores were noted between incisions closed with staples vs sutures. CONCLUSIONS: Absorbable staples enable faster closure of a surgical incision without compromising scar quality or patient comfort. LEVEL OF EVIDENCE: 3 Therapeutic.

Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012.

BACKGROUND: Perforation of one or several intraperitoneal organs during a liposuction procedure is an exceptional but underestimated complication. Knowledge of this complication is essential because of frequent delay in diagnosis and possible dramatic consequences. METHODS: Nineteen cases were evaluated by experts and are presented in a retrospective analysis. Sixteen women and three men, aged 24 to 72 years, were operated on in France between July of 2001 and January of 2012. Abdominal liposuction (200 to 2400 ml) was performed in combination or not with an abdominoplasty. RESULTS: Uncommon pain and an intestinal obstruction were present in all of the patients. The peritonitis was never frank, replaced frequently by infraclinic peritonitis with septic and/or hypovolemic shock. Diagnosis, performed by abdominal scan between days 1 and 7, revealed intraperitoneal gas or liquid. Perforation, unique or multiple, because of the intraperitoneal passage of the cannula, often in the umbilical region and promoted by the presence of a hernia, involved the following organs: ileum (14 cases), jejunum (two cases), spleen (two cases), transverse colon (one case), cecum (one case), and sigmoid (one case). Death occurred in three cases, between days 2 and 11. Eleven patients had temporary ileostomy or colostomy. Associated complications were abdominal wall cellulitis, necrotizing fasciitis, thrombophlebitis, lung collection, and late subobstructive syndrome. CONCLUSIONS: Visceral perforation during liposuction, a severe and sometimes fatal complication with late and difficult diagnosis, is not often reported. Careful technique, particularly if an umbilical approach is used, should avoid this dramatic complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Reepithelialization from stem cells of hair follicles of dermal graft of the scalp in acute treatment of third-degree burns: first clinical and histologic study.

BACKGROUND: The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in keratinocyte stem cells. The purpose of this study was to double scalp harvesting in one procedure and to evaluate the capacity of the dermal layer to spontaneously reepithelialize from hair follicle stem cells. METHODS: Two layers of 0.2-mm split-thickness skin graft, a dermoepidermal graft and a dermal graft, were harvested from scalp during the same procedure. Fifteen burn patients were included in this study. Healing of the scalp donor site and percentage of graft taken were evaluated. The Vancouver Scar Scale was used at 3 months and 1 year. Histologic studies were performed at day 0 and 3 months on grafts, and on the scalp at day 28. RESULTS: Nine patients were treated on the limbs with meshed dermal graft. Six were treated on the hands with unmeshed dermal graft. Graft take was good for both types of grafts. The mean time for scalp healing was 9.3 days. Histologic study confirmed that the second layer was a dermal graft with numerous annexes and that, at 3 months, the dermis had normal thickness but with rarer and smaller epidermal crests than dermal graft. The difference between the mean Vancouver Scar Scale score of dermal graft and dermoepidermal graft was not significant. CONCLUSION: The authors' study shows the efficacy of dermal graft from the scalp and good scalp healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Assessment of burned hands reconstructed with Integra(®) by ultrasonography and elastometry.

INTRODUCTION: Hand injuries have major psychological, social and professional repercussions. Treatment of burned hands is suggested to be early and optimal to avoid catastrophic consequences and allow social and professional rehabilitation. Our study analyses the long-term results obtained with Integra(®), a dermal substitute used for the treatment of deep burns of the hands. PATIENTS AND METHODS: A total of 29 hands were treated with Integra(®). Long-term monitoring was performed on 12 hands with a clinical, ultrasonographic and elastometric study. The results were compared with those from a series of healthy hands. This study, with a low number of subjects, is a pilot report. RESULTS: This study showed a low complication rate, with a high percentage of engraftment of thin skin, and good cosmetic and functional quality. The thickness and viscoelasticity of the skin treated with Integra(®) in our series appeared to be similar to those of healthy skin. CONCLUSION: Integra(®) artificial skin is an attractive alternative in the treatment of deep burns of the hand and can achieve results with aesthetic and functional characteristics that are close to those of healthy skin.

Matrix therapy with RGTA OTR4120 improves healing time and quality in hairless rats with deep second-degree burns.

BACKGROUND: ReGeneraTing Agents (RGTAs) are biodegradable polymers engineered to mimic heparan-sulfate in the extracellular matrix of damaged tissue. RGTAs improve tissue healing in several animal models by stabilizing and protecting heparin-binding growth factors and matrix proteins. RGTA restores the normal matrix architecture and supports tissue regeneration. In this study, the authors evaluated the effects of RGTA on epidermal repair and dermal remodeling in a rat burn model. METHODS: Deep second-degree burns were induced in 156 hairless rats, of which half (n = 78) received topical and intramuscular RGTA immediately after the burn followed by intramuscular RGTA weekly for 1 month. The controls (n = 78) received saline according to the same protocol. Rats were killed starting on each day of the first week and on days 14, 28, 60, 120, 240, and 365. The burns were evaluated by photography, histology, and immunohistochemistry. RESULTS: Coagulation necrosis involved the entire epidermis and superficial adnexa. Compared with the controls, speed of epidermal repair, as assessed between days 3 and 7 based on cell-layer number and anticytokeratin-14 staining, was faster in the RGTA group; and the zone of stasis, as assessed based on secondary vascular lesions in the dermis, was smaller. On day 7, reepithelialization was complete in both groups. On days 14 and 28, the remodeled dermal zone was smaller in the RGTA group. CONCLUSION: RGTA accelerated epidermal repair and protected the dermis from secondary effects of heat as quantified by zone-of-stasis size and extent of dermal remodeling.

[Arteriovenous malformations]. / Malformations artérioveineuses.

Arteriovenous malformations are serious high-flow vascular malformations. Four progressive stages have been described: dormancy, expansion, destruction and heart failure. Progression from one stage to another is not systematic but depends on events - physiological or traumatic, sometimes iatrogenic. Pulsed Doppler imaging of venous waveforms and magnetic resonance imaging (MRI) are the most informative examinations for both diagnosis and follow-up of arteriovenous malformations.Arteriography and angio-MRI help guide treatment decisions. Treatment of the malformation must not be envisioned until it reaches a symptomatic stage. It most often combines an endovascular procedures and wide surgical excision. A syndromic form must be considered in cases of systemic angioma.

Growth factors improve latissimus dorsi muscle vascularization and trophicity after cardiomyoplasty.

BACKGROUND: Dynamic cardiomyoplasty consists of wrapping the electrostimulated latissimus dorsi muscle (LDM) around the failed heart. Partial ischemia followed by atrophy of the middle and distal part of the LDM were observed in 30% of clinical cases after LDM flap elevation from its origin. In the current study, we hypothesized that local administration of growth factors at the LDM/epicardial interface could improve muscle vascularization and trophicity. METHODS: In 24 sheep, dynamic cardiomyoplasty was performed using the left LDM. A multiperforated catheter was positioned at the LDM/epicardial interface for a weekly administration, during a 1-month period, of the following factors: basic fibroblast growth factor (bFGF, n = 6), vascular endothelial growth factor (VEGF, n = 6), and regenerating agent (RGTA, n = 6). Six sheep injected with phosphate-buffered saline (used for dilution of the growth factors) were used as a control group. At 3 months, angiographic, histologic, and histomorphometric studies were performed. RESULTS: Angiographic studies of the animals treated with growth factors demonstrated hypervascularization due to the development of new vessels. Histomorphometric and histologic studies showed a significant increase in the number of capillaries and arterioles (100 fields/muscle) in the groups treated with bFGF (443.0 +/- 101.2, p < 0.01), RGTA (293.2 +/- 29.3, p < 0.05), and VEGF (246.5 +/- 45.9, p < 0.05), as compared with the control group (81.5 +/- 11.4). A significantly lower atrophy score was observed in the groups treated with bFGF (1.4 +/- 0.18, p < 0.05), RGTA (1.59 +/- 0.17, p < 0.05), and VEGF (1.96 +/- 0.14, NS), as compared with the control group (2.48 +/- 0.16). CONCLUSIONS: Local administration at the heart/muscle interface of growth factors increases muscle vascularization and avoids muscle atrophy in an experimental cardiomyoplasty model, both of which are advantageous to the contracting LDM. The local growth factors delivery system used in this study appears efficient, easy to implant, and manipulate and safe.