Surgical management of axillary hidradenitis suppurativa with latissimus dorsi flap on a 24-year-old patient: A case report.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with distinct characteristics: chronic nature, morphology, and location. It originates from occluded and ruptured follicles, releasing keratin and bacteria into the nearby dermis. This causes an inflammatory reaction, leading to the formation of abscesses and the destruction of the pilosebaceous junction. CASE PRESENTATION: We present the case 24-year-old female with a severe, stage III case of HS who had a lesion (approx. 10 × 15 cm) on her right axilla spanning 4 years. Despite some response to medical treatment, she experienced recurrent symptoms, due to this, surgical intervention was decided, using a latissimus dorsi thoracodorsal artery perforator (TDAP) flap. The lesion was successfully removed, and the flap was placed, leading to proper postoperative healing, cicatrization, and sensitivity in the patient. DISCUSSION: HS poses a challenge due to its recurring course. Treatment involves pharmacological and surgical approaches, with the former suited for mild to moderate cases and the latter for severe instances. Surgical options, like TDAP flaps, show lower recurrence rates than skin grafts. TDAP flaps also offer advantages such as reduced bulkiness and favorable aesthetic and functional outcomes compared to other latissimus dorsi flaps. CONCLUSION: HS represents an obstacle in terms of systemic effects and aesthetic concerns. Lattisimus dorsi flaps have emerged as an effective treatment method due to the reliable vascular supply and adequate volume to the recipient site as demonstrated by our case, where the patient showed appropriate evolution with no morbidity associated with the procedure as well as adequate aesthetic results.

Adipose derived stromal vascular fraction and fat graft for treating the hands of patients with systemic sclerosis. A randomized clinical trial.

BACKGROUND: Systemic Sclerosis in the hand is characteristically evidenced by Raynaud's phenomenon, fibrosis of the skin, tendons, ligaments, and joints as well as digital ulcers with prolonged healing. Current medical treatment does not always cure these complications. Local adipose-derived stromal vascular fraction administration into the hands has been proposed as an emerging treatment due to its regenerative properties. The objective of this randomized controlled clinical trial was to evaluate the safety and clinical effects of fat micrografts plus adipose derived-stromal vascular fraction administration into the hands of patients with systemic sclerosis. METHODS: This was an open-label, monocentric, randomized controlled study. Twenty patients diagnosed with systemic sclerosis were assigned to the experimental or control group. Fat micrografts plus the adipose derived-stromal vascular fraction were injected into the right hand of experimental group patients. The control group continued to receive only medical treatment. Demographic, serologic data and disease severity were recorded. Digital oximetry, pain, Raynaud phenomenon, digital ulcers number, mobility, thumb opposition, vascular density of the nail bed, skin affection of the hand, serologic antibodies, hand function, and quality of life scores were evaluated in both groups. RESULTS: The results of the intervention were analyzed with the Wilcoxon rank test, and the differences between the control and experimental groups at 0 days and 168 days were analyzed with the Mann-Whitney U test. Adverse events were not observed in both groups. At the end of the study, statistically significant improvements were observed in pain levels (p<0.05) and number of digital ulcers (p<0.01) in the experimental vs control group. CONCLUSION: The injection of adipose derived-stromal vascular fraction plus fat micrografts is a reproducible, and safe technique. Pain and digital ulcers in the hands of patients with systemic sclerosis can be treated with this technique plus conventional medical treatment.

Mesenchymal Stem Cells for the Compassionate Treatment of Severe Acute Respiratory Distress Syndrome Due to COVID 19.

Mesenchymal stem cells (MSC) have received particular attention due to their ability to inhibit inflammation caused by cytokine storm induced by COVID-19. In this way some patients have been treated successfully. The aim of this study was to evaluate the safety and describe the clinical changes after IV administration of allogeneic human umbilical cord MSC (ahUCMSC), in patients with bilateral pneumonia caused by COVID-19, complicated with severe ARDS, as compassionate treatment. This was a pilot, open-label, prospective, longitudinal study. Five patients that did not improve in their clinical conditions after 48 hours of receiving the standard medical management used by the Medical Center and with persistent PaO2/FiO2 less than 100 mmHg were enrolled. ahUCMSC were infused IV, at dose of 1x106 per Kg of body weight over 15 minutes. Patients were monitored after the infusion to detect adverse event. Pa02/FiO2, vital signs, D-dimer, C reactive protein and total lymphocytes were monitored for 21 days after the infusion or until the patient was discharged from the hospital. Descriptive statistics were used with means or medians and standard deviation or interquartile range according to the type of variable. The Wilcoxon's rank-sum was used for stationary samples. Adverse events occurred in three patients and were easily and quickly controlled. Immediately after the infusion of ahUCMSC, constant rise of PaO2/FiO2 was observed in all patients during the first 7 days, with statistical significance. Three patients survived and were extubated on the ninth day post-infusion. Two patients died at 13 and 15 days after infusion. The infusion of ahUCMSC in patients with severe ARDS caused by COVID-19, was safe, and demonstrated its anti-inflammatory capacity in the lungs, by improving the respiratory function expressed by PaO2 / FiO2, which allowed the survival of 3 patients, with extubation at 9 days.