Atypical Presentation of a Marjolin Ulcer After a Burn: A Case Report.

The development of a nonhealing ulcer on a chronic wound or scar should raise suspicions of the plastic surgeon or nurse regarding the potential for malignant degeneration to a Marjolin ulcer. Occasionally, a Marjolin ulcer may present as exophytic granulation tissue within a scar. Most Marjolin ulcers are well-differentiated injuries; however, because of their aggressive nature and poor prognosis, to ensure surgical success, diagnosis of Marjolin ulcer should be confirmed and treatment initiated as soon as possible.

Use of Amniotic Membrane as a Biological Dressing for the Treatment of Torpid Venous Ulcers: A Case Report.

Chronic venous disease manifested as ulcers in the lower limb is a highly prevalent pathology in our population. Antiseptics and dressings designed to improve epithelialization are often used to cure the ulcer during outpatient therapy. Despite careful management, sometimes ulcers do not respond to treatment. In this report, we discuss the antiseptic and potentially immunomodulatory effects of the amniotic membrane as a biological dressing for the treatment of venous ulcers refractory to conventional therapy.

Use of the Meek Micrografting Technique for Coverage of Extensive Burns: A Case Report.

Traditional mechanical meshing methods have generally been the first-choice treatment of patients with extensive burns (>20% total body surface area). The limited availability of donor areas has sparked the development of resources such as the Meek micrografting technique. We present the case of a 43-year-old male patient with an 85% total body surface area third-degree flame burn. After the initial stabilization, there was a need for rapid and effective coverage of as much burned surface as possible. Thus, Meek micrografting was chosen. Its results in this patient are presented and discussed. The Meek technique is a useful method of skin expansion. It is indicated in patients with extensive burns, where donor areas are limited. The high rates of graft take and quality of the coverage attained make this technique appealing, albeit at a greater economic cost than with traditional mechanical meshing methods.

Paracrine Anti-inflammatory Effects of Adipose Tissue-Derived Mesenchymal Stem Cells in Human Monocytes.

The inflammatory process is an essential phenomenon in the induction of immune responses. Monocytes are key effector cells during the inflammatory process. A wide range of evidence indicates that mesenchymal stem cells from adipose tissue (ASC) are endowed with immunomodulatory capacity. However, the interaction between ASC and monocytes in the innate immune response is not well understood. The aim of this work was to investigate the possible paracrine anti-inflammatory effects of ASC in human monocytes. Monocytes were isolated from buffy coats and ASC from fat of non-obese patients. Conditioned medium (CM) from ASC in primary culture was used. We have assessed the effects of CM on the production of inflammatory mediators, degranulation, migration, phagocytic activity, senescence, oxidative stress, mitochondrial membrane potential and macrophage polarization. We have shown that ASC exert paracrine anti-inflammatory actions on human monocytes. CM significantly reduced the production of TNFα, NO and PGE2 and the activation of NF-κB. In addition, we observed a significant reduction of degranulation, phagocytic activity and their migratory ability in the presence of the chemokine CCL2. The senescence process and the production of oxidative stress and mitochondrial dysfunction were inhibited by CM which also reduced the production of TNFα by M1 macrophages while enhanced TGFß1 and IL-10 release by M2 macrophages. This study have demonstrated relevant interactions of ASC with human monocytes and macrophages which are key players of the innate immune response. Our results indicate that ASC secretome mediates the anti-inflammatory actions of these cells. This paracrine mechanism would limit the duration and amplitude of the inflammatory response.

Desbridamiento enzimático con Nexobrid® en el paciente quemado: exposición de manejo terapéutico a propósito de un caso / Desbridamento enzimático com Nexobrid® no paciente queimado: exposição do manejo terapêutico e relato de caso / Enzymatic debridement in the burn patient with Nexobrid®: exposition of therapeutic management and case report

Objetivo: Exponer el manejo terapéutico del desbridante enzimático Nexobrid® a través de un caso representativo. Reporte del caso: Se expone el caso de un paciente varón de 43 años que sufre quemaduras circulares de segundo grado profundo en ambas manos por flash eléctrico y llama, que fue tratado mediante desbridamiento enzimático con Nexobrid®, sin llegar a precisar de la realización de injertos cutáneos. Se alcanzó la epitelización completa de las lesiones 28 días tras la quemadura, sin realizarse injertos cutáneos, y logrando una buena calidad cicatricial, sin aparición de limitaciones funcionales. Consideraciones finales: El desbridamiento enzimático con Nexobrid® es un nuevo recurso terapéutico que permite realizar un desbridamiento completo y específico del tejido quemado, sin precisar de la logística de un quirófano. Pese a los buenos resultados reportados en la literatura reciente, los beneficios del uso del desbridante enzimático Nexobrid®, todavía han de ser respaldados por mayor cantidad de estudios con un adecuado nivel de evidencia.

Objetivo: Expor o manejo terapêutico do agente de debridamento enzimático Nexobrid® em um caso representativo. Relato de caso: Relatamos o caso de um homem de 43 anos com queimaduras profundas de segundo grau em ambas as mãos causadas por flash elétrico e chama, que foi tratada por desbridamento enzimático com Nexobrid®, sem a necessidade de enxerto de pele. Epitelização completa foi obtida 28 dias após a queimadura, sem a necessidade de realizar enxertos na pele, conseguindo uma boa qualidade da cicatriz, sem qualquer limitação funcional após 102 dias de seguimento. Considerações finais: O desbridamento enzimático com Nexobrid® é um novo recurso terapêutico que permite um desbridamento completo e específico de tecidos queimados, sem requerer a logística de uma cirurgia. Apesar dos bons resultados relatados na literatura recente, os benefícios deste tratamento devem ser respaldados por uma ampla gama de estudos com níveis adequados de evidência.

Objective: To expose the therapeutic management of the enzymatic debriding agent Nexobrid® through a representative case. Case report: We expose the case of a 43 year-old male suffering from circular deep second degree burns in both hands caused by electric flash and flame, who was treated through enzymatical debridement with Nexobrid®, without the need of skin grafting. Complete epithelialization was achieved 28 days after the burn, without the need to perform skin grafting, achieving good scar quality, without any functional limitation after 102 days follow-up. Final considerations: Enzymatical debridement with Nexobrid® is a new therapeutic resource which allows for a complete and specific debridement of burned tissues, without requiring the logistics of a surgery. Despite the good results reported in recent literature, the benefits of this treatment must be supported by a wider range of studies with adequate levels of evidence.