Perichondritis and auricular cellulitis related to piercings as first manifestation of monkeypox / Pericondritis y celulitis auricular relacionadas con piercings como primera manifestación de viruela del mono

Introduction: Pinna infections are usually due to Staphylococcus aureus infection. It is common for the patient to have had an earring in the area of infection. Monkeypox infection has gone from being an endemic infection to a worldwide health emergency. Case summary: In this article we present five cases of monkeypox earring infection of the pinna and what common features we have seen that differentiate them from Staphylococcus aureus infection. Discussion: Symptoms of monkeypox include general malaise, fever with uni- or bilateral lymphadenopathy, and then the appearance within one or two days of skin lesions, we want to alert he otolaryngologist and the medical society to the possibility the diagnostic possibility of monkeypox in patients with an auricular perichondritis.(AU)

Introducción: Las infecciones del pabellón auricular se deben habitualmente a la infección por Staphilococcus Aureus. Es habitual que el paciente se haya realizado un pendiente en la zona de la infección. La infección por viruela del Mono ha pasado de ser una infección endémica a una emergencia sanitaria a nivel mundial. Caso: Exponemos en este artículo cinco casos de infección del pabellón auricular por pendiente por viruela del mono y que características comunes hemos visto que las diferencian de la infección por Staphilococcus Aureus. Discusión:Los síntomas de la viruela del mono incluyen malestar general, fiebre con linfadenopatía uni o bilateral, y posteriormente la aparición en uno o dos días de lesiones cutáneas, queremos alertar al otorrinolaringólogo y a la sociedad médica de la posibilidad diagnóstica de viruela del mono en pacientes con una pericondritis auricular.(AU)

Quemaduras del pabellón auricular: membrana amniótica frente a cura oclusiva para prevención de condritis / Burns of the auricular pavillion: amniotic membrane versus occlusive cure for chondritis prevention

Introducción y objetivo: Prevenir la condritis es un pilar importante en el tratamiento de las quemaduras del pabellón auricular teniendo en cuenta que, en la actualidad, no existe un protocolo de manejo frente a esta patología y sus posteriores complicaciones. El presente estudio pretende analizar la literatura disponible acerca del manejo de las quemaduras auriculares y comparar el uso de membrana amniótica frente a la cura oclusiva en un grupo de pacientes con quemadura en pabellón auricular para prevenir la deformidad de oreja en coliflor como secuela. Material y método: Revisión de la literatura sobre las diversas formas de tratamiento de las quemaduras auriculares y estudio en un grupo de pacientes de la Unidad de Quemados de la Subred Integrada de Servicios en Salud Norte E.S.E. UHMES Simón Bolívar de Bogotá, D.C., Colombia, con quemaduras en pabellones auriculares a los que se les aplicó membrana amniótica para cubrir las lesiones con el fin de disminuir el riesgo de condritis y la consecuente deformidad en coliflor, entre otras complicaciones. Resultados: De la revisión de la literatura obtenemos una comparativa del uso de tratamientos conservadores frente a quirúrgicos y en el estudio sobre pacientes tratados con membrana amniótica observamos una importante disminución en la respuesta inflamatoria local, dolor, frecuencia de curaciones y por lo tanto, menor estancia hospitalaria. Conclusiones: Nuestro trabajo aporta revisión bibliográfica y experiencia propia comparativa de interés para la prevención de la condritis postquemadura auricular y contribuye a protocolizar el tratamiento de este tipo de lesiones a fin de evitar sus secuelas. Nivel de evidencia científica 4c Terapéutico.(AU)

Background and objective: Preventing chondritis is an important pillar in the treatment of burns of the auricular pavilion because, currently, there is no management protocol for this pathology and its subsequent complications. The present study aims to analyze the available literature on the management of auricular burns, and to compare the use of amniotic membrane versus occlusive treatment in a group of patients with burns in the auricular pavilion to prevent cauliflower ear. Methods: Literature review of the different ways of treatment for ear burns and study in a group of patients from the Burn Unit of the Integrated Subred of Health Services North E.S.E. Simón Bolívar (UHMES) from Bogotá D.C Colombia, with burns on the auricular pavilion to which amniotic membrane was applied to cover up the injuries in order to reduce the risk of chondritis and the consequent cauliflower deformity, among other complications. Results: From the literature review, we obtain a comparison between the use of conservative treatments versus surgical procedures and, in the study of patients treated with amniotic membrane, we observed a significant decrease in the local inflammatory response, pain, frequency of wound healing, and therefore, shorter hospital stay. Conclusions: Our study provides a bibliographic review and our own comparative experience, both of interest for the prevention of post-auricular burn chondritis and contributes to create protocols for treatment of this type of injury in order to avoid its sequelae.Level of evidence 4c Terapeutic.(AU)

Tracing the Origins of "Cauliflower Ear" and Its Earlier Names over Two Millenia.

OBJECTIVES: The post-traumatic ear deformity, known today as cauliflower ear, has been described since antiquity. It has long been associated with pugilistic sports (wrestling, boxing) as well as among the mentally ill. The aim of this study is to present the various terms used since antiquity to describe these traumatic deformations of the auricle and to trace the origin of the modern moniker "cauliflower ear." METHODS: Historical study, only based on original documentation accessed through personal libraries and universities repositories, completed with online sources and etymological dictionaries. RESULTS: We were able to identify no fewer than 39 names for the deformity. The term cauliflower ear is of relatively recent origin. It was coined in the first decade of the 20th century, initially in the popular press and subsequently adopted by the medical profession. CONCLUSION: Ironically, the deformity has only superficial resemblance to a cauliflower. The vegetable, which is part of the cabbage family, has a symmetrical and highly ordered fractal geometry with well-circumscribed excrescences. Cauliflower ear, by contrast, notably lacks symmetry and its rounded protuberances flow into one another. Although somewhat a misnomer, the term is deeply rooted in both popular and medical culture. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:E1315-E1321, 2021.

A guide to managing disorders of the ear pinna and canal.

This review will help you troubleshoot everything from infections and foreign bodies to trauma and neoplasm.

Signo de Frank y dolor torácico / Franks sign and chest pain

No disponible

Modified Tragus Edge and Transmasseteric Anteroparotid Approach for Intracapsular and Condylar Neck Fractures.

The aim of this study was to evaluate the effects of protecting the facial nerve and reducing the scar visibility using a modified tragus edge and transmasseteric anteroparotid approach compared to classic preauricular approach for intracapsular and condylar neck fractures. This retrospective study included 64 patients (78 sides) who underwent surgical treatment for intracapsular or condylar neck fractures from January 2014 to June 2018. Patients were divided into the experimental group (treated via a modified tragus edge and transmasseteric anteroparotid approach), and the control group (treated via the classical preauricular approach). Therapeutic outcome assessment parameters included facial nerve injury, salivary fistulae, wound infection, restricted mouth opening, postoperative occlusion disorders, and scar visibility. In the control group, there were 3 cases of facial nerve injuries and 2 cases of salivary fistulae. One case of temporary facial nerve injury occurred in the experimental group, with complete recovery within 1 month. The scars were less visible in the experimental group than in the control group. These results suggest that a modified tragus edge and transmasseteric anteroparotid approach reduced the incidences of facial nerve injuries, minimized the scar visibility, improved exposure of the operative site and fixation of titanium screws or plates, and did not increase the frequency of other complications.

Reconstrucción postraumática de una pérdida parcial auricular / Posttraumatic reconstruction of a partial ear loss

RESUMEN Introducción: Los objetivos de la reconstrucción auricular son mantener la permeabilidad del canal auditivo externo y restaurar la forma general y la proyección. Objetivo: caracterizar un caso clínico de reconstrucción postraumática de una pérdida parcial auricular, enfatizando en la importancia de la secuencia terapéutica empleada. Presentación del caso clínico: Acude a consulta externa un paciente masculino de 26 años. Refiere haber sido tratado en el cuerpo de guardia 10 días atrás, al haber perdido un fragmento de oreja por una mordida en una riña. Al examen físico se constata la existencia de una pérdida parcial irregular de la oreja derecha. Se decide esperar tres semanas, e indicar chequeo preoperatorio. Al cabo de este tiempo se realiza el primer tiempo reconstructivo quirúrgico, con injerto autólogo de cartílago auricular de la oreja izquierda, que fue colocado en forma de "bolsillo" en la región temporal. A las tres semanas del primer tiempo quirúrgico, se realiza, bajo anestesia local, el segundo tiempo reconstructivo con la liberación de la región auricular del "bolsillo" creado, el avance de un colgajo posterior y la colocación de un injerto libre de piel. El paciente refirió una gran satisfacción por los resultados estéticos obtenidos. Principales comentarios: se empleó una secuencia terapéutica ante un defecto traumático parcial del pabellón auricular en sus tercios superior y medio. Este tipo de secuela traumática requirió el empleo de procederes quirúrgicos en varios tiempos operatorios que garantizaran un buen aporte sanguíneo de los tejidos, ausencia de tensión y adecuados resultados estéticos finales(AU)

ABSTRACT Introduction: The aims of auricular reconstruction are to maintain the permeability of the external auditory canal and restore general shape and projection. Objective: Characterize a clinical case of posttraumatic reconstruction of a partial ear loss, highlighting the importance of the therapy sequence followed. Clinical case presentation: A male 26-year-old patient attends outpatient consultation. He reports that he was treated in the emergency service 10 days before upon having lost a section of his ear due to a bite in a fight. Physical examination reveals irregular partial loss of the right ear. It is decided to wait three weeks and indicate preoperative checkup. At the end of that period the first surgical reconstruction session is conducted, with autologous graft of auricular cartilage from the left ear, which was placed in the form of a "pocket" in the temporal region. Three weeks after the first surgical session, the second reconstruction is performed under local anesthesia, with release of the "pocket" from the auricular region, advancement of a posterior flap and placement of a free skin graft. The patient reported great satisfaction with the esthetic results obtained. Main remarks: A therapy sequence was followed in response to a partial traumatic defect of the outer ear in its upper and middle thirds. This type of traumatic sequel required the performance of surgical procedures at several operative moments, ensuring good blood supply to tissues, absence of tension and appropriate final esthetic results(AU)

Epigenetic inhibitor zebularine activates ear pinna wound closure in the mouse.

BACKGROUND: Most studies on regenerative medicine focus on cell-based therapies and transplantations. Small-molecule therapeutics, though proved effective in different medical conditions, have not been extensively investigated in regenerative research. It is known that healing potential decreases with development and developmental changes are driven by epigenetic mechanisms, which suggests epigenetic repression of regenerative capacity. METHODS: We applied zebularine, a nucleoside inhibitor of DNA methyltransferases, to stimulate the regenerative response in a model of ear pinna injury in mice. FINDINGS: We observed the regeneration of complex tissue that was manifested as improved ear hole repair in mice that received intraperitoneal injections of zebularine. Six weeks after injury, the mean hole area decreased by 83.2 ±â€¯9.4% in zebularine-treated and by 43.6 ±â€¯15.4% in control mice (p < 10-30). Combined delivery of zebularine and retinoic acid potentiated and accelerated this effect, resulting in complete ear hole closure within three weeks after injury. We found a decrease in DNA methylation and transcriptional activation of neurodevelopmental and pluripotency genes in the regenerating tissues. INTERPRETATION: This study is the first to demonstrate an effective induction of complex tissue regeneration in adult mammals using zebularine. We showed that the synergistic action of an epigenetic drug (zebularine) and a transcriptional activator (retinoic acid) could be effectively utilized to induce the regenerative response, thus delineating a novel pharmacological strategy for regeneration. The strategy was effective in the model of ear pinna regeneration in mice, but zebularine acts on different cell types, therefore, a similar approach can be tested in other tissues and organs.

[Clinical application of cartilage replantation in situ from amputated ear in the reconstruction of ear in secondary stage].

Objective: To investigate the feasibility and clinical effect of reconstruction the ear using cartilage from amputated ear. Methods: 30 patients (22 males, 8 females, age 22-50, 18 cases right ear, 12 cases left ear) with partial auricles defects received replantation of amputated ears using the cartilages from the amputated ears from January, 2013 to June, 2017.Firstly, an advancements postauricular skin flap was made.Secondly, the skin of the amputated ear was removed and its cartilage was retained, then the cartilage was sutured in situ to form cartilage bracket.Finally, the postauricular crimp scalp flap was sutured to form the helix structure.After three months, the back of the reconstructive ear was repaired with the full thickness graft to restore the cranio-auricular angle. Results: Thirty cases were applied with this method to repair the defects.The sizes of auricle contour were good, and the cranio-auricular angles were restored after skin-grafting.The ear shape was stable in 3-6 months' follow-up.VAS was used to evaluate patients satisfaction.All parameters before and after the procedure had significant difference (P<0.05). Conclusions: Patients with partial auricles defects can receive replantation of amputated ears using the cartilages from the amputated ears which has the advantage of short treatment period, satisfactory clinical effect and avoidance using the costal cartilages.Its long-term effect is stable.

Incomplete Ear Amputation.

Ear amputations are common in emergency departments as the auricle's protrusion from the lateral aspect of the head makes it particularly susceptible to trauma. Of the numerous approaches for auricle injuries, the classic methods include microsurgical replantation, primary reattachment, composite graft, retroauricular pocket principle, secondary reconstruction with rib cartilage, and methods using postauricular flap. The success of the operation depends largely on choosing the appropriate surgical procedure since many factors can influence surgical outcome. There is no 1 gold standard technique to treat the variety of auricle injuries. Inappropriate choice of surgical approach can be detrimental to subsequent reconstructive surgery. Therefore, the initial choice of optimal surgical approach is particularly important. In this article, a rare report of left subtotal ear laceration with inferior lobule pedicle by nonmicrosurgical primary reattachment was presented. The operation obtained an ideal cosmetic effect.

A two-stage inversion technique for total auricular reconstruction: case report and literature review.

BACKGROUND: The reconstruction of a total amputated auricle is aesthetically demanding for otorhinolaryngology surgeons. Although various reattachment methods have been introduced since 1898, only a few have achieved satisfactory aesthetic outcomes. This study aimed to present a successful case of auricular reconstruction using a two-stage inversion technique. CASE PRESENTATION: The patient's left ear was extensively lacerated in a violent event 3 h before admission. The first-stage surgery was performed within 6 h of ischemic time. The amputated segment was prepared and trimmed carefully, and the anterior aspect of the avulsed auricle was directly sutured. The posterior skin of the ear was separated from the cartilage to close the wound. Then, using an inversion maneuver, the cartilage was pushed into a postauricular underlying muscle bed. In the second-stage surgery 27 days after the first procedure, the auricle was released and the normal ear structure was restored using full-thickness skin grafting. During a follow-up of more than 9 years, the patient showed satisfactory postoperative results in terms of cosmetic and functional outcomes of the reattached auricle. The size of his left ear was about 90% of the size of his right ear. CONCLUSIONS: The reconstruction of a total amputated auricle is challenging. The key to surgery lies in the sufficient preservation of the meticulous shape of the cartilage. The microsurgical anastomosis is a good choice only in selected cases. It is believed that the two-stage inversion technique can be a simple alternative to reconstruct the auricle in most situations when it is lacerated and contaminated.

Estudio epidemiológico del trauma de pabellón auricular en el Hospital General Dr. Manuel Gea González, México / Epidemiological study of auricle trauma at Hospital General Dr. Manuel Gea González, México

Introducción y Objetivo: La posición expuesta del pabellón auricular lo predispone a una gran cantidad de lesiones. Su reconstrucción tras amputación traumática o laceración requiere una evaluación cuidadosa y experiencia en reconstrucción auricular para lograr un resultado exitoso. El tratamiento temprano de este tipo de lesiones previene la cicatrización defectuosa y por lo tanto mejores condiciones para una reconstrucción estética. El objetivo del presente estudio es conocer la población más afectada por el trauma del pabellón auricular y su etiología en nuestro medio. Material y Método: Realizamos un estudio retrospectivo de pacientes diagnosticados de trauma del pabellón auricular atendidos por la División de Cirugía Plástica y Reconstructiva del Hospital General Dr. Manuel Gea González de la Ciudad de México (México), durante un período de 5 años, con un total de 214 pacientes. Resultados: Dada la especial exposición del pabellón auricular en varones que usan pelo corto, la proporción en cuanto a sexo fue 4.5:1 en nuestra serie. La edad más frecuente fue los 33 años; entre los 0 y 40 años se encontró el 82% de los pacientes, con un promedio de 26 años de edad. El lado izquierdo fue el más afectado (54.6% de los casos). La mayoría de las lesiones fueron, de acuerdo a la clasificación de Weerda, de grado I (abrasiones o heridas sin compromiso del cartílago), con un 37.8% de los casos, seguidas por las de grado IV (lesiones por avulsión con pérdida de segmento o amputación total) con pérdida de cartílago en el 35.5%. El mecanismo más frecuente fue un traumatismo directo seguido por la mordedura humana. El área anatómica más afectada fue el hélix, seguramente por ser la estructura más externa. No hubo ningún caso candidato a reimplante. Conclusiones: Este trabajo nos permitió establecer el grupo de edad más afectado en nuestro medio por trauma auricular, así como las principales causas del mismo. Aportamos también 2 casos de lesión iatrogénica en pabellón auricular en pacientes pediátricos que nos ayudaran a prevenir o evitar dichas complicaciones El 59.3% de los casos se debió a riñas o agresión por tercera persona, cifra que refleja la problemática social de nuestro país

Background and Objective: The anatomical localization or the auricles make them susceptible of trauma. Reconstruction after traumatic amputation requires a careful evaluation and experienced surgeon in auricle reconstruction for a good result. Early treatment of this kind of lesions avoids pathologic wound healing and gets proper conditions for auricle reconstruction. The objective of our study is to know which is the most affected population by auricle trauma and the etiology of this lesions in our area. Methods: We realized a retrospective study analyzing clinical and photographic files of the patients attended by auricle trauma in a 5 years period at Hospital General Dr. Manuel Gea González in the City of México (México): a total of 214 patients. Results: Because of the exposed localization of the auricle in males with short hair, we found a rate 4.5:1 male/female in our study. The most frequent age was 33 years and 82% of the patients were between 10 and 40 years old, with a media of 26 years old. Left side was involved in 54.6%. Concerning Weerda classification 37.8% cases were I degree (wounds without cartilage compromise) followed by 35.5% cases in IV degree (avulsion with certain degree of cartilage lost). The most frequent mechanism of injury was by direct trauma followed by human bite. The most frequent localization was the helix that could be explained by being the most external part of the auricle. None of our patients were reimplantation candidate. Conclusions: Our study let us establish the most frequently affected age group in our area by auricle trauma, and its main etiology. Besides, we report two cases of iatrogenic auricle lesion in pediatric patients than can help us to prevent or avoid these complications. In our series, 59.3% of the cases was due to fights or aggressions for a third person, that reflect the social problematic in our country

The blastema and epimorphic regeneration in mammals.

Studying regeneration in animals where and when it occurs is inherently interesting and a challenging research topic within developmental biology. Historically, vertebrate regeneration has been investigated in animals that display enhanced regenerative abilities and we have learned much from studying organ regeneration in amphibians and fish. From an applied perspective, while regeneration biologists will undoubtedly continue to study poikilothermic animals (i.e., amphibians and fish), studies focused on homeotherms (i.e., mammals and birds) are also necessary to advance regeneration biology. Emerging mammalian models of epimorphic regeneration are poised to help link regenerative biology and regenerative medicine. The regenerating rodent digit tip, which parallels human fingertip regeneration, and the regeneration of large circular defects through the ear pinna in spiny mice and rabbits, provide tractable, experimental systems where complex tissue structures are regrown through blastema formation and morphogenesis. Using these models as examples, we detail similarities and differences between the mammalian blastema and its classical counterpart to arrive at a broad working definition of a vertebrate regeneration blastema. This comparison leads us to conclude that regenerative failure is not related to the availability of regeneration-competent progenitor cells, but is most likely a function of the cellular response to the microenvironment that forms following traumatic injury. Recent studies demonstrating that targeted modification of this microenvironment can restrict or enhance regenerative capabilities in mammals helps provide a roadmap for eventually pushing the limits of human regeneration.

Reconstruction of a near total ear amputation with a neurosensorial radial forearm free flap prelaminated with porous polyethylene implant and delay procedure.

When an auricular defect is caused by high-energy trauma that causes damage to the surrounding tissues, the patient may be not a candidate for reconstruction with local flaps and free tissue transfer may be necessary. Here we present a case of total auricular reconstruction in a 27 year-old man who had total loss of the left ear and traumatized temporal skin and fascia. A radial forearm flap prelaminated by a porous polyethylene implant was employed. A "printed" ear made of silicone, based on the patient's CT-scan of the contralateral ear, was used for intraoperative molding of the future reconstruction. Prolonged prelamination time and surgical delay (three months) were performed to reduce edema, distortion and loss of definition of the framework after revascularization. After subsequent integration and neovascularization of the added tissue, the prelaminated flap was transferred. Flap reinnervation was also performed by direct coaption of the great auricular nerve to the lateral antebrachial cutaneous nerve. The flap fully survived and there were no complications in the early postoperative period. Between 3 and 6 months, the patient returned to normal ranges in terms of warmth and cold, and recovered the discriminative facial sensibility. After one year the auricular reconstruction was intact and satisfactory aesthetic results were achieved. This method may offer a satisfactory solution for a difficult problem and may be considered for acquired total ear defects.

To stitch or not to stitch: A case review: Auricular lacerations involving cartilage management in the emergency department.

Patients with Parkinsonism are at risk of frequent falls by virtue of their unstable gait. Auricular lacerations involving the cartilage are usually managed by Plastics Surgeons. Patient Mr Jones (an alias for this case review) had sustained a significant full thickness auricular laceration that was complicated by a past medical history with Parkinson's disease. This case review summarises a nurse practitioner's (NP) clinical decision-making processes and the experience in the management and treatment of auricular cartilage lacerations in the emergency department.

Rescate venoso tras reimplante auricular / Venous salvage after ear replantation

El reimplante de pabellón auricular tras una avulsión traumática permite restaurar el segmento amputado con buenos resultados. El procedimiento es técnicamente demandante debido al pequeño calibre de los vasos a anastomosar y a la lesión por avulsión que suele presentar la íntima, no siendo posible restablecer el drenaje venoso en todos los pacientes. La congestión venosa postoperatoria es la complicación más frecuente de los reimplantes auriculares. Existen diversos protocolos postoperatorios de anticoagulación/antiagregación, sin que haya evidencia a favor de la superioridad de ninguno de ellos. Ante la congestión venosa del segmento reimplantado, las medidas de rescate incluyen el empleo de hirudo medicinalis y los sangrados pautados tras el rascado de una zona cruenta. Cuando las cifras de hemoglobina tras las medidas de rescate descienden fuera del rango normal suele ser necesaria la transfusión de concentrados de hematíes, una medida habitual en este tipo de procedimiento. Presentamos un caso de reimplante auricular donde no pudo restablecerse el drenaje venoso intraoperatoriamente, así como el protocolo de sangrado utilizado tras la congestión venosa del mismo. Además discutimos las diferentes medidas que suplen el drenaje venoso en los reimplantes de pabellón auricular (AU)

Ear replantation after traumatic avulsion amputation restores the amputee segment with good results. This demanding procedure presents a significant challenge due to the small vessels size and the avulsion injury that the amputated pinna frequently presents, not being possible to restore venous outflow in all patients. Postoperative venous congestion is the most common complication of ear replantation. Regardless the various anticoagulation/antiagregation therapeutic options, there is no evidence that demonstrates the superiority of neither of them. In case of venous congestion an alternative mean of drainage is mandatory, including medicinal leech therapy and blood drainage through small incisions. In these cases, blood transfusions are a common measure in this kind of procedures, usually necessary to maintain hemoglobin levels within normal. We present a case of ear replantation in which venous drainage could not be restored, its postoperative course and the bleeding drainage protocol used after venous congestion. In addition, we discuss the various measures that supplement venous drainage in pinna replantation (AU)

Exosomes of human placenta-derived mesenchymal stem cells stimulate angiogenesis.

BACKGROUND: The therapeutic potential of mesenchymal stem cells (MSCs) may be attributed partly to humoral factors such as growth factors, cytokines, and chemokines. Human term placental tissue-derived MSCs (PlaMSCs), or conditioned medium left over from cultures of these cells, have been reported to enhance angiogenesis. Recently, the exosome, which can transport a diverse suite of macromolecules, has gained attention as a novel intercellular communication tool. However, the potential role of the exosome in PlaMSC therapeutic action is not well understood. The purpose of this study was to evaluate PlaMSC-derived exosome angiogenesis promotion in vitro and in vivo. METHODS: MSCs were isolated from human term placental tissue by enzymatic digestion. Conditioned medium was collected after 48-h incubation in serum-free medium (PlaMSC-CM). Angiogenic factors present in PlaMSC-CM were screened by a growth factor array. Exosomes were prepared by ultracentrifugation of PlaMSC-CM, and confirmed by transmission electron microscopy, dynamic light scattering, and western blot analyses. The proangiogenic activity of PlaMSC-derived exosomes (PlaMSC-exo) was assessed using an endothelial tube formation assay, a cell migration assay, and reverse transcription-PCR analysis. The in-vivo angiogenic activity of PlaMSC-exo was evaluated using a murine auricle ischemic injury model. RESULTS: PlaMSC-CM contained both angiogenic and angiostatic factors, which enhanced endothelial tube formation. PlaMSC-exo were incorporated into endothelial cells; these exosomes stimulated both endothelial tube formation and migration, and enhanced angiogenesis-related gene expression. Laser Doppler blood flow analysis showed that PlaMSC-exo infusion also enhanced angiogenesis in an in-vivo murine auricle ischemic injury model. CONCLUSIONS: PlaMSC-exo enhanced angiogenesis in vitro and in vivo, suggesting that exosomes play a role in the proangiogenic activity of PlaMSCs. PlaMSC-exo may be a novel therapeutic approach for treating ischemic diseases.