Therapeutic effect of autologous concentrated growth factor on lower-extremity chronic refractory wounds: A case report.

BACKGROUND: Management of chronic refractory wounds is one of the toughest clinical challenges for surgeons. Because of poor blood supply, less tissue coverage, and easy exposure, the lower leg is a common site for chronic refractory wounds. The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs. Concentrated growth factor (CGF) is a novel blood extract that contains various growth factors, platelets, and fibrins to promote wound healing process. However, there has been little research reported on the treatment of lower extremity wounds with CGF. CASE SUMMARY: A 37-year-old man, without any past medical history, presented an ulcerated chronic wound on his right lower leg. The skin defect exhibited clear boundaries, with a size of 2.0 cm × 3.5 cm. The depth of wound was up to the layer of deep fascia. Staphylococcus aureus was detected by bacterial culture. The final diagnosis was right lower extremity ulcers with infection. Cefathiamidine, silver sulfadiazine, and mupirocin cream were applied to control the infection. CGF gel was prepared from the patient's blood sample, and was used to cover the wound after thorough debridement. The skin wound was successfully healed after three times of CGF treatment. CONCLUSION: CGF displays an excellent wound healing promoting effect in patients with lower-extremity chronic refractory wounds.

Experimental study on repairing of nude mice skin defects with composite skin consisting of xenogeneic dermis and epidermal stem cells and hair follicle dermal papilla cells.

OBJECTIVE: To investigate the influence of hair follicle dermal papilla cells (DPCs) on biological features of composite skin. METHODS: In the test group, xenogeneic acellular dermal matrix was employed as the frame, DPCs were seeded on the subcutaneous side, and epithelial stem cells onto the dermal papilla side of the dermal frame so as to construct a composite skin. In the control group, there was no DPC in the frame. The two kinds of composite skin were employed to cover skin defects on the back of the nude mice. Wound healing was observed 4 weeks after grafting and area was analyzed and contraction rate was calculated. The tissue samples in the grafted area were harvested for HE staining and the state of the composite skin was observed. The stress-strain curve of the sampled skin was measured, so as to calculate the maximal breaking power of the sample. The data were collected and statistically analyzed. RESULTS: HE staining indicated that the epithelial depth was increased (more than 10 layers of cells) in test group, with only 6-7 layers in control group. The skin contraction rate in test group on the 4th week after skin grafting (3.94+/-0.013)% was much lower than that in control group (29.07+/-0.018)% (P<0.05). It was indicated by biomechanical test that the stress-strain curve of the composite skin in the test group was closer to that of normal nude mice skin in comparison to that in control group. The maximal breaking force of the composite skin in test group was (1.835+/-0.035)N (Newton), while that in control group was (1.075+/-0.065)N (P<0.01). CONCLUSION: Reconstruction of epidermis in composite skin was promoted by dermal DPCs seeded in the dermal matrix frame. As a result, there was less skin contraction in the composite skin with DPCs, so that the biological characteristics of the skin were improved.

[Isolation and differentiation characteristics of dermal multipotent stem cells from humans of different ages cultured in vitro].

OBJECTIVE: To study isolation, identification and differentiation characteristics of dermal multipotent stem cells from human of different age in vitro culture. METHODS: Skin samples( 1 cm x 1 cm) were harvested from fetus, infant, adult and elderly. The original clones were screened in stem cell medium. The diameter and number of clones were recorded. Analysis of each clone and determination of the expression of various related proteins were carried out. RESULTS: The number of suspended clones from normal skins of fetus, infant, adult and the elderly were (20. 1 +/-2. 5) x 102 , (15. 8 +/-5. 7) x 102, (10. 8 +/-1.3) x 10(2), (6.2 +/- 1.4) x 10(2), respectively ( P <0.01), while the diameter of the clones from them were (83 +/-12) microm, (55 +/- 10) microm, (46 +/- 12) Lm, (42 +/-8) microm, respectively ( P <0.05). Cloned cells from fetus, infant, adult and elderly could differentiate into neuron cell , neuroglia cell, smooth muscle cell, and adipocyte. The clones from fetus were inclined to differentiate into neuron cells, but those from infant were inclined to differentiate into neuroglia cells, and those from adult and elderly were inclined to differentiate into adipocytes. After 1 month of culture, the clone forming rate of the cells from fetus, infant, adult and elderly were 41. 1% , 25.5% ,17.7% ,15.2% , respectively. The individual clone cells also showed ability of multidirectional differentiation. Nestin, fibronectin, c-Myc, STAT3 and hTERT protein were expressed in all clones. CONCLUSION: Multipotent stem cells with multi-direction differentiation and proliferation can be efficiently isolated from dermis of human of different age in stem cell culture medium. The number, proliferation and differentiation of dermal multipotent stem cells can be affected by age.