Ash Mosahebi

Modern surgical management of peripheral nerve gap

The management of peripheral nerve injury requires a thorough understanding of the complex physiology of nerve regeneration. The ability to perform surgery under magnification has improved our understanding of the anatomy of the peripheral nerves. However, the level of functional improvement that can be expected following peripheral nerve injury has plateaued. Advancements in the field of tissue engineering have led to an exciting complement of commercially available products that can be used to bridge peripheral nerve gaps. However, the quest for enhanced options is ongoing. This article provides a review of the current treatment options available following peripheral nerve injury, a summary of the published studies using commercially available nerve conduits and nerve allografts in humans and the emerging hopes for the next generation of nerve conduits with the advancement of nanotechnology.

Nerve Conduits for Peripheral Nerve Surgery

Summary: Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial.

Current and Future Nanotechnology Applications in the Management ofMelanoma: A Review

Melanoma is a common malignancy with a high survival rate amongst those diagnosed early. The management of advanced disease is challenging, and current chemosurgery techniques have minimal effect on survival. Nanotechnology, offers great potential in revolutionizing the management of melanoma. New molecules and nanoparticles are designed worldwide in an aim to improve the diagnosis and spread to sentinel lymph nodes and other organs. Novel drug delivery systems are formulated to optimise the distribution and pharmacokinetics of chemotherapeutic agents while reducing their toxic effects. The scope of such molecules extends to therapeutic applications including photodynamic and photothermic therapy where light is converted to heat to combat neoplastic lesions; immunotherapy where nanoparticles are used as immunomodulators or vaccines against cancer cells; and gene therapy which targets pro-oncogenes on signal transduction pathways. This review paper presents current knowledge of the use of nanotechnology in the management of cancer, with a focus on melanoma.

The CelluTome epidermal graft-harvesting system: a patient-reported outcome measure and cost evaluation study

Conventional split skin grafts (SSG) require anaesthesia, specialist equipment and can have high donor site (DS) morbidity. The CelluTome epidermal graft‐harvesting device is a novel alternative, providing pain‐free epidermal skin grafts (ESG) in the outpatient setting, with projected minimal DS trauma and improved patient satisfaction. This study aimed to compare ESG with SSG by evaluating patient‐related outcome measures (PROMs) and the cost implications of both.

Upregulation of epidermal gap junctional proteins in patients with venous disease

Leg ulceration is a feared complication of venous insufficiency. It is not known whether varicose veins predispose skin to poor wound healing. The expression pattern of gap junctional protein connexin, a known marker of poor wound healing, was investigated across various stages of venous disease.

The value of 3D images in the aesthetic evaluation of breast cancer conservative treatment. Results from a prospective multicentric clinical trial

PURPOSE BCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software created for the objective evaluation of aesthetic result of breast cancer conservative treatment using a single patient frontal photography. The lack of volume information has been one criticism, as the use of 3D information might improve accuracy in aesthetic evaluation. In this study, we have evaluated the added value of 3D information to two methods of aesthetic evaluation: a panel of experts; and an augmented version of the computational model - BCCT.core3d. MATERIAL AND METHODS Within the scope of EU Seventh Framework Programme Project PICTURE, 2D and 3D images from 106 patients from three clinical centres were evaluated by a panel of 17 experts and the BCCT.core. Agreement between all methods was calculated using the kappa (K) and weighted kappa (wK) statistics. RESULTS Subjective agreement between 2D and 3D individual evaluation was fair to moderate. The agreement between the expert classification and the BCCT.core software with both 2D and 3D features was also fair to moderate. CONCLUSIONS The inclusion of 3D images did not add significant information to the aesthetic evaluation either by the panel or the software. Evaluation of aesthetic outcome can be performed using of the BCCT.core software, with a single frontal image.

Systematic review of the efficacy of fat grafting and platelet‐rich plasma for wound healing

Adipose‐derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet‐rich plasma (PRP), there may be enhanced healing effects due to the pro‐angiogenic and anti‐inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm2. Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.