Marta Markowicz

Platelet-rich plasma in burns

Platelet-rich plasma stimulates angiogenesis, promoting vascular in-growth and fibroblast proliferation. In addition, PRP functions as haemostatic by forming a fibrin clot. Also application of PRP enhances wound-healing in both soft and hard tissue. A survey of the literature to assess the current clinical experience and the possible effects of platelet-rich plasma (PRP) on wound-healing in burn cases yields only few reports. The application of PRP is not currently standardized and the effects in wound-healing are poorly understood. The use of PRP as an analog to fibrin sealant is also only seldomly reported. The value of PRP application in burns remains unclear. A definitive assessment as to the application of PRP in burn treatment will require further studies. Theoretically the effects of PRP in burn wounds could be beneficial, however the interaction in tissue repair and regeneration must be better understood.

Human Serum from Platelet-Poor Plasma for the Culture of Primary Human Preadipocytes

In adipose tissue engineering, the use of human serum is essential to achieve the goal of an autologous system. Serum from conventional human plasma (SCP) contains platelet‐derived growth factor (PDGF), a growth factor known to be both a potent inhibitor of adipose differentiation and also the most important stimulator of proliferation in human serum. Serum from platelet‐poor plasma (SPPP) is considered to be PDGF‐deprived and should therefore inhibit the differentiation of preadipocytes to adipocytes to a lesser extent. Effective cultivation of preadipocytes with SPPP requires compensating for the missing stimulatory PDGF effect on proliferation. However, the addition of other growth factors to the media needs to provide stimulation of proliferation without significant inhibition of differentiation. Primary human preadipocytes were isolated from adipose tissue samples of 10 healthy human donors and cultured under four different medium conditions (SCP, SPPP, SPPP + 1 nM basic fibroblast growth factor [bFGF], and SPPP + 1 nM epidermal growth factor [EGF]) for five generations. Proliferation activity and differentiation capacity were assessed for each sample, generation, and culture condition by calculating doubling time and measuring glycerol‐3‐phosphate dehydrogenase (GPDH)‐specific activity. The use of SPPP resulted in a marked rise in GPDH activity compared with the cells cultured with SCP. Supplementing SPPP with 1 nM bFGF or EGF increased proliferation activity significantly. SPPP can be considered superior to SCP for the culture of primary human preadipocytes in adipose tissue engineering in terms of proliferation activity and differentiation capacity.

Human bone marrow mesenchymal stem cells seeded on modified collagen improved dermal regeneration in vivo.

In the correction of functional and aesthetic impairments, loss of soft connective tissue creates the need for adequate implant material. The reconstruction of defects resulting from radical excisions, trauma, or hereditary diseases has seen the use of combined grafts and flaps. With the aim of minimizing donor site morbidity, new methods have been evaluated. Because of a low rate of vascularization, with artificial dermal templates the take has only been poor. As shown in previous studies, improved angiogenetic potency and epidermal formation has been obtained in modified, cell-seeded collagen matrices. We have now investigated the suitability of adult bone marrow mesenchymal stem cells (hMSC) for soft tissue engineering. In this study, hMSC were isolated and expanded. Cells (106) were seeded onto EDC cross-linked collagen sponges and implanted in 30 immunodeficient mice. Collagen sponges without cells were used as controls. The grafts were evaluated after 2 and 6 weeks. After explantation, macroscopic appearance, weights, and histology (scaffold degradation, cellularity, and invasion depth of the seeded cells) were all assessed. After 2 and 6 weeks in vivo, new vessels were found macroscopically on all cell-seeded collagen grafts. The control grafts appeared to be degraded with a lower rate of vessel ingrowth. In the experimental group, weight gain was significant after 2 and 6 weeks in vivo compared to the same grafts after 72 h in vitro, while weight increased only slightly in the control group. Histologically, populated scaffolds showed a high density of vascularization under a capsule. The control sponges showed single capillaries and a thicker capsule. Compared to the controls, cellularity (cells/field) was greater in cell-containing collagen grafts after 2 and 6 weeks. The results obtained demonstrate that in vitro cultured human mesenchymal stem cells seeded on modified collagen sponges may be able to act as a replacement for soft tissue.

Aesthetically pleasant umbilicoplasty.

The umbilicus is an important aesthetic feature of the abdomen and thus calls for an optimized reinsertation technique. Localization and characteristics of the umbilicus were assessed in 137 adults. In addition, age, height, weight, pregnancy, and gender were recorded. Each participant reviewed his own photographs while the authors reviewed all of them. The categorization included a rating and an evaluation of the silhouette. A vertical-configured umbilicus was the most frequently observed. Nevertheless, the score for oval shape was superior. Following a pregnancy, the navel became shorter and wider. Furthermore, the distances measured between the fixed bony points were larger in males and as BMI increased. The height of a person had no impact on the position or height of the umbilicus. An oval-shaped umbilicus that is positioned at 2/3 of the distance from the pubis to the xiphisternum may lead to the most aesthetic results. Thus, the goal in umbilicoplasty is to obtain this configuration.

Early and Long-Term Evaluation of Perfusion Changes in Free DIEP-Flaps for Breast Reconstruction via IC-View and Duplex Ultrasound : Autonomous or Peripheral Perfusion?

Controversy surrounds the question whether free flaps remain dependent for blood supply on their vascular pedicle or if there is an autonomization by neovascularization from the surrounding wound bed. This becomes important when flap shaping or repositioning are performed. Our study involved 23 patients who received a deep inferior epigastric perforator (DIEP) flap for breast reconstruction. IC-View laser video angiography (Pulsion Medical Systems AG, Munich, Germany) was executed immediately and 18 months postoperatively. Two zones (close and distant to the pedicle) and the contralateral breast were compared quantitatively. Via duplex ultrasound, late perfusion changes were measured to analyze flow volume, velocity, and diameter of the internal thoracic artery and the DIEP-flap pedicle. In the long term, early postoperative flap hyperperfusion changed to flap hypoperfusion. No enhanced flow from the flap surrounding into the flap borders was measured. These results might indicate a long-term increase in total peripheral vascular resistance of the transplanted tissue. Postoperative perfusion after 18 months remains dependent on the anastomosed vascular pedicle.

A clinical evaluation of a transparent, absorbent, adhesive wound dressing

The performance of a transparent absorbent adhesive wound dressing (TAAWD) was observed over 7 days in five plastic surgery clinics across Germany. The study included 47 diverse postoperative linear wounds and donor sites with dry or minimal exudate levels. Data on ease of application and removal, adhesive strength, skin compatibility, conformability to the body, visual wound inspection and parameters of wound assessment were collected and analysed. At the end of the observation period, 100% of wounds were recorded as healing with no reported complications. Clinicians considered that the new dressing had predominantly met clinical needs in 89% of cases. The dressing was shown to be skin friendly, easy to apply, adhere and conform to the skin while protecting the wound and allowing the patient to shower. Due to its transparency, the dressing enabled direct wound surveillance without potential disruption to the wound and healing process.

Collagen Matrices with Enhanced Angiogenic and Regenerative Capabilities

The application of collagen matrices in covering wound defects has been under investigation for quite some time. First applications led to the development of Integra®, a well-known product consisting of collagen and chondroitin sulfate cross-linked with glutaraldehyde and contained on a silicon foil. Application of this product requires a two-stage procedure necessitating hospitalisation of the recipient for about 2 weeks. Subsequent to vascularisation of the collagen, the foil is removed and the collagen surface is covered with autologous split skin in the second stage. The long hospitalisation period creates a need for a material of improved angiogenic capabilities.

So heilen Narben nach Brust OP besser

Den Therapieverlauf unterstützen – Für den Behandlungserfolg rekonstruktiver Eingriffe an der Brust ist eine gute Nachsorge immens wichtig. Die entscheidenden Schritte erfolgen dabei noch in der Klinik. Worauf sollten Pflegekräfte achten?

Brustrekonstruktion: Implantat oder Eigengewebe?

Das kann die Plastische Chirurgie – Jedes Jahr erkranken in Deutschland etwa 55.000 Frauen neu an Brustkrebs. Vielen von ihnen bietet nur eine radikale Brustamputation die Chance auf Heilung – ein verstümmelnder Eingriff für die Betroffenen. Doch heute gibt es viele Möglichkeiten, diesen Frauen wieder zu einem positiven Körperbild zu verhelfen.