Sara Carella

Improvement of Mouth Functional Disability in Systemic Sclerosis Patients over One Year in a Trial of Fat Transplantation versus Adipose-Derived Stromal Cells

Background. Systemic sclerosis (SSc) is a multisystem disease characterized by cutaneous and visceral fibrosis. Face and mouth changes include telangiectasia, sicca syndrome, and thinning and reduction of mouth width (microcheilia) and opening (microstomia). We applied autologous fat transplantation compared with autologous adipose-derived stromal cells (ADSCs) injection to evaluate the clinical improvement of mouth opening. Methods. From February to May 2013 ten consecutive SSc patients were enrolled from the outpatient clinic of Plastic Surgery Department of Sapienza University of Rome. Patients were divided into two groups as follows: 5 patients were treated with fat transplantation and 5 patients received infiltration of ADSCs produced by cell factory of our institution. To value mouth opening, we use the Italian version of Mouth Handicap in Systemic Sclerosis Scale (IvMHISS). Mouth opening was assessed in centimetres (Maximal Mouth Opening, MMO). In order to evaluate compliance and physician and patient satisfaction, we employed a Questionnaire of Satisfaction and the Visual Analogic Scale (VAS) performed before starting study and 1 year after the last treatment. Results and Conclusion. We noticed that both procedures obtained significant results but neither one emerged as a first-choice technique. The present clinical experimentation should be regarded as a starting point for further experimental research and clinical trials.

Autologous cultured melanocytes in vitiligo treatment comparison of two techniques to prepare the recipient site: Erbium-doped yttrium aluminum garnet laser versus dermabrasion

In neonatal intensive care units, extravasation is one of the most common injuries occurring in infants as a complication of infusion therapy. These very preterm infants have immature skin which is easily damaged. They often require a longer duration of intravenous therapy, and obtaining intravenous access can be difficult. An invasive treatment should be avoided, whenever possible, particularly for very immature infants. In our Special Operative Unit for ulcers and difficult-to-heal wounds, University of Rome, we successfully treated a premature neonate, who experienced extravasation of hypertonic fluid, using dermal substitutes and products of regenerative medicine. Extravasation of intravenous fluids is the non-intentional leakage of infused fluid into the surrounding tissue, causing damage. The incidence of extravasation of intravenous fluid after routine infusions in children and babies has been reported as 11-58% (1, 2). The prevalence of extravasation injuries that cause skin necrosis is 38%0 (3). Most injuries occur in infants of less than 26 weeks gestation (3). This is most likely due to the immature skin of these infants. Hypertonic solutions, like alimentation solutions, may cause osmotic imbalance, impaired cell function and lead to tissue injury. Tissue extravasation can occur with varying degrees of morbidity. The severity of damage depends on the volume of the substance infused, the stage of infusion and the nature of the fluid extravasated. The patient with an extravasation injury in moderate cases can present with local swelling, erythema, blistering and pain; in severe cases ulcers and damage of the underlying tissues, with subsequent functional and aesthetic impairments can occur. Preterm babies are especially at risk for severe damage from extravasation because of their prematurity, the fragility and small calibre of their peripheral veins (4). Furthermore, they cannot localize pain, thus allowing the infusion to continue unnoticed. If left untreated, these iatrogenic injuries may lead to extensive skin necrosis and damage to tendons, muscles, nerves and joints causing limb contractures (5, 6). Moreover, if extravasation is next to a major artery in the forearm or leg, vascular flow can be obstructed and amputation will be required (7). Injuries to the physis by extravasation is reported in literature and growth plate arrest have been described (8). The most common sites for extravasation injuries are the dorsum of the hand, the dorsum of the foot, the volar surface of the wrist and forearm, the leg, the scalp and the antecubital fossa. Most injuries are moderate and resolve spontaneously, and only a low rate (0.24%) of them are severe and result in loss of skin tissues, infections and involvement of underlying structures (6). Specific therapies are based upon assessment of the degree of the injury. The goal in managing tissue damage after extravasation is to improve tissue perfusion and prevent progression of tissue necrosis. Significant progress has been made over the years in the development of biomaterials to aid rapid wound closure. These therapeutic devices allow a conservative approach thus resulting in reduction of extravasation injuries occurring in neonatal intensive care units. Furthermore they are well-tolerated and atraumatic, and have the advantage of avoiding or delaying surgery. We document the successful combined treatment using dermal substitutes and products of regenerative medicine of a patient affected by a severe injury from extravasation caused by a hypertonic solution.

The use of hyalomatrix PA in the treatment of extravasation affecting premature neonates.

the yellow coloring and the extent to which the yellow represents fat deposition within the connective tissue portions of the nerve or lipid deposition is unknown and is likely not to be known from patients having neurolysis of chronic compression because these nerves cannot be harvested for histologic evaluation. However, this study could be conducted on freshly amputated limbs in a future study. DOI: 10.1097/PRS.0b013e3182365fbf

Co2/Erbium:YAG/Dye Laser Combination: An Effective and Successful Treatment for Angiofibromas in Tuberous Sclerosis

AbstractBackground Tuberous sclerosis, an autosomal dominant neurocutaneous syndrome seen in approximately 1 in 6,000 people worldwide, is characterized by the appearance of hamartomas in multiple organs. The classic clinical triad consists of angiofibromas, epilepsy, and developmental delay. Dermatologic disorder is one of the main characteristics. Angiofibromas, a common form of presentation, causes significant cosmetic and medical problems. The current treatment for skin lesions is laser therapy. The carbon dioxide (CO2) laser has been used satisfactorily in treating these lesions, but several studies have demonstrated a high percentage of recurrences. Erbium:yttrium–aluminum–garnet (YAG) laser treatment has been used to resurface skin abnormalities in patients with dermatologic conditions. The dye laser as an alternative uses the principles of selective photothermolysis and is very effective in treating the vascular component of tuberous sclerosis. The use of all these lasers to treat skin lesions in patients affected by tuberous sclerosis has never been described in the literature.MethodsA retrospective study, conducted from 2007 to May 2013, investigated 13 patients who had tuberous sclerosis treated with an erbium:YAG/CO2/dye laser combination.ResultsAll the patients showed great improvement of their skin lesions. The results were evident immediately after the first treatment. No patient experienced complications or recurrence.ConclusionsThe combined use of the erbium:YAG/Dye/CO2 laser is a safe and effective treatment for skin lesions in patients affected by tuberous sclerosis.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effect of enzymatic debridement with two different collagenases versus mechanical debridement on chronic hard-to-heal wounds

A chronic ulcer is usually defined as an injury that does not spontaneously evolve towards healing and does not progress through normal healing stages such as inflammation, proliferation and remodelling. This study was designed in order to compare two types of collagenases with mechanical debridement alone. It was thus possible to evaluate their differences in terms of pain and debridement efficacy. Patients were divided into three groups: 30 patients were daily dressed using an ointment based on collagenase produced by Vibrio alginolyticus (B group), 30 patients were daily dressed using an ointment based on a collagenase preparation derived from Clostridium histolyticum (N group) and 30 patients underwent classical mechanical debridement (M group). Complete wound healing over a period of 8 weeks occurred in 24 patients (27%) out of 90;10 patients belonging to the B group, 8 patients to the N group and 6 patients to the M group. This study was performed in order to highlight the differences between two commercially available collagenase‐based ointments in comparison with mechanical debridement alone. At the final time point of week, the difference in the percentage of debridement was not statistically significant in all groups, but at 4 weeks, the debrided area in the B group was larger with respect to the N and M groups, suggesting a more rapid wound bed cleansing process. On the basis of our experience, collagenase derived from V. alginolyticus with hyaluronic acid showed chemical and physical properties that make it a product of great manageability and ensure the protection of peri‐wound skin. Moreover, less pain was experienced by the patients.

Surgical and Laser Treatment of Sturge-Weber Syndrome

Sturge-Weber syndrome (also called encephalofacial or encephalotrigeminal angiomatosis) is a rare neurocutaneous syndrome characterized by facial port-wine stains in the trigeminal nerve distribution area. An innovative treatment based on surgical and laser techniques of a patient affected with Sturge-Weber syndrome is reported. The aesthetic and functional results were satisfactory.

The Use of Human Adipose-Derived Stem Cells in the Treatment of Physiological and Pathological Vulvar Dystrophies.

“Vulvar dystrophy” is characterized by chronic alterations of vulvar trophism, occurring in both physiological (menopause) and pathological (lichen sclerosus, vulvar graft-versus-host disease) conditions. Associated symptoms are itching, burning, dyspareunia and vaginal dryness. Current treatments often do not imply a complete remission of symptoms. Adipose-Derived Stem Cells (ADSCs) injection represents a valid alternative therapy to enhance trophism and tone of dystrophic tissues. We evaluated efficacy of ADSCs-based therapy in the dystrophic areas. From February to April 2013 we enrolled 8 patients with vulvar dystrophy. A biopsy specimen was performed before and after treatment. Digital photographs were taken at baseline and during the follow-up. Pain was detected with Visual Analogue Scale and sexual function was evaluated with Female Sexual Function Index. All patients received 2 treatments in 3 months. Follow-up was at 1 week , 1 and 3 months, and 1 and 2 years. We obtained a significant vulvar trophism enhancement in all patients, who reported pain reduction and sexual function improvement. Objective exam with speculum was easy to perform after treatment. We believe ADSCs-based therapy finds its application in the treatment of vulvar dystrophies, since ADSCs could induce increased vascularization due to their angiogenic properties and tissue trophism improvement thanks to their eutrophic effect.

Chemotherapy Extravasation Management: 21-Year Experience

Abstract Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. Evidence-based standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Our aim was to explore the prevention and treatment of extravasation injuries, proposing a standard therapeutic protocol together with a review of the literature. From January 1994 to December 2015, 545 cases were reviewed (age range, 5–87 years; 282 men and 263 women). Our therapeutic protocol consisted of local infiltration of saline solution and topical occlusive applications of corticosteroids. The infiltrations were administrated 3 to 6 times a week depending on damage severity. Our protocol allowed us to prevent ulceration in 373 cases. Only 27 patients required surgery (escarectomy, skin graft, regional, and free flap). Numerous treatments have been proposed in literature. The antidotes have been discussed controversially and are not considered standard methods for treatment, especially when polychemotherapy is administrated and the identification of the responsible drug is not possible. We proposed the use of saline solution injection to dilute rapidly the drug, thus reducing its local toxic effects. This method is easy to use and always reproducible even when the drug is not known or when it is administrated in combination with other drugs. It is possible to perform it in ambulatory regimen, and, overall, it represents a standard method.

The Megasession Technique for Excision of Multiple Neurofibromas

&NA; The authors have indicated no significant interest with commercial supporters.