Treatment of a Severe Pediatric Lyell Syndrome with Amniotic Membrane: Case Report and Histological Findings

Background: Lyell Syndrome (TEN, Toxic epidermal necrolysis) represents a medical emergency particularly in pediatric patients in whom the massive skin damage can quickly lead to multi-organ dysfunction and death. Prompt restoration of the physiologic mucosal/cutaneous barrier is mandatory. The use of amniotic membranes has been described in the treatment of ophthalmic Lyell Syndrome, but its use has not yet been adopted for the management of larger cutaneous wounds. Study Hypothesis: Here we report the use of amniotic membranes in a pediatric case of severe Lyell Syndrome with complete skin surface, ocular and mucosal involvement with life threating presentation. Methods: A 7-year old female was admitted to our Burn Centre for severe cutaneous/mucosal exfoliation (100% Total body surface area, TBSA) as a result of an adverse reaction to ibuprofen administration. Supportive fluid administration, cardiac-pulmonary assistance and pain management were complemented by serial grafting of amniotic membranes on all affected areas to provide coverage of the exfoliated skin/mucosa. Biopsies were obtained to monitor histological skin changes. Results: The patient showed an excellent response to amniotic membrane treatment, with rapid restoration of mucosal and cutaneous layers in the grafted areas. This resulted in a decreased need for dressing changes, avoidance of additional surgeries and a reduced dependence on supportive therapy. Lower pain levels than usually expected led to a reduced need for narcotic pain medications and allowed for early physical rehabilitation and a short hospital stay. Histology confirmed evidence of topical immune-modulation in treated areas (reduction of inflammatory infiltrate). Conclusion: As we tested in numerously TEN and burn pediatric injuries Amniotic membranes with their regenerative and immune-modulatory effects may represent an life saving treatment even in the worst cases of pediatric Lyell syndrome

Fascia lata allografts as biological mesh in abdominal wall repair: preliminary outcomes from a retrospective case series.

BACKGROUND:The use of biological meshes in management of infected abdominal hernias or in abdominal fields at high risk of infection (potentially contaminated or with relevant comorbidities) is well established. Available products include xenogenic patches or decellularized dermal allografts. Despite their biomechanical features, banked fascial allografts have not been investigated yet in this setting. The authors evaluated the safety and effectiveness of banked fascia lata allografts as biological meshes in abdominal wall repair. METHODS: A consecutive series of patients affected by abdominal wall defects and who were candidates for repair by means of a biological mesh and treated in the authors' institution with banked fascia lata allografts were reviewed retrospectively. Data from clinical and instrumental follow-up evaluations up to 48 months (average, 23 months) were analyzed. RESULTS: Twenty-one patients (aged 1 to 86 years) with abdominal wall defects resulting from traumatic (n = 1), neoplastic (n = 6), or multiple previous laparotomies (n = 14) were treated from January of 2008 to October of 2012. Operations had no relevant postoperative complications. At clinical/instrumental follow-up examinations, no major signs of recurrence, laxity, infection of grafts, or other related pathologic symptoms were recorded. Three patients suffered from temporary minor complications (e.g., wound seroma, partial cutaneous dehiscence). At instrumental (computed tomographic scan or magnetic resonance imaging) evaluations, the neofascial tissue appeared stable until medium-term follow-up (3 to 6 months), later being gradually degraded and apparently replaced by host tissue. CONCLUSION: According to limited preliminary outcomes, banked fascia lata allografts seem to provide a biocompatible, safe, and effective alternative to other biological meshes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV

Padova Hospitale Onlus: report of a 15 years experience in surgical and medical assistance in developing countries

Nowadays, an urgent need for global medical cooperation and assistance still bears upon healthcare providers. Since plastic, reconstructive and aesthetic surgery is a surgical specialty with social purposes, the humanitarian importance of the discipline is, nowadays, stronger than ever. Padova Hospitale Onlus is a no-profit charity association with the aim to ensure sustainable medical programs, in particular in the field of plastic and reconstructive surgery. The activity of the association in terms of fund raising strategies, volunteer enrollment and operative strategies, have been reviewed and reported in order to stimulate further collaboration, emulation and contributions. Since 1996, the association has assisted over 20\u2019000 people during 50 missions over the five continents, performing more than 2\u2019000 surgical operations and almost 8\u2019000 medical examination, involving more than 320 volunteers, supplying healthcare material or healthcare facilities. Furthermore, an high rate of surgical records and of medical assistance has been performed in the last two years, depicting a positive rising trend of activity. However, scarce financial means, absence of a structured coordination and/or cooperation between associations may often affect the long-term sustainability of these interventions. Thus, only an experienced and structured association may grant the required resources to sustain adequate and fruitful short-term or long-term projects for the promotion of an humanitarian cooperation as much \u201cdemand driven\u201d as possible

Synthetic Hair Implantation and Squamous Cell Carcinoma of the Scalp.

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Skin Substitutes and Bioscaffolds: Temporary and Permanent Coverage

Advancements in surgical wound treatment have led to skin substitutes and bioscaffolds as temporary and permanent coverage for burn wounds. Skin substitutes are used to improve wound coverage and restore the functional and aesthetic qualities of skin, and help to prevent wound infection and maintain a moist wound healing environment. Although allografts are preferred when autografts are not possible, high costs and limited availability have led to the use of xenografts and the development of skin substitutes and bioscaffolds. Despite constant evolution in the development of these skin substitutes and bioscaffolds, no single product stands out as the gold standard

Multidisciplinary care in severe pediatric electrical oral burn.

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result