Tissue-Material Integration and Biostimulation Study of Collagen Acellular Matrices

Background: Breast reconstruction after mastectomy using silicone implants is a surgical procedure that occasionally leads to capsular contracture formation. This phenomenon constitutes an important and persistent cause of morbidity, and no successful therapies are available to date. Recently, the use of acellular membranes as a protective material for silicone prostheses has been gaining attention due to their ability to prevent this adverse outcome. For this reason, the evaluation of the tissue-material integration and the induced biostimulation by acellular membranes results crucial. Evaluation of in vivo tissue integration and biostimulation induced by three different natural acellular collagen membranes. Methods: Scanning electron microscopy was performed to analyse the membrane porosity and cells-biomaterial interaction in vitro, both in dry and wet conditions. Adipose-derived stem cells were cultured in the presence of membranes, and the colonisation capacity and differentiation potential of cells were assessed. In vivo tests and ex vivo analyses have been performed to evaluate dermal integration, absorption degree and biostimulation induced by the evaluated membrane. Results: Analysis performed in vitro on the three different acellular dermal matrices evidenced that porosity and the morphological structure of membranes influence the liquid swelling ratio, affecting the cell mobility and the colonisation capacity. Moreover, the evaluated membranes influenced in different manner the adipose derived stem cells differentiation and their survival. In vivo investigation indicated that the absorption degree and the fluid accumulation surrounding the implant were membrane-dependent. Finally, ex vivo analysis confirmed the membrane-dependent behavior revealing different degree of tissue integration and biostimulation, such as adipogenic stimulation. Conclusion: The physico-chemical characteristics of the membranes play a key role in the biostimulation of the cellular environment inducing the development of well-organized adipose tissue

Italian recommendations on enzymatic debridement in burn surgery.

Abstract Introduction Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. Methods The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. Results The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. Discussion The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available

Yassine Sami Turki - Intervista

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Malattia di Paget perianale: presentazione di 5 casi

Obiettivo. La malattia di Paget extramammaria (EMPD) è una neoplasia molto rara che frequentemente si associa a carcinomi cutanei o viscerali, sincroni o metacroni. Obiettivo dello studio è valutare retrospettivamente i risultati ottenuti in 5 casi di malattia di Paget perianale osservati e rivedere la letteratura sull’argomento. Pazienti e metodi. Cinque pazienti con EMPD perianale sono stati trattati presso la nostra Divisione da marzo 1996 a dicembre 2006. In 3 casi la malattia era confinata entro l’epidermide, in un caso plurirecidivo era presente un’infiltrazione del derma e un paziente presentava un adenocarcinoma del retto inferiore con diffusione pagetoide. I pazienti sono stati sottoposti ad ampie exeresi perianali e ricostruzioni con graft cutanei. L’asportazione dell’adenocarcinoma del retto è stata realizzata per via transanale. In due casi è stata eseguita una sigmoidostomia di protezione per favorire la guarigione della ferita. Risultati. Non si sono verificate complicanze postoperatorie, neanche a distanza. In due casi la malattia ha recidivato localmente, ma nessun paziente ha presentato metastasi a distanza. Quattro pazienti sono vivi e liberi da malattia, mentre un paziente con recidiva di malattia è deceduto per insufficienza cardiocircolatoria. Discussione. L’analisi della letteratura consente un’identificazione chiara della EMPD primitiva (intraepiteliale/intradermica) e della forma associata ad adenocarcinomi anorettali, interpretata come diffusione pagetoide. Poche informazioni sono invece ricavabili nei casi in cui la malattia si presenta come adenocarcinoma degli annessi. La malattia tende a recidivare anche dopo chirurgia exeretica radicale e ha capacità metastatizzanti, anche nella forma in situ. Conclusioni. La malattia di Paget perianale è una patologia complessa e difficile da diagnosticare. L’ associazione con carcinomi sincroni o metacroni impone follow-up lunghi con controlli clinici e strumentali frequenti

Al centro di Tunisi. Geografie dello spazio pubblico dopo una rivoluzione Au centre de Tunis. Géographies de l'espace publique après une révolution

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