Autologous keratinocyte suspension in platelet concentrate accelerates and enhances wound healing - a prospective randomized clinical trial on skin graft donor sites: platelet concentrate and keratinocytes on donor sites.

BACKGROUND: Wound healing involves complex mechanisms, which, if properly chaperoned, can enhance patient recovery. The abilities of platelets and keratinocytes may be harnessed in order to stimulate wound healing through the formation of platelet clots, the release of several growth factors and cytokines, and cell proliferation. The aim of the study was to test whether autologous keratinocyte suspensions in platelet concentrate would improve wound healing. The study was conducted at the Lausanne University Hospital, Switzerland in 45 patients, randomized to three different topical treatment groups: standard treatment serving as control, autologous platelet concentrate (PC) and keratinocytes suspended in autologous platelet concentrate (PC + K). Split thickness skin graft donor sites were chosen on the anterolateral thighs of patients undergoing plastic surgery for a variety of defects. Wound healing was assessed by the duration and quality of the healing process. Pain intensity was evaluated at day five. RESULTS: Healing time was reduced from 13.9 ± 0.5 days (mean ± SEM) in the control group to 7.2 ± 0.2 days in the PC group (P < 0.01). An addition of keratinocytes in suspension further reduced the healing time to 5.7 ± 0.2 days. Pain was reduced in both the PC and PC + K groups. Data showed a statistically detectable advantage of using PC + K over PC alone (P < 0.01). CONCLUSION: The results demonstrate the positive contribution of autologous platelets combined with keratinocytes in stimulating wound healing and reducing pain. This strikingly simple approach could have a significant impact on patient care, especially critically burned victims for whom time is of the essence. CLINICAL TRIAL REGISTRY INFORMATION: Protocol Record Identification Number: 132/03Registry URL: http://www.clinicaltrials.gov

Indications and Controversies in Lipofilling for Partial Breast Reconstruction.

The treatment of sequelae after conservative breast cancer treatment can be a challenge. Lipomodeling, although controversial in the beginning, is a safe technique that can help in the treatment of these deformities, without an important impact on the imaging surveillance. Depending on the severity of the deformity, one or several sessions of fat transfer can be required. The technique is easy and reproducible, but before obtaining satisfying results with a low complication rate, a learning curve should be completed. The final result is natural, with normal breast consistency, with no additional scars

Incisions et technique opératoire de base du lifting cervicofacial [Incisions and baseline operative technique of cervicofacial lifting]

Le lifting cervicofacial est l’une des interventions les plus emblématiques de la chirurgie esthétique et cette intervention a un peu plus de 100 ans. Dans les chapitres qui vont venir au cours de ce rapport, de nombreux points techniques seront précisés. Une technique de base reproductible, fiable et s’adressant aux plus grands nombres est présentée afin de débuter cette chirurgie dans des conditions optimales. La gestion préopératoire et postopératoire est également exposée. Le but de ce chapitre est de préciser les incisions et la technique opératoire de base du lifting cervicofacial, avec la description des suspensions du SMAS et du platysma, ainsi que celle des procédés complémentaires que sont la lipoaspiration et la lipostructure. Ce chapitre permettra de comprendre les éléments plus complexes qui viendront se greffer au cours des différents chapitres suivants. [Cervicofacial lifting is one of the most iconic procedure of plastic surgery and is about hundred years old. In the following chapters of this report, numerous technical points will be specify. A baseline reliable and reproducible technique, appealing to the largest possible audience is presented in order to begin this surgery in optimum conditions. Pre- and postoperative management is also exposed. The aim of this chapter is to precise incisions and baseline operative technique of cervicofacial lifting, with description of SMAS and platysma suspensions as well as complementary procedures like liposuccion and lipofilling. This chapter will lay the foundation of more complex elements that will be described in the various following chapters.

Indications and Controversies in Total Breast Reconstruction with Lipomodeling.

Complete breast reconstruction with fat grafting is an appealing technique because it does not add scars or use flaps, is autologous, and has the secondary benefit of liposuction. It is a multiple stage surgery and usually requires balancing of the contralateral breast. After using this technique since 2001, the authors narrowed the indications, the ideal candidate being a patient with small breasts and enough donor sites for up to 4 or 5 lipomodeling sessions. Breast reconstruction with fat grafting alone in total breast reconstruction has very limited indications, because lipomodeling in combination with other autologous reconstruction gives very nice results

Development of a cost-effective method for platelet-rich plasma (PRP) preparation for topical wound healing.

Platelet-rich plasma (PRP) is a volume of plasma fraction of autologous blood having platelet concentrations above baseline whole-blood values due to processing and concentration. PRP is used in various surgical fields to enhance soft-tissue and bone healing by delivering supra-physiological concentrations of autologous platelets at the site of tissue damage. These preparations may provide a good cellular source of various growth factors and cytokines, and modulate tissue response to injury. Common clinically available materials for blood preparations combined with a two-step centrifugation protocol at 280g each, to ensure cellular component integrity, provided platelet preparations which were concentrated 2-3 fold over total blood values. Costs were shown to be lower than those of other methods which require specific equipment and high-cost disposables, while safety and traceability can be increased. PRP can be used for the treatment of wounds of all types including burns and also of split-thickness skin graft donor sites, which are frequently used in burn management. The procedure can be standardized and is easy to adapt in clinical settings with minimal infrastructure, thus enabling large numbers of patients to benefit from a form of cellular therapy

Cell Therapy Assistance in Reconstructive Surgery for Musculoskeletal Tissues Following Burn and Trauma: Swiss Cellular Transplantation Platform

The sterol compositions of three oceanic jellyfish have been determined using gas chromatographic mass spectrometric techniques involving the use of two separate gas chromatographic column systems. The components in overlapping peaks have been identified by comparison of the mass spectra of peaks in the two column systems using subtractive techniques. A mid-water animal, Periphylla periphylla, was found to contain a very complex and unusual sterol profile including rare 5alpha-stanols, whereas two other oceanic jellyfish Pelagia noctiluca and Atolla wyvillei contained similar mixtures of delta5 sterols to those previously isolated from coastal species

Transverse Facial Artery Perforators: Anatomical, Two- and Three-Dimensional Radiographic Study

BACKGROUND: Increased anatomical knowledge of skin vascularization, such as the recent description of angiosome and perforasome concepts, has led to important innovations in flap surgery. In this sense, few studies have been performed on face vascularization especially for facial artery perforasomes. The aim of this study was to analyze the number, size, and localization of transverse facial artery perforators and their perfusion area. METHODS: Fourteen hemifaces of fresh adult cadavers from the Department of Anatomy of Lyon University were harvested. Transverse facial artery perforators were identified, dissected, cannulated, and selectively injected with 1 ml of patent blue or contrast solution. Photography, microangiography, and computed tomography were performed. Perforator diameter and localization from the lateral canthus were measured. Exact topography and size of the perforasome were analyzed. RESULTS: Twenty-three transverse facial artery perforators were identified. Mean perforator diameter was 1.01 +/- 0.3 mm. Mean perforating site was 31.0 +/- 8.0 mm lateral to and 38.7 +/- 8.8 mm below the lateral canthus. Mean single perforasome surface area was 25.3 +/- 18.34 cm and mean transverse facial artery skin territory was 40.5 +/- 9.78 cm. CONCLUSIONS: The transverse facial artery provides at least one perforator that can be accurately localized using a Doppler probe. Clinical applications related to the improved knowledge of transverse facial artery perforators could be as follows: (1) performing a lateral facial skin flap; (2) facial composite allotransplants; (3) face-lift procedures to improve skin perfusion; and (4) prevention of vessel injury in aesthetic procedures such as dermal filler injection or thread-lift techniques

Effective Treatment of Invasive Aspergillus fumigatus Infection Using Combinations of Topical and Systemic Antifungals in a Severely Burned Patient.

The authors describe an invasive Aspergillus fumigatus deep-burn wound infection in a severely burned patient that was successfully treated with a combination of topical terbinafine and systemic voriconazole antifungal therapy. To our knowledge, this is the first case report describing the effective control of an invasive deep-burn wound infection using this combination