54 research outputs found
Development of a Murine Model for the Exploration of the Biological Effects of External Volume Expansion. Sviluppo di un modello murino per l'esplorazione degli effetti biologici dell'espansione volumetrica esterna
No full textBackground: External Volume Expansion (EVE) refers to a class of devices that non-invasively stretch and expand tissue compartments by external application of suction. EVE has been suggested to increase compartments volume and stimulate the formation of a more developed vascular network, leading to less stiff and better vascularized tissues. It is proposed to patients as a method to prepare recipient sites, in particular breasts, in view of a fat grafting procedure, basing on the theory that fat grafts will better survive and retain volume if the recipient site is more vascularized and provides less compression. However, the method requires high patient compliance and no experimental validation for it has been attempted.
Aims: basing on our group's previous experience in downsizing and testing in animal models clinical devices for wound healing, in particular in settings requiring the application of mechanical forces to soft tissues, we proposed to design an animal model for EVE in which to test the validity of the hypothesis of its being beneficial to fat grafting and explore its mechanisms and potentials.
Methods: we designed and built a miniaturized EVE device to be applied to the dorsum of mice. We then designed a series of stepwise incremental studies. We tested the capacity of EVE of inducing angiogenesis and cell proliferation with 28 days long continuous stimulation. We analyzed its effects on tissues in terms of mechanical stretch, hypoxia and ischemia, edema, inflammation, cell proliferation and angiogenesis after a single 2 hours stimulation. We produced a mathematical modeling for the effects of EVE on tissues in relation to fat grafting. We tested if EVE is beneficial to fat grafting and if beneficial effects are maintained also in the setting of chronic radiation damage. We tested if EVE can stimulate adipogenesis and what role inflammation can play in it.
Results: in our series of studies, we successfully designed a miniaturized animal model in which to test External Volume Expansion. We demonstrated that the hypotheses of stimulation of cell proliferation, angiogenesis, and expansion of tissue compartments on which it is proposed as a preparatory method to fat grafting is confirmed in experimental settings. We showed how mechanical stretch of tissues, hypoxia and ischemia, edema, and inflammation are all intervening factors that can contribute to these effects. Our results suggest that pre-stimulation with EVE is successful in achieving increased fat graft weight and volume retention, and that its beneficial effects are maintained also in the setting of recipient sites having sustained radiation injury. We also demonstrated that EVE has a potential for direct stimulation of adipogenesis, and gathered supportive results to a role for macrophages in this.
Discussion: our results validate the technique for its use in the preparatory phase to fat grafting, and can help moving towards making fat grafting a more effective and reliable procedure with improved outcomes for patients. We gathered evidence that help increasing our understanding of how EVE works and what it implies for tissues. This is the basis for optimizing the technique, make it safer, and increase patients' compliance. For example, stimulation patterns can be improved, duration of treatment can be reduced, and practices such as continuation of EVE after fat grafting should be abandoned as detrimental. Our unexpected observations on adipogenesis also open interesting opportunities, such as that of re-starting EVE after fat grafting when this is at the peak of its remodeling phase. And linking this effect with the understanding of the similarity to other conditions in which adipogenesis is seen and desired, such as tissue engineering, or pathological, such as lymphedema, can expand the potential of our animal model to alternative broader fields
Title: Necrotizing Fasciitis: classification, diagnosis and management
No full textNecrotizing fasciitis (NF), a life-threatening rare infection of the soft tissues, is a medical and surgical emergency. It is characterized by subtle, rapid onset of spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Once suspected, immediate and extensive radical debridement of necrotic tissues is mandatory. Appropriate antibiotics and intensive general support avoid massive systemic diffusion of the infective process and are the key for successful treatment. However, early diagnosis is missed or delayed in 85% to 100% of cases in large published series: because of the lack of specific clinical features in the initial stage of the disease, it is often underestimated or confused with cellulitis or abscess. Mortality rates are still high and have shown no tendency to decrease in the last 100 years. Unfortunately, the prevalence of the disease is such that physicians rarely become sufficiently confident with NF to be able to proceed with rapid diagnosis and management. This review covers the literature published in MEDLINE in the period 1970 to December 31, 2010. Particular attention is
given to the clinical and laboratory elements to be considered for diagnosis. A wide variety of diagnostic tools have been described to facilitate and hasten the diagnosis of NF, but the most important tool for early diagnosis still remains a high index of clinical suspicion
"Synchronous" multifocal necrotizing fasciitis
No full textBackground: Necrotizing fasciitis (NF) is an infection of the soft tissue, and is fatal if not promptly and aggressively treated. Although it is rare, it is not exceptional; nevertheless, its presentation may be misleading and may delay the diagnosis. We highlight the possible synchronous development of NF in multiple noncontiguous areas. Case Report: A 44-year-old diabetic man with no history of trauma complained of nonspecific lower back pain, which he treated with analgesics and oral antibiotics. Erythema at the left arm appeared, and the general condition worsened. The patient was admitted to the Emergency Department, and NF was diagnosed at the right gluteus and left arm. Conclusion: "Synchronous" multifocality is not an expected presentation of NF, and it complicates the diagnosis and delays treatment, with a potentially negative impact on outcome. (C) 2013 Elsevier Inc
Preliminary report of in vitro reconstruction of a vascularised tendon-like structure: a novel application for adipose derived stem cells (ADSCs)
No full textIntroduction. A greater supply of tendinous tissue can be obtained through tissue engineering technology with increasing application of adult stem cells. It is well known that adipose derived stem cells (ADSCs), found in abundance in adipose tissue, have the same differentiating capacity as mesenchymal stem cells (MSCs) yet have the advantage of being easily isolated. In the present study, we combined the great facility of ADSCs to differentiate with the application of an external mechanical stimulus to successfully create an in vitro reconstructed tendon like structure with a microcapillary network.
Materials and methods. Hyalonect® meshes were used as scaffold. Human ADSCs were seeded onto the biomaterials, and the cell/scaffold constructs were cultured under mechanical stress for up to 15 days. Human tenocytes were used in the same conditions as control. Performance were assessed by histology, immunochemistry, ultrastructure, and biomolecular analysis. Results. ADSCs seeded onto Hyalonect® adhered and differentiated along the entire surface of the biomaterial and began to infiltrate within its structure. Subsequently, endothelial cells migrated, forming capillary in the new extracellular matrix.
Conclusions. This technique allowed for the creation of a vascularized tendon equivalent that could easily be detached from the bioreactor, thus facilitating its implant at the lesion site. These results highlight biological performance of biodegradable hyaluronic acid-based (HYAFF-11) scaffolds, which were shown to be suitable for deposition of the autologous extracellular matrix critical for ADSCs differentiation
Trattamento con innesti di tessuto adiposo della fibrosi cutanea periorale in pazienti affette da sclerosi sistemica progressiva
No full textPSYCHIATRIC ASPECTS IN BURN PATIENTS
No full textAfter an epidemiological analysis of psychiatric disorders as a consequence of burns and also psychiatric aspects of burn victims before the accident, this paper discusses the correlation between psychiatric disorders and burns from the epidemiological, etiopathogenetic and clinical-therapeutic aspects.
Burn patients often suffer from psychiatric disorders and there is a clear connection between the extent and/or severity of injuries (TBSA) and mental illness, particularly anxiety, mood disorders, and post-traumatic stress disorder.
The occurrence of psychiatric disorders (mainly substance or alcohol abuse/dependence, suicidal behaviour, schizophrenia and personality disorders – antisocial or borderline) is a clear-cut risk factor for those with burn injuries.
The occurrence or onset of psychiatric illness during burn hospitalization or recovery is a negative factor for wellbeing and also for the quality of life in the medium-long term.
A burn injury is a traumatic experience for patients, not only as regards psychological aspects (no integration of the traumatic experience with self-perception of life) but also personal ones (knowledge of self-vulnerability, difficulty in accepting the new aspect of the body, with its possible deformation and scars) after trauma. All aspects which may refer to primordial and psychoanalytic fear of death must be taken into consideration. It is also necessary to consider the concepts of accident proneness and consequent pre-burn impulsivity, which may anticipate/represent a person's predisposition to a traumatic event.
All these concepts have clinical and therapeutic importance for multidisciplinary care.
This paper focuses on the relationship between burn injuries and psychiatric illness: post-traumatic stress disorder (acute and chronic), affective disorders, and personality traits. They must all be examined not only as regards their outcomes but also the patient's pre-trauma psychopathology and susceptibility. Also of importance is facing therapy for all these disorders and its correlation with burn care (in terms of length of hospital stay, quality of life, and functional and psychological results)
Leeching as Salvage Venous Drainage in Ear Reconstruction: Clinical Case and Review of Literature
No full textBackground:. Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one.
Methods:. We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion.
Results:. More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion.
Discussion:. In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching.
Conclusion:. Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow
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