Clinical application of both amniotic membranes and adipose derived mesenchymal stem cells in a cat with a large skin defect

Surgical procedures on large skin defects can be challenging in the short term due to the size of the lesion, infection, and tissue defect. A regenerative therapy for skin wounds has been applied to promote the healing process. An 8-month-old, Korean domestic short-haired female cat, weighing 3 kg, was rescued with extensive defects on the right flank to right inguinal region caused by bite wounds. In this case, amniotic membranes and adipose-derived mesenchymal stem cells were used as the regenerative therapy to treat the large skin defect rather than a surgical intervention alone. To the best of our knowledge, this is the first report of a case with of a large skin defect treated by applying allogeneic amniotic membranes and allogeneic mesenchymal stem cells to a cat.

Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage—Clinical Outcome of 34 Patients

Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length ( W/ L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables ( P < .05 Kruskal–Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A ( W/ L ＞ 0.5) were more difficult to close than in group B ( W/ L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.

Report of Eleven Patients of Subcutaneous Panniculitis-Like T-Cell Lymphoma: Clinicopathologic Features, 18F-FDG PET/CT Findings and Outcome

ObjectivesSubcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a fairly rare subtype of primary cutaneous lymphoma. This study aims to investigate the clinicopathologic features, 18F-FDG PET/CT findings, and outcome of patients with SPTCL.MethodsA retrospective single-center study enrolled 11 patients with SPTCL between August 2010 and March 2020. A total of 26 18F-FDG PET/CT scans were performed, and the initial and follow-up PET/CT imaging features, clinicopathologic and immunohistochemical characteristics, and outcome were analyzed.ResultsThe male-to-female ratio was 1.2. The mean age at diagnosis was 24.2 years (age range: 13–48 years). Histopathological examinations revealed atypical T-lymphocyte rimming of individual subcutaneous adipocytes, mostly with CD2+, CD3+, CD4−, CD5+, CD8+, CD56−, T-cell intracellular antigen-1+, Granzyme B+, and high Ki-67 index. Multiple large skin ulcerations with a maximum diameter of 10 cm were observed in one of the 11 patients (9.1%, 1/11), and hemophagocytic syndrome was found in another one. At initial PET/CT scans, the lesions in all 11 patients showed increased uptake of 18F-FDG with a wide range of maximum standard uptake value (SUVmax) from 2.0 to 14.9. The morphology of the lesions presented as multiple nodules and/or disseminated plaques mainly involving the trunk and/or limbs. Five patients had extracutaneous non-lymph node lesions with SUVmax of 5.6 ± 2.8 on 18F-FDG PET/CT. No significant correlation between SUVmax and Ki-67 index was observed (r = 0.19, P &gt; 0.05). Follow-up 18F-FDG PET/CT scans in six patients showed complete remission of the disease in two, partial remission in three, and progressive disease in one. During the follow-up period, there was no death except for the patient with multiple ulcerations who died 4 months after diagnosis of SPTCL.ConclusionsSPTCL may be a group of heterogeneous diseases with varying degrees of 18F-FDG uptake. 18F-FDG PET/CT demonstrates its usefulness in detecting disease extent, providing diagnostic work-up, staging, and evaluating treatment response of SPTCL. Multiple large skin ulcerations may be a factor of poor prognosis for patients with SPTCL.

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Background: Malignant phyllodes tumors of the breast are fairly rare and fast-growing tumors. They do not respond to chemotherapy or hormonal therapy except in malignant phyllodes tumors. Therefore, the primary treatment for malignant phyllodes tumors is wide surgical excision. Case presentation: Herein, we report a case study which featured a 26-year-old woman presented with a giant malignant phyllodes tumor measuring 20 × 17 × 13 cm. In order to reduce the chance of local recurrence, treatment for these types of tumors usually involves extensive excision with at least 1 cm of surgical margins. The patient underwent extended lumpectomy with 1-3 cm surgical margins, which left a large skin defect of 25 × 15 cm. Repair of such a large skin defect is a challenge to breast surgeons. This is the first reported case in which a “kiss” flap was successfully used to repair the skin defect created after resection of a giant malignant phyllodes tumor.Conclusions: The kiss flap could be considered as an effective method to repair large chest wall defects after resection of giant phyllodes tumors.

Mesenchymal stromal exosome–functionalized scaffolds induce innate and adaptive immunomodulatory responses toward tissue repair

Designing scaffolds capable of inducing and guiding appropriate immune responses holds promise for tissue repair/regeneration. Biofunctional scaffolds were here prepared by immobilizing mesenchymal stromal exosomes onto fibrous polyester materials and allowed cell-mediated delivery of membrane-bound vesicles. Quantitative cell-level analyses revealed that immune cells dominated the uptake of exosomes from scaffolds in vivo, with materials and exosomes acting as the recruiter and trainer for immune cells, respectively, to synergistically promote beneficial macrophage and regulatory T cell responses in skin wounds in mice. Adaptive T helper cell responses were found active in remote immune organs, and exosome-laden scaffolds facilitated tissue repair in large skin injury models. This study demonstrated important mechanisms involved in local and systemic immune responses to biological implants, and understanding tissue-reparative immunomodulation may guide the design of new biofunctional scaffolds.

Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

The management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

Evaluation of Wound Healing Following Wide Surgical Resection and Subdermal Skin Flap Reconstruction for Management of Soft Tissue Tumours in 20 Dogs

Background: Tumours in dogs are increasing day by day and the mainstay of treatment is surgery. Wide surgical resection of soft tissue tumour in dogs is mandatory to prevent recurrence but it leads to the formation of a large skin defect requiring skin reconstruction. Among the various skin reconstruction techniques, subdermal skin flap is a simple reconstruction technique which can be performed by harvesting full-thickness skin from the surrounding skin without using special instruments. The current study was aimed to evaluate the healing and recurrence of tumours in dogs after wide surgical resection of tumour and subdermal skin flap reconstruction.Methods: 20 dogs with soft tissue tumours presented to MSVH, GADVASU, Ludhiana, Punjab, during the period 2019-2020 were treated by wide surgical resection and subdermal skin flap technique. Routine clinico-physical, Hematobiochemical, Radiographic examinations, Fine Needle Aspiration Cytology, Histopathology and Culture Sensitivity Test were performed. Different types of flap were created according to the location of tumour and availability of the loose skin and wound healing was evaluated and complications recorded. Result: Healing of subdermal flap was seen in 15 dogs (75%) while necrosis of subdermal flap was recorded in 5 dogs (25 %) of the cases of which 4 of them had mobility of flap base and were located in ventral abdomen (n=4) and limb (n=1). Overall tumour recurrence was recorded in 3 dogs (15%) which were located in limbs of which 2 dogs had lung metastasis and the tumours were malignant. It can be concluded that single pedicle advancement flaps for thoracic region; bipedicle advancement flap for thoracic and abdominal regions; rotational flaps for lateral thoracic region and transposition flap for proximal limb region are feasible skin reconstruction techniques for the repair of large skin defects in dogs.