Dermal regeneration template: a new option for the repair of a large surgical defect after mohs surgery in epidermolysis bullosa

La epidermólisis ampollar es un raro trastorno hereditario caracterizado por fragilidad cutánea, formación de ampollas mucocutáneas recurrentes luego de un traumatismo mínimo y cicatrización deficiente de heridas. Además, algunas variantes se han asociado con la aparición de carcinomas espinocelulares. Presentamos el caso clínico de un paciente con epidermólisis ampollar, que presentó un extenso carcinoma espinocelular localizado en cara posterior de brazo. Este fue tratado con cirugía micrográfica de Mohs y el defecto quirúrgico resultante fue reparado aplicando una matriz de regeneración dérmica sobre la herida durante un mes. Posteriormente continuamos con curaciones y ungüento antibiótico sobre la herida dos veces al día, completando la cicatrización con un excelente resultado cosmético y funcional. Enfatizamos en el carácter novedoso de esta opción terapéutica y en su utilidad en pacientes con epidermólisis ampollar.

Epidermolysis bullosa is a rare hereditary disorder characterized by skin fragility, recurrent mucocutaneous blisters following minimal trauma, and compromised wound healing. Moreover, some variants have been associated with squamous cell carcinoma. Following, we present the clinical case of a patient with epidermolysis bullosa, who presented a large squamous cell carcinoma of the arm. It was resected using Mohs micrographic surgery, and the final defect was repaired by applying a dermal regeneration template over the wound for a month. After this period, we continued using cures and antibiotic ointment over the wound twice a day, and healing was completed with excellent cosmetic and functional results. We emphasize the novelty of this therapeutic option, and its usefulness in patients with epidermolysis bullosa.

Reconstrucción plantar con matriz de regeneración dérmica (Integra®) en paciente quemado eléctrico: presentación de un caso y revisión de la literatura / Plantar reconstruction with matrix of dermal regeneration (Integra®) in an electric burned patient: case report and literature review

Resumen Introducción: Las lesiones complejas de la cara plantar del pie son de difícil manejo desde el punto de vista reconstructivo. En la literatura el tratamiento de elección es la cobertura mediante colgajos libres. Nuestro objetivo es presentar el caso de un paciente con una lesión plantar compleja, exitosamente resuelta con el uso de matriz de regeneración dérmica (Integra®) e injerto dermoepidérmico. Caso clínico: Hombre de 35 años, que sufre quemadura eléctrica de alta tensión con lesión compleja plantar bilateral. Se manejó con escarectomías sucesivas hasta delimitar el daño tisular, y posterior cobertura con Integra® e injerto con resultado estético y funcional óptimo. Discusión: Aunque los colgajos libres son la elección en el tratamiento de esta zona anatómica, infrecuentemente son la única alternativa de reconstrucción en el paciente quemado. No hay mayor evidencia en la literatura en el uso de matrices dérmicas para la cobertura de este tipo de lesiones. Conclusión: Los autores consideran que el manejo de lesiones plantares complejas mediante el uso de matrices de regeneración dérmica es una alternativa válida a considerar en situaciones en que, por diversos motivos, no se puede ofrecer un colgajo libre.

Abstract Introduction: Complex wounds of the plantar aspect of the foot are difficult to manage in the reconstructive point of view. The standard of treatment is covering the defect with free flaps. Our goal is to present the case of a patient successfully treated with the use of matrix dermal regenaration Integra® and dermoepidermal graft for a complex plantar lesion. Clinical case: Thirty-five year old man, who suffers from high voltage electrical burn with bilateral plantar complex injury. It was handled with successive escharectomies to delimit tissue damage and subsequent coverage with Integra® and grafting with optimal aesthetic and functional results. Discussion: Although free flaps are the choice in the treatment of this anatomical area, they are infrequently the only reconstructive option in burned patients. There is no greater evidence in the literature on the use of dermal matrices to cover such injuries. Conclusion: The authors believe that the management of complex footpad lesions using dermal regeneration matrices are a valid alternative to consider in situations where for various reasons, free flaps can't be offered.

Influence of collagen/fibroin scaffolds containing silver nanoparticles on dermal regeneration of full-thickness skin defect wound in rat / 中华烧伤杂志

Objective@#To explore the influence of collagen/fibroin scaffolds containing silver nanoparticles on dermal regeneration of full-thickness skin defect wound in rat.@*Methods@#Eighty-one collagen/fibroin scaffolds containing silver nanoparticles (with the mass concentration of silver nanoparticles as 10 mg/L) and 81 collagen/fibroin scaffolds without silver nanoparticles were produced respectively with freeze-drying method and enrolled as silver nanoparticles scaffold group (SNS) and control scaffold group (CS). Nine scaffolds in each group were cultured with human fibroblasts. At post culture hour (PCH) 2, 12, and 24, the human fibroblasts adherent to the scaffolds (n=3) in two groups were counted. Four full-thickness skin defect wounds were reproduced on the back of each one of the 36 SD rats. The rats were divided into groups SNS (wounds were transplanted with collagen/fibroin scaffolds containing silver nanoparticles) and CS (wounds were transplanted with collagen/fibroin scaffolds without silver nanoparticles) according to the random number table, with 18 rats in each group. In post surgery week (PSW) 1, 2, and 4, 6 rats in each group were sacrificed respectively for general observation, observation of histological structure, inflammatory cell infiltration, and collagen deposition with HE staining, count of CD68 positive cells with immunohistochemical staining, and mRNA expressions of interleukin-6 (IL-6) and IL-10 with real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, t test, and Bonferroni correction.@*Results@#(1) At PCH 2, 12, and 24, the numbers of human fibroblasts adherent to the scaffolds in the two groups were close (with t values from 1.77 to 2.60, P values above 0.05). (2) In PSW 1, no obvious symptom of infection was observed in wound or wound edge of rats in group SNS with obvious vascularization of scaffolds, while obvious symptoms of infection were observed in wounds of rats in group CS with some scaffolds exfoliated. In PSW 2, the scaffolds were firmly attached to the wounds of rats in group SNS, while obvious contracture was observed in the wounds of rats in group CS with a lot of scaffolds exfoliated. In PSW 4, the scaffolds covered the wounds of rats in group SNS with obvious epithelization on the surface of the scaffolds, while all the scaffolds exfoliated, leaving obvious contracture of residual wounds of rats in group CS. (3) In PSW 1 and 2, compared with those in group CS, more collagen secretion and tissue regeneration and less inflammatory cell infiltration in the scaffolds were observed in the wounds of rats in group SNS. In PSW 4, obvious epithelization was observed in the wounds of rats in group SNS, while inflammatory cell infiltration was observed without obvious epithelization in the wounds of rats in group CS. (4) In PSW 1, the number of CD68 positive cells in the wounds of rats in group SNS [(54±10) /mm2] was similar to that in group CS [(78±7) /mm2, t=1.52, P>0.05]. In PSW 2 and 4, the numbers of CD68 positive cells in the wounds of rats in group SNS [(154±10) and (77±7) /mm2] were significantly less than those in group CS [(268±16) and (136±13) /mm2, with t values respectively 7.31 and 3.83, P values below 0.01] respectively. (5) Except for the expression in PSW 4 (t=1.23, P>0.05), the mRNA expressions of IL-6 in the wounds of rats in group SNS in PSW 1 and 2 were significantly lower than those in group CS (with t values respectively 13.12 and 4.65, P values below 0.01). Except for the expression in PSW 1 (t=3.08, P<0.05), the mRNA expressions of IL-10 in PSW 2 and 4 in the wounds of rats in the two groups were similar (with t values respectively 2.14 and 0.49, P values above 0.05).@*Conclusions@#Besides good biocompatibility, collagen/fibroin scaffolds containing silver nanoparticles have obvious effect in modulating inflammation, thus they can accelerate dermal regeneration induced by collagen/fibroin scaffolds for wound repair.