Full-thickness dermal wound regeneration using hypoxia preconditioned blood-derived growth factors: A case series.

Hard-to-heal wounds can be detrimental to patients' quality of life. Currently, there is scarcity of therapeutic alternatives to mainstay surgical treatment, which uses the principles of tissue debridement, temporary wound coverage, and subsequent tissue reconstruction. Here, a new approach is proposed that harnesses the regenerative power of autologous peripheral blood, through a process termed hypoxia-adjusted in vitro preconditioning. The effectiveness of this method is demonstrated with six cases of surgical wounds, including two cases of large full-thickness dermal wounds that developed as a result of skin necrosis following abdominoplasty and buttock-lift procedures in heavy smokers, as well as a case of extensive inflammatory tissue damage that occurred following breast surgery. While these wounds differed in size (4-160 cm2), geometry and location, all of them could be managed conservatively with topical application of growth factor-enriched hypoxia preconditioned serum derived from the patient's own peripheral blood. This treatment led to complete wound closure by latest 135 days. The finding of complete skin regeneration even in large (>10 cm2), full-thickness wounds, where initially no dermal tissue was available in the wound bed, strongly suggests that the treatment targeted key cellular regenerative mechanisms, including differentiation, angiogenesis, granulation tissue induction, contraction and epithelialization. The method is readily clinically applicable, cost effective, and overcomes limitations of the classic reconstructive approach.

PET scanning in plastic and reconstructive surgery.

In this report we highlight the use of PET scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge.

Influence of vascular endothelial growth factor gene modification on skin substitute grafted on nude mice / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of vascular endothelial growth factor (VEGF) gene modification on skin substitute grafted on nude mice.</p><p><b>METHODS</b>Human fibroblasts were transfected with VEGF adenovirus vector. Then the genetic modified fibroblasts were seeded on patches of Integra artificial skin. Twenty-four hours later, the Integra patches were grafted onto full-thickness skin defects on nude mice. Seventy-two nude mice were divided into experiment (n = 18, E, with fibroblasts seeded on Integra which were transfected by adenovirus containing VEGF in advance), GFP control (n = 18, the fibroblasts were transfected with adenovirus containing labelled GFP segment as same as that in E group, but containing no VEGF gene), Fb control (n = 18, without gene transfection), and control (n = 18, no fibroblast was seeded on Integra) groups. The survival rate, the revascularization process and the histological changes in the grafts in gene modified group (experimental group) and control groups were observed and analyzed.</p><p><b>RESULTS</b>The revascularization condition in the experimental group was much better than that in the control group. The grafts adhered firmly to the wound during early postoperation stage, and were more prone to bleed when separated from the wound. The survival rate was obviously higher, while the infection rate was much lower in experimental group (100.0%) compared with the control groups (83.3%, 75.0%, 77.8%, respectively) (P < 0.05).</p><p><b>CONCLUSION</b>High expression of VEGF by gene modification can promote the vascularization process of skin substitute, hence improve the grafting result.</p>