Therapy of percutaneous infection around craniofacial implants.

This study sought to develop treatment strategies for managing percutaneous infection around craniofacial implants. The present general pathogen situation together with a bacterial resistance were determined in 57 infected peri-implant sites. Forty-four implants were randomly assigned for wound cleaning and split into three groups-two with local antibiotics of proven efficacy and one with 3% hydrogen peroxide (H2O2). The pathogen spectrum differed depending on the severity of the infection, with Staphylococcus aureus clearly correlated with the degree of inflammation (positive correlation: R = 0.72). It was observed that the use of additional local antibiotics was not superior to conventional wound cleaning with 3% H2O2. It is suggested that sulcus fluid flow rate measurements could serve as a simple and reliable objective parameter for recall examinations.

Impact of microenvironment on the growth of primary human epidermal cells.

Although the conditions for in vitro cultivation of adult stem cells and tissue are easily standardized, little is known about the optimal conditions for biointegration after transfer of the tissue graft, playing an important role in the treatment of defects especially soft-tissue skin injuries. To examine the influence of the microenvironment, we investigated the doubling time of primary epithelial cells in relation to the culture medium. Serum from patients of different age groups (n = 15, <20 years; n = 9, >20 years; and fetal calf serum) was pooled independently of age and added to culture medium of epithelial cells from a skin donor (10%). Number of cells was counted in vitro after 1 and 4 days of cultivation using a photometric extinction test. Results were plotted using quotient for calculating cell proliferation ([T4 -T1]:T1). Statistical significance was calculated by Wilcoxon test. Highest proliferation rate was achieved by cultivating the cells in the heterological serum admixture. Homologous serum admixtures in the cell cultures of <20 donators yielded a significantly higher proliferation rate than adult serum (P < 0.01). High regenerative capacity of skin in children has, thus far, mainly been attributed to the high plasticity of the cellular structures. Our study shows for the first time that the age-dependent regenerative capacity in vitro is also influenced by age-dependent humoral factors. In vivo cells from older patients may thus be transferred into an altogether suboptimal microenvironment. Responsible humoral factors should be more closely examined to optimize the clinical management of cellular transplants.

Cultured epithelial autografts in the treatment of facial skin defects: clinical outcome.

PURPOSE: To report the treatment of facial skin defects by cultured epithelial autografts and its clinical outcome. PATIENTS AND METHODS: Between 2002 and 2003, 18 patients with secondary facial skin defects (after tumor excision, trauma, or due to chronic wound healing dysfunction) were successfully treated with autologous cultivated keratinocytes. Overall, 12 patients were included in our study. At the time of this evaluation, the average time lapse after treatment with autologous cultivated keratinocytes was 13.1 months. From 9 of 12 patients a skin biopsy was taken, 12 of 12 patients were neurologically tested, and the results of 12 of 12 patients' esthetics were evaluated by photography and in written form with a standardized questionnaire. RESULTS: Histologically, 9 of 12 patients showed a regular epithelial layer with evidence of basal cells of the basal membrane and conspicuously arranged connective tissue. The neurologic quality of the skin was discreetly reduced in 9 of 12 patients, but this was not experienced by the patient as a limitation. The wound closure was permanent in the case of all 12 patients. Scar tissue was found frequently, when the wound size was greater than 2.5 cm2. On the basis of the standardized questionnaire, 12 of 12 patients rated the degrees of their subjective satisfaction. CONCLUSION: From the esthetic, histologic, and neurologic points of view, cultured epithelial autografts are an auspicious alternative to conventional grafting methods for facial skin replacement. Optimizing cell growth in vitro to decrease the cultivation period still remains an essential goal for the future to increase patient acceptance of the procedure as well.

Spontaneous scalp arteriovenous fistula in a child with hartnup disease.

PURPOSE: To report the endovascular treatment of a spontaneous scalp arteriovenous fistula (AVF) in a child with Hartnup disease. CASE REPORT: A 6-year-old girl with Hartnup disease presented with recurrent attacks of intense, migraine-like, right-sided headache; a tender, pulsatile small mass was observed in the scalp. Selective digital subtraction angiography revealed a high-flow scalp AVF fed by the frontal branch of the right superficial temporal artery draining via the scalp veins. Endovascular treatment was performed by direct puncture of the distal feeding artery and injection of 2 mL of a 50% mixture of N-butyl-cyanoacrylate and Lipiodol. Serial arteriograms performed 6 months and 2 years later documented complete resolution of the lesion. The patient has had no recurrence of clinical symptoms or local signs for recanalization. CONCLUSIONS: Scalp AVFs may progress in size, causing significantly disabling symptoms, particularly in children. We recommend endovascular treatment at the earliest possible stage.