Role of Enzymic Antioxidants in Mediating Oxidative Stress and Contrasting Wound Healing Capabilities in Oral Mucosal/Skin Fibroblasts and Tissues.

Unlike skin, oral mucosal wounds are characterized by rapid healing and minimal scarring, attributable to the "enhanced" healing properties of oral mucosal fibroblasts (OMFs). As oxidative stress is increasingly implicated in regulating wound healing outcomes, this study compared oxidative stress biomarker and enzymic antioxidant profiles between patient-matched oral mucosal/skin tissues and OMFs/skin fibroblasts (SFs) to determine whether superior oral mucosal antioxidant capabilities and reduced oxidative stress contributed to these preferential healing properties. Oral mucosa and skin exhibited similar patterns of oxidative protein damage and lipid peroxidation, localized within the lamina propria/dermis and oral/skin epithelia, respectively. SOD1, SOD2, SOD3 and catalase were primarily localized within epithelial tissues overall. However, SOD3 was also widespread within the lamina propria localized to OMFs, vasculature and the extracellular matrix. OMFs were further identified as being more resistant to reactive oxygen species (ROS) generation and oxidative DNA/protein damage than SFs. Despite histological evaluation suggesting that oral mucosa possessed higher SOD3 expression, this was not fully substantiated for all OMFs examined due to inter-patient donor variability. Such findings suggest that enzymic antioxidants have limited roles in mediating privileged wound healing responses in OMFs, implying that other non-enzymic antioxidants could be involved in protecting OMFs from oxidative stress overall.

Functional recovery after bilateral extended autologous latissimus dorsi breast reconstruction: A prospective observational study.

BACKGROUND: The impact of unilateral extended autologous latissimus dorsi (EALD) flap harvest and axillary surgery on shoulder function has been well described, but the impact of bilateral EALD flap harvest has not been clearly defined nor is it clear whether reconstructions should be synchronous or staged. METHODS: In this prospective observational study, patients undergoing bilateral EALD breast reconstruction (February 2003-December 2009) completed the disability, arm, shoulder and hand (DASH) questionnaire preoperatively and at five post-operative timepoints. Intensive shoulder physiotherapy was offered to those whose DASH score was >30 at 6 weeks or >20 at 12 weeks post-operatively. RESULTS: Sixty patients underwent bilateral EALD flap breast reconstruction (51 synchronous, 9 metachronous). Patients with pre-existing shoulder pathology (n = 1) and those who failed to return any post-operative DASH questionnaire (n = 10) were excluded from initial DASH analysis. However, these eleven patients were included in a separate analysis as an intention-to-treat analysis. Statistical analysis was performed using non-parametric, Friedman test and multiple comparison model. Forty-nine patients' DASH scores were analysed. DASH score initially increased after surgery and then returned to functionally normal within 3-6 months (median DASH: preoperative = 1 vs 6 weeks post-operation = 26, p = <0.001; vs 3 months = 19, p = <0.001; vs 6 months = 13, p = <0.001); thereafter, the scores remained less than 12 (p = <0.001). Median DASH score after synchronous reconstruction was not higher than that after metachronous reconstructions, although the metachronous sample size was small. CONCLUSION: With appropriate patient selection and intensive physiotherapy, bilateral EALD breast reconstruction does not appear to cause significant long-term impairment of shoulder function, and patients can now be counselled about the likely timecourse of shoulder recovery. There seems no reason to stage bilateral reconstruction to reduce shoulder morbidity.

Therapeutic hypothermia and frostbite injury: a preventable source.

Frostbite injury from cold exposure is not uncommon. The application of ice pack is well known in clinical practice; however, its improper use can pose danger to the patient. We report a case of frostbite injury due to prolonged use of ice packs in a ventilated patient.

Oral lichen planus: a clinical study.

OBJECTIVE: To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus (OLP). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. METHODOLOGY: Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. RESULTS: A total of 95 patients (40 male and 55 female), aged between 17 and 62 years were enrolled. Diabetes (n=05) and hypertension (n=04) were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 (54.7%), followed by erosive in 31 (32.6%) and atrophic/erythematous types in 12 (12.6%) patients. The disease caused pain, burning and other symptoms in 72 (75.7%) patients. Buccal mucosa was the chief site of involvement (n=31). Other sites involved were tongue (n=20), lips (n=28), palate (n=9) and floor of mouth (n=03). Stress, spicy foods and poor oral hygiene aggravated disease in most (n=77) of the patients. CONCLUSION: OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease.

Sciatic nerve palsy--a complication of posterior approach using enhanced soft tissue repair for total hip arthroplasty.

Sciatic nerve palsy is a rare but well recognised complication of total hip replacement. There are a variety of potential causes of sciatic nerve palsy and its prevalence with different approaches has been mentioned in the literature.(1-5) The posterolateral or 'Southern' approach with some form of enhanced soft tissue repair is a commonly used approach for primary total hip arthroplasty. However, the sciatic nerve is recognised to be in close proximity to the surgical field. We report a case of sciatic nerve palsy after this approach as a result of a surgical suture used for soft tissue repair.

A novel, cost effective escharotomy simulator and trainee assessment.

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. In the 21st century, however, it is important to continue to develop simple teaching aids which are available to large audiences in low and middle-income countries. We present a simple 'escharotomy simulator' which has been well received, resulting in an increase in knowledge, and an increase in confidence to carry out the procedure.

Combined CO(2) laser with photodynamic therapy for the treatment of nodular basal cell carcinomas.

BACKGROUND: Basal cell carcinomas (BCC) are often seen by plastic surgeons and dermatologists in the outpatient setting. Treatment usually necessitates excision of these lesions with an appropriate margin guided by published recommendations, often resulting in less than ideal cosmetic outcomes, especially if local flaps or skin grafts are required for reconstruction. Photodynamic therapy (PDT) and CO(2) laser when used as monotherapy have been successfully used to treat BCCs, with greatest success in the superficial histologic subtype. These modalities when used alone have a number of limitations when compared with surgical excision, including a limited depth of penetration of PDT (2-mm absorption), which potentially limits the efficacy of treatment of nodular BCCs greater than this thickness or which are deeply invasive. We describe our positive experiences of combination therapy with both modalities in 12 patients, with the aim of improving treatment efficacy. METHODS: Twelve patients with 13 biopsy-proven nodular BCCs on the head and neck were treated with combined therapy using an Ultra Pulse CO(2) and PDT using Methyl Aminolevulinate (METVIX) and the Aktilite 16 LED lamp. RESULTS: A total of 12 patients (13 lesions) were treated using combined CO(2) laser/PDT. Nine were male and 2 female; 1 had gender reassignment. The mean age was 67, with a range of 54 to 85. The mean follow-up period was 18.1 months, with a range of 7 to 26 months. All lesions responded to treatment as assessed by clinical evaluation, with regular follow-up on a 3-month basis. There were no recurrences during this time period. The only complications encountered were mild hypopigmentation in 2 cases and mild discomfort experienced with PDT. CONCLUSION: In this study, CO(2) laser and PDT appear to play a synergistic role in the treatment of nodular basal cell carcinomas. Both the surgical team and the patients have been pleased with the results. The mean recurrence-free follow-up was 18.1 months. This apparently synergistic treatment appears most appropriate for patients who value excellent cosmetic outcome over the inconvenience of making additional visits to the clinic or where avoidance of an invasive procedure is an important factor.

Survival of skin graft in mycosis fungoides - a solution for a management dilemma.

We present a case where the surgical defect caused by Fournier's gangrene in a patient with mycosis fungoides was managed in a novel way.

Toe-tourniquet syndrome: a diagnostic dilemma!

Strangulation of digits, the 'toe-tourniquet' syndrome needs prompt intervention as failure to recognise the condition can lead to ischaemia and loss of the appendage. It is a common condition though relatively under reported. Those who deal with children more frequently are aware of the condition but this is not the case for all medical practitioners and hence the diagnostic dilemma for accidental injury or child abuse arises. We report this case to increase physician awareness of the syndrome, to highlight the importance of early release of the tourniquet and to avoid misinterpretation of the condition as child abuse.