Effects of mesenchymal stem cell culture on radio sterilized human amnion or radio sterilized pig skin in burn wound healing.

Deep second and third degree burns treatment requires fibroblasts, keratinocytes and other skin cells in order to grow new dermis and epidermis. Cells can proliferate, secrete growth factors and extracellular matrix required to repair the damaged tissue. Radiosterilized human amnion and radiosterilized pig skin have been used as natural origin skin dressings for burned patients. Adipose-derived mesenchymal stem cells can differentiate into fibroblasts and keratinocytes and improve wound-healing progress. These cells can stimulate vascular tissue formation, release growth factors, synthetize new extracellular matrix and immunoregulate other cells. In this study, we developed mesenchymal stem cells-cellularized skin substitutes based from radiosterilized human amnion or pig skin. Third-degree burns were induced in mice animal models to evaluate the effect of cellularized skin substitutes on burn wound healing. Mesenchymal phenotype was immunophenotypically confirmed by flow cytometry and cell viability was close to 100%. Skin recovery was evaluated in burned mice after seven and fourteen days post-coverage with cellularized and non-cellularized sustitutes. Histological techniques and immunofluorescence were used to evaluate re-epithelization and type I collagen deposition. We determined that cellularized-human amnion or cellularized-pig skin in combination with mesenchymal stem cells improve extracellular matrix deposition. Both cellularized constructs increase detection of type I collagen in newly formed mouse skin and can be potentially used as skin coverage for further clinical treatment of burned patients.

Tricoepitelioma múltiple / Multiple tricoephitelioma

El tricoepitelioma, descrito por Brooke en 1892 y también llamado epitelioma adenoideo quístico, es una genodermatosis autosómica dominante originada en el complejo pilosebáceo. Existen dos formas clínicas: la solitaria y la múltiple. Algunos autores recomiendan no tratarlo; sin embargo las lesiones múltiples tienden a deformar la anatomía y la resección parcial presenta recidivas así como cicatrices excesivas y en algunos casos tienen un comportamiento agresivo. Presentamos un caso clínico de tricoepitelioma con deformidad severa de la cara en el que se realizó tratamiento radical con restitución de unidades estéticas mediante colgajos locales. Consideramos que los casos agresivos o deformantes deben ser tratados de forma radical, eliminando todo el espesor de la piel para obtener resultados satisfactorios (AU)

Trichoepithelioma, first described by Brooke in 1892, also known as cystic adenoid epithelioma, is a dominantly inherited genodermatosis originated in the follicle bulb. There are two clinical forms, solitary and multiple. Some authors advocate not to treat them, but multiple trichoepithelioma presents a significant cosmetic problem and partial resection can lead to recurrence and excessive scarring, some cases with an aggressive behavior. We present a clinical case of multiple tricoepithelioma with severe deformity of the face in which we realized radical resection with restitution of anatomical units by local flaps. We consider that the multiple cases should be excised with total skin to avoid recurrence and obtain acceptable results (AU)

Protocolo de tratamiento de cicatrices queloides en el pabellón auricular del Hospital General Dr. Manuel Gea González / Treatment protocol of auricular keloid scars in the General Hospital Dr. Manuel Gea González

Las cicatrices queloideas son una de las patologías de más difícil tratamiento por el alto porcentaje de recidivas que presentan, hasta un 100 % en tratamientos únicos y un 50% en tratamientos combinados. El pabellón auricular es un blanco frecuente de esta patología. Presentamos el protocolo de tratamiento empleado en nuestro hospital en los últimos 6 años con terapia combinada en 51 pacientes y 64 pabellones auriculares afectados por queloides. Aplicamos de forma preoperatoria 3 dosis de triamcinolona o betametasona intralesional, con diferencia de 4 a 6semanas entre dosis y 4 semanas después de la última dosis, realizamos resección de la cicatriz dejando piel suficiente para el cierre sin tensión. En los pacientes que presentaban antecedente de resección quirúrgica se añadió al tratamiento el uso de colchicina, comenzando el día de la cirugía y manteniéndolo durante 8 semanas, a dosis de 1 mg. al día, con control de pruebas de función hepática pre y postratamiento. En el 74.5% de los casos la cicatriz queloide fue unilateral; el 56.8% de los pacientes fueron mujeres; las edades fluctuaron entre los 8 y los 61 años con una media de 24 años de edad. En el 65% de los casos el queloide se presentó en el pabellón auricular derecho y en cuanto a su localización dentro del mismo, el 42% se presentó en el lóbulo. La causa en el 56% de los casos fue por perforación. El 18.6% de las cicatrices tratadas cedieron con la infiltración intralesional; de las 48 cicatrices que recibieron tratamiento quirúrgico, hubo recidiva en el12.5% ( 6 cicatrices ), con un seguimiento de entre 8 meses a6 años (AU)

Keloid scars are one of the most difficult pathologies to treat because its high rate of recurrence, from 100% with single treatment to 50% with combined therapy. The auricle is a frequent localization of keloids We report our experience in the last 6 years with combined therapy in 51 patients and 64 auricles with keloid scars.: Alls cars were injected with triamcinolone or betamethasone 3 times with 4-6 weeks between each injection. Four weeks after the last injection, the keloids were excised and skin closure was done without tension. In those patients with history of surgical excision, we added to the treatment colchicine, 1 mg daily, for8 weeks with hepatic function test before and after the administration of colchicine. The keloid was unilateral in 74.5% of the cases; 56.8% females; the age of presentation was between 8 and 61 years old, with a media of 24 years old. The right auricle was affected in65% and the most frequently affected area was the lobule in42% .The etiology in 56% of the cases were secondary to piercing. In 18.6% of the cases the scar was resolved with the intralesional injection of triamcinolone or betametasone. From the 48 excisions performed, 12.5% (6 keloid scars) presented recurrence, with a follow up of 8 months to 6 years (AU)