Venous Ulcers.

Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence.

A successful long-term method of fat grafting: recontouring of a large subcutaneous postradiation thigh defect with autologous fat transplantation.

A method of harvesting fat with intact cells using a veterinary needle and a fine needle aspiration device is described. Viable fat cells are obtained in large amounts. A large subcutaneous postradiation thigh defect was reconstructed with harvested fat placed subcutaneously in various sessions. A good, but not perfect, reconstruction was obtained. This case indicates that viable fat cells can be transplanted and can survive even in the adverse environment of a postradiation defect.

Reconstruction of aplasia cutis congenita of the trunk in a newborn infant using acellular allogenic dermal graft and cultured epithelial autografts.

Aplasia cutis congenita, a congenital condition characterized by the absence of all skin layers, occurs mostly on the scalp, but may also involve the trunk and extremities. Conservative treatment using silver sulfadiazine with daily dressing change has been recommended to avoid donor site morbidity and operative risks to the neonate who may have other congenital defects. Others have proposed early surgical intervention to prevent problems associated with delayed wound healing. In this case of a newborn, the authors used an alternative therapy to avoid delayed wound healing and multiple surgical interventions. During one operative procedure, a 130-cm2 lesion on the trunk was covered with allogeneic dermis and cultured epithelial autografts (CEAs). After 2.5 weeks and with three additional applications of CEAs at bedside, 90% of the wound had healed. At 27 months, the grafted area was smooth, and pliable with normal skin texture.

Myofibroblast phenotype and apoptosis in keloid and palmar fibroblasts in vitro.

Keloid formation is a wound healing response, which fails to resolve and leads to formation of a raised collagen mass extending beyond the original wound margins. Keloids are typically excluded from palms and soles. Therefore we compared keloid and palmar fibroblasts in vitro using fibroblasts from nonaffected individuals as controls. Collagen I, alpha-smooth muscle actin and thrombospondin-1 were found at higher levels in keloid than in palmar fibroblasts. These differences were ameliorated by addition of TGFbeta1. The potential for resolution of the wound healing response was estimated analyzing apoptosis during serum starvation. Annexin V and TUNEL assays showed that palmar fibroblasts underwent faster apoptosis, than did the keloid fibroblasts, and started detaching. Addition of TGFbeta1 counteracted this effect. The weak expression of the myofibroblast phenotype and the advanced apoptosis of palmar fibroblasts suggest mechanisms for the exclusion of keloids from palmar sites.