Improvement of wound healing by capsaicin through suppression of the inflammatory response and amelioration of the repair process.

Wound healing is a complex biological process involving cytokines with four phases: Hemostasis, inflammation, proliferation and remodeling. Understanding the molecular mechanism of the inflammation phase could improve wound healing in the clinic as excess inflammation is a critical point for dysregulation of normal wound healing. Capsaicin (CAP), a major component of chili peppers, is known to exhibit anti­inflammatory properties through a range of different pathways, such as the neurogenic inflammation and nociception pathways. To improve the understanding of the relationship between CAP and wound healing, it is crucial to elucidate the CAP­related molecular panel involved in regulating inflammation. Therefore, the present study aimed to analyze the effects of CAP on wound healing using an in vitro cell model and an in vivo animal model. Cell migration, viability and inflammation were examined using fibroblasts, and wounds were evaluated in mice under CAP treatment. In the present study, it was found that 10 µM CAP increased cell migration and decreased interleukin 6 (IL­6) expression in in vitro cell assays. In the in vivo animal experiments, the CAP­treated wounds exhibited lower densities of polymorphonuclear neutrophils and monocytes/macrophages, as well as lower IL­6 and C­X­C motif chemokine ligand 10 protein levels. Furthermore, in CAP­treated wounds, CD31­positive capillaries and collagen deposition at the late phase of wound healing were present at higher densities. In summary, an improvement in wound healing by CAP was shown through suppression of the inflammatory response and amelioration of the repair process. These findings suggest that CAP has potential as a natural therapeutic agent for the treatment of wound healing.

Eccentric free muscular perforator flaps in the proximal lateral leg for hand and foot reconstruction.

BACKGROUND: We aimed to introduce our modifications by using eccentrically located muscular perforators to shorten the distance between the recipient vessels and the flap pedicle for overcoming the "short pedicle" drawback of the proximal lateral leg perforator (PLLP) flap. PATIENTS AND METHODS: A retrospective review of 12 cases undergoing free PLLP flap for hand and foot regions reconstruction during 2010 and 2019. The mean age was 43.3 years. Most defects resulted from burn and trauma injuries. The dimensions of defects ranged from 8 × 1.5 cm2 to 12 × 6.5 cm2 . Muscular perforators were designed eccentrically 1-3 cm away from the central point of the flap to shorten the distance between the recipient vessels and the pedicle. The flap was designed to be 0.5-1 cm larger than the defect. RESULTS: The flap size ranged from 9 × 2 cm2 to 15 × 6 cm2 . All pedicles were long enough to ensure an appropriate anastomosis without tension. The post-operative course in all cases was uneventful. All flaps survived without complications. Primary repair of the donor sites was performed in all patients. Donor leg function was not hampered by flap harvesting. All patients were satisfied with the scar after at least 1 year of follow-up. CONCLUSION: Based on our experience, selection of the eccentric locations of the musculo-cutaneous perforators were effective methods to overcome the short pedicle length of this flap type. Using our modifications, thin PLLP flaps can be used in foot and hand reconstruction with minimal donor site morbidity and a high success rate.

Curcumin-Loaded Self-Microemulsifying Gel for Enhancing Wound Closure.

INTRODUCTION: Wound healing is a process in which damaged cutaneous tissues are repaired and is a dynamic physiological interaction involving several types of cells, tissues, and proteins. Compared with typical treatments, specifically in terms of multifunctional properties, bioactive drug-loaded wound dressing in a controlled and sustained delivery system is an advanced tool that significantly improves wound healing. Curcumin substantially enhances wound healing and prevents oxidative damage. However, the effects of this compound on improving wound healing are limited by its aqueous solubility, poor tissue absorption, and rapid metabolism. Hence, the current study aimed to investigate the therapeutic effect of curcumin-loaded self-microemulsifying gel on wound healing. METHODS: Ex vivo permeation studies of the skin of BALB/c mice were performed using a diffusion cell sampling system. The in vivo therapeutic effect was investigated with a full-thickness wound model. Two 6-mm full-thickness circular wounds were created on the back of the mice via punch biopsy. Then, they received different topical gels for 12 days to enhance wound closure. RESULTS: The curcumin-loaded self-microemulsifying gel had higher skin flux, cumulative amount, and permeability coefficient than the commercial gels. In addition, it enhanced wound healing. CONCLUSIONS: This is the first study that utilized self-microemulsifying gel loaded with curcumin as a delivery system for wound healing. However, the effect of this delivery system on wound healing or skin disease treatment should be further investigated.

Drainage outflow restriction as a parameter associated with cortical venous reflux in craniofacial arteriovenous malformations with cavernous sinus drainage.

PURPOSE: Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to demonstrate how it affected our treatment strategy. METHODS: Cases of CF-AVMs associated with CS drainage were collected from a prospectively collected database of patients with CF-AVMs who underwent endovascular treatment from September 2016 to March 2018. Clinical data and angioarchitectural findings were analyzed. Factors associated with the presence of venous reflux (cortical venous reflux (CVR) or dural sinus reflux (DSR)) were analyzed. RESULTS: Fifteen CF-AVM patients associated with CS drainage were analyzed. Three cases of venous reflux from the CS were identified (CVR, 2; DSR, 1). Lesions with unilateral venous drainage, ≤ 2 draining veins, and the absence of antegrade CS outflow were more likely to develop venous reflux from the CS. We successfully performed additional trans-venous coil embolization of the superior ophthalmic vein in two patients with malformations associated with venous reflux to close this venous connection to the CS. CONCLUSION: CF-AVMs associated with CS drainage confer an increased risk of CVR and DSR, especially in cases where the drainage outflow is restricted. Identification of this venous angioarchitecture is essential in the evaluation and treatment planning of CF-AVMs.

Factors Influencing Postoperative Complications in Reconstructive Microsurgery for Head and Neck Cancer.

PURPOSE: The present study aimed to analyze multiple variables and to determine the factors influencing postoperative complications in reconstructive microsurgeries for head and neck cancer. MATERIALS AND METHODS: This was a retrospective review of the medical records of patients with head and neck cancer who underwent free flap reconstruction after ablation surgery at the Cathay General Hospital (Taipei, Taiwan) from January 2010 to December 2014. Clinical and surgical procedure-related factors were retrieved from a database and analyzed. Major complications included flap failure and life-threatening events. Minor complications were defined as requiring only routine wound care or conservative treatments. To evaluate group differences, the χ2 test was applied for categorical variables and the Mann-Whitney U test was used for continuous variables. RESULTS: In total, 158 patients (145 men [91.8%], 13 women [8.2%]) were included in this study. The mean age of the study population was 52.4 years (range, 34 to 84 yr). The mean body mass index (BMI) was 23.71 kg/m2. Most patients (93.7%) had a history of cigarette smoking. Some patients had diabetes (20.3%) and hypertension (31.6%). The percentage of patients who underwent radiotherapy before surgery was 19.6%. The percentage whose flap required a salvage operation was 8.9%. The success rate of the microvascular surgeries was 95.6%. The major complication rate was 6.3% and the minor complication rate was 27.8%. No surgical mortality was noted. CONCLUSION: In these patients, poor nutrition status, indicated by low BMI and low albumin level, was associated with a greater tendency to develop postoperative complications. Patients who had diabetes or who had received radiotherapy before surgery had a high risk for major complications. A large skin paddle seemed to be an influencing factor for minor complications, such as wound dehiscence and superficial loss of flaps.