Vacuum-assisted closure therapy in the management of patients undergoing vulvectomy.

OBJECTIVES: To investigate whether systematic postoperative VAC therapy could improve vulvectomy healing. STUDY DESIGN: We reviewed medical data from 54 women who underwent in the period of March 2006 to December 2009 radical vulvectomy or wide local vulvectomy with defect volume >40cm(3). Patients were divided into two groups according to immediate postoperative care. Patients treated with systematic vacuum-assisted closure (VAC) therapy immediately after surgery were included in the "VAC group" while patients receiving conventional care (CC) were included in the "CC group". RESULTS: The characteristics of the VAC group (n=30) and CC group (n=24) were similar and there were no significant differences in operative data, histological results or oncologic follow-up. The median length of use of VAC was 11 days after surgery (6-38). The length of hospital stay for patients in the VAC group and CC group was 17.8 (±8.7) and 18.4 days (±9.9) (p=0.8) respectively. The lengths of complete healing were 44.4 (±18.4) vs. 60.2 (±28.7) days (p=0.0175) respectively. CONCLUSIONS: In our study we proved that using VAC dressing immediately after vulvectomy (at least 6cm×7cm) for 11 days reduces the total length of cicatrization by approximately 16 days.

Specific MALDI imaging and profiling for biomarker hunting and validation: fragment of the 11S proteasome activator complex, Reg alpha fragment, is a new potential ovary cancer biomarker.

MALDI imaging mass spectrometry represents a new analytical tool to directly provide the spatial distribution and relative abundance of proteins in tissue. Twenty-five ovary carcinomas (stages III and IV) and 23 benign ovaries were directly analyzed using MALDI-TOF MS. The biomarker with the major prevalence (80%) has been fully identified using MALDI MS and nanoESI MS and MS/MS after separation by RP-HPLC and trypsin enzymatic digestion. This marker with an m/z of 9744 corresponds to 84 amino acid residues from the 11S proteasome activator complex, named PA28 or Reg-alpha. Validation of this marker has been performed using MALDI imaging, classical immunocytochemistry with an antibody raised against the C-terminal part of the protein, specific MALDI imaging, and Western blot analysis. The validation, using immunocytochemistry, confirmed the epithelial localization of this fragment with nucleus localization in benign epithelial cells and a cytoplasmic localization in carcinoma cells. This indicates that this antibody could be used to discriminate the borderline tumor cases. At this point, a multicentric study needs to be conducted in order to clearly establish the potential of this biomarker. Taken together these studies reflect that direct tissue analysis and specific MALDI imaging strategies facilitate biomarker hunting and validation which can be named pathological proteomics.