Adipose-derived Stem Cells Added to Platelet-rich Plasma for Chronic Skin Ulcer Therapy.

INTRODUCTION: Adipose-derived stem cells (ASCs) hold great promise for regenerative medicine applications due to their ability to promote the healing process through in situ differentiation and secretion of paracrine factor. The aim of this paper is to present a clinical adjunct for chronic skin wound therapy based on ASCs added to platelet-rich plasma (PRP), to obtain an enhanced PRP (e-PRP). MATERIALS AND METHODS: For 18 months, 24 control-group patients with 31 chronic skin ulcers were treated with standard wound care, while 16 experimental-group patients with 21 chronic skin ulcers were treated with standard wound care and 1 e-PRP injection. The patients were randomly assigned to the control or experimental group. Outpatients had weekly follow-up visits where they were subjected to standard treatment and the wound healing process was assessed. RESULTS: At the end of the study, the control and experimental groups had similar healing rates but wound closure rates were significantly different (P = 0.0257): 0.0890 cm(2) x day and 0.2287 cm(2) x day respectively, resulting in a faster recovery for the group treated with e-PRP. No side effects were reported. CONCLUSION: In the authors' experience, e-PRP significantly enhanced wound closure rates when compared to standard wound care, without causing any serious complications. This finding highlights e-PRP as a valuable resource for chronic wound treatment.

Role of adipose-derived stem cells in chronic cutaneous wound healing.

AIM: Adipose tissue represent an alternative source of multipotent stem cells with characteristics similar to bone marrowderived mesenchymal stem cells (BMSCs), easier to isolate and effective in wound healing enhancement. MATERIAL OF STUDY: Each patient being considered for stem cells graft was subjected to a conventional liposuction procedure (local anaesthesia, aspirated volume about 80cc), in order to isolate a pellet of adipose-derived stem cells (ASCs), which was then mixed with the platelet-rich plasma (PRP) previously collected, in order to obtain an enhanced-ASCs- PRP (e-PRP), now ready for grafting in the context of skin edges as well as at the bottom of the lesion itself. RESULTS: Flow cytometric analysis performed on the pellet obtained with our isolation process, showed that a mean of 5 x 105 ASCs (range: 4,0-6,0 x 105, SD: ± 1 x 105) were collected from 80 ml of adipose tissue, harvested with standard wet liposuction procedure. It represented the 5% of all sample cells (1 x 107), while the others 95% were mostly being blood-derived and endothelial cells. DISCUSSION: By now, the most used isolation protocols take about two hours due to the complex isolation procedure, requiring both animal-derived reagents and collagenase. The amount of ASCs obtained with our isolation process is sufficient to be directly engrafted in the wound without the need of in vitro expansion but, neither serum nor animalderived reagents are used, and it takes only 15' minutes. CONCLUSION: ASCs application is an innovative, effective approach in the treatment of chronic wounds.

Endoscopic forehead surgery for migraine therapy Personal technique.

AIM: The aim of this study is to prove the therapeutic effectiveness of nerve decompression, performed endoscopically for frontal migraine and by open surgery for occipital migraine. MATERIALS AND METHODS: Twenty patients were enrolled and underwent surgery for endoscopic resection of the glabellar muscle group, including the corrugator supercilii, depressor supercilii, and procerus muscles, while the occipital decompression was performed in open surgery through decompression of occipital nerves from occipital, semispinalis capitis, trapezius and sternocleidomastoid muscles. Every patient was diagnosed with: migraine without aura, chronic tensiontype headache and new daily persistent headache, refractory to medical management. RESULTS: Analyzing the answers given by the patients to validated questionnaires, 9 referred alleviation of migraine symptoms (45%), 8 described elimination of their migraine headaches (40%) while 3 didn't report any improvement. DISCUSSION: Our data confirmed the results of previous studies, pointing out the effectiveness of trigeminal branches and occipital nerves (trigger points) decompression from the surrounding muscles. Moreover, our technique has the same results but it's less invasive and has less collateral effects. CONCLUSIONS: Our results highlight migraine surgery as an effective treatment for patients with migraine headaches who do not tolerate or do not wish to continue medical interventions. KEY WORDS: Endoscopic surgery, Headache migraine.