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Advances in Therapy Mar 2024Despite differing etiologies, acute thermal burn injuries and full-thickness (FT) skin defects are associated with similar therapeutic challenges. When not amenable to...
Despite differing etiologies, acute thermal burn injuries and full-thickness (FT) skin defects are associated with similar therapeutic challenges. When not amenable to primary or secondary closure, the conventional standard of care (SoC) treatment for these wound types is split-thickness skin grafting (STSG). This invasive procedure requires adequate availability of donor skin and is associated with donor site morbidity, high healthcare resource use (HCRU), and costs related to prolonged hospitalization. As such, treatment options that can facilitate effective healing and donor skin sparing have been highly anticipated. The RECELL Autologous Cell Harvesting Device facilitates preparation of an autologous skin cell suspension (ASCS) for the treatment of acute thermal burns and FT skin defects. In initial clinical trials, the approach showed superior donor skin-sparing benefits and comparable wound healing to SoC STSG among patients with acute thermal burn injuries. These findings led to approval of RECELL for this indication by the US Food and Drug Administration (FDA) in 2018. Subsequent clinical evaluation in non-thermal FT skin wounds showed that RECELL, when used in combination with widely meshed STSG, provides donor skin-sparing advantages and comparable healing outcomes compared with SoC STSG. As a result, the device received FDA approval in June of 2023 for treatment of FT skin defects caused by traumatic avulsion or surgical excision or resection. Given that health economic advantages have been demonstrated for RECELL ± STSG versus STSG alone when used for burn therapy, it is prudent to examine similarities in the burn and FT skin defect treatment pathways to forecast the potential health economic advantages for RECELL when used in FT skin defects. This article discusses the parallels between the two indications, the clinical outcomes reported for RECELL, and the HCRU and cost benefits that may be anticipated with use of the device for non-thermal FT skin defects.
Topics: Humans; Motivation; Skin; Wound Healing; Skin Transplantation; Burns; Transplantation, Autologous
PubMed: 38253788
DOI: 10.1007/s12325-023-02777-7 -
Asian Biomedicine : Research, Reviews... Apr 2023Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and...
BACKGROUND
Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and emergence of antimicrobial resistance.
OBJECTIVES
To ascertain the prevalence of bacteria causing SSTIs and their antimicrobial susceptibility patterns.
METHODS
A prospective study between November 2020 and May 2021. A total of 447 samples from SSTIs were analyzed.
RESULTS
A total of 347 samples revealed mono-bacterial growth, of which 67% were male. SSTIs are common among patients aged 21-50 years with the dominance (78%) of gram-negative rods (GNRs). (36%), spp. (22%), (16%), and (11%) were predominant organisms. GNRs were highly resistant (>65%) to ciprofloxacin and trimethoprim-sulfamethoxazole. For injectable antibiotics, the highest resistance was determined against ceftriaxone, and the least resistance was determined against amikacin. Resistance against carbapenem was the highest among (53%) and spp. (32%). showed the highest resistance against ciprofloxacin, and the least resistance was determined against clindamycin. Of 57 isolates, 86% isolates were methicillin-resistant (MRSA). All isolates of and were sensitive to polymyxin B and vancomycin, respectively. The prevalence of multidrug-resistant and spp. was higher among deep-seated SSTIs (dSSTIs).
CONCLUSIONS
The predominant etiology of SSTIs is GNR. Currently, there is very high resistance against oral antibiotics. Antimicrobial resistance against carbapenem has also increased. Moreover, there is a high frequency of MRSA. MDR and spp. isolates are frequently involved in dSSTIs.
PubMed: 37719324
DOI: 10.2478/abm-2023-0045 -
Nature Communications Apr 2024The composition of the microbial community in the intestine may influence the functions of distant organs such as the brain, lung, and skin. These microbes can promote...
The composition of the microbial community in the intestine may influence the functions of distant organs such as the brain, lung, and skin. These microbes can promote disease or have beneficial functions, leading to the hypothesis that microbes in the gut explain the co-occurrence of intestinal and skin diseases. Here, we show that the reverse can occur, and that skin directly alters the gut microbiome. Disruption of the dermis by skin wounding or the digestion of dermal hyaluronan results in increased expression in the colon of the host defense genes Reg3 and Muc2, and skin wounding changes the composition and behavior of intestinal bacteria. Enhanced expression Reg3 and Muc2 is induced in vitro by exposure to hyaluronan released by these skin interventions. The change in the colon microbiome after skin wounding is functionally important as these bacteria penetrate the intestinal epithelium and enhance colitis from dextran sodium sulfate (DSS) as seen by the ability to rescue skin associated DSS colitis with oral antibiotics, in germ-free mice, and fecal microbiome transplantation to unwounded mice from mice with skin wounds. These observations provide direct evidence of a skin-gut axis by demonstrating that damage to the skin disrupts homeostasis in intestinal host defense and alters the gut microbiome.
Topics: Mice; Animals; Gastrointestinal Microbiome; Hyaluronic Acid; Colitis; Intestinal Mucosa; Fecal Microbiota Transplantation; Dextran Sulfate; Mice, Inbred C57BL; Disease Models, Animal; Colon
PubMed: 38589392
DOI: 10.1038/s41467-024-47072-3 -
Nature Communications Jun 2024The longevity of grafts remains a major challenge in allogeneic transplantation due to immune rejection. Systemic immunosuppression can impair graft function and can...
The longevity of grafts remains a major challenge in allogeneic transplantation due to immune rejection. Systemic immunosuppression can impair graft function and can also cause severe adverse effects. Here, we report a local immuno-protective strategy to enhance post-transplant persistence of allografts using a mesenchymal stem cell membrane-derived vesicle (MMV)-crosslinked hydrogel (MMV-Gel). MMVs are engineered to upregulate expression of Fas ligand (FasL) and programmed death ligand 1 (PD-L1). The MMVs are retained within the hydrogel by crosslinking. The immuno-protective microenvironment of the hydrogel protects allografts by presenting FasL and PD-L1. The binding of these ligands to T effector cells, the dominant contributors to graft destruction and rejection, results in apoptosis of T effector cells and generation of regulatory T cells. We demonstrate that implantation with MMV-Gel prolongs the survival and function of grafts in mouse models of allogeneic pancreatic islet cells and skin transplantation.
Topics: Animals; Hydrogels; Mice; Fas Ligand Protein; Transplantation, Homologous; Mice, Inbred C57BL; T-Lymphocytes, Regulatory; Islets of Langerhans Transplantation; Skin Transplantation; B7-H1 Antigen; Mesenchymal Stem Cells; Mice, Inbred BALB C; Graft Survival; Graft Rejection; Humans; Male; Apoptosis
PubMed: 38890279
DOI: 10.1038/s41467-024-49135-x -
International Wound Journal Sep 2023The study aimed to assess the functional and aesthetic outcomes of abdominal full-thickness skin grafts (FTSGs) in paediatric postburn digital and palmar flexion...
The study aimed to assess the functional and aesthetic outcomes of abdominal full-thickness skin grafts (FTSGs) in paediatric postburn digital and palmar flexion contractures. The digital and palmar functions and aesthetics of 50 children who met the criteria were evaluated at pre-operation, the 3rd- and 12th-month post-operation, respectively. In the evaluation, the Vancouver Scar Scale (VSS), total active movement (TAM), and Jebsen-Taylor Hand Function Test (JHFT) were used. The contralateral, unaffected hand served as the criteria for functional recovery. The complications of donor sites were observed, and the take rate of skin grafts was calculated. The VSS scores at the 3rd and 12th months post-operation were lower than those before the operation. The TAM of each finger was improved at the 3rd and 12th months post-operation, compared with that before the operation. There was a significant difference in the time to complete the JHFT between the affected hand and the unaffected at the 3rd month post-operation, but no significant difference between them at the 12th month post-operation. The excellent and good take rate of the skin grafts was 90.00%.No donor site complications were observed. The abdominal FTSGs are effective in repairing paediatric digital and palmar scar contractures, with satisfying functional and aesthetic results, especially in large defects after scar release and resection.
Topics: Child; Humans; Skin Transplantation; Cicatrix; Burns; Contracture; Esthetics
PubMed: 36950772
DOI: 10.1111/iwj.14145 -
Frontiers in Immunology 2023Atopic dermatitis (AD) is a chronic, recurrent inflammatory disease characterized by itching. The gut microbiome can help maintain skin immune homeostasis by regulating...
Atopic dermatitis (AD) is a chronic, recurrent inflammatory disease characterized by itching. The gut microbiome can help maintain skin immune homeostasis by regulating innate and adaptive immunity. Here, we report a case of AD in a 15-year-old adolescent boy who benefited from washed microbiota transplantation (WMT). WMT was performed for three courses, with each course lasting for three consecutive days and an interval of one month between two courses. Clinical assessments were conducted at each WMT course, and skin, blood, and stool samples were collected for microbial analysis. After three months of WMT treatment, the boy's itchiness was effectively controlled: his skin showed noticeable improvement, with reduced in the skin lesions. The scores of SCORAD (SCORing Atopic Dermatitis), EASI (Eczema Area and Severity Index), NRS (Numerical Rating Scale), and DLQI (Dermatology Life Quality Index) significantly decreased compared to the baseline. Serum levels of eosinophil ratio, tumor necrotic factor-α, and interleukin-6 also reduced to the normal levels. There was a significant decrease in in the skin lesions. Additionally, the intestinal flora became more diverse, and the abundance of species, significantly increased after WMT. No adverse events were reported during the treatment and the 1-year follow-up period. This case report provides direct clinical evidence for WMT as a novel promising treatment strategy for AD, and preliminary experimental data suggests the existence of an intestinal-skin axis in terms of the gut microbiota and the skin immune homeostasis.
Topics: Male; Humans; Adolescent; Dermatitis, Atopic; Gastrointestinal Microbiome; Staphylococcus aureus; Skin; Pruritus
PubMed: 38035082
DOI: 10.3389/fimmu.2023.1275427 -
Stem Cell Research & Therapy Sep 2023The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of fractional CO laser in combination with stromal vascular fraction (SVF) compared with fractional CO laser alone in the treatment of burn scars: a randomized controlled clinical trial.
BACKGROUND
The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO laser with fractional CO laser alone in the treatment of burn scars.
METHOD
This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings.
RESULTS
The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO laser were significantly better than the group treated with fractional CO laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO laser was significantly higher than the other group.
CONCLUSION
The results confirm the efficacy of SVF injection in combination with fractional CO laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions.
TRIAL REGISTRATION
The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337 .
Topics: Humans; Cicatrix; Carbon Dioxide; Iran; Stromal Vascular Fraction; Lasers
PubMed: 37742019
DOI: 10.1186/s13287-023-03480-8 -
Journal of Ayub Medical College,... 2023Kidney transplantation remains the best possible solution for patients with chronic kidney disease, providing better long-term outcomes and drastically improving quality...
Kidney transplantation remains the best possible solution for patients with chronic kidney disease, providing better long-term outcomes and drastically improving quality of life. However, it comes with its own set of risks. The use of immunosuppressives following renal transplants has been shown to increase the development of malignancies and infections, and the occurrence of post-transplant malignancies is now the third most common cause of death in transplant patients. This involves multiple mechanisms, including the carcinogenic tendency of some immunosuppressive drugs, along with the induction and promotion of post-transplant malignancies by certain viruses. The quantification of Cancer risk must be made an integral part of the overall management of transplant patients, and appropriate follow-up screening needs to be adopted. Kaposi's sarcoma, lymphoma, and non-melanoma skin cancers have a greater incidence. If a malignancy develops immediately after transplantation, it may have been transmitted from the donor; donor-transmitted and donor-derived tumours may be differentiated based on a two-year time limit. Immunosuppressive medications with carcinogenic tendencies, reduced immunological control of oncogenic viruses, and poor immunosurveillance remain the most important risk factors. The gravity of this situation is further exacerbated by the fact that not only is there an increased risk of developing these malignancies in the post-transplant period, but the prognosis is also worsened when compared to non-transplant patients. All transplant centers should therefore adopt a multidisciplinary approach including early detection and prompt treatment, to improve outcomes in transplanted patients.
Topics: Humans; Kidney Transplantation; Quality of Life; Neoplasms; Kidney Neoplasms; Carcinoma, Renal Cell; Immunosuppressive Agents
PubMed: 38406957
DOI: 10.55519/JAMC-04-12230 -
The British Journal of Dermatology Feb 2024Graft-versus-host disease (GvHD) is a major life-threatening complication of allogeneic haematopoietic stem cell transplantation (HSCT), limiting the broad application...
BACKGROUND
Graft-versus-host disease (GvHD) is a major life-threatening complication of allogeneic haematopoietic stem cell transplantation (HSCT), limiting the broad application of HSCT for haematological malignancies. Cutaneous GvHD is described as a post-transplant inflammatory reaction by skin-infiltrating donor T cells and remaining recipient tissue-resident memory T cells. Despite the major influence of lymphocytes on GvHD pathogenesis, the complex role of mononuclear phagocytes (MNPs) in tissues affected by GvHD is increasingly appreciated.
OBJECTIVES
To characterize the identity, origin and functions of MNPs in patients with acute cutaneous GvHD.
METHODS
Using single-cell RNA sequencing and multiplex tissue immunofluorescence, we identified an increased abundance of MNPs in skin and blood from 36 patients with acute cutaneous GvHD. In cases of sex-mismatched transplantation, we used expression of X-linked genes to detect rapid tissue adaptation of newly recruited donor MNPs resulting in similar transcriptional states of host- and donor-derived macrophages within GvHD skin lesions.
RESULTS
We showed that cutaneous GvHD lesions harbour expanded CD163+ tissue-resident macrophage populations with anti-inflammatory and tissue-remodelling properties including interleukin-10 cytokine production. Cell-cell interaction analyses revealed putative signalling to strengthen regulatory T-cell responses. Notably, macrophage polarization in chronic cutaneous GvHD types was proinflammatory and drastically differed from acute GvHD, supporting the notion of distinct cellular players in different clinical GvHD subtypes.
CONCLUSIONS
Overall, our data reveal a surprisingly dynamic role of MNPs after HSCT. Specific and time-resolved targeting to repolarize this cell subset may present a promising therapeutic strategy in combatting GvHD skin inflammation.
Topics: Humans; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Macrophages; Skin Diseases; Cytokines
PubMed: 38010706
DOI: 10.1093/bjd/ljad402 -
Life (Basel, Switzerland) Feb 2024This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The... (Review)
Review
This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.
PubMed: 38398732
DOI: 10.3390/life14020223