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Katsushima C, Sowa Y, Sakamoto M, Abe H, Yamanaka H, Tsuge I, Katsube M, Saito S, Morimoto N. Multivariate Analysis of Risk Factors for Complications in Pediatric Tissue Expansion. Ann Plast Surg 2024; 92:522-527. [PMID: 38685492 DOI: 10.1097/sap.0000000000003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Tissue expanders represent one of the main surgical options for skin reconstruction in cases of tumors, traumalike burn injury, scar contracture, and alopecia. However, the tissue expander device is also associated with complications such as infection and extrusion. The aim of this study was to analyze risk factors for major complications of use of tissue expanders in pediatric patients using multivariate analysis. METHODS A retrospective, single-center observational study was performed over 10 years in pediatric patients who were treated with tissue expanders for tumors, nevus, scars, burn reconstruction, and alopecia from April 2012 to March 2022. The primary outcome was overall complications per operation and expander, including infection and extrusion. Ten predictor variables were included as risk factors based on previous studies and as new factors considered important from clinical experience. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications such as expander infection or extrusion. RESULTS The study included 44 patients who underwent 92 operations using 238 tissue expanders. The overall complication rate per expander was 14.3%. Univariate logistic regression analysis identified associations of younger age, number of expanders used per operation, history of infection, and tissue expander locations with a higher complication rate. In multivariate logistic regression analysis, younger age (odds ratio, 1.14; P = 0.043) was associated with a high likelihood of expander complications. CONCLUSIONS Younger age is an independent risk factor for tissue expander complications in pediatric patients. This factor should be considered in preoperative planning and discussions with the patient's family.
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Affiliation(s)
| | | | - Michiharu Sakamoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyasu Abe
- Department of Biomedical Statistics & Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Yamanaka
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Tsuge
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Motoki Katsube
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Saito
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Yusuf CT, Lopez CD, Girard AO, Khoo KH, Yang R, Redett RJ. Lower Extremity Pediatric Tissue Expansion: A Single Surgeon's 16-Year Experience. Ann Plast Surg 2024; 92:41-49. [PMID: 37856241 DOI: 10.1097/sap.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Tissue expansion is a well-established approach to soft tissue reconstruction in the pediatric population for lower extremity pathologies. Unfortunately, complication rates range from 19% to 40% in literature, including infection and implant extrusion, leading to delays in reconstruction. These challenges have prompted investigation toward categorizing risk factors for lower extremity tissue expander placement. METHODS A retrospective study of pediatric patients who underwent lower extremity tissue expander placement by the senior author (R.J.R.) was performed over a 16-year period. Patient charts were reviewed to categorize baseline and operative characteristics. Primary outcome variables were surgical-site infection, expander extrusion, and expander deflation. Univariate and multivariate logistic regressions were performed ( α < 0.05). RESULTS There were 59 tissue expanders in our cohort. The overall complication rate was 27.1% with a 77.2% successful reconstruction rate. Greater number of expanders placed during 1 operation is associated with 2.5 increased odds of having any complication and is associated with 0.4 decreased odds of having a successful reconstruction. Incisions made in scar tissue for expander placement appear to be associated with a greater than 7 times increased odds of readmission. CONCLUSIONS Reconstruction of soft tissue pathologies using lower extremity tissue expanders in the pediatric population is an effective yet challenging technique. This study identified that the number of expanders inserted during 1 operation, incisions made over scar tissue, and expanders placed in the anterior thigh were correlated with having a negative impact on reconstructive outcomes. Extra care should be taken with patients who require multiple expanders during 1 operation and with choosing the location and incision of expander placement.
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Affiliation(s)
| | - Christopher D Lopez
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Alisa O Girard
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Kimberly H Khoo
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Robin Yang
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Richard J Redett
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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Hermans MHE. An Introduction to Burn Care: The Sequel. Adv Skin Wound Care 2024; 37:9-18. [PMID: 38117166 DOI: 10.1097/asw.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
GENERAL PURPOSE To review burn care, with an emphasis on burn-specific issues and treatment. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Select the appropriate treatment guidelines for patients who have burn injuries.2. Identify common complications of major burns.3. Choose the recommended pharmacologic approaches to burn care.
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Affiliation(s)
- Michel H E Hermans
- Founder and President, Hermans Medical Consulting, Hoorn, the Netherlands
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Dong C, Yu Z, Du J, Zhang Y, Liu W, Huang Z, Xiong S, Wang T, Song Y, Ma X. Montelukast Attenuates Retraction of Expanded Flap by Inhibiting Capsule Formation around Silicone Expander through TGF-β1 Signaling. Plast Reconstr Surg 2023; 152:1044e-1052e. [PMID: 36988445 DOI: 10.1097/prs.0000000000010459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Tissue expansion has tremendous applications in plastic surgery, but flap retraction provides insufficient tissue for use. Inspired by the use of montelukast to suppress capsular contracture, the authors investigated the effects of montelukast on capsule formation around the expander and retraction of the expanded scalp of the rat. METHODS Thirty-six male Sprague-Dawley rats were randomly divided into control and montelukast groups. In each group, 12 expanded flaps with or without capsules were harvested for histologic and molecular analysis; the six remaining expanded flaps were transferred to repair defects. Myofibroblast and transforming growth factor-β1 expression in the capsule was determined using immunofluorescence. Capsule ultrastructure was observed using transmission electron microscopy. Related protein expression in the capsules was detected using Western blot analysis. RESULTS A comparison of control and montelukast groups revealed that areas of the harvested expanded flaps with capsules were greater (2.04 ± 0.11 cm 2 versus 2.42 ± 0.12 cm 2 , respectively; P = 0.04); the retraction rate decreased (41.3% ± 2.16% versus 28.13% ± 2.17%, respectively; P < 0.01). However, the increased areas and decreased retraction disappeared after capsule removal. The number of myofibroblasts declined. Thin, sparse collagen fibers were observed in the capsules. The expression of COL1, COL3, TGF-β1, EGR1, and phosphorylated ERK1/2 in the capsules decreased. Furthermore, the recipient area repaired by the transferred expanded flap was increased from 4.25 ± 0.39 cm 2 to 6.58 ± 0.31 cm 2 ( P < 0.01). CONCLUSION Montelukast attenuates retraction of the expanded flap by inhibiting capsule formation through suppressing transforming growth factor-β1 signaling. CLINICAL RELEVANCE STATEMENT This study provides novel insights into a method for increasing the area of the expanded flap.
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Affiliation(s)
- Chen Dong
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Zhou Yu
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jing Du
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Yu Zhang
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Wei Liu
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Zhaosong Huang
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Shaoheng Xiong
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Tong Wang
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Yajuan Song
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
| | - Xianjie Ma
- From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University
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Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline. J Plast Reconstr Aesthet Surg 2022; 75:3365-3372. [PMID: 35729044 DOI: 10.1016/j.bjps.2022.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/12/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal. METHODS We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer. RESULTS There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes. CONCLUSIONS The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.
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Liu W, Xiong S, Zhang Y, Du J, Dong C, Yu Z, Ma X. Transcriptome Profiling Reveals Important Transcription Factors and Biological Processes in Skin Regeneration Mediated by Mechanical Stretch. Front Genet 2021; 12:757350. [PMID: 34659370 PMCID: PMC8511326 DOI: 10.3389/fgene.2021.757350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Mechanical stretch is utilized to promote skin regeneration during tissue expansion for reconstructive surgery. Although mechanical stretch induces characteristic morphological changes in the skin, the biological processes and molecular mechanisms involved in mechanically induced skin regeneration are not well elucidated. Methods: A male rat scalp expansion model was established and the important biological processes related to mechanical stretch-induced skin regeneration were identified using Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and gene set enrichment analysis (GSEA). Analysis was also conducted by constructing a protein–protein interaction (PPI) network, identifying key modules and hub genes, determining transcription factor (TF)-mRNA regulatory relationships, and confirming the expression pattern of the TFs and hub genes. Results: We identified nine robust hub genes (CXCL1, NEB, ACTN3, MYOZ1, ACTA1, TNNT3, PYGM, AMPD1, and CKM) that may serve as key molecules in skin growth. These genes were determined to be involved in several important biological processes, including keratinocyte differentiation, cytoskeleton reorganization, chemokine signaling pathway, glycogen metabolism, and voltage-gated ion channel activity. The potentially significant pathways, including the glucagon signaling pathway, the Wnt signaling pathway, and cytokine–cytokine receptor interaction, were distinguished. In addition, we identified six TFs (LEF1, TCF7, HMGA1, TFAP2C, FOSL1, and ELF5) and constructed regulatory TF–mRNA interaction networks. Conclusion: This study generated a comprehensive overview of the gene networks underlying mechanically induced skin regeneration. The functions of these key genes and the pathways in which they participate may reveal new aspects of skin regeneration under mechanical strain. Furthermore, the identified TF regulators can be used as potential candidates for clinical therapeutics for skin pretreatment before reconstructive surgery.
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Affiliation(s)
- Wei Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shaoheng Xiong
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Du
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chen Dong
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhou Yu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xianjie Ma
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Karimi H, Latifi NA, Mehrjerdi AZ, Jafarnejad B, Karimi AM. Histopathological Changes of Organs (Lungs, Liver, Kidney, and Brain) After Using Two Types of AgiCoat and Acticoat Nanosilver Dressings on Deep Second-Degree Burn in Rat. J Burn Care Res 2021; 41:141-150. [PMID: 31400763 DOI: 10.1093/jbcr/irz137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Prevention of infections is a very important issue in treating the burn wounds. The nanosilver dressings have many promising advantages, but absorption of silver ions and its adverse effects to the body were always a question. The aim of this study was to compare Silver serum levels and acute toxic effects of nanosilver on histopathology of organs (lungs, liver, kidney, spleen, and brain) in two types of AgiCoat and Acticoat (nanosilver) dressings on second-degree deep burn in rat. This is an experimental study conducted in our animal laboratory. We divided 24 Sprague-Dawley male rats weighing 300 to 350 randomly into two groups. After anesthesia, a second deep-degree burn was made over dorsal skins of rats by standard method. For group A, Agicoat and, for group B, Acticoat dressings were used. The dressings were changed every 3 days with AgiCoat and Acticoat, respectively. After 14 days, we got blood samples and tissue samples taken from heart, liver, kidneys, spleen, lungs, and brain and a sample from dorsal skin of the rat for histopathological examinations. The results showed that the levels of serum silver in both groups were significantly higher than the standard level (1.22 part per million (PM); AgiCoat, P = .017; Acticoat, P = .000), but there was no significant difference between the groups (P = .551). Examination of the relationship between the level of serum silver and histopathological changes in liver showed that hepatotoxicity of AgiCoat was higher compared with Acticoat and the difference was significant (P = .002). There were no pathological changes in brain, kidneys, spleen, heart, and lungs. Wound healing was faster in Acticoat group. The nanosilver dressings can cause toxicity in liver but not in kidney, brain, spleen, heart, and lungs. Liver pathology and hepatotoxicity were more prominent in AgiCoat group. Wound healing was faster in Acticoat group.
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Affiliation(s)
- Hamid Karimi
- Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences
| | - Noor-Ahmad Latifi
- Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences
| | - Ali Zare Mehrjerdi
- Pathology Department, School of medicine, Iran University of Medical Sciences
| | - Babak Jafarnejad
- Plastic surgery Department, School of medicine, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Karimi
- Pathology Department, School of medicine, Iran University of Medical Sciences
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Dong C, Zhu M, Huang L, Liu W, Liu H, Jiang K, Yu Z, Ma X. Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases. BURNS & TRAUMA 2021; 9:tkaa037. [PMID: 33426134 PMCID: PMC7780061 DOI: 10.1093/burnst/tkaa037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/07/2020] [Indexed: 11/14/2022]
Abstract
Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.
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Affiliation(s)
- Chen Dong
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Minhui Zhu
- Department of Burn and Plastic Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Luguang Huang
- Information Center, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Wei Liu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Hengxin Liu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Kun Jiang
- Information Center, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Zhou Yu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Xianjie Ma
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
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Karimi H, Sedigh-Maroufi S, Akbari H, Latifi NA, Momeni M, Karimi AM, Safari R. Pregnancy and burns: Guidelines for safe management. Burns 2020; 46:1620-1631. [PMID: 32690332 DOI: 10.1016/j.burns.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND IThe incidence of burns in pregnancy is very low, therefore little is confirmed in the specific management of pregnant women who are burned. PURPOSE We conducted a study to survey the frequency of pregnancy in our patients and evaluate the risk factors of mortality for mother and foetus. Finally we provide recommendations about management of mother and child. MATERIALS AND METHODS Retrospectively, we surveyed data of our pregnant patients for an 18 year period. All demographic data, gestational age, history of previous pregnancy or miscarriage, diabetes, suicide, number of operations, presence of inhalation injury, TBSA, percentage of burn in abdomen and lower extremity, early excision and outcome of mother and foetus were gathered in a special questionnaire. Uni-variate regression and multi-variate regression were done for mortality of mother and child. RESULTS We treated 89 pregnant patients. Mean (SD) of mother's age and their pregnancy age were 24.08±5.56 years and 19.18±9.24 weeks, respectively. Mean TBSA (SD) was 36 (18%). Median of TBSA was 38 (IQR: 25, 70). Median of TBSA in Abdomen was 8 (IQR: 7, 9). Median of TBSA in lower extremities was 18 (IQR: 9, 34). Nine cases were due to attempted suicide. For 34 patients skin grafting was done. The main cause of death of the mothers was sepsis. The infections were due to Pseudomonas aeruginosa, Acinetobacter, E. coli, Klebsiella and Staphylococcus. In uni-variate regression model, TBSA, gestational week, and burns involving the abdomenwere related to maternal mortality. In multi-variate regression model, TBSA had high influence on maternal mortality, with every percent of burn surface area, the risk of mortality increased by 3.4% (p-value <0.005). In a uni-variate regression, TBSA and abdominal burn was associated with foetal mortality. However, in the multi-variate regression, only inhalation injury and TBSA had association with foetal mortality. Inhalation injury increased foetal mortality up to 16 times (p-value <0.05). CONCLUSION TBSA burned is the only major risk factor of maternal mortality. TBSA burned and inhalation injury are the main risk factors of foetal mortality.
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Affiliation(s)
- Hamid Karimi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Akbari
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Noor-Ahmad Latifi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- General Surgery, Motahary Burn Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Roya Safari
- Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Haramshahi SMA, Bonakdar S, Moghtadaei M, Kamguyan K, Thormann E, Tanbakooei S, Simorgh S, Brouki-Milan P, Amini N, Latifi N, Joghataei MT, Samadikuchaksaraei A, Katebi M, Soleimani M. Tenocyte-imprinted substrate: a topography-based inducer for tenogenic differentiation in adipose tissue-derived mesenchymal stem cells. ACTA ACUST UNITED AC 2020; 15:035014. [PMID: 31896091 DOI: 10.1088/1748-605x/ab6709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tendon tissue engineering based on stem cell differentiation has attracted a great deal of attention in recent years. Previous studies have examined the effect of cell-imprinted polydimethylsiloxane (PDMS) substrate on induction differentiation in stem cells. In this study, we used tenocyte morphology as a positive mold to create a tenocyte-imprinted substrate on PDMS. The morphology and topography of this tenocyte replica on PDMS was evaluated with scanning electron microscopy (SEM) and atomic force microscopy. The tenogenic differentiation induction capacity of the tenocyte replica in adipose tissue-derived mesenchymal stem cells (ADSCs) was then investigated and compared with other groups, including tissue replica (which was produced similarly to the tenocyte replica and was evaluated by SEM), decellularized tendon, and bone morphogenic protein (BMP)-12, as other potential inducers. This comparison gives us an estimate of the ability of tenocyte-imprinted PDMS (called cell replica in the present study) to induce differentiation compared to other inducers. For this reason, ADSCs were divided into five groups, including control, cell replica, tissue replica, decellularized tendon and BMP-12. ADSCs were seeded on each group separately and investigated by the real-time reverse transcription polymerase chain reaction (RT-PCR) technique after seven and 14 days. Our results showed that in spite of the higher effect of the growth factor on tenogenic differentiation, the cell replica can also induce tenocyte marker expression (scleraxis and tenomodulin) in ADSCs. Moreover, the tenogenic differentiation induction capacity of the cell replica was greater than tissue replica. Immunocytochemistry analysis revealed that ADSCs seeding on the cell replica for 14 days led to scleraxis and tenomodulin expression at the protein level. In addition, immunohistochemistry indicated that contrary to the promising results in vitro, there was little difference between ADSCs cultured on tenocyte-imprinted PDMS and untreated ADSCs. The results of such studies could lead to the production of inexpensive cell culture plates or biomaterials that can induce differentiation in stem cells without growth factors or other supplements.
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Affiliation(s)
- Seyed Mohammad Amin Haramshahi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran. Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
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Topczewska JM, Ledwon JK, Vaca EE, Gosain AK. Mechanical stretching stimulates growth of the basal layer and rete ridges in the epidermis. J Tissue Eng Regen Med 2019; 13:2121-2125. [PMID: 31381259 DOI: 10.1002/term.2952] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 11/12/2022]
Abstract
We have developed four experimental models of mechanical stimulation applied to the back skin using tissue expansion (TE) procedure performed on minipigs. The technique is used by plastic surgeons for decades, to amend the congenital or accidental skin defects, though underlying changes in epidermis are not well understood. We found that the initial stretching increased proliferation of basal keratinocytes leading to elongation of the basal layer, and increased cellular density. The increased number of the rete ridges, suggests that they absorbed the impact of excessive proliferation, preserving layered organization of epidermis. We found β1 integrin to be a very sensitive responder to stimulation instigated by TE procedure, able to dynamically relocate to adjust the basal cell against external force. Repeated mechanical stimulation with a seven-day interval generated healthy tissue without detrimental effects. Given the similarities between the structure of the porcine and human epidermis, we speculate that a similar mechanism functions in human skin. A better understanding of the underlying process could help improve medical care and outcomes for patients undergoing surgical reconstruction.
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Affiliation(s)
- Jolanta M Topczewska
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joanna K Ledwon
- Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elbert E Vaca
- Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction. Plast Reconstr Surg 2019; 144:936e-937e. [PMID: 31425419 DOI: 10.1097/prs.0000000000006126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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