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Abtahi‐Naeini B, Pourmahdi‐Boroujeni M, Alipour N, Sattari H, Pourmoghaddas Z. Klebsiella pneumoniae-infected hemorrhagic ulcerative infantile hemangioma: A rare complication. Clin Case Rep 2024; 12:e9149. [PMID: 38966289 PMCID: PMC11222967 DOI: 10.1002/ccr3.9149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
Key Clinical Message Infections in infantile hemangiomas (IHs) are generally limited, and only few cases have been reported. The rapid expansion of an ulcerated IH should raise concern for possible complications to monitor and provide immediate therapeutic interventions. This case highlights the importance of prompt treatment in large segmental IHs to prevent ulceration and related complications, including bleeding and superinfection. Abstract IH is a benign tumor proliferating during early infancy. While many IHs spontaneously resolve, complications like ulceration, bleeding, and potential damage to vital organs can occur, leading to pain, infection, and scarring. A 6-month-old girl with a previously treated IH on her left leg developed a Klebsiella-infected ulcer at the site. The ulcer resulted from non-standard treatments used before admission. Upon hospitalization, she was initially treated with cefepime and propranolol, but a week later, the wound culture revealed Klebsiella pneumoniae, prompting a switch to piperacillin/tazobactam. After successfully managing the infection and bleeding, the child was discharged in good condition with orders to continue treatment with propranolol for at least a year. This case highlights the potential of IHs to become infected even with uncommon germs such as Klebsiella and the importance of receiving appropriate medical care to prevent further complications.
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Affiliation(s)
- Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
- Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Narjes Alipour
- Department of PediatricsIsfahan University of Medical SciencesIsfahanIran
| | - Hossein Sattari
- Clinical Research Development CenterNajafabad Branch, Islamic Azad UniversityNajafabadIran
| | - Zahra Pourmoghaddas
- Pediatrics Infectious Diseases DepartmentIsfahan University of Medical SciencesIsfahanIran
- Pediatric Cardiovascular Research Center. Cardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
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Chen J, Lopez CD, Girard AO, Abousy M, Redett RJ, Groves M, Yang R. Dehydrated human amnion/chorion membrane allografts for myelomeningocele and wound reconstruction. Childs Nerv Syst 2021; 37:3721-3731. [PMID: 34609611 DOI: 10.1007/s00381-021-05352-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
A growing body of literature demonstrates the clinical promise of dehydrated human amnion/chorion membrane (dHACM), a cryopreserved tissue product derived from placental amniotic membrane, to enhance post-operative wound healing. The purpose of this study is to review the potential of dHACM to facilitate post-surgical and myelomeningocele wound repair. A comprehensive literature search of PubMed was conducted to identify studies investigating dHACM use in pediatric and surgical wound care published from inception to October 2020. For each study, patient characteristics, wound characteristics, and outcomes following dHACM application were documented and assessed. Of the 190 articles reviewed, 15 publications were included in the final analysis. Results demonstrated that the average wound healing time varied across clinical indications (e.g., 14 days for trauma reconstruction to 116 days for Moh's surgery repair). Across indications, pediatric patients had shorter healing periods compared to adults (P < 0.01). Chronic wounds (> four weeks old) were documented in both adult (n = 3) and pediatric (n = 2) wound repair publications; all chronic surgical wounds demonstrated complete wound closure with dHACM. No complications from dHACM use were reported. Advantages of dHACM included increased patient satisfaction, cost-savings, and faster wound healing. We then present two cases of myelomeningocele wound repair facilitated successfully by dHACM. Overall, dHACM proves to successfully expedite wound repair in pediatric patients with chronic or complicated wounds such as those from myelomeningocele repair. It is important for surgeons to consider wound duration, size, and patient age to better predict graft success in enhancing wound repair.
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Affiliation(s)
- Jonlin Chen
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA
| | - Christopher D Lopez
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA
| | - Alisa O Girard
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA
| | - Mya Abousy
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA
| | - Richard J Redett
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA
| | - Mari Groves
- Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic & Reconstructive Surgery, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Suite 8161, Baltimore, MD, 21287, USA.
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Liao S, Wu J, Li Z, Cheng G, Lu B, Liu G, Li X, Lu W. Study on the Mechanism of Targeted Poly(lactic-coglycolic acid) Nano-Delivery Carriers in the Treatment of Hemangiomas. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:1236-1243. [PMID: 33183467 DOI: 10.1166/jnn.2021.18689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hemangiomas, also called infantile hemangiomas (IH), are the most common congenital benign vascular tumors in infants and young children. At present, there are many treatment methods for proliferative hemangiomas, which have different effects and lack predictability. Propranolol has gradually replaced glucocorticoids as the first-line treatment for infants and young children with hemangiomas. However, premature discontinuation is prone to relapse, and the efficacy and safety of medication need to be further studied and determined. The exact pathogenesis of hemangiomas is still unclear. Therefore, in this study, poly(lactic-co-glycolic acid) (PLGA) nanoparticles were used as drug delivery carriers, propranolol was encapsulated, and PLGA-propranolol (PLGA-PP) nanodelivery preparations were prepared and targeted. Anisotropy and pharmacokinetics were preliminary studied. At the same time, after the treatment of HemECs cells with PLGA-PP in gradient concentration in vitro, CCK-8 method was used to detect the cell proliferation, and Anyixin-V/PI double staining method was used to detect the apoptosis rate of cells. The effect of PLGA-PP nano-delivery vector on hemangioma was studied by western blot method to detect the expression level of Id-1 protein in HemECs. The results showed that after PLGA-PP treated HemECs for 24 h, PLGA-PP significantly inhibited HeECs proliferation and promoted their apoptosis, and the intracellular Id-1 protein expression was also reduced. Therefore, this study believes that the mechanism of PLGA-PP nano-targeted delivery preparations in the treatment of hemangiomas is achieved by down-regulating the Id-1 gene, thereby inhibiting the colonization of HemECs and promoting its apoptosis effect.
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Affiliation(s)
- Sheng Liao
- Department of Vascular Surgery, Quzhou People's Hospital, Quzhou City, 324000, Zhejiang Province, China
| | - Jiawen Wu
- Department of Vascular Surgery, Quzhou People's Hospital, Quzhou City, 324000, Zhejiang Province, China
| | - Zhituo Li
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150006, China
| | - Guobing Cheng
- Department of Vascular Surgery, Quzhou People's Hospital, Quzhou City, 324000, Zhejiang Province, China
| | - Baitao Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Harbin Medical University, Harbin, 150006, China
| | - Guojun Liu
- Department of Rehabilitation Medicine, Heilongjiang Agricultural Reclamation General Hospital, Harbin, 150088, China
| | - Xiaoyang Li
- Department of Vascular Surgery, Quzhou People's Hospital, Quzhou City, 324000, Zhejiang Province, China
| | - Wei Lu
- Department of Vascular Surgery, Quzhou People's Hospital, Quzhou City, 324000, Zhejiang Province, China
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Insights on the Human Amniotic Membrane in Clinical Practice with a Focus on the New Applications in Retinal Surgery. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2020. [DOI: 10.1007/s40883-020-00190-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lay SummaryRecently, the use of the human amniotic membrane (hAM) has been extended to treat retinal disorders such as refractory macular holes, retinal breaks and dry and wet age-related macular degeneration. Not only the hAM has proved to be an excellent tool for repairing retinal tissue, but it has also shown a promising regeneration potential. This review aims to highlight the novel use of the hAM in treating retinal diseases. Although the hAM has been used in the ocular anterior segment reconstruction for more than 60 years, in the last 2 years, we have found in literature articles showing the use of the hAM in the retinal surgery field with interesting results in terms of tissue healing and photoreceptor regeneration.
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McNamara SA, Hirt PA, Weigelt MA, Nanda S, de Bedout V, Kirsner RS, Schachner LA. Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review. J Wound Care 2020; 29:321-334. [PMID: 32530778 DOI: 10.12968/jowc.2020.29.6.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
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Affiliation(s)
- Stephanie A McNamara
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Penelope A Hirt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Maximillian A Weigelt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Sonali Nanda
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Valeria de Bedout
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Lawrence A Schachner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
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Frigerio A, Bleicher J, Pierce J, Reems JA, Vanderhooft SL, Lewis G. Amnion membrane allografts in a critically ill infant with Netherton syndrome-like phenotype. JAAD Case Rep 2019; 5:395-397. [PMID: 31049379 PMCID: PMC6479109 DOI: 10.1016/j.jdcr.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Alice Frigerio
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josh Bleicher
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jan Pierce
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jo-Anna Reems
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, Utah.,Division of Hematology and Hematologic Malignancies, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sheryll L Vanderhooft
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Giavonni Lewis
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Blei F. Update December 2018. Lymphat Res Biol 2018. [DOI: 10.1089/lrb.2018.29054.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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