Use of skin graft punch graft type for the healing of leg ulcers in treated Hansen's disease patients

Hansen's disease is an infectious illness caused by Mycobacterium leprae. It affects preferentially the skin and the peripheral nervous system leading to incapacities, such as leg ulcers, which happens due to the direct action of the bacillus on the organs or its indirect action on the peripheral nervous system. Leg ulcers can occur by two physiopathologic processes. There are many treatments for general leg ulcers, which include the ones caused by Hansen's disease sequels. Among them, surgical treatment shows to be effective when using skin graft, which can be performed by several techniques. Considering the low number of techniques known for treating leg ulcers in Hansen's disease sequels, the aims of this work were to standardize alternative techniques, to detect the main bacteria found in ulcer secretion cultures, to analyze the patients profile and the ulcers, to describe the histophatologies found, and to correlate these data with those of literature from all over the world. Skin graft punch type was carried out and analyzed; males had a mean age of 59.4 years old and females, 54.2 years old. Patients were 73.6% male and 26.3% female. Lepromatous type was present in 89.4% patients and tuberculoid type was seen in 10.5% of them. Associated systemic diseases were observed in 26.3% patients. Mean time of ulcers evolution was 11.6 years in male and 12.8 years in women. The average diameter of ulcers in the pre-treatment period was 8.5 X 9.5 cm in male and 10.2 X 6.8 cm in women. After the graft, their average diameters were 3.2 X 2.7 cm in male and 5.1 X 5.6 cm in women. Statistical analysis showed that there was no significant correlation between the ulcer diameter and its reduction or not in the post-surgery period (p=0.269732). The mean age of patients whose ulcers diameter did not change or reduced by only 20% was 63.5 years. Using the Spearman's coefficient, it was possible to observe that there was no significant correlation between the patients' age and the ulcers diameter reduction after the skin graft (p=0.222531). Evolution time of ulcers that did not present any satisfactory result in the post-surgery period was 12.1 years. The Spearman's coefficient showed that there was no significant correlation between the ulcers evolution time and the ulcers diameter reduction in the post-surgery period (p=0.191655). Cultures presented 50% of cases with Pseudomonas aeruginosa. Statistical analysis showed there is no correlation between the bacterial types found and the ulcer evolution in the post-surgery period (p=0.697531). The average of the ulcers diameter reduction was 42.4%, and in 26.3% of the patients the lesions disappeared after the skin graft.

Mesh skin graft and digital pad transfer to reconstruct the weight-bearing surface in a dog

A 2-month-old dog was presented with injuries involving both hind paws. Only the 5th digit and its digital pad were present on the right paw. Following a full-thickness skin graft, the 5th digital pad was transferred distal to the metatarsal bones. The transferred pad permitted weight-bearing on the limb.

Comparative study between fibrin glue and platelet rich plasma in dogs skin grafts

OBJETIVO: Comparar a cola de fibrina (Tissucol®) e o plasma rico em plaquetas em enxertos cutâneos de espessura completa em malha em cães. MÉTODOS: Foram utilizados 18 cães, distribuídos em dois grupos, cola de fibrina (CF) e plasma rico em plaquetas (PRP). em todos os animais foi realizado um enxerto cutâneo de 3x3 cm, em malha de espessura completa. No membro esquerdo foi colocado o biomaterial entre o enxerto e o leito receptor, cada qual em seu grupo, o membro direito serviu como grupo controle. Todos os animais foram avaliados clinicamente a cada 48 horas até o décimo quarto dia, através das variáveis: exsudação, coloração, edema e aspecto cosmético; histologicamente em três animais, no terceiro, sétimo e décimo quarto dia de pós-operatório através das variáveis: fibroblastos, colágeno, tecido de granulação, integração-aderência microscópica e inflamação aguda. RESULTADOS: Avaliações clínicas demonstraram que o grupo CF apresentou melhor escores em todas variáveis quando comparado com o grupo PRP. Nas avaliações histológicas o grupo PRP apresentou maior presença de fibroblastos ao sétimo e décimo quarto dia. CONCLUSÃO: A cola de fibrina foi clinicamente superior ao grupo plasma rico em plaquetas quando usados em enxertos cutâneos de espessura completa em cães.

Enxerto dermoadiposo em cavidades anoftálmicas secundárias - estudo retrospectivo e revisão da literatura

Purpose: To evaluate the dermofat graft in the anophthalmic socket treatment. Methods: A retrospective study including 28 anophthalmic cavity carriers treated with dermofat graft was carried out. The patients were analyzed according to age, sex, socket contraction degree, first surgery performed, reason for graft choice, procedure's results and complications. The data were analyzed according to the frequency of occurrence. Results: Nineteen (67.8%) of the 28 analyzed patients were male. According to age the majority of patients were between 40 to 60 years old (13 patients - 46.4%) and the most common cause of eyeball loss was trauma (seven cases - 25%). Anophthalmic socket type III was the most frequently observed (32.1%). The evisceration was the first procedure in 13 cases, enucleation in 11 and skin graft was done in two patients. Two patients came to the service after evisceration and did not provide any information about the first surgery. The choice to use the dermofat graft was to replace volume at the socket of 12 patients (42.8%). Most of the patients (53.6%) had no complications and graft necrosis was the problem most frequently observed (32.1%). The surgery was considered good in 71.4% and not good in only 7.1%. Conclusion: the dermofat graft is an efficient and easy technique to reconstruct the anophthalmic cavity. The authors suggest this procedure must be introduced in the medical training services since it provide good results.

Fixação de enxerto cutâneo em malha de espessura total com sutura ou cola de fibrina

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A comparison of human and porcine acellular dermal tissues in the subcutaneous space of a rat model

The study compared the host response to a human and a porcine acellular dermal tissue implanted in the subcutaneous space of a rat model. The human and porcine acellular grafts were surgically implanted in the subcutaneous tissue of rats (5 rats/group) and the materials were evaluated at 7, 15, 30, 60 and 180 postoperative days (PO). The histological immune response was quantified using a digital image analysis system, which evaluated the number of vessels present in the implants and in the surrounding soft tissue, the area of inflammatory cell infiltration in the grafts, the width of the capsular formation present around the tissues and the area of implants absorbed. The data were submitted to statistical analysis. Light microscopy showed mononuclear cellular infiltration, the presence of a capsular formation surrounding the grafts and the presence of vacuolar structures (optically empty spaces) inside the implants. The image analysis comparing both materials showed significant inflammatory cells in the human graft at 15 and 30 PO, thicker capsular formation in the porcine tissue at 60 PO, increased number of vessels inside the implants and in the surrounding tissues in the porcine graft and a similar absorption pattern in both materials at 180 PO. The histological findings showed that both tissues were well-tolerated when implanted in the subcutaneous tissue of rats, allowing us to consider the porcine acellular dermal graft as a provisional alternative material for reconstructive plastic surgery. Copyright © 2005 Taylor & Francis LLC.

Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Avaliação da cicatrização de feridas cutâneas induzidas em teúis (Tupinambis merianae) tratadas com policresuleno, titntura de iodo, clorexidine e enxerto autólogo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diagnóstico diferencial entre Doença de Crohn e Hidradenite Supurativa: relato de caso

Crohn’s disease is a chronic infl ammatory bowel disease with segmental transmural infl ammation, which complicate with formation of fi stulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is diffi cult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn’s disease complicated with perianal and rectovaginal fi stula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofl oxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fi stula at the site of resection, consistent with Crohn’s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fi stulas. Currently in therapy with good biological evolution of fi stulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn’s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient’s quality of life.

Graft versus host disease in a rat small bowel transplant model after T-cell depleted donor specific bone marrow infusion

Baixas doses de irradiação associadas à infusão de células da medula óssea não previnem a ocorrência da reação do enxerto versus hospedeiro após o transplante intestinal. OBJETIVO: Neste estudo foi avaliado a potencial vantagem em estender o regime imunossupressor associado a infusão de células de medula óssea do doador depletadas de células T na prevenção da reação do enxerto versus hospedeiro após o transplante intestinal. MÉTODOS: Transplante heterotópico de intestino delgado foi realizado em ratos Lewis como receptores e da como doadores, distribuídos em cinco grupos de acordo com a duração da imunossupressão, irradiação e do uso de medula óssea normal ou depletada: G1 (n=6), sem irradiação e G2 (n=9), G3 (n=4), G4 (n=5) e G5 (n=6) foram irradiados com 250 rd. Grupos1, 2, 4 e G3 e 5 foram infundidos com 100 x 10(6) células da medula normal e depletada respectivamente. Animais no G1,2,3 foram imunossuprimidos com 1mg/kg/FK506/ IM por cinco dias e G4 e cinco por 15 dias. Anticorpos monoclonais contra células CD3 e colunas magnéticas foram utilizadas para a depleção da medula óssea. Os animais foram examinados para a presença de rejeição, reação do enxerto versus hospedeiro, chimerismo e biópsias intestinais e da pele. RESULTADOS: Rejeição mínima foi observada em todos os grupos; entretanto, a reação do enxerto versus hospedeiro somente nos animais irradiados. Extensão da imunossupressão alterou a gravidade da reação nos animais dos G4 e 5. Rejeição foi a causa mortis no G1 e a reação do enxerto versus hospedeiro nos Grupos 2,3,4 e 5, não controlada com a infusão de medula óssea depletada. O chimerismo total e de células T do doador foi estatisticamente maior nos grupos irradiados em comparação ao G1. CONCLUSÃO: A extensão do regime de imunossupressão associado a baixas doses de irradiação diminui a gravidade da reação do enxerto versus hospedeiro, não abolida pelo uso de medula óssea depletada.

FTY720 in combination with cyclosporine - an analysis of skin allograft survival and renal function

Acute and chronic nephrotoxicity caused by CsA Continuous administration impair kidney allograft survival. Several clinical and experimental protocols have shown benefits to the kidney after decreasing CsA dose, withdrawing the drug or delaying its introduction after transplantation.FTY720 is a new Compound that has immunosuppressive characteristics and increase allograft survival in animal models without causing the side effects of calcineurin inhibitors (CNIs). FTY720 described mechanism of action that consists to alter the lymphocyte migration pattern without impairment of the immune system response against pathogens.In our mice model, FTY720 administered alone or in combination with CsA during 21 days increased skin allograft survival in a fully mismatched strain combination and did not cause significant changes in renal function. Moreover, renal structure was normal in all groups suggesting that at low doses (10 mg/kg/day) CsA can be associated during short-term period to other immunosuppressive drugs, i.e. FTY720 without affecting the kidney.Combination of immunosuppressive compounds with FTY720 and/or delayed introduction of low cyclosporine dose Could prevent graft rejection and avoid nephrotoxicity. (c) 2006 Elsevier B.V. All rights reserved.

The essential role of annexin A1 mimetic peptide in the skin allograft survival

Immunosuppressive drugs have a critical role in inhibiting tissue damage and allograft rejection.Studies have demonstrated the anti-infl ammatory effects of the annexin A1 (AnxA1) in the regulationof transmigration and apoptosis of leucocytes. In the present study, an experimental skin allograftmodel was used to evaluate a potential protective effect of AnxA1 in transplantation survival. Micewere used for the skin allograft model and pharmacological treatments were carried out using eitherthe AnxA1 mimetic peptide Ac2-26, with or without cyclosporine A (CsA), starting 3 days beforesurgery until rejection. Graft survival, skin histopathology, leucocyte transmigration and expressionof AnxA1 and AnxA5 post-transplantation were analysed. Pharmacological treatment with Ac2-26increased skin allograft survival related with inhibition of neutrophil transmigration and inductionof apoptos is, thereby reducing the tissue damage compared with control animals. Moreover, AnxA1and AnxA5 expression increased after Ac2-26 treatment in neutrophils. Interestingly, thecombination of Ac2-26 and cyclosporine A showed similar survival of transplants when compared withthe cyclosporine A group, which could be attributed to a synergistic effect of both drugs. Investigationsin vitro revealed that cyclosporine A inhibited extracellular-signal-regulated kinase (ERK) phosphory-lation induced by Ac2-26 in neutrophils. Overall, the results suggest that AnxA1 has an essential role inaugmenting the survival of skin allograft, mainly owing to inhibition of neutrophil transmigration andenhancement of apoptosis. This effect may lead to the development of new therapeutic approachesrelevant to transplant rejection.

Detection of Leishmania (L.) chagasi in canine skin

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of the season of the year, truck type and location on truck on skin bruises and meat quality in pigs

The purpose of this study was to evaluate the effect of the season of the year (summer vs winter), type of truck (A: single decker vs B : double-decker) and pig location on the truck (front, middle, rear) on the incidence of skin bruising and pork quality variation. For this purpose, 2660 gilts of an average weight of 126.7 (+/- 6.6) kg originating from 19 different farms were used. No interaction between season of the year, type of truck and location on truck was observed. A higher number of bruises on the body at unloading and slaughter (P < 0.0001) and a higher number of bruises on the carcass (P < 0.01) were observed in winter. At unloading a higher number of bruises on the body and on the carcass after slaughter was observed in pigs transported on Truck A (P=0.004 and P=0.05). A higher, although not significant, number of bruises was found on the body of pigs transported in the rear compartment of both trucks. Higher paleness value was found in the longissimus and semimembranosus muscles in summer (P=0.0001) than in winter. Cold and heat stress have a negative influence on skin bruises and meat quality, respectively. Poor vehicle design increases the incidence of bruised carcasses without detracting from pork quality regardless of the climate conditions tested and location of the animal it] the truck. (c) 2006 Elsevier B.V. All rights reserved.

The field resistance of potato cultivars to foliar late blight and its relationship with foliage maturity type and skin type in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)