Two‐Dimensional and Three‐Dimensional Ultrasound of Artificial Skin

Wound healing may be a difficult problem, and variable types of artificial skin prototypes have been developed for supporting this process. Using ultrasound, we studied 4 cellulose‐derived artificial skin prototypes and assessed their two‐dimensional and three‐dimensional morphology. These prototypes were identified on ultrasound both on in vitro and in vivo studies. They allowed the sonographic observation of deeper layers on different types of surfaces of the body with good definition on the in vivo examinations performed on healthy skin and cutaneous ulcers. The ultrasound detection of these artificial biomaterials may potentially support the noninvasive monitoring of wound healing.     

Second‐trimester prenasal and prefrontal skin thickening—Association with MECP2 triplication syndrome

MECP2 triplication syndrome is a rare and usually lethal genetic disorder characterized by progressive neurologic and cognitive regression. None of the four reported cases describe prenatal sonographic features of affected offspring. We report a second‐trimester fetus with marked prefrontal and prenasal skin thickening, retrognathia, and later, third‐trimester mild cerebral ventriculomegaly. Amniocyte karyotype was normal male, but newborn whole‐genome oligonucleotide microarray showed duplication and triplication of chromosome Xq28 containing the MECP2 gene. Comparative genomic hybridization may be diagnostic in fetuses with prefrontal and prenasal skin thickening, additional sonographic findings, and normal karyotype. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 41 :434–437, 2013     

The effect of high‐ and low‐frequency transcutaneous electrical nerve stimulation upon cutaneous blood flow and skin temperature in healthy subjects

The reported non‐analgesic effects of transcutaneous electrical nerve stimulation (TENS) include alterations to the local circulation; however, research in this area has produced equivocal findings. In the present study, the effect of low‐ (4 Hz) and high‐frequency (110 Hz) TENS on forearm skin blood perfusion was assessed using laser Doppler flowmetry. The effect on skin temperature was also assessed using a skin thermistor. Thirty healthy human volunteers were recruited and randomly assigned to a control or one of the two treatment groups. TENS was applied to the skin overlying the median nerve under double‐blind conditions for 15 min. Blood flow and skin temperature readings were recorded pre‐TENS, during TENS application and continued for 15 min post‐TENS application. Analysis of results showed significant increases in blood perfusion during the treatment period in the low‐frequency group when compared to the other two groups (P = 0·0106; ANOVA). No significant changes in skin temperature were observed. The results of this study demonstrate that low‐frequency TENS produces a local increase in cutaneous blood flow.     

Emergency Management of Pediatric Skin and Soft Tissue Infections in the Community‐associated Methicillin‐resistant Staphylococcus aureus Era

Objectives: Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections. Methods: This was a cross‐sectional survey of subscribers to the American Academy of Pediatrics Section on Emergency Medicine (AAP SoEM) list‐serv. Enrollment occurred via the list‐serv over a 3‐month period. Vignettes of equivocal SSTI, cellulitis, and skin abscess were presented to participants, and knowledge, diagnostic, and therapeutic approaches were assessed. Results: In total, 366 of 606 (60.3%) list‐serv members responded. The mean (± standard deviation [SD]) duration of practice was 13.6 (±7.9) years, and 88.6% practiced in a pediatric emergency department. Most respondents (72.7%) preferred clinical diagnosis alone for equivocal SSTI, as opposed to invasive or imaging modalities. For outpatient cellulitis, PEPs selected clindamycin (30.6%), trimethoprim‐sulfa (27.0%), and first‐generation cephalosporins (22.7%); methicillin‐sensitive S. aureus (MSSA) was routinely covered, but many regimens failed to cover CA‐MRSA (32.5%) or group A streptococcus (27.0%). For skin abscesses, spontaneous discharge (67.5%) was rated the most important factor in electing to perform a drainage procedure; fever (19.9%) and patient age (13.1%) were the lowest. PEPs elected to prescribe trimethoprim‐sulfamethoxazole (TMP‐Sx; 50.0%) or clindamycin (32.7%) after drainage; only 5% selected CA‐MRSA–inactive agents. All PEPs suspected CA‐MRSA as the etiology of skin abscesses, and many attributed sepsis (22.1%) and invasive pneumonia (20.5%) to CA‐MRSA, as opposed to MSSA. However, 23.9% remained unaware of local CA‐MRSA prevalence for even common infections. Conclusions: Practice variation exists among PEPs for management of SSTI. These results can be used to measure changes in SSTI practices as standardized approaches are delineated. ACADEMIC EMERGENCY MEDICINE 2010; 17:187–193 © 2010 by the Society for Academic Emergency Medicine     

Restoring full‐thickness defects with spray skin in conjunction with dermal regenerate template and split‐thickness skin grafting: a pilot study

Complex, full‐thickness soft tissue defects secondary to large burns, trauma and war‐related injuries continue to challenge reconstructive surgeons. To achieve positive surgical outcomes in these patient populations, novel approaches are needed to restore the functional, protective and aesthetic properties of skin. Herein, we provide the first report describing the staged use of a dermal regenerate template (DRT) with a spray‐on epidermal regenerative modality (spray skin) in addition to autologous split‐thickness skin grafting (STSG) in non‐burn trauma and compare these results with those of patients treated with DRT and STSG alone. A pilot study was performed to evaluate whether the use of spray skin technology (ReCell, Avita Medical) as an adjunct to DRT (Integra, Integra Lifesciences) and autologous skin grafting in the treatment of patients with large full‐thickness soft tissue losses impacts donor site burden as well as recipient and donor site re‐epithelialization. In this retrospective study, two patients who were treated with DRT and STSG alone (control group) were compared with two patients who were treated with DRT and spray skin/STSG in combination (experimental group). The mechanisms of injury, total defect and treatment sizes, time to complete re‐epithelialization, lengths of follow‐up, outcomes and complications were reviewed. Our group observed that using a DRT in conjunction with spray skin/STSG can reduce donor site burden and decrease time to complete healing. It can also permit greater or larger meshing ratios, while aiding in improved re‐pigmentation when compared with similar wounds treated with a DRT and autologous skin grafting alone. Copyright © 2017 John Wiley & Sons, Ltd.     

COVID‐19‐associated facial cutaneous mucormycosis superinfection: A potentially life‐threatening disease

A 49‐year‐old male was involved in an accident and an abdominal computer tomographic examination revealed papillary renal cell carcinoma of the right kidney. During hospitalization, the patient was infected with COVID‐19. In the following COVID‐19 treatment, a black dot developed on the right side of the head and face. Antifungal therapy and surgical debridement were initiated and gradual improvement was observed.     

Heat‐related changes in skin tissue dielectric constant (TDC)

The impact of 20 min of whole‐body heating (WBH) on the tissue dielectric constant (TDC) of forearm and hand skin was evaluated in 24 young adults. TDC was measured in triplicate at 300 MHz using an open‐ended transmission line method in which the effective measurement depth was about 2 mm. TDC measurements are an effective way to assess and track localized oedema and lymphoedema. The underlying hypothesis was that heat‐induced eccrine gland activation would increase TDC values via an increase in fluid within the TDC measurement volume. The goal was to test this concept and to determine the magnitude of the change when environmental temperatures were elevated to near 42°C and to estimate TDC recovery time. The practical aspect of this research is motivated by the fact that patients in whom such measurements are made may arrive at the clinic in various states of sweat gland activation. Thus, knowledge of the effect of such activation on measured TDC values permits better understanding of possible relationships between such activation and TDC values. Results showed that increasing environmental temperature from 23·3 ± 1·6 to 41·5 ± 1·3°C increased forearm and thenar eminence skin temperatures to 37·8 ± 0·5 and 37·9 ± 0·4°C, respectively. These changes were associated with increases in TDC at arm from 30·7 ± 4·6 to 36·3 ± 5·7 (18·2%) and at hand from 34·7 ± 4·9 to 45·1 ± 5·5 (30%). Based on calculated TDC recovery rates, it is concluded that temperature‐related TDC variability can be minimized using a wait time of at least 15 min after bandage removal prior to TDC measurements in affected limbs.     

Substance‐P and transforming growth factor‐β in chitosan microparticle‐pluronic hydrogel accelerates regenerative wound repair of skin injury by local ionizing radiation

Clinical irradiation therapy for cancer could increase the risk of localized wound complications. This study was conducted to evaluate the potential use of a chitosan microparticle‐pluronic F127 (CSMP‐PF) hydrogel complex containing bioactive molecules, substance P and transforming growth factor‐β1, to regeneratively repair skin damaged by local ionizing radiation (IR). The BALB/c/bkl mice were locally irradiated to their limbs with a single 40 Gy dose of Co‐60 γ rays to induce a skin injury. The morphological characteristics of the chitosan microparticles were analysed by scanning electron microscopy. The amounts of bioactive molecules taken up and released by the CSMP‐PF hydrogel complex were measured. Haematoxylin and eosin staining of IR‐damaged skin showed acanthosis and hyperkeratosis in the epidermis; and damage to hair follicles/skin appendages and adipose tissue, as well as panniculus carnosus, in the dermis. Injection of the CSMP‐PF hydrogel complex into IR‐damaged skin resulted in skin repair, suggesting that the complex has potential for use in the regenerative repair of IR‐damaged skin.     

Infectious‐mononucleosis‐like exanthema associated with COVID‐19 in a child

Cutaneous manifestations of childhood COVID‐19 differ from those of adults. Maculopapular rash is not specific and could be mistaken with other viral exanthema. A nasopharyngeal swab is strongly recommended to confirm the possible COVID‐19 diagnosis.     

Wound healing grafts: Omega‐3 fatty acid lipid content differentiates the lipid profiles of acellular Atlantic cod skin from traditional dermal substitutes

Acellular fish skin (ACS) has emerged as a dermal substitute used to promote wound healing with decreased scar formation and pain relief that may be due to polyunsaturated fatty acid (PUFA) content. However, the PUFA content of ACS is still unknown. The aim of this study was to compare the total fatty acids and lipid profiles of ACS to two bovine‐based grafts and standard of care human cadaver skin (HCS). Furthermore, there was also the goal to assess the capability of ACS lipid content to enhance wound healing. The fatty acid analysis was performed with GC–FID, and an LC–MS untargeted method was developed in order to the analyse the lipid profiles of the grafts was. The enhancement of wound healing by the ACS extract was investigated in vitro on HaCat cells. Our results showed that ACS had the highest content of PUFA (27.0 ± 1.43% of their total fatty acids), followed by HCS (20.6 ± 3.9%). The two grafts of bovine origin presented insignificant PUFA amounts. The majority of the PUFAs found in ACS were omega‐3, and in HCS, they were omega‐6. The untargeted lipidomics analysis demonstrated that ACS grafts were characterized by phosphatidylcholine containing either 20:5 or 22:6 omega‐3 PUFA. The ACS lipid extract increased the HaCat cells migration and enhanced wound closure 4 hr earlier versus control. Our study demonstrated that ACS has a lipid profile that is distinct from other wound healing grafts, that PUFAs are maintained in ACS post‐processing as phosphatidylcholine, and that ACS lipid content influences wound healing properties.     

Platelet‐rich plasma,a powerful tool in dermatology

Platelet‐rich plasma (PRP), a platelet concentrate contained in a small volume of plasma, has become a promising option in the last decade to treat different diseases related to the skin due to its high concentration of growth factors. When it is of autologous origin, it decreases the probability of suffering adverse reactions and transfusion‐transmitted infections, thus it is an optimal and safe therapy for the patient. PRP has been used in the treatment of several dermatological conditions such as acne, alopecia, and skin ulcers. Its use has also extended to other skin conditions such as melasma, hyperpigmentation, and burns, where it stimulates tissue repair and regeneration. The purpose of this article is to review the management and treatment of different dermatological alterations with PRP. Although there are a variety of studies that support the use of PRP, more research is needed to standardise the protocols for obtaining, processing, and applying it as well as understanding the biological and molecular bases of its functioning.