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Objetivo: Evaluar los resultados estéticos y funcionales, así como el grado de satisfacción, posteriores a la reconstrucción de defectos de la extremidad inferior en niños con colgajo de dorsal ancho preservador del músculo como una alternativa para estos casos. Método: Se incluyeron pacientes menores de 18 años con defectos en la extremidad inferior tratados en un periodo de 3 años. Se realizó colgajo dorsal ancho preservador de músculo en todos los pacientes. Se valoraron la apariencia estética, la fuerza muscular del área donadora y la función en el área receptora a los 3 meses de realizado el colgajo. Resultados: Se realizaron 13 colgajos de dorsal ancho preservadores de músculo. La apariencia estética de las áreas donadora y receptora fue satisfactoria en la mayoría de los casos. La mayoría de los pacientes presentaron una fuerza muscular normal (M5) en el sitio donador y pudieron deambular. Conclusiones: El colgajo de dorsal ancho preservador de músculo tiene un grado de satisfacción muy elevado, excelente simetría y preservación de la función muscular del sitio donador. Es una técnica ideal en defectos tisulares importantes de la extremidad inferior en la población pediátrica.

Introduction: The iatrogenic effects of repairing peripheral nerve injuries (PNIs) with autografts (AGTs) encouraged the present study to involve a new approach consisting of grafting xenogeneic prerecellularized allogeneic cells instead of AGTs. Methods: We compared sheep's AGT regenerative and functional capacity with decellularized human nerves prerecellularized with allogeneic Schwann-like cell xenografts (onwards called xenografts). Mesenchymal stem cells were isolated from ovine adipose tissue and induced in vitro to differentiate into Schwann-like cells (SLCs). Xenografts were grafted in ovine sciatic nerves. Left sciatic nerves (20 mm) were excised from 10 sheep. Then, five sheep were grafted with 20 mm xenografts, and five were reimplanted with their nerve segment rotated 180° (AGT). Results: All sheep treated with xenografts or AGT progressively recovered the strength, movement, and coordination of their intervened limb, which was still partial when the study was finished at sixth month postsurgery. At this time, numerous intrafascicular axons were observed in the distal and proximal graft extremes of both xenografts or AGTs, and submaximal nerve electrical conduction was observed. The xenografts and AGT-affected muscles appeared partially stunted. Conclusions: Xenografts and AGT were equally efficacious in starting PNI repair and justified further studies using longer observation times. The hallmarks from this study are that human xenogeneic acellular scaffolds were recellularized with allogenic SCL and were not rejected by the nonhuman receptors but were also as functional as AGT within a relatively short time postsurgery. Thus, this innovative approach promises to be more practical and accessible than AGT or allogenic allografts and safer than AGT for PNI repair.

Objective: Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care., Design and Setting: Single-center pilot, proof-of-concept, single-blind randomized controlled trial., Patients and Intervention: Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone., Outcome Measures: The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone., Main Results: Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 μm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group., Conclusions: A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.

Background: With some frequency, in mestizo rhinoplasty, we focus much of our attention on the nasal tip. This work also highlights the importance of obtaining a proper balance of the columella, achieving a pleasing visual effect of the vector lines that make up the nasal profile (columella and nasal tip vectors)., Methods: We performed a complete medical history in all patients and developed a surgical plan after nasal anatomy analysis. Pre- and postoperative photographs were obtained for medium and long term control., Results: We treated 112 patients with this surgical technique, 77 with an open approach and 35 with a closed approach. The results were documented in the short and long term with a range of 6 months to 5 years., Conclusions: We feel that the use of an angulated extended columellar graft is highly polyfunctional, providing length, definition and support to nasal tip grafts. Because of the graft design, it is possible to predetermine the new columella length/tip, thus visualizing the columella and nasal tip vectors of the nasal profile. The angulated extension prevents cephalic-lateral-caudal displacements of the tip graft, and to some degree it is possible to increase or decrease nasal length depending on the angularity of the extension., (Copyright © 2014 Elsevier Inc. All rights reserved.)