Exosomes are small extracellular vesicles released by a range of cells, including mesenchymal stromal/stem cells (MSCs), immune cells, cancerous cells, etc. These particles contain biomolecules such as DNA, microRNA, messenger RNA, protein, and lipid, and play a vital role in establishing cellular communication. After reaching the target cells, the particles cause changes in function, fate, morphology, differentiation, and growth. Exosomes released from a variety of sources have the ability to influence the behavior of cells involved in wound healing, enhance neovascularization, promote collagen deposition, reduce inflammation, and quicken the healing process. According to new research, endothelial cell adhesion, migration, proliferation, vascular repair, and angiogenesis are all accelerated during the wound healing process when deleted in malignant brain tumors 1 (DMBT1) is used as an active stimulant. This article will review DMBT1 protein as one of the major elements of exosomes from human urine-derived MSCs.

Background: Ablative oncologic procedures for colorectal or gynecologic malignancies can result in large skin or tissue volume defects. Although direct closure may be possible, such attempts can lead to postoperative complications such as wound breakdown, organ prolapse, chronic seroma, or infection. Various procedures, from flap surgery to local wound care, can be useful additions to improve patient outcomes. Methods: This study retrospectively reviews cases of patients with multiple comorbidities who had undergone concomitant interventions after pelvic ablative surgery. Various interventions after pelvic ablative surgery, from reconstructing the defect to managing postoperative complications, are described. Results: Careful planning and selection of the reconstruction method can significantly improve patient outcomes. The authors suggest using gluteal flaps for most reconstructive demands. Conclusion This case series emphasizes the utility of using various flaps, especially the gluteal flap, in reconstructing oncologic defects in the pelvic and perineal regions. The insights gained from this study will hopefully be of assistance to future research and clinical practice, ultimately improving patient outcomes.

Clay is ubiquitous, and its hydrous phyllosilicate properties have promoted its use as a traditional wound healing agent in many cultures. Various types of natural clay have been utilized for skin diseases and wound treatments. Therefore, we aimed to study natural and synthetic clay minerals and summarize their applicability in medical settings. A review of prospective studies published since 2008 examining the properties of different forms of natural clay minerals and their therapeutic benefits in wound care was conducted. Studies were obtained using the databases of Google Scholar, PubMed, Web of Science, and HINARI (Health Inter-Network Access to Research Initiative) and searching related journals. The primary outcomes were assessed qualitatively and were categorized by the type of natural clay used. The included papers studied five available types of clay: Chamliyal clay, French green clay, Oregon Mineral Technologies blue clay, Kisameet clay, and various synthetic clays. The studies found how these forms of clay together demonstrate anti-inflammatory and antibacterial properties while promoting fibroblast regeneration and circulation while remaining biocompatible. Clay-based materials may be a potential alternative for conventional dressings for wound healing in resource-limited settings. This review opens doors to expanding clay-based therapies for wound healing.

Preauricular sinus, a congenital malformation resulting from incomplete fusion of the first and second branchial arches, is a relatively common condition with a reported prevalence of 0.1% to 0.9%. While mostly asymptomatic, it can lead to abscess formation when infected. We present a unique case of a neglected preauricular sinus abscess that extended to the scalp, causing significant complications. The report discusses the clinical presentation, diagnostic approach, treatment modalities, and potential complications associated with this unusual and severe presentation. Prompt and appropriate management, combined with conservative treatment and surgical intervention, led to successful outcomes. This case highlights the importance of recognizing potential risks and implementing a systematic approach in managing recurrent preauricular sinus abscesses.

Patients undergoing insertion of cardiac implantable electronic devices often exhibit perioperative hemorrhagic complications. Perioperative antithrombotic management, which balances the risk of acute thrombosis and postoperative bleeding, is therefore important for these patients. In this case report, we present three cases of cardiovascular implantable electronic device (CIED) insertion. While the three patients each had different reasons for not discontinuing antithrombotic medications, they all needed CIEDs. During the CIED implantation procedures, a small incision was made on the pectoralis muscle region to obtain a small subcutaneous pocket, and Tachosil, a fibrin sealant patch, was inserted below and above the inserted device. The patients showed no pocket hematoma formation or any hemorrhagic complications. We thus concluded the application of a fibrin sealant patch could be an option for perioperative anticoagulation management without interruption of anticoagulants and antiplatelets.

Background: Hypertrophic scars and keloids result from burns, trauma, infection, and surgery and affect daily life. Although various scar management options are available, their efficacy remains uncertain. Silicone-based products, including sheets and gels, are the primary choices for scar management. This study assesses the effectiveness of Mepiform and Mepiform Ultra Scar Gel and their optimal use. Methods: Eighteen patients who underwent primary repair between January and June 2021 were enrolled and divided into those using both Mepiform products and those using only Mepiform Ultra Scar Gel. Scars were evaluated at baseline and after 2, 4, 8, 12, and 24 weeks. The Vancouver Scar Scale score was evaluated at 12 and 24 weeks. The patients provided feedback through a survey. Results: Group 1 (both Mepiform products) showed greater improvements in vascularity (33%), height (33%), and overall sum (67%) on the Vancouver Scar Scale from weeks 12 to 24. Group 2 (only Mepiform Ultra Scar Gel) showed improvements in vascularity (22%), height (22%), and overall sum (33%). Both groups reported positive outcomes, with group 1 demonstrating higher improvement percentages for most parameters. Conclusion This study provides valuable insights into Mepiform and Mepiform Ultra Scar Gel in postoperative scar management despite a limited sample size. All scars in the study either remained stable or improved. Better results from group 1 suggest combining Mepiform products offers advantages. The consistent and prolonged use of silicone-based products is emphasized, and larger-scale research is needed to validate these findings.

Hand injuries due to high-pressure paint gun devices are rare but may lead to serious outcomes. The authors describe a case of a high-pressure injury of the thumb that was managed promptly and later reconstructed successfully with minimal functional deficit. A 39-year-old man with a high-pressure paint gun injury of the right thumb was referred. Though the external wound was small, X-ray and computed tomography images showed extensive spread of paint inside. The paint was removed through a wide skin incision. After 6 weeks, the surgical wound had completely healed, except for a defect around the interphalangeal joint with bone exposure. A reverse thenar perforator-based island flap based on the princeps pollicis artery was elevated and moved to the defect. After defect reconstruction, the patient recovered pinch and grasp function through physiotherapy. High-pressure paint gun injuries of the thumb can lead to significant functional deficits of the hand. A small skin lesion may cause the actual extent of damage to be underestimated, as extensive penetration of paint can cause severe damage to the soft tissues. Thus, immediate surgical removal of the paint and coverage of the remnant wounds with an appropriate flap are necessary.

Background: Keloid scars occur idiopathically, and the ear is a common site of keloid scar formation after ear-piercing. Management is always challenging because of the high likelihood of recurrence. When treating a large keloid scar, surgical debulking is inevitable. Among various surgical options, the fillet flap is useful for very large scars with broad stalks that cannot be removed by simple excision and primary closure. Methods: From April 2016 to June 2021, scar revision with a fillet flap was performed on 24 auricular keloid scars. The operation was performed to debulk the scar as much as possible, while retaining a thin envelope of scar tissue. The patients were observed for 1 year postoperatively. Oral tranilast (a transforming growth factor-β suppressor) was administered to reduce the risk of recurrence during follow-up. When recurrence was observed, triamcinolone was injected into the scar. Results: All 24 cases were successfully treated without major problems such as flap loss. The postoperative contour and volume of the scars were appropriate when recurrence did not occur. During the follow-up period, there were nine cases of keloid recurrence, and the mean number of triamcinolone injections was 2.7. One patient experienced a second recurrence 10 months after the first recurrence and needed two more injections. Conclusion The fillet flap is an appropriate option for removing a large keloid scar with a broad stalk. Although it does not guarantee that recurrence will not take place, it provides a small and flat scar into which triamcinolone can be injected if the keloid scar recurs.

Reconstruction of lower extremity wounds in patients with abnormalities in vascular anatomy is often challenging. A 71-year-old man was admitted to our hospital after sustaining two contact burns on his right leg while sleeping on an electric blanket. Fourth-degree burns amounting to approximately 3% of total body surface area were confirmed, with eschar formation on the right instep and pretibial area. Both wounds on the lower leg required flap reconstruction. In addition, the patient had anterior tibial artery hypoplasia. We considered a two-flap reconstruction method that should leave the source artery and muscle intact and generally has a good prognosis. A peroneal artery perforator-based keystone flap was used on the right lower leg, and a right dorsalis pedis island flap on the foot dorsum. Surgery was performed successfully, and at 8 months postoperatively, the patient walked naturally and had no complaints of discomfort. Additionally, cosmetic results were satisfactory. Accordingly, we introduce a surgical method that is useful in cases similar to that described.

Background: Acellular dermal matrices (ADMs) have shown promise in promoting tissue regeneration; however, their integration in challenging cases with limited vertical-axis neovascularization remains difficult. This study investigates whether clinically meaningful transverse-axis neovascularization is identified in ADM engraftment and whether this can be further accelerated by platelet-rich plasma (PRP). Methods: ADM and PRP-soaked ADM were implanted into New Zealand rabbits, and histological analysis was performed at different periods to compare neovascularization. Results: Histological analysis revealed that among 32 biopsy sites, there was transverse-axis neovascularization with an average length of 606.89 μm. When divided into two groups for assessing the impact of PRP on transverse-axis neovascularization, the extent of such neovascularization was measured as 582.99 μm in the control group and 630.79 μm in the experimental group. However, there was no statistically significant difference between the two groups (P=0.693). Conclusion The results of the present study indicate that achieving meaningful transverse-axis neovascularization in implanted ADMs remains a challenge, warranting further investigation into ADM structure and vertical-axis neovascularization.