Search Results (153)

Background and Clinical Significance: Hidradenitis suppurativa (HS) is a chronic, debilitating skin disorder that often affects the inframammary fold (IMF). While surgical management, particularly wide local excision (WLE), is the gold standard for severe cases, less is known about the role of breast surgery techniques in treating HS in this area; Case Presentation: This report presents two cases of female patients with bilateral inframammary HS and mammary hypertrophy, both treated with reduction mammaplasty to excise diseased tissue while addressing breast volume and contour. Both patients had experienced inadequate response to medical therapies, including biologic treatments, and presented with distinct clinical features—one with significant asymmetry and active disease, and the other with more scarring and hypertrophic lesions. During follow-up, no recurrence of disease was observed and both patients reported improved breast appearance and satisfaction; Conclusions: These cases underscore the importance of a multidisciplinary approach, with dermatologists and surgeons both playing a key role in the management of this complex condition. Full article

Background: Body contouring surgery is a critical aspect of reconstructive and esthetic care, addressing both functional and psychosocial needs. As the global prevalence of obesity and related metabolic disorders is constantly on the rise, it is inevitable that patients presenting for body contouring procedures would display comorbid cardiometabolic conditions that can negatively impact surgical outcomes. Clustered cardiometabolic abnormalities have been linked to increased rates of surgical complications, medical adverse events, prolonged hospitalization, and need for revision procedures. However, its impact on body contouring surgery outcomes remains insufficiently characterized. Materials and Methods: TriNetX Global Collaborative Network, comprising deidentified electronic medical records from over 170 healthcare organizations was utilized for this study. Adults undergoing body contouring surgery were stratified by the presence of a composite cardiometabolic burden, defined as the combination of obesity, diabetes mellitus and hypertension, in the year preceding surgery. Cohorts were matched 1:1 using propensity score matching based on baseline demographics, comorbidities, and substance use. Risk ratios with 95% confidence intervals were calculated, with statistical significance set at p < 0.05. Outcomes were assessed at 30, 60, and 90 days postoperatively. Results: Among 188,164 body contouring patients, 6892 with composite cardiometabolic burden were propensity score–matched to controls. The study group was associated with significantly higher wound complications, surgical site infections, antibiotic use, and emergency department visits at 30, 60, and 90 days postoperatively, with no difference in hypertrophic scarring. Conclusions: Composite cardiometabolic burden, as defined in the study, demonstrated a significantly increased risk of adverse events following body contouring surgery, including wound-related morbidity, surgical site infection and increased healthcare utilization. These risks are evident from the early postoperative period and persist through at least the first 90 days after the procedure. Full article

Hypertrophic scars are characterized by excessive collagen deposition, fibrotic remodeling, and functional impairment. However, the ability of current models is limited in recapitulating human pathology. This study presents a novel approach using induced pluripotent stem cell-derived scar organoids to model hypertrophic scar characteristics in vitro. Following established protocols, human pluripotent stem cells were differentiated into skin organoids and induced fibrotic transformation by treatment with TGF-β1 (10 ng/mL) and hypoxia (5% O₂) from day 45 onward. Scar organoids exhibited significant contraction and increased collagen I deposition compared with skin organoids. Immunofluorescence analysis showed reduced LHX2 expression, indicating loss of hair follicle development, while collagen I expression was significantly elevated. Dark-field imaging revealed marked morphological divergence between skin and scar organoids. RNA sequencing revealed distinct transcriptomic profiles. Expression of hair follicle-associated gene families (KRT and KRTAP) was upregulated in scar organoids, whereas epidermal structure-related genes (KRT4, KRT7, CLDN7, and WNT7) were downregulated. These findings demonstrate that iPSC-derived scar organoids successfully recapitulate key features of human hypertrophic scars, including excessive collagen production, loss of skin appendage development, and contractile behavior. This platform offers potential for future applications in drug screening, precision medicine, and understanding the molecular mechanisms underlying scar formation. Full article

Background: Apoptotic vesicles (ApoVs) derived from adipose stem cells (ASCs) have recently emerged as important mediators of tissue repair and are implicated in pathways relevant to hypertrophic scar (HS). Although ASCs exhibit potential in scar modulation, the therapeutic value of their apoptotic clearance products remains largely unexplored. Methods: In this study, we investigated the efficacy and mechanism of staurosporine (STS)-induced adipose stem cell derived apoptotic vesicles (ASCs-ApoVs) in mitigating HS. Western blot, RT-qPCR, and immunofluorescence were used to assess fibrotic markers including α-SMA, COL1A1, and COL3A1 and so on in hypertrophic scar derived fibroblasts (HS-fibroblasts). Results: ASCs-ApoVs significantly reduced profibrotic marker expression in HS-fibroblasts without short-term cytotoxicity. CDC20 down-regulation was identified as a critical target, through which ASCs-ApoVs suppressed Wnt/β-catenin signaling, as evidenced by the downregulation of β-catenin, c-MYC, Cyclin D1, and AXIN2. The efficacy of ASCs-ApoVs in hypertrophic scar regulation was also confirmed by the rabbit ear scar model. Furthermore, ASCs-ApoVs demonstrated notable structural and functional stability. Conclusions: In summary, our results established STS-induced ASCs-ApoVs as a potent multi-target strategy for hypertrophic scar regulation. Besides, the scalable production, functional stability, and favorable safety profile of ASCs-ApoVs underscore a strong promise for clinical translation. Full article

Background: Deep burns in pediatric population often require split-thickness skin grafts (STSGs) and the identification of an optimal donor site is crucial to minimize morbidity, accelerate healing and reduce short- and long-term complications. The scalp appears to be increasingly used in clinical practice, but evidence remains limited, despite the promise of novel bioengineering and regenerative approaches. Methods: A systematic review about the use of scalp for STSG in pediatrics was conducted across PubMed, Scopus, and Cochrane (2005–2025). Clinical outcomes considered were donor-site healing time, early and late complications, perioperative practices, and quality of scars. Results: Four studies met the inclusion criteria (n = 417, mean age 2.9–7.3 years) with follow-up periods up to 27 years. Epithelialization occurred between 7 and 25 days. Early complications included folliculitis (up to 44% in certain hair types) and delayed healing (n = 13; 52%). A rigorous harvesting technique is needed to avoid preventable complications. Late sequelae included alopecia (1.6% to 33%—the latter largely unperceived by patients) and hypertrophic scarring (1.6–4%). Scar quality was rated good in >80% of cases. Conclusions: Evidence supports the scalp as a safe, efficient, and cosmetically favorable donor site for pediatric STSG. Based on evidence and clinical experience, we propose the first structured scalp-donor management algorithm to optimize safety, reduce complications, and standardize perioperative care in the management of pediatric burns. Full article

Background/Objectives: Thermal injuries represent a significant global health burden, often complicated by hypertrophic scarring, chronic inflammation, and delayed re-epithelialization. While Mesenchymal Stem Cell (MSC) transplantation has shown promise, its clinical translation is hindered by risks of tumorigenicity and immunological concerns. This study evaluates the efficacy of cell-free Extracellular Vesicle (EV) therapy—derived from both mammalian MSCs and plant sources (PDNVs)—as standardized, off-the-shelf alternatives. This study synthesizes evidence focusing on re-epithelialization velocity, angiogenic activity, and anti-fibrotic outcomes, while assessing the impact of second-generation delivery scaffolds on therapeutic durability. Methods: Conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261305379), this review interrogated PubMed, Scopus, Embase, and Web of Science for studies published between 2015 and 2026. Eligible studies included in vivo animal models of thermal injury using purified vesicles from mammalian MSC sources or plant-derived nanovesicles compared with placebo, standard care, or untreated controls. Data were synthesized narratively; methodological quality was appraised using the SYRCLE risk of bias tool and compliance with MISEV guidelines. Results: Synthesis of 50 studies revealed that vesicle-based interventions consistently accelerate wound closure and improve histological healing. Mammalian ADSC-derived vesicles demonstrated superior anti-fibrotic effects via the miR-192-5p and miR-125b-5p axes, while hUC-MSC vesicles attenuated systemic inflammatory signaling via miR-181c. Plant-derived nanovesicles (PDNVs) showed potent antioxidant and re-epithelialization effects, with emerging potential as engineered genetic carriers. Crucially, advanced delivery systems, including bioactive hydrogels and microneedle patches, were repeatedly associated with improved local retention and more durable effects than bolus injections. Conclusions: Vesicle-based therapies show consistent pro-healing signals in preclinical models, suggesting source-dependent profiles: MSC-derived vesicles excel in immunomodulation and anti-fibrotic remodeling, while PDNVs provide a scalable, low-immunogenicity platform. As a cell-free strategy, these therapies circumvent the safety risks of live cell transplantation. This review identifies a critical shift toward second-generation delivery scaffolds to overcome the clearance crisis of topical applications, emphasizing the need for harmonized MISEV-aligned characterization in future clinical translation. Full article

Keloids and hypertrophic scars are fibroproliferative disorders of wound healing characterized by excessive extracellular matrix deposition, constant inflammation, and high recurrence rates despite appropriate management. Conventional therapies, including surgical excision, corticosteroid injections, laser therapy, and radiation, can provide temporary relief. However, treatment failure remains common, specifically in refractory keloids. Recent findings suggest these outcomes cannot be fully explained by technical or mechanical factors alone, and pathological scarring may reflect underlying immune and neuroimmune dysfunction. Current evidence shows prolonged activation of pro-inflammatory and pro-fibrotic cytokine pathways like IL-6, TNF-α, TGF-β, and IL-17 drives sustain fibroblast activation and disrupts normal wound healing and remodeling. Additionally, the skin functions as an integrated neuro-endocrine-immune organ, allowing bidirectional communication between cutaneous nerves, immune cells, and stromal tissue. Neurogenic inflammation is mediated by neuropeptides, mast cell activation, and stress-induced hypothalamic–pituitary–adrenal axis dysregulation, which further amplifies inflammation within scar tissue. Psychiatric comorbidities like depression, anxiety, and chronic psychological stress serve as a positive feedback mechanism and are increasingly recognized as biologically active contributors to immune dysregulation. This review highlights critical gaps in current management strategies and emphasizes the need for biologically informed, multidisciplinary approaches to improve long-term outcomes for keloid and hypertrophic scar management. Full article

Background: Congenital muscular torticollis (CMT) is usually managed conservatively during infancy, whereas surgical treatment is considered for persistent deformity in older children. However, evidence remains limited regarding the outcomes of distal resection combined with proximal release of the sternocleidomastoid muscle in children presenting beyond infancy. This study aimed to evaluate the functional and cosmetic outcomes of this combined approach in patients aged 3 years and older. Methods: This retrospective single-surgeon series included 37 patients with CMT aged 3 to 14 years who underwent distal resection combined with proximal release of the sternocleidomastoid muscle between 2002 and 2024. Preoperative and postoperative assessments were performed using the clinical outcome framework originally described by Lee et al., goniometric measurement of cervical rotation and lateral flexion, and clinical evaluation of head tilt, facial asymmetry, scar appearance, lateral band formation, and sternocleidomastoid V-column contour. Patients were also analyzed according to age at surgery, as 3–10 years and 11–14 years. Results: The mean age at surgery was 4.7 years, and the mean follow-up duration was 3.4 years. Significant postoperative improvement was observed in all major functional outcomes. Mean cervical rotation improved from 54.2 ± 8.6° to 87.9 ± 3.4°, and mean lateral flexion improved from 24.1 ± 6.8° to 44.5 ± 3.2° (both p < 0.001). Preoperative functional assessment scores averaged 6.8 ± 1.4, whereas postoperative total outcome scores averaged 14.2 ± 0.9. At final follow-up, no patient had residual head tilt. Mild residual facial asymmetry persisted in 3 patients (8.1%). Overall, postoperative outcomes were rated as excellent in 33 patients (89.2%) and good in 4 patients (10.8%). A slight partial loss of the sternocleidomastoid V-column contour was observed in 34 patients (91.9%), although this finding was not documented as a major cosmetic concern in the available clinical records. Hypertrophic scarring developed in 1 patient (2.7%). No lateral band formation, recurrence, revision surgery, infection, or hematoma was observed. Conclusions: Distal resection combined with proximal release provided favorable functional and cosmetic outcomes in children older than 3 years with CMT. The technique was associated with marked improvement in cervical motion, correction of head tilt, low complication rates, and a high proportion of excellent or good results. Full article

This perspective contains the current understanding of the cellular and molecular mechanisms involved in wound healing (the articles taken into consideration relate to the three-year period 2023–2025). Nevertheless, these biological pathways remain inadequately characterized; this is seen by the modifications leading to pathological conditions, such as keloids, chronic wounds, or hypertrophic scars and diabetic wounds. Focus is also directed to novel therapy suggested for these types of conditions. Understanding these scientific issues is crucial for professionals across many fields who see such presentations often. Full article

Background: Burn injuries have both physical and psychological impacts on patients. Factors such as personal beliefs, prior experiences, and geographic, economic, or cultural barriers, as well as fear of hospitals, can contribute to delays in seeking specialized care. When combined with inadequate first aid or the inappropriate use of pharmaceutical or traditional remedies, these delays may worsen burn severity, prolong healing, and negatively affect quality of life. From a clinical perspective, delayed presentation following burn injury has been linked to burn wound progression, which increases the risk of local infection, hypertrophic scarring and prolonged functional impairment. Methods: This analytical cross-sectional study was conducted at the Clinical Emergency Hospital of Bucharest between January and September 2025. The primary objective was to characterize adult burn patients presenting more than 24 h after injury (Group A) and to describe self-reported psychosocial/behavioral characteristics and explore unadjusted patterns among delayed presenters. Data were collected from medical records and a structured questionnaire administered to delayed presenters. A secondary descriptive comparison was performed with patients presenting within 24 h (Group B) to provide contextual reference. Results: The majority of patients were male (62.2%) and of working age (18–65 years, 82.4%). Thermal burns from domestic accidents were most common (58.8%), with scalds predominating. Second-degree burns were the most frequent (60.5%), primarily affecting the upper and lower limbs. Mean total body surface area (TBSA) was low (2.86 ± 1.91%), although higher values were observed in radiation burns and closed-space accidents. More than half of the patients did not receive any first aid, while the remainder used various pharmaceutical or natural products, some of which were inappropriate for burn treatment. The main reasons for delaying specialized care were the expectation that injuries would heal spontaneously, negligence, and fear of the hospital. In contrast, escalating pain, edema, and family insistence were the primary motivators for seeking professional medical attention. Delayed presentation was associated with older burn lesions, higher burn severity and an increased likelihood of hospitalization or refusal of recommended admission. Conclusions: Burn injuries predominantly affect working-age males and most frequently arise from domestic thermal accidents. Delayed presentation and inadequate first aid are common and influenced by behavioral, social, and demographic factors. Targeted public education, improved first aid practices, and timely healthcare-seeking are essential to reduce burn severity and improve patient outcomes. Full article

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39–11.99; p = 0.37; I² = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, −0.03 to 0.14; p = 0.21; I² = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I² = 35%), and wound infection (RD = 0.00; 95% CI, −0.03 to 0.03; p = 0.93; I² = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, −0.70 to 1.30; p = 0.56; I² = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications. Full article

Background/Objectives: Ventricular repolarization abnormalities (VRA) represent a grey area in athlete screening: some patterns are physiological, while others are precursors to heart disease. Objective: to clarify the natural history of VRA and the associated factors of structural diagnosis. Methods: Retrospective observational single-center study of athletes with resting or stress VRA at the first evaluation, with normal echocardiography; minimum follow-up of 2 years. Clinical data, resting and stress ECG, echocardiography, and selective advanced imaging throughout follow-up were collected. Primary outcome: cardiovascular diagnosis at follow-up; time-to-event analysis and associations between ECG characteristics and diagnosis. Results: Fifty-three athletes (mean age 22.2 ± 9.2 years; 92.5% male) were included; 60.4% had resting VRA, and 100% had exercise-induced VRA at baseline. Over 7.3 ± 4.5 years, 28/53 (52.8%) received a diagnosis; median time-to-detection was 7.0 years (95% CI 6.0–not reached); RMST10 was 6.7 years (95% CI 5.7–7.7). Diagnoses included hypertrophic cardiomyopathy (24.5%), non-ischaemic left-ventricular scar (11.3%), myocardial bridging (7.5%), hypertensive remodelling (5.7%), coronary anomaly (1.9%), and ventricular pre-excitation (1.9%). Persistence of resting VRA from baseline to follow-up was more frequent in athletes with a final diagnosis (p = 0.01), whereas topography and exercise-induced abnormalities did not discriminate groups. Advanced imaging contributed substantially to case ascertainment. No major adverse cardiovascular events have been identified throughout follow-up. Conclusions: In athletes with screening-detected VRA and normal echocardiography, persistence of resting VRA was associated with higher detection of a cardiovascular diagnosis, while exercise-induced changes alone show limited diagnostic yield. The long median time-to-detection supports prolonged, pre-planned surveillance, with priority for advanced imaging in profiles with persistent abnormalities. These findings align with a risk-adapted, personalized management strategy in sports cardiology. Full article

Background and Clinical Significance: Heat-press injuries of the hand can cause deceptively deep, progressive tissue damage, and dorsal multi-digit involvement carries a high risk of joint stiffness and scar contracture. Case Presentation: A 58-year-old left-hand-dominant woman sustained a dorsal heat-press injury affecting the left index to small fingers; we performed staged reconstruction with tangential debridement and artificial dermis placement (Day 9) followed by full-thickness skin grafting (FTSG) from the right infraclavicular region (Day 23), with supervised rehabilitation from Day 15 and active ROM resumed on postoperative day (POD) 6 after FTSG. Conclusions: At long-term follow-up (POD 821 after FTSG; ≈2.2 years), the reconstructed digits showed no hypertrophic scarring and achieved full finger motion with full fist formation; serial joint-specific active ROM tracking may enhance interpretability and comparability of outcomes in this uncommon but functionally critical injury pattern. Full article

Background: The use of implantable cardioverter defibrillators (ICDs) in elite athletes following sudden cardiac arrest (SCA) or the diagnosis of high-risk cardiac conditions presents a complex interplay of medical, psychological, and legal challenges. Despite evolving guidelines, data on clinical outcomes and return-to-sport (RTS) trajectories in elite athletes remain limited. Objective: To describe the clinical profiles, management strategies, and career outcomes of elite athletes who received ICDs. Methods: A retrospective multilingual media and literature search was performed up to January 2026 to identify elite athletes with ICDs. Inclusion criteria required evidence of professional or Olympic-level competition, confirmed ICD implantation, and sufficient clinical and career data. Cases were analyzed for demographics, underlying diagnosis, prevention type, post-ICD outcomes, and RTS status. Results: Thirty-seven elite athletes were identified (mean age 25.8 ± 4.3 years). The most common sport was football (n = 25). Hypertrophic cardiomyopathy, non-ischemic LV scar, and arrhythmogenic cardiomyopathy were the most frequent diagnoses, although 49% of etiologies remained unspecified. ICDs were implanted for secondary prevention in 70% of cases. Following ICD implantation, 25 athletes (68%) completed RTS, including 24 (65%) at the professional level. Among these, nine experienced shocks, and four ultimately discontinued competition. The sole fatality occurred in an athlete who had voluntarily explanted the ICD. Conclusions: A substantial proportion of elite athletes with ICDs successfully return to high-level sport, but clinical outcomes, risk tolerance, and legal frameworks remain variable. These findings support continued shifts towards personalized shared decision making and highlight the need for standardized, sport-specific RTS protocols, long-term registries, and psychosocial support in this population. Full article

Initially characterized as a component of the extracellular matrix (ECM) in cartilage, cartilage intermediate layer protein 2 (CILP2) is now recognized as a pleiotropic secretory protein with far-reaching roles in physiology and disease. This review synthesizes evidence establishing CILP2 as a key modulator at the nexus of metabolic dysfunction, cancer, and other pathologies. Genomic studies have firmly established the NCAN-CILP2 locus as a hotspot for genetic variants influencing dyslipidemia and cardiovascular risk. Functionally, CILP2 is upregulated by metabolic stress, including high glucose and oxidatively modified LDL (oxLDL), and actively contributes to pathologies such as dyslipidemia, diabetes, and sarcopenia by impairing glucose metabolism and mitochondrial function. Its role extends to fibrosis and neurodevelopment, promoting hypertrophic scar formation and neurogenesis through interactions with ATP citrate lyase (ACLY) and Wnt3a, respectively. More recently, CILP2 has emerged as an oncoprotein, overexpressed in multiple cancers, including pancreatic ductal adenocarcinoma and colorectal cancer. It drives tumor proliferation and metastasis and correlates with tumor microenvironment remodeling through mechanisms involving Akt/EMT signaling and immune infiltration. The dysregulation of CILP2 in patient serum and its correlation with disease severity and poor prognosis highlight it as a promising biomarker and a compelling therapeutic target across a spectrum of human diseases. Full article