Search Results (513)

Background: Skin and soft tissue infections (SSTIs) are a major cause of emergency room (ER) visits and hospitalizations. Long-acting lipoglycopeptides (LALs), such as dalbavancin and oritavancin, offer potential for early discharge and outpatient management, especially in patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) or with comorbidities. Methods: We conducted a retrospective observational cohort study from March to December 2024 in an Italian tertiary-care hospital. Adult patients treated in the ER with a single dose of dalbavancin (1500 mg) or oritavancin (1200 mg) for SSTIs were included. Demographic, clinical, and laboratory data were collected. Follow-up evaluations were performed at 14 and 30 days post-treatment to assess outcomes. Results: Nineteen patients were enrolled (median age 59 years; 53% female). Most had lower limb involvement and elevated inflammatory markers. Three patients (16%) were septic. Fourteen patients (74%) were discharged without hospital admission; hospitalization in the remaining cases was due to comorbidities rather than SSTI severity. No adverse drug reactions were observed. At 14 days, 84% of patients had clinical resolution; only 10% had recurrence by day 30, with no mortality nor readmission reported. Conclusions: LALs appear effective and well-tolerated in the ER setting, supporting early discharge and reducing healthcare burden. Broader use may require structured care pathways and multidisciplinary coordination. Full article

Medical phantoms are essential to imaging calibration, clinician training, and the validation of therapeutic procedures. However, most ultrasound phantoms prioritize acoustic realism while neglecting the viscoelastic and anisotropic properties of fibrous soft tissues. This gap limits their effectiveness in modeling realistic biomechanical behavior, especially in wave-based diagnostics and therapeutic ultrasound. Current materials like gelatine and agarose fall short in reproducing the complex interplay between the solid and fluid components found in biological tissues. To address this, we developed a soft, anisotropic composite whose dynamic mechanical properties resemble fibrous biological tissues such as skin and skeletal muscle. This material enables wave propagation and vibration studies in controllably anisotropic media, which are rare and highly valuable. We demonstrate the tunability of damping and stiffness aligned with fiber orientation, providing a versatile platform for modeling soft-tissue dynamics and validating biomechanical simulations. The phantoms achieved Young’s moduli of 7.16–11.04 MPa for skin and 0.494–1.743 MPa for muscles, shear wave speeds of 1.51–5.93 m/s, longitudinal wave speeds of 1086–1127 m/s, and sound absorption coefficients of 0.13–0.76 dB/cm/MHz, with storage, loss, and complex moduli reaching 1.035–6.652 kPa, 0.1831–0.8546 kPa, and 2.138–10.82 kPa. These values reveal anisotropic response patterns analogous to native tissues. This novel natural fibrous composite system affords sustainable, low-cost ultrasound phantoms that support both mechanical fidelity and acoustic realism. Our approach offers a route to next-gen tissue-mimicking phantoms for elastography, wave propagation studies, and dynamic calibration across diverse clinical and research applications. Full article

Skin and soft tissue infections (SSTIs) are becoming an urgent public health issue worldwide. The globe is facing a growing problem with drug-resistant germs, and current treatments are not quite cutting it. There is a real need for new therapies that can tackle these challenges more effectively. This brings us to an interesting question: Can extracellular vesicles (EVs) from different sources, such as mesenchymal stem cells (MSCs), immune cells, or even plants and animals, help in treating SSTIs, especially given the rise in drug resistance? Studies have shown that MSC-derived EVs are particularly noteworthy because they carry components such as antimicrobial peptides (AMPs) that can work together to fight infections, boost the immune response, and aid in healing. These vesicles play a role in how our body interacts with infections, helping to clear bacteria, reduce inflammation, and promote tissue repair. We also see that EVs from plants and bacteria can directly fight off germs, while those from animals can support the healing process of skin. Although early studies have shown promise for EV therapies, there are still hurdles to overcome, such as ensuring consistent production and delivery. This review looks at the potential of EVs as powerful agents in managing infections and supporting healing, highlighting an exciting area of research in medicine. Full article

For many years, staphylococci have been detected mainly in infections of the skin and soft tissues, organs, bone inflammations, and generalized infections. Thromboembolic diseases have also become a serious plague of our times, which, as it turns out, are closely related to the toxic effects of staphylococci. Staphylococcus aureus, because of the presence of many different kinds of virulence factors, is capable of manipulating the host’s innate and adaptive immune responses. These include toxins and cofactors that activate host zymogens and exoenzymes, as well as superantigens, which are highly inflammatory and cause leukocyte death. Coagulases and staphylokinases can control the host’s coagulation system. Nucleases and proteases inactivate various immune defense and surveillance proteins, including complement components, peptides and antibacterial proteins, and surface receptors that are important for leukocyte chemotaxis. On the other hand, secreted toxins and exoenzymes are proteins that disrupt the endothelial and epithelial barrier as a result of cell lysis and disintegration of linking proteins, which ultimately increases the risk of thromboembolism. In this review, we discuss various virulence factors and substances that may inhibit their activity. Full article

Soft tissue reconstruction in patients with upper extremity necrotizing soft tissue infections (NSTIs) can be challenging; these defects can be large with exposed critical structures. Following appropriate source control and debridement, soft tissue reconstruction is based on size, exposed structures, medical co-morbidities and the physiologic status of the patient. There are multiple options for soft tissue coverage from local wound care to free tissue transfer. Dermal substitutes can help prepare a healthy wound bed that can later accept a skin graft. Local rotational flaps, distant pedicled flaps and free flaps are also options depending on the patient and the defect. Patients can have good functional outcomes after soft tissue reconstruction after upper extremity NSTI. Full article

Background/Objectives: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and aggressive cutaneous lymphoma, often misdiagnosed due to nonspecific clinical features. Early diagnosis and treatment remain challenging. Methods: We report the case of a 31-year-old female with a chronic non-healing gluteal wound initially treated as an abscess. The lack of improvement prompted repeated investigations, culminating in the diagnosis of SPTCL with an alpha–beta T-cell phenotype. Results: Management involved combined chemotherapy and surgical wound reconstruction. Six cycles of CHOEP-21 chemotherapy led to complete clinical remission. A soft tissue defect superinfected with multidrug-resistant organisms was successfully reconstructed using Integra Dermal Regeneration Template followed by split-thickness skin grafting. Conclusions: This case highlights the diagnostic complexity of SPTCL and the therapeutic potential of dermal matrix application in complex wound management, especially in immuno-compromised patients. Full article

Background/Objectives: Advanced destruction of the ankle and subtalar joints due to neuropathy, chronic infection, or inflammatory conditions presents a major surgical challenge, often resulting in limb amputation. This descriptive retrospective study aims to evaluate outcomes of reconstructive surgery in patients, in whom limb preservation was prioritized over amputation despite significant soft tissue and osseous involvement. Methods: Between January 2013 and December 2022, 31 reconstructive procedures were performed on 29 patients (16 women and 13 men) with severe hindfoot deformities. Etiologies included Charcot arthropathy (55%), osteomyelitis (25%), combined pathology (10%), and rheumatoid deformity with skin defect (10%). Surgical procedures included tibiotalocalcaneal arthrodesis (39%), astragalectomy with tibiocalcaneal arthrodesis (32%), tibiotalar arthrodesis (23%), and multistage procedures (6%). Fixation methods varied based on the extent of deformity and infection. The union was assessed via radiographs and CT imaging, and outcomes were statistically analyzed using Fisher’s exact test. Results: Successful arthrodesis was achieved in 74% of cases (23/31). The union rate was significantly influenced by the type and level of fixation (p = 0.0199), with the lowest rate observed in tibiotalocalcaneal arthrodesis using external fixation (17%). Complications included surgical site infection or abscess in 42% of cases, requiring reoperation in 35%. Limb amputation was ultimately necessary in five patients (16%). Conclusions: Despite high complication rates, limb-preserving reconstructive surgery remains a viable alternative to amputation in selected high-risk patients with severe hindfoot pathology. Appropriate preoperative planning, tailored surgical strategy, and patient compliance are essential to achieving functional limb salvage and restoring weight-bearing capacity. Full article

Background: The opportunistic pathogen Staphylococcus aureus causes skin and soft tissue infections that are associated with biofilm formation, and in immunocompromised patients can progress to surgical site infections, pneumonia, bacteremia, sepsis, and even death. Most antibiotics actively damage living, dividing cells on the surface of the biofilm, where there is a high concentration of nutrients and oxygen, while in the depths, where these factors are scarce, slowly growing cells remain. Objectives: The aim of our study was to evaluate the antibiofilm potential of ethyl acetate roots (EtOAcR) and aerial parts (EtOAcAP) extracts from the perennial Bulgarian plant Geum urbanum L. against methicillin-resistant S. aureus (MRSA) NBIMCC 8327. Methods: The effects of both extracts on the expression of biofilm-related genes, icaA and icaD, were investigated. The cytotoxicity of EtOAcR and EtOAcAP on A-375 (human melanoma), A-431 (epidermoid skin cancer) and HaCaT (normal keratinocytes) cell lines, and the induction of apoptosis were determined. Finally, the in vivo skin irritation potential of the most active extract was studied. Results: Both tested extracts inhibited biofilm formation at concentrations that did not affect bacterial growth. Interestingly, the expression of icaA and icaD was upregulated, although the biofilm development was inhibited 72.4–90.5% by EtOAcAP and 18.9–20.4% by EtOAcR at sub-MICs. EtOAcAP extract showed a more favorable cytotoxic profile on non-tumorigenic cells and stronger antineoplastic activity (IC₅₀ = 6.7–14.68 µg/mL) as compared to EtOAcR extract (IC₅₀ = 8.73–23.67 µg/mL). Therefore, a skin irritation test was performed with the EtOAcAP extract at ten-times higher concentrations than the minimum inhibitory one, and, resultantly, the primary irritation index was equal to zero (no skin irritation observed). Conclusions: The EtOAcAP extract was proven to be an effective antistaphylococcal agent with favorable skin tolerance. The extract showed strong antineoplastic activity and antibiofilm effect at sub-MICs, which outlines new prospects for its development as a natural product for specific skin applications in medical practice. Full article

Facial aging is a multifactorial and stratified biological process characterized by progressive morphological and biochemical alterations affecting both cutaneous (Layer I) and subcutaneous (Layer II) tissues. These age-related changes manifest clinically as volume depletion, tissue ptosis, and a decline in overall skin quality. In response to these phenomena, thread lifting techniques have evolved significantly—from simple mechanical suspension methods to sophisticated bioactive platforms. Contemporary threads now incorporate biocompatible polymers and hyaluronic acid (HA), aiming not only to reposition soft tissues but also to promote dermal regeneration. This review provides a comprehensive classification and critical assessment of thread lifting materials, focusing on their chemical composition, mechanical performance, degradation kinetics, and biostimulatory potential. Particular emphasis has been given to the surface integration of HA into monofilament threads, especially with the emergence of advanced delivery systems such as NAMICA, which facilitate sustained HA release. Advanced thread materials, especially those fabricated from poly(L-lactide-co-ε-caprolactone) [P(LA/CL)], demonstrate both tensile support and regenerative efficacy. Emerging HA-covered threads exhibit synergistic bioactivity, stimulating skin remodeling. NAMICA technology represents an advancement in the field, in which HA is encapsulated within biodegradable polymer fibers to enable gradual release and enhanced dermal integration. Nonetheless, well-designed human studies are still needed to substantiate its therapeutic efficacy. Consequently, the paradigm of thread lifting is shifting from purely mechanical interventions toward biologically active systems that promote comprehensive ECM regeneration. The integration of HA into resorbable threads, especially when combined with sustained-release technologies, represents a meaningful innovation in aesthetic dermatology, meriting further preclinical and clinical evaluation. Full article

Hyaluronic acid (HA) is an unbranched polysaccharide particularly abundant in the extracellular matrix (ECM) of soft connective tissues. In humans, about 50% of the total HA in the organism is localized in the skin. HA plays an essential role in the hydration of the ECM, in the regulation of tissue homeostasis, in the resistance to mechanical stimuli/forces, and in the modulation of tissue regeneration. For these reasons, HA is widely used in regenerative medicine and cosmetics. In this study we used an innovative fluid dynamic system to investigate the effects of a cross-linked macrostructural HA formulation on dermal collagen of healthy human skin explants. The good preservation of skin explants provided by the bioreactor allowed applying refined high-resolution microscopy techniques to analyze in situ the HA-induced modifications on the ECM collagen fibrils up to 48 h from the application on the skin surface. Results demonstrated that this HA formulation, commercially proposed for subcutaneous injection, may act on dermal ECM also when applied transcutaneously, improving ECM hydration and modifying the organization of the collagen fibrils. These findings, obtained by the original combination of explanted human skin use with an advanced culture system and multiscale imaging techniques, are consistent with the volumizing and anti-aging effect of HA. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Background/Objectives: Clarithromycin (CLA) is a widely used antibiotic effective against a variety of bacterial strains, making it a common treatment for respiratory, skin, and soft tissue infections. Moreover, extensive studies have confirmed the anticancer activity of CLA against different cancers, particularly when combined with conventional therapies. This study investigates the potential anticancer and antibacterial activities of developed CLA-loaded bovine serum albumin nanoparticles (CLA-BSA NPs), designed with optimized physicochemical properties to enhance drug delivery. Methods: The CLA-BSA NPs were synthesized using the desolvation method, followed by drug loading. Characterization techniques, including Dynamic Light Scattering (DLS), Fourier-Transform Infrared (FTIR) Spectroscopy, X-Ray Diffraction (XRD), Transmission Electron Microscopy (TEM), and Thermogravimetric Analysis (TGA). Results: The results confirmed that CLA interacts with BSA NPs through van der Waals forces. The performance of drug–nanocarrier interaction was further assessed through in vitro drug release studies. The release studies demonstrated that CLA had a robust release profile in reductive media, with a cumulative release of 50.9% in acetate buffer (pH 5.0) supplemented with 10 mM glutathione (GSH). Further biological activity assays were also conducted, including cell viability assays (MTT) and antibacterial activity tests. CLA-BSA NPs demonstrated anticancer activity against the lung cancer (A549) cell line, while showing minimal cytotoxicity on normal human dermal fibroblast (HDF) cells. The antibacterial activity was assessed against Streptococcus pyogenes, Bacillus cereus, and Staphylococcus aureus. Among the tested strains, Bacillus cereus exhibited the highest sensitivity, with a minimum inhibitory concentration (MIC) of 0.032 µg/mL, compared to 0.12 µg/mL for Staphylococcus aureus and >32 µg/mL for Streptococcus pyogenes. Conclusions: In conclusion, these findings highlight CLA-BSA NPs as a promising drug delivery system that enhances the anticancer and antibacterial efficacy of CLA. Full article

Aim of the study: Several previous experimental studies simulated ancient Egyptian mummification of human bodies using the embalming protocol described by Herodotus. Besides two human experiments, several animal studies have been performed with very different species, mostly over short observation periods. We used a human-sized piglet model that matches closely to humans and undertook a long-term experiment with two detailed examination time points over 13 years. This was conducted to test the efficacy of the Herodotus embalming method in the long term. Material and Methods: An 88 kg piglet, 1.30 m body length, obtained from a veterinary practice was chosen as the skin is similar to humans. Using the described formula, the carcass was cleaned, eviscerated, filled with spices and natron sachets, and then covered with 240 kg of natron for 40 days. It was then reopened, and most of the sachets were removed. The surface was cleaned with wine, the body cavity partly refilled with sachets and spices, the surface treated with oils, wax, honey and bitumen, and finally sealed with linen bandages. The body weight was regularly monitored over the 13-year period. At 7 and 13 years, re-examination, with a protocol including CT scanning, histology and microbiology, was performed. Results: The monitoring of the body weight showed a rapid loss of weight within the first year, gradually slowing, reaching more than 66% of its weight. In the final 6 years, the body weight was reduced by only 1.7 kg. The CT scans at 7 years and 13 years showed that the structures of the heart, muscle, skin, and soft tissue were well preserved, and the body significantly shrunken; only the musculature showed air inclusions. Histology and microbiology (examined at baseline, 7 years and 13 years) revealed excellently conserved tissue with anaerobic microbe spores, very limited tissue destruction, and no significant fungal or parasitic invasion. However, the preserved kidneys and internal genitalia had disappeared. Conclusions: This ongoing long-term project confirmed excellent mummification with near-perfect body conservation at 13 years, supporting the efficacy of the described Herodotus technique. This model is suitable for the assessment of special preservation techniques recently suggested for individual soft tissue organs. Full article

Background: Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including Pseudomonas aeruginosa, atypical mycobacteria, and select multidrug-resistant Gram-negative organisms. Their excellent tissue penetration, bactericidal activity, and convenient dosing make them effective for certain skin and soft tissue infections. However, their use is limited by potential safety concerns, including tendinopathy (odds ratio up to 9.1 in corticosteroid users), QT interval prolongation with risk of torsades de pointes, phototoxicity, and rising antimicrobial resistance. Methods: A literature search of PubMed, Scopus, and Web of Science was conducted for articles from January 1985 to April 2025 with the search terms (quinolone OR fluoroquinolone) AND (dermatology OR “skin and soft tissue infection” OR “skin structure infection”). Abstracts and presentations were excluded. A Google search used the same terms for articles from government regulatory agencies. Results: This review provides practical guidance on the clinical use of topical and oral fluoroquinolones in dermatology. Delafloxacin demonstrated over 90% cure rates in trials for complicated skin infections. However, serious safety concerns remain, including a ninefold increase in tendinopathy risk among older adults on corticosteroids and corrected QT intervals exceeding 500 milliseconds in high-risk patients. Phototoxicity varies, with agents like sparfloxacin linked to heightened ultraviolet sensitivity. Resistance to ciprofloxacin exceeds 20 percent in Escherichia coli and P. aeruginosa in some populations. Culture-based prescribing, shorter treatment courses, and preference for topical treatments can reduce risk and preserve efficacy. Conclusions: Fluoroquinolones remain clinically useful in dermatology when prescribed selectively. Their appropriate use requires careful attention to patient risk factors along with their evolving resistance patterns and ongoing stewardship efforts. Full article

Bacteroides pyogenes is a Gram-negative obligate anaerobe rod. It is naturally found in the oral microbiome of cats and dogs, which represents a primary source of disease for humans. The present review provides an update on the role of B. pyogenes as a pathogen responsible for infections in humans. Indeed, an increasing number of B. pyogenes infections have been reported in recent years, including skin and soft tissue infections as well as severe diseases like osteomyelitis, Lemierre’s syndrome, and bloodstream infection. Pre-analytical and analytical phases are crucial to guarantee the isolation of anaerobic bacteria, including B. pyogenes. Moreover, the introduction of MALDI-TOF mass spectrometry and 16S rRNA sequencing in clinical microbiology laboratories may be partially responsible for the increasing number of reports of B. pyogenes infections. However, the mechanisms underlying the pathogenicity of B. pyogenes remain poorly understood and require further investigations. Indeed, despite common antimicrobial susceptibilities, infections frequently persist and require multiple courses of antibiotics. In addition, based on literature data, this review indicates that treatment of skin and soft tissue infections often necessitates surgical procedures and hospitalization. Full article