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BackgroundWound healing involves complex mechanisms, which, if properly chaperoned, can enhance patient recovery. The abilities of platelets and keratinocytes may be harnessed in order to stimulate wound healing through the formation of platelet clots, the release of several growth factors and cytokines, and cell proliferation. The aim of the study was to test whether autologous keratinocyte suspensions in platelet concentrate would improve wound healing. The study was conducted at the Lausanne University Hospital, Switzerland in 45 patients, randomized to three different topical treatment groups: standard treatment serving as control, autologous platelet concentrate (PC) and keratinocytes suspended in autologous platelet concentrate (PC + K). Split thickness skin graft donor sites were chosen on the anterolateral thighs of patients undergoing plastic surgery for a variety of defects. Wound healing was assessed by the duration and quality of the healing process. Pain intensity was evaluated at day five.ResultsHealing time was reduced from 13.9 ± 0.5 days (mean ± SEM) in the control group to 7.2 ± 0.2 days in the PC group (P < 0.01). An addition of keratinocytes in suspension further reduced the healing time to 5.7 ± 0.2 days. Pain was reduced in both the PC and PC + K groups. Data showed a statistically detectable advantage of using PC + K over PC alone (P < 0.01).ConclusionThe results demonstrate the positive contribution of autologous platelets combined with keratinocytes in stimulating wound healing and reducing pain. This strikingly simple approach could have a significant impact on patient care, especially critically burned victims for whom time is of the essence.Clinical trial registry informationProtocol Record Identification Number: 132/03Registry URL: http://www.clinicaltrials.gov

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Health issues for severe burns and trauma affecting populations from both civilian and military can have many similarities. Much of the medical progress for treatment and surgical care has been documented during times of catastrophic events and war. Death and morbidity of military personnel due to blast and combat-related injuries has declined as a result of improved surgical management, faster transport, and the use of antibiotics. Integration of cellular therapies could aid in repairing damaged tissues more rapidly. As bio-engineered cells and materials would be readily available, they could rapidly be used in the military settings, especially for the treatment of burns and trauma. Cell sources that can be easily expanded and stocked (allogenic sources) would be interesting cell sources to have developed to avoid the biopsy from the patient and the time necessary to prepare the cells before treatment. Cell sources can originate from both animal and human and at all periods of development extending from embryonic to adult. Cell sources can be technically demanding or they can be developed from primary tissue and the resulting cells can remain more similar to their original state. The use of progenitor cells have been developed in a unique Federal Transplantation Program Registration in Switzerland (cell lines have been described and deposited in the European Protection Agency Cell Depository, Porton Down's) should help to advance cellular therapy programs with qualified material that is available when needed for both soft and hard tissues that have been injured. We will give an overview of: i) cell therapies used in military practice to date; ii) Description of cell types and cell choices for regenerative medicine; and iii) The organization of the progenitor cell therapy platform in Switzerland; iv) Pre-requisite recommendations for the future of using cell therapies in world defense and human security.

Background: Increased anatomical knowledge of skin vascularization, such as the recent description of angiosome and perforasome concepts, has led to important innovations in flap surgery. In this sense, few studies have been performed on face vascularization especially for facial artery perforasomes. The aim of this study was to analyze the number, size, and localization of transverse facial artery perforators and their perfusion area. Methods: Fourteen hemifaces of fresh adult cadavers from the Department of Anatomy of Lyon University were harvested. Transverse facial artery perforators were identified, dissected, cannulated, and selectively injected with 1 ml of patent blue or contrast solution. Photography, microangiography, and computed tomography were performed. Perforator diameter and localization from the lateral canthus were measured. Exact topography and size of the perforasome were analyzed. Results: Twenty-three transverse facial artery perforators were identified. Mean perforator diameter was 1.01 ± 0.3 mm. Mean perforating site was 31.0 ± 8.0 mm lateral to and 38.7 ± 8.8 mm below the lateral canthus. Mean single perforasome surface area was 25.3 ± 18.34 cm2 and mean transverse facial artery skin territory was 40.5 ± 9.78 cm2. Conclusions: The transverse facial artery provides at least one perforator that can be accurately localized using a Doppler probe. Clinical applications related to the improved knowledge of transverse facial artery perforators could be as follows: (1) performing a lateral facial skin flap; (2) facial composite allotransplants; (3) face-lift procedures to improve skin perfusion; and (4) prevention of vessel injury in aesthetic procedures such as dermal filler injection or thread-lift techniques.

The authors describe an invasive Aspergillus fumigatus deep-burn wound infection in a severely burned patient that was successfully treated with a combination of topical terbinafine and systemic voriconazole antifungal therapy. To our knowledge, this is the first case report describing the effective control of an invasive deep-burn wound infection using this combination.

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