Annals of plastic surgery
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Tetanus in the United States is decidedly rare, and most of us will not see a case of it during our careers. Given its lethality, it is a disease about which one must be aware. Be willing to consider it as a diagnosis, no matter the immunization status of the patient, if clinical signs and symptoms warrant. ⋯ Using mechanical ventilation, paralysis, narcotics, and muscle-relaxing sedatives, the authors supported him until his tetany subsided. He survived and was discharged to home when complete coverage of his burns and left leg anterior compartment was obtained. The authors discuss the presentation, diagnosis, and treatment of tetanus, as well as its incidence in the general population and in the previously immunized patient.
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Annals of plastic surgery · Aug 2004
Randomized Controlled Trial Comparative Study Clinical TrialClinical comparative study of aquacel and paraffin gauze dressing for split-skin donor site treatment.
The management of split-thickness skin graft donor sites is targeted towards promoting the healing process, while minimizing adverse effects and complications. The aim of this study was to compare donor site treatment outcome between Aquacel, a carboxymethylcellulose-based hydrofiber dressing, and the standard mesh paraffin gauze dressing. The study included 23 adult patients. ⋯ The results indicated that patients treated with Aquacel experienced significantly less pain and a more rapid rate of epithelialization compared with patients treated with mesh paraffin gauze dressing. Final scarring (ie, after the 1-year follow-up) was significantly better with the Aquacel dressing. We conclude that Aquacel dressing is superior to the standard mesh paraffin gauze dressing for split-thickness donor site area in pain relief, ease of treatment, promotion of epithelialization, and the quality of scarring.
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Annals of plastic surgery · Aug 2004
Alpha V integrin prolongs collagenase production through Jun activation binding protein 1.
Robust expression of alphav integrin and matrix metalloproteinase 1 (MMP1) plays an important role in cancer metastasis and wound healing. A patient with an abnormal scar that appeared stretched and thinned out was found to have fibroblasts that overexpressed alphav integrin; therefore, a relationship between alphav integrin expression and MMP1 production was sought. A yeast 2 hybrid screen revealed alphav integrin interacts with jun activation binding domain-1 (JAB1). ⋯ Overexpression of alphav correlated with enhanced MMP1 transcription, as determined by a luciferase assay (P < or = 0.05). Diminution of JAB1 with JAB1 antisense abolished alphav integrin up-regulation of MMP1. We conclude alphav integrin signals through JAB1 to prolong MMP1 production and that this signaling pathway in fibroblasts may lead to abnormal scarring.