Day 2 :
Keynote Forum
Aziz Ghahary
University Of British Columbia, Canada
Keynote: A novel wound dressings with anti-scarring properties
Biography:
Aziz Ghahary, PhD and Professor, the director of the BC professional Firefighters ‘Burn and Wound Healing Research Group has published more than 168 peer-reviewed articles some of which directly related to autoimmune diseases such as type I diabetes. Dr. Ghahary has been awarded more than 50 research grants from different local, national and international granting agencies. Dr. Ghahary is the leading investigator in identifying a serum 14-3-3 eta protein as a biomarker for early detection of RA and psoriatic RA and this test has now been launched by the Quest Diagnosis and Lifelab in US and Canada, respectively. Finally, he recently identified a small molecular with anti-scaring properties, which has now been approved by the Health Canada and the Vancouver General Hospital Ethic Committee to proceed to Phase 1 Clinical Trial.
Abstract:
Wound healing outcome is regulated by a fine balance between deposition and degradation of extracellular matrix (ECM). Over healing process in skin is mediated by exaggerated ECM deposition and abnormalities in ECM degradation. Current treatment modalities for prevention of burn hypertrophic scarring has limited efficacy which raised a great need for innovation within wound care industry. Moving toward novel approaches to prevent post burn hypertrophic scarring, we identified the anti-scarring properties of Kynurenine (Kyn), a naturally occurring small molecule generated from tryptophan degradation. Although daily application of Kyn containing cream prevents scarring in a rabbit ear model, an effective wound dressing, slowly releasing controlled doses of Kyn, will be more beneficial for Kyn delivery to extensive burns where the dressings get changed every 4-5 days. This study aims to develop a new generation of wound dressings having anti-scarring properties.
Methods: The Effect of Kyn treatment on the expression of different ECM components, collagen type-I, fibronectin and MMP1 and 3 was evaluated. Wound dressings were manufactured by incorporating Kyn into PVA/PLGA nanofibers using electrospinning process. Drug release profile was determined by incubating the electrospun mats in PBS. The anti-scarring properties of these nanofibrous wound dressings were evaluated in vitro and in vivo.
Results: In vitro studies showed that while Kyn doesn’t have any adverse effect on the dermal cells’ viability, it significantly decreases the expression of collagen type-I and fibronectin and increases the expression of MMP1, which is a collagenase, and MMP3. Whereas the Kyn-loaded PVA demonstrated immediate and complete drug release of the drug, addition of PLGA envelop via dip-coating significantly reduced the burst release, due to added tortuosity and increased hydrophobicity of the shell. In vivo studies showed that wound treatment with Kyn-loaded dressings significantly improves the wound healing outcome and eliminates evidence of scarring in the rat excisional wounds.
Conclusions: Anti-fibrotic effects of Kyn are mediated by increasing the expression of MMPs and reducing the production of ECM components in vitro and in vivo. This study sets the stage for development of a new generation of wound dressings facilitating the controlled and prolonged release of this anti-scarring drug.
Applicability of research to practice: These wound dressings can improve/prevent fibrotic conditions developed upon burn, trauma and surgical procedures without compromising the health of the patient.
- Body and Extremities | Oral & Maxillofacial Surgery | Trauma surgery | Reconstructive surgery|
Session Introduction
Peter Lisborg
PKLP Aesthetics, Austraia
Title: The Avelar Technique: Preserving Vascularity, Innervation and Lymphatics in Tummy Tuck Surgery
Biography:
Dr. Peter Lisborg was born 1958, in Comox Canada. He completed his medical studies and surgical training in Austria. He practises in Klagenfurt in the south of Austria where he has a day clinic. He conducts a workshop yearly that is also CME certified. Dr Lisborg became well known in the USA after he introduced the Avelar Abdominoplasty at the World Congress of Liposuction in Sat. Louis, 2005. As a member of the below listed national and international associations of cosmetic surgeons he regularly takes part in many international congresses as a speaker to share knowledge and experience. He is member of American Academy of Cosmetic Surgery & Austrian Academy of Cosmetic Surgery. He was also the President of International Division of American Board of Cosmetic Surgery & World Academy of Cosmetic Surgery.
Abstract:
Patients with abundant abdominal skin were selected for Avelar abdominoplasty as a safe ambulatory procedure by preserving the vascularisation of the abdominal flap.
284 consecutive patients were operated using IV sedation and tumescent solution. Following liposuction and superficial skin resection, undermining was restricted to the median plane for umbilicus transposition. Skin perfusion was measured using a laser Doppler flow assessment system.
There were no intraoperative complications and no major postoperative complications. Postoperative wound infections were observed in 13 patients (4,5%).There were no cases of skin necrosis, postoperative bleeding or seroma despite not using drains in any cases. The measurement of skin perfusion has demonstrated only a minimal postoperative reduction of perfusion in the lower abdominal flap.
The modified Avelar technique has proven to be a safe ambulatory procedure. The perfusion of the abdominal flap is maintained thus avoiding necrosis and reducing wound complications. In comparison to studies of flap perfusion after more traditional procedures, the preservation of perfusion and also of the lymphatic system appears to be very beneficial.
Biography:
Mohammad Abadi is a specialist for maxillofacial surgery: After he studied medicine and dental medicine in Hamburg/ Germany, he finished his specialist's education in Braunschweig / Germany and changed to Kassel to extend his experience in the field of tumour and reconstruction surgery. He is currently working in his private Practise in Hamburg/ Germany and is also occupied as an associated Professor at the Azad University in Tehran/ Iran in the department of Maxillofacial Surgery. His main field is the reconstruction in the face and mouth region with free and pedicle flaps.
Abstract:
Hemifacial microsomia affects one in 5,600 to 20,000 births. It is primarily characterized by a diminished formation of the lower and upper jaws, resulting in facial asymmetry, usually accompanied by malformation of the ears and often combined with conductive hearing loss.
Without treatment, the functional consequences of the hypoplasticity or absence of the condyle can lead to severe facial scoliosis. Condyle replacement surgery between the ages of 10 and 12 has therefore proven to be beneficial. Before reaching the right age for surgery, the lower jaw is orthodontically guided via an articulation region. A condyle is then formed by means of an autogenous bone graft, which functionally supports the lower jaw and enables normal intercuspation to be achieved by postoperative orthodontic therapy. Different kinds of osteotomy can be used to correct the lower jaw deformity. One possible distinction is between total and segmental osteotomy.
If the hemifacial microsomia only affects the soft tissues (condyle and occlusion are intact), cheek relining is indicated, with several possible choices of technique and material.
We report the case of a 47-year-old female patient with right-sided hemifacial microsomia who achieved an esthetically optimal outcome by means of three 3 successive and interrelated procedures. These 3 techniques consisted of: 1) compensation of the deficient bone volume on the right side with 3 individually manufactured facial implants in the angle of the jaw, the chin, and the cheekbone area 2) rebasing of the cheeks with a pediculate pectoralis flap from the right side 3) lipofilling of the right side of the face with autologous fat.
Getachew Alemayehu
Gondar University, Ethopia
Title: Craniopagus parasiticus:Parasitic Head protuberant from temporal area of cranium: A case report
Biography:
Graduated from Gondar University for the Doctor of medicine and has one and half years working experience as a lecturer at Bahirdar University. At present, a fourth year resident in surgery at Bahirdar University,Ethiopia.
Abstract:
Background: Craniopagus parasiticus is a rare medical case and it is unique unlike other cases reported from different literature. The head of parasitic twins is protruding from the temporal area of cranium.Parasitic head had two deformed lower limbs; one is too rudimentary attached to the mass; long bones of bilateral lower limbs and some pelvic bones. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs: There is also rudimentary labium but no vaginal opening.
Case presentation: A 38-years-old multigravida (Gravida V para IV) women from Amhara ethnicity referred from rural health center to Referral Hospital due to prolonged second state of labor at 42+1 weeks. Upon arrival She had contraction, term sized gravid uterus, and fetal heart beat was 112.On digital pelvic examination the cervix was fully diluted, station of the head was high and the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decide to emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were 7 and 9 at 1 and 5 min,respectively.The infant appeared to be grossly normal except the parasitic co-twin attached at the cranium.The neonate was investigated with the available investigations (CBC,X-Ray,Doppler Ultasound) and Pediatric side consultation made. After a week of counselling and investigations, successful separation operation was done.During post-operative time the neonate comfortably suckling on breasts and no neurological deficit.