1.
Artificial Dermis and Autologous Platelet-Rich Plasma for Treatment of Refractory Wounds: A Clinical Study
Lv Y, Yang Z, Chen Z, Xie J, Li H, Lou Y, Cao D
The international journal of lower extremity wounds. 2021;:15347346211050710
Abstract
Refractory wounds present a complex and serious clinical dilemma in plastic and reconstructive surgery. However, there are currently no standard guidelines for the treatment of refractory wounds. Artificial dermis (AD) has achieved some satisfactory results, but also has some limitations. Autologous platelet-rich plasma (PRP), as a cell-therapy material, was a valuable and safe treatment dressing for chronic non-healing wounds. This study aimed to evaluate the efficacies of artificial dermis (AD) with and without autologous platelet-rich plasma (PRP) in patients with refractory wounds. Sixteen patients with refractory wounds were randomly allocated to autologous PRP therapy combined with artificial dermis (PRP + AD [N = 8]) or an artificial dermis program only (AD [N = 8]). We compared the efficacies of the two methods in terms of times to wound healing, infection control, and AD vascularization, as well as hospitalization days and eventual clinical outcomes.13 patients achieved complete healing, including seven (87.5%) in the PRP + AD group and six (75.0%) in the AD group (P > .05). The times to wound healing, infection control, and AD vascularization, and hospitalization time after transfer were significantly shorter in the PRP + AD group compared with the AD group (P < .05). In conclusion, the combination of AD and PRP promoted refractory wound healing and shortened waiting times compared with simple dermal grafts.
2.
Treating toxic epidermal necrolysis with systemic immunomodulating therapies: a systematic review and network meta-analysis
Tsai TY, Huang IH, Chao YC, Li H, Hsieh TS, Wang HH, Huang YT, Chen CY, Cheng YC, Kuo PH, et al
Journal of the American Academy of Dermatology. 2020
Abstract
BACKGROUND Various systemic immunomodulating therapies (SITs) have been used to treat toxic epidermal necrolysis (TEN) but their efficacy remains unclear. OBJECTIVE To perform a systematic review and network meta-analysis (NMA) evaluating the effects of SITs on mortality for Stevens-Johnson syndrome (SJS)/TEN overlap and TEN. METHODS A literature search was performed in online databases (from inception to Oct 31, 2019). Outcomes were mortality rates and SCORe of Toxic Epidermal Necrolysis (SCORTEN)-based standardized mortality ratio (SMR). A frequentist random-effects model was adopted. RESULTS Sixty-seven studies involving 2079 patients were included. An NMA of 10 treatments revealed that none was superior to supportive care in reducing mortality rates and that thalidomide was associated with a significantly higher mortality rate (Odds ration [OR], 11.67; 95% confidence interval [CI], 1.42-95.96). For SMR, an NMA of 11 treatment arms demonstrated that corticosteroids and intravenous immunoglobulin (IVIg) combination therapy was the only treatment with significant survival benefits (SMR, 0.53; 95% CI, 0.31-0.93). LIMITATIONS Heterogeneity and a paucity of eligible randomized controlled trials. CONCLUSIONS Combination therapy with corticosteroids and IVIg may reduce mortality risks in patients with SJS/TEN overlap and TEN. Cyclosporine and etanercept are promising therapies but more studies are required to provide clearer evidence.