Human skin is a remarkable organ that sustains insult and injury throughout life. The ability of skin to expeditiously repair wounds is paramount to survival. With an aging global population, coupled with a rise in the prevalence of conditions such as diabetes, chronic wounds represent a significant biomedical burden. Mesenchymal stem cells (MSC), a progenitor cell population of the mesoderm lineage, have been shown to be significant mediators in inflammatory environments. Preclinical studies of MSC in various animal wound healing models point towards a putative therapy. This review examines the body of evidence suggesting that MSC accelerate wound healing in both clinical and preclinical studies and also the possible mechanisms controlling its efficacy. The delivery of a cellular therapy to the masses presents many challenges from a safety, ethical, and regulatory point of view. Some of the issues surrounding the introduction of MSC as a medicinal product are also delineated in this review.

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Therapeutic, IV.

The optimal time for delayed autologous breast reconstruction after postmastectomy radiation therapy (PMRT) is unknown. Although most reconstructive surgeons recommend waiting for 6 months, this timing is arbitrary. A retrospective analysis was performed of 199 patients undergoing delayed autologous reconstruction; 100 patients had prior PMRT, whereas 99 patients had no previous radiation. Radiated patients had higher overall complications (40% vs. 20.2%, P = 0.0023), including wound dehiscence (11% vs. 3%, P = 0.049), and trended toward increased postsurgical infections (7% vs. 1%, P = 0.065). Logistic regression models of unequally distributed variables found radiation therapy to be the only independent risk factor for wound dehiscence (odds ratio, 3.97; P = 0.04). Mean follow-up for radiated and nonradiated patients was 33.3 months and 39.4 months, respectively. After PMRT, 17 patients were reconstructed within 6 months and 83 after 6 months. No significant differences in complications were observed between these groups. An alternate analysis examined 51 patients reconstructed within 12 months of PMRT and 49 patients reconstructed after; again, there were no differences in complications. As overall complications are similar in patients reconstructed early or late after PMRT, autologous breast reconstruction can potentially be performed earlier than is the current accepted practice.