The role of cellular and tissue-based therapies (CTPs) in the treatment of chronic wounds continues to grow. However, the utility of these is only partially investigated and very few head-to-head studies exist. In general, the ideal CTP would provide a structural matrix which would allow for dermal and epidermal regeneration with a single application. At present, this Holy Grail is very far from where we are. However, new CTPs continue to be designed with the goal of wound closure in mind. Acellular fish skin (AFS) is one such therapy. The histologic features make it amenable to cellular modulation, and its ability to provide omega-3 fatty acids to the local tissue makes it an unprecedented anti-inflammatory, antibacterial, antiviral, and analgesic component. There is burgeoning research on AFS that continues to validate its efficacy, although, much more substantial data will be required before its general acceptance. In this review, we will go through the current literature to evaluate the strengths and gaps in our current knowledge with the goal of providing a context for use in modern clinical practice.

Pyoderma gangrenosum (PG) is an uncommon inflammatory neutrophilic disorder with a spectrum of clinical presentations with variable courses. Most cases are associated with an autoimmune disorder and manifest in middle-aged adults as a painful lesion that progresses to painful necrotizing ulcers of the lower extremity. Owing to its variability, clinical diagnosis remains difficult and many patients are often misdiagnosed, with resulting delay in treatment. While early immunosuppressant therapy is key to preventing progression of PG, surgical treatment has been met with criticism because of the risk of potentiating pathergy, an exaggerated skin reaction due to trauma. This article presents a case series in which 3 patients with PG lesions underwent different treatment methods, including surgical debridement and use of fetal bovine dermis (FBD). The use of FBD in conjunction with medical treatment provided pain relief and wound coverage as well as encouraged growth of granulation tissue and long-term stability. Commercial cellular and tissue-based products used to aid in accelerating PG wound closure are also reviewed.

Objective. As part of a quality assurance project at a large tertiary care surgical program in New York City, the effect of debridement, negative pressure wound therapy, and cellular- and tissue-based products (CTPs) on limb salvage was evaluated based on the following outcomes: freedom from amputation, wound closure, and freedom from readmission. Fetal bovine collagen was among the CTPs evaluated. Materials and Methods. The data used in this study were derived from a database of all patients who had undergone procedures involving placement of a dermal matrix at the center over a 2.5-year period (January 2016–June 2018). This retrospective analysis included 256 patients who underwent debridement and/or placement of a CTP as part of the treatment course for chronic wounds. Results. Of the 252 patients identified, 34 required either minor or major all-cause amputation from the initial wound intervention, whereas for 218 patients, there were no recorded amputations through the end of the study period after the initial wound intervention. When fetal bovine collagen was evaluated as an explanatory variable to the presence of future amputation, a statistically significant relationship between the variables was found. Conclusions. The results of the current data analysis indicate that a treatment algorithm that includes appropriate antibiotic therapy, tangential hydrosurgery, application of fetal bovine collagen, and a short course of negative pressure wound therapy may be a more favorable option to achieve limb salvage, freedom from readmission, and wound closure.

METHODS:Cosmetic surgery tourism patient demographics and outcomes were reviewed between March 2020 and September 2021 at our institution. RESULTS:We identified fourteen female patients, averaging 36.4 years of age. All patients underwent body contouring procedures, most commonly abdominoplasty (12/14), frequently combined with liposuction or breast augmentation. On average, patients presented 39.4 days after their operation and travelled 69.6 miles to our facilities. All patients utilized Emergency Department resources, and 13/14 patients were admitted, resulting in 66 total hospital days, averaging 5.1 days per admission. Nine required an additional procedure, including two who returned to the operating room. Eight patients traveled internationally for surgery, six to Mexico and two to the Dominican Republic. Domestically, Miami, Florida was the most popular destination (5/14).CONCLUSION: Surprisingly, cosmetic surgery tourism continued unabated during the COVID-19 pandemic. After developing a complication, patients frequently utilized emergency department resources and often were treated by nonsurgeons before arriving at our institution. Surgical tourism continues to place the onus of finding appropriate postoperative care on patients, with their surgeon some hundreds of miles away. Additionally, surgical tourism during a pandemic may confound healthcare resource utilization strategies.