Introduction Burns are dynamic wounds that may present a progressive expansion of necrosis into the initially viable zone of stasis. Therefore, salvage of this zone is a major subject of focus in burn research. The beneficial effects of mesenchymal stem cells (MSCs) on the survival of the zone of stasis have been previously documented. However, many gaps still exist in our knowledge regarding the underlying protective mechanisms. Hence, this study was designed to evaluate the pathophysiological basis of MSCs in the prevention of burn wound progression. Methods Wistar rats received thermal trauma on the back according to the “comb burn” model. Animals were randomly divided into sham, control, and stem cell groups with sacrifice and analysis at 72 hours after the burn. The stasis zones were evaluated using histochemistry, immunohistochemistry, biochemistry, real-time polymerase chain reaction assay, and scintigraphy to evaluate the underlying mechanisms. Results Gross evaluation of burn wounds revealed that vital tissue percentage of the zone of stasis was significantly higher in the stem cell group. Semiquantitative grading of the histopathologic findings showed that MSCs alleviated burn-induced histomorphological alterations in the zone of stasis. According to CC3a staining and expression analysis of Bax (B-cell leukemia 2–associated X) and Bcl-2 (B-cell leukemia 2) genes, MSCs attenuated increases in apoptosis postburn. In addition, these transplants showed an immunomodulatory effect that involves reduced neutrophilic infiltration, down-regulation of proinflammatory cytokines (tumor necrosis factor α, interleukin 1β [IL-1β], and IL-6), and up-regulation of the anti-inflammatory cytokine IL-10 in the zone of stasis. Burn-induced oxidative stress was significantly relieved with MSCs, as shown by increased levels of malondialdehyde, whereas the expression and activity of the antioxidant enzyme superoxide dismutase were increased. Finally, MSC-treated interspaces had enhanced vascular density with higher expression levels for vascular endothelial growth factor A, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor β. Gamma camera images documented better tissue perfusion in animals treated with MSCs. Conclusions The protective effects of MSCs are mediated by the inhibition of apoptosis through immunomodulatory, antioxidative, and angiogenic actions.

Our findings suggest that bone marrow, adipose tissue and dental pulp may serve as a universal donor MSC source for the prevention of burn wound progression.

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BackgroundConsidering that revision rhinoplasty is one of the most difficult plastic surgical procedures, evaluating patient satisfaction is fundamental in order to determine success and identify variables that may affect the outcomes. Our first study objective was to determine satisfaction levels in revision patients and to compare results with those obtained in primary rhinoplasty patients. Second, we sought to identify factors that may influence the degree of satisfaction.MethodsSatisfaction was evaluated in 54 revision and 54 primary rhinoplasty patients using the rhinoplasty outcome evaluation questionnaire. To identify associated factors, patients were assessed for demographic characteristics, medical history, follow-up time, reason for revision, graft usage, the severity of nasal deformity, and satisfaction with the provided care and information given before the surgery.ResultsAll revision and primary rhinoplasty patients experienced improvements in satisfaction scores. Although the improvements were higher in primary rhinoplasty patients, the levels obtained in revision patients can be considered high. We found that young and male patients tend to have less satisfaction increment after the surgery. Patients who underwent revision for aesthetic reasons had higher improvements in satisfaction scores when compared to those patients who underwent revision for a combination of aesthetic and functional reasons. The improvement in satisfaction scores in patients who were satisfied with the information given before surgery was higher.ConclusionOur data suggest that significant patient satisfaction is achieved after revision rhinoplasty and highlight the importance of the informed consent process when planning revision, especially on young and male patients.Level of evidenceIII.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3166-5) contains supplementary material, which is available to authorized users.

Background. Basal cell carcinoma comprises the vast majority of skin cancers. It predominantly affects fair-skinned individuals, and its incidence is rising rapidly. Etiology may be multifactorial, but sun exposure appears to play a critical role. When detected early, the prognosis is excellent. Thus appropriate diagnosis, treatment, and surveillance are of utmost importance. Methods. From January 1994 to May 2012, 518 basal cell carcinomas were excised in our clinic. Data were collected retrospectively. Results. During 18-year period, 518 BCCs were excised from 486 patients. Most of the patients were males with a median age of 65.6 years. Most of the basal cell carcinomas were located in the head region. Nodular histological subtype dominated our series. Six percent of the excised lesions required reexcision because of involved margins. Our recurrence rate was 6.94% with the nose and the periauricular and periocular regions being the most common sites of occurrence. Conclusion. Although there is relatively low attributable mortality, the morbidity and cost of treatment are significant. A large body of information serves as a foundation for oncologic principles, diagnosis methods, surgical excisions, follow-up protocols, and reconstructive methodologies that are currently in use. Surgical ablation remains the mainstay of treatment.