Cirrhosis with steatohepatitis after adjuvant tamoxifen

healing, hyaluronic acid promotes epithelial migration and differentiation, improves angiogenesis, and enhances collagen production. 4 Methods of chemically modifying natural polymers for clinical use have been applied to hyaluronic acid, to produce materials that have different physico-chemical properties but similar biological properties to the native compound. 5 Hyaff-NW (Fidia Advance Biopolymers, Padua, Italy) is a 100% benzyl-esterified derivative of hyaluronic acid processed into fibres and prepared as a flat, non-woven pad dressing, which can be seeded with fibroblasts before application. Laserskin (Fidia Advanced Biopolymers) is a 100% benzyl-esterified hyaluronic acid-membrane for the culture and delivery of autologous keratinocytes. Laser-drilled microperformations allow keratinocytes to migrate through the membrane onto the wound bed. A 45-year-old man sustained 50% full-thickness flame burns to both arms, right chest, and lower abdomen, with a further 30% partial-thickness burns to his legs. On admission, a 4 cm 3 4 cm piece of split-skin was harvested to initiate keratinocyte and fibroblast cultures. Early tangential excision and grafting of the burns with cadaveric allograft or Hyaff-NW containing autologous fibroblasts was then done. 14 days later, allografted areas were demabraded to remove the cadaveric epidermis and produce a dermal bed. 30 Laserskin membranes (3000 cm 2 ), seeded with autologous keratinocytes, were then applied on two separate occasions. 24 days after the first application, 80% of the cadaveric dermis/Laserskin areas and all of the Hyaff-NW/Laserskin areas were covered with epithelium. Histology of both areas revealed an acanthotic, continuous epidermis with interdigitations at the dermo-epidermal junction that resembled the rete ridge pattern seen in normal skin. The underlying wound bed of Hyaff-NW/Laserskin treated areas showed evidence of new collagen synthesis and organisation into a dermis-like structure. The wounds were completely healed 7 weeks after burn excision with no unusual scarring so far. Long-term studies of these biomaterials are required to establish if they improve the survival of patients and reduce morbidity compared with conventional split-skin or keratinocyte grafting. A new era in the management of extensive burns may have begun.