Could Exosomes be a Promising Therapy to Accelerate Wound Healing and Skin Regeneration in Ischemic Nasal Flaps?

Severe nasal soft tissue avulsions often involve skin flaps with compromised vascularity. Ischemic changes ranging from epidermolysis to full-thickness necrosis can occur. Angiogenesis is a critical step in wound healing and tissue repair as well as a key factor in skin flap survival. In previous studies, the authors show that angiogenic capacity declines with age, slowing wound healing. Regenerative medicine is rapidly evolving. Stem cell-derived exosomes are gaining popularity in this field, and potential benefits to stimulate angiogenesis and tissue regeneration, accelerating healing, have been demonstrated in preclinical studies. Therapy could hypothetically be targeting exosomes to deliver proangiogenic factors directly to the ischemic skin flap in the early stage of healing, when inflammation and angiogenesis occur. We present the case of a 75-year-old man with a nasal soft tissue partial degloving injury of the dorsum and tip; the avulsed flap was rolled on itself at the nasal tip for 3 h, showing marked signs of venous congestion. The flap was unrolled and repositioned, but venous congestion persisted, evolving into partial tissue necrosis, which was treated with Rosa Damascena stem cell-derived exosomes (RSCEs) on postinjury Days 6, 11, and 16. Wound healing was achieved with complete skin regeneration at 30 days postinjury. In this case, RSCEs were safely utilized to treat a posttraumatic ischemic nasal flap, suggesting their potential as a therapeutic option to support healing and improve outcomes. Randomized, controlled clinical trials are required to validate this preliminary finding. Level of Evidence: 4 (Therapeutic).