Split thickness porcine graft in the treatment of close-range shotgun wounds to extremities with vascular injury

Long-term results with autogenous tissue repair of traumatic extremity vascular injuries

With extensive vascular injuries in which a vascular conduit is required, there is controversy as to whether an autogenous or prosthetic graft is preferable. The authors reviewed their experience with 91 extremity arterial injuries in which autogenous tissue was used to repair vascular injuries of the extremities. Twenty-two patients also had concomitant repair of associated venous injuries with autogenous vein grafts. Ten patients required amputations, despite patent grafts in five patients, because of severe muscle necrosis. Two patients had thrombosis of their vein grafts develop in the early postoperative period but did not require amputation. The authors identified only one late vein graft failure in a patient in whom an infected pseudoaneurysm developed. Three patients with extensive soft tissue injuries had infection develop in vein grafts, with subsequent massive bleeding that ultimately required arterial ligation. Among the 22 patients with repair of their venous injuries, occlusion of popliteal vein repairs was documented in two patients and suspected in three others. The remainder of patients had satisfactory results. The excellent results obtained in the vast majority of the authors' patients with extremity vascular injuries reinforces their preference for using autogenous tissue whenever a vascular conduit is required. Exceptions include patients with extensive soft tissue loss precluding adequate graft coverage, the repair of large vessels, and life-threatening emergencies when there is insufficient time to harvest and prepare a vein.

Polytetrafluoroethylene grafts in the rapid reconstruction of acute contaminated peripheral vascular injuries

Conventional wisdom dictates that autogenous tissue interposition be used in contaminated wounds when direct vascular repair is not feasible. Although there are few reports of successful use of PTFE grafts in grossly contaminated wounds, doubt still exists regarding the use of any prosthetic material in such wounds for reconstruction of vascular injury. Twenty-five vascular reconstructions were performed in 20 patients during a 3.5 year period. These patients had life-threatening multiple trauma and severe local tissue damage along with their arterial and venous injuries in open contaminated wounds after blunt (16 patients) and penetrating (4 patients) trauma. In all patients, 6 mm PTFE was used for interposition bypass for arterial injuries, and in five of these patients, 8 mm PTFE was used for concomitant venous interposition bypass. One patient died and there was one arterial and one venous graft thrombosis in the same patient 3 months after a shotgun blast injury to the groin, but there was no limb loss. All other grafts remained patent without wound infection, sepsis, or anastomatic disruption. Under the circumstances of these peripheral vascular injuries, PTFE was an acceptable choice for primary reconstruction in our patients. Its ready availability in many calibers, sparing of autogenous vein for future use, and its expedience in vascular reconstruction comprise the advantages of using PTFE in multiply traumatized patients without producing the feared evidence of infected prosthetic grafts.

The healing of hamster oral mucosal wounds covered by porcine grafts. A histologic study

The purpose of this study was to ascertain whether porcine skin grafts are incorporated by the host or act as temporary dressings which are sloughed and to determine the host reaction in terms of inflammatory response. A split-thickness 5-mm square recipient bed was prepared in the cheek pouches of 20 hamsters. Previously frozen, irradiated porcine skin was sutured onto each bed. Animals were killed at 3, 7, 10, 14 and 28 days. Results indicated that at 3 days the graft showed signs of necrosis and host epithelium was migrating under it. Some acute inflammation was evident. By 7 days all 7 grafts had sloughed and epithelialization was complete. The graft bed was maturing collagenous tissue with a mild infiltrate of chronic inflammatory cells. At 10 days healing was almost complete. In all instances the graft appeared to have been sloughed between the 3rd and 7th day and there was no evidence of a massive inflammatory response, foreign body reaction, host incorporation or graft vascularization. These results suggest that porcine skin could be used as a "biologic dressing" in periodontal mucogingival surgery involving grafting.

A controlled comparative study of the use of porcine xenograft in the treatment of partial thickness skin loss in an occupational health centre

Twenty-eight patients with partial thickness skin loss of the limbs, mainly due to burns, were treated on an out-patient basis in an occupational health centre. Thirteen patients were treated with porcine skin graft and the other 15 by the conventional method with paraffin gauze. The results showed that the median healing time was 13 days in the porcine skin graft group and 28 days in the control group. Other than healing time, the effects of porcine xenograft in reducing pain, infection and sickenss absence were far greater than those with conventional treatment. From a comparison of total dressing costs, it was estimated that for lesions of comparable size the cost of treatment with porcine xenograft was approximately one-third of that using paraffin gauze.