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Seretis K, Bounas N. Securing skin grafts: A network meta-analysis. J Plast Reconstr Aesthet Surg 2024; 96:146-157. [PMID: 39089211 DOI: 10.1016/j.bjps.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/11/2024] [Accepted: 07/08/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Skin grafting is one of the most common procedures in plastic surgery. However, there are no defined guidelines for optimal fixation. The aim of this network meta-analysis (NMA) was to consolidate existing evidence by comparing various graft securing methods and determining the most effective approach for clinical practice. METHODS An NMA was conducted using a predetermined protocol after searching several electronic databases from inception to October 2023 for studies examining skin grafting fixation outcomes in adults. RESULTS A total of 27 studies were included in the analysis involving 1937 patients. Negative pressure wound therapy (NPWT) was the only method to significantly improve graft take percentages in comparison with the other modalities, whereas tie-over bolster (TOB) provided the worst results in take rates when examined as events. Fibrin glue (FIB) and TOB reduced hematoma and seroma rates when data were investigated in conjunction. CONCLUSIONS NPWT appears to be the most effective for skin graft adherence as opposed to traditional techniques. Its cost-effectiveness remains unclear, as NPWT is a relatively costly intervention compared with other methods. FIB and TOB are methods that can serve as a method of reducing hematoma and seroma rates in patients at high risk of bleeding. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece.
| | - Nikolaos Bounas
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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Othman S, Messa CA, Elfanagely O, Bormann B, Mellia JA, Broach RB, Kovach SJ, Fischer JP. Sticking to What Matters: A Matched Comparative Study of Fibrin Glue and Mechanical Fixation for Split-Thickness Skin Grafts in the Lower Extremity. INT J LOW EXTR WOUND 2024; 23:231-237. [PMID: 34605281 DOI: 10.1177/15347346211047748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Split-thickness skin grafts (STSGs) remain a valuable tool in the reconstructive surgeons' armamentarium. Staple or suture mechanical fixation (MF) serves as the gold standard of care, though fibrin glue (FG) has gained popularity as a fixation modality. We compare STSG outcomes following application of FG versus MF through a study of lower extremity wounds. Methods: A retrospective review (2016-2019) of patients who underwent a STSG was performed. Two cohorts consisting of patients undergoing a STSG with FG or MF (suture or staple) were matched according to wound size, wound location, and body mass index. Results: A total of 67 patients with 79 wounds were included (FG: n = 30, wounds = 39; MF: n = 37; wounds = 40). There was no significant difference between groups regarding time to 100% graft take (FG: 39 days, MF: 35.1 days; P < .384) or 180-day graft complications (FG: 10.3%, MF: 15%; P < .737). Adjusted operative time for FG (51.8 min) was lower than for MF cases (67.5 min) at a level that approached significance (P < .094). FG patients were significantly less likely to require a postoperative wound vacuum-assisted closure (VAC) (FG: 16.7%; MF: 76.7%; P < .001) and required a significantly lower number of 30-day postoperative visits (FG: 1.5 ± .78 visits; MF: 2.5 ± .03 visits; P < .001). The MF group had higher mean aggregate charges ($211,090) compared with the FG group (mean: $149,907), although these were not statistically significant (P > .05). Conclusion: The use of FG for STSG shows comparable clinical outcomes to MF, with a significantly decreased need for postoperative wound VAC, the number of 30-day postoperative visits, and a lower wound-adjusted operative time.
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Affiliation(s)
- Sammy Othman
- University of Pennsylvania, Philadelphia, PA, USA
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Baver Acaban M, Sarı A, Demirbağ HO, Ersöz G, Aktaş S. The effects of topical mafenide acetate application on skin graft survival in bacterial contaminated wounds. Burns 2024; 50:433-443. [PMID: 37985270 DOI: 10.1016/j.burns.2023.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Infection related skin graft loss still remains as a common problem even with the use of systemic antibiotics. Mafenide acetate (Sulfamylon) is a topical antimicrobial agent with a wide spectrum of antimicrobial activity. Since mafenide acetate has the ability to penetrate the burn eschar, it was preferred in the treatment of infected full-thickness skin grafts. We investigated the effects of topical Mafenide acetate application on graft survival in an experimental model of contaminated wound beds in rats. MATERIALS AND METHODS Twenty-eight male Wistar albino rats were included in the study. A full-thickness skin graft (FTSG) was harvested from the back region and the wound bed was inoculated with Pseudomonas aeruginosa. The same FTSG was sutured in place. Rats were divided into 4 groups. In groups 1 and 2, wound care was performed with gauze and hydrofiber dressings respectively. In groups 3 and 4, Mafenide acetate soaked hydrofiber and Mafenide acetate soaked gauze dressings were used respectively. The dressings were closed for 4 days in all groups. The rats in groups 1 and 2 received dressing changes every day. The dressing of the rats in group 3 was changed once every two days. The dressing of the rats in group 4 was changed twice a day. RESULTS In groups 3 and 4, the graft survival rates decreased significantly from day 7 to day 14 in all groups. Histologically, detachment at the dermoepidermal junction, disorganization of collagen along with increased numbers of fibroblasts and a decrease in graft adhesion to the wound bed were determined in Mafenide acetate-treated groups. CONCLUSION In rats treated with Mafenide acetate, graft survival was higher on day 7 and gradually decreased towards day 14. Application of a 2.5% solution of Mafenide acetate longer than 7 days on inoculated skin grafts in a rat model causes significant cytotoxicity and graft loss.
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Affiliation(s)
- M Baver Acaban
- Plastic, Reconstructive and Aesthetic Surgery Department of Mersin University Medical Faculty, Mersin, Turkey.
| | - Alper Sarı
- Plastic, Reconstructive and Aesthetic Surgery Department of Mersin University Medical Faculty, Mersin, Turkey
| | - Hatice Oruç Demirbağ
- Histology and Embryology Department of Mersin University Medical Faculty, Mersin, Turkey
| | - Gülden Ersöz
- Infectious Diseases and Clinical Microbiology Department of Mersin University Medical Faculty, Mersin, Turkey
| | - Savaş Aktaş
- Histology and Embryology Department of Mersin University Medical Faculty, Mersin, Turkey
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Abu-Baker A, Țigăran AE, Peligrad T, Ion DE, Gheoca-Mutu DE, Avino A, Hariga CS, Moraru OE, Răducu L, Jecan RC. Exploring an Innovative Approach: Integrating Negative-Pressure Wound Therapy with Silver Nanoparticle Dressings in Skin Graft Procedures. J Pers Med 2024; 14:206. [PMID: 38392639 PMCID: PMC10890209 DOI: 10.3390/jpm14020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Skin grafting is a helpful instrument in a plastic surgeon's arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation of neoangiogenesis, and promotion of an anti-inflammatory environment. Silver nanoparticle dressings also bring multiple benefits by bearing an antimicrobial effect and providing a humid medium, which are favorable for epithelialization. The combination of NPWT (negative-pressure wound therapy) with AgNPs (silver nanoparticles) has not been widely studied. MATERIALS AND METHODS This study aimed to compare the outcomes of silver nanoparticle sheets with the combination of negative-pressure wound therapy and silver nanoparticle dressings. We conducted a comparative prospective study on 80 patients admitted to the Plastic Surgery Department of "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital between 1st of January 2020 and 31st of December 2022. The study population was randomized to receive either silver nanoparticle dressings or negative-pressure wound therapy (NPWT) combined with silver nanoparticle dressings. Various parameters were monitored, including patient comorbidities and graft-related data such as defect etiology, graft integration, and graft size. Dressings were changed, and graft status was evaluated at 7, 10, and 14 days postoperatively. Additionally, baseline C-reactive protein (CRP) levels were measured before surgery and 7, 10, and 14 days postoperatively. RESULTS The study demonstrated an enhanced integration of skin grafts at all evaluation stages when employing NPWT combined with AgNPs, particularly evident 10 days post operation. Significant variations in graft integration were also observed based on factors such as diabetes, cardiovascular disease, graft size, or the origin of the grafted defect. Moreover, dynamic C-reactive protein monitoring showed a statistically significant decrease in CRP levels 10 days post operation among patients treated with NPWT in conjunction with silver dressing, consistent with the nearly complete integration of skin grafts at this evaluation threshold. CONCLUSION Several factors influence the postoperative evolution of split-skin grafts. Postoperative dressings target local factors to enhance graft integration further. Our research demonstrated that the innovative combination of NPWT-assisted dressings, complemented by a silver nanoparticle sheet, resulted in improved benefits for graft integration and the alleviation of systemic inflammation.
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Affiliation(s)
- Abdalah Abu-Baker
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Andrada-Elena Țigăran
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Teodora Peligrad
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Anatomy, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Adelaida Avino
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery, Emergency Clinical Hospital, 014461 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Oriana Elena Moraru
- Discipline of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Vascular Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Laura Răducu
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Radu-Cristian Jecan
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
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Park JK, Kim KW, Kim HJ, Choi SY, Son KH, Lee JW. 3D-Printed Auxetic Skin Scaffold for Decreasing Burn Wound Contractures at Joints. J Funct Biomater 2023; 14:516. [PMID: 37888181 PMCID: PMC10607279 DOI: 10.3390/jfb14100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
For patients with severe burns that consist of contractures induced by fibrous scar tissue formation, a graft must adhere completely to the wound bed to enable wound healing and neovascularization. However, currently available grafts are insufficient for scar suppression owing to their nonuniform pressure distribution in the wound area. Therefore, considering the characteristics of human skin, which is omnidirectionally stretched via uniaxial stretching, we proposed an auxetic skin scaffold with a negative Poisson's ratio (NPR) for tight adherence to the skin scaffold on the wound bed site. Briefly, a skin scaffold with the NPR effect was fabricated by creating a fine pattern through 3D printing. Electrospun layers were also added to improve adhesion to the wound bed. Fabricated skin scaffolds displayed NPR characteristics (-0.5 to -0.1) based on pulling simulation and experiment. Finger bending motion tests verified the decreased marginal forces (<50%) and deformation (<60%) of the NPR scaffold. In addition, the filling of human dermal fibroblasts in most areas (>95%) of the scaffold comprising rarely dead cells and their spindle-shaped morphologies revealed the high cytocompatibility of the developed scaffold. Overall, the developed skin scaffold may help reduce wound strictures in the joints of patients with burns as it exerts less pressure on the wound margin.
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Affiliation(s)
- Jung-Kyu Park
- Department of Health Sciences and Technology, GAIHST, Gachon University, 155, Gaetbeol-ro, Yeonsu-gu, Incheon 21999, Republic of Korea;
| | - Kun Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea; (K.W.K.); (H.J.K.); (S.Y.C.)
| | - Hyun Joo Kim
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea; (K.W.K.); (H.J.K.); (S.Y.C.)
| | - Seon Young Choi
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea; (K.W.K.); (H.J.K.); (S.Y.C.)
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea; (K.W.K.); (H.J.K.); (S.Y.C.)
| | - Jin Woo Lee
- Department of Health Sciences and Technology, GAIHST, Gachon University, 155, Gaetbeol-ro, Yeonsu-gu, Incheon 21999, Republic of Korea;
- Department of Molecular Medicine, College of Medicine, Gachon University, 155, Gaetbeol-ro, Yeonsu-gu, Incheon 21999, Republic of Korea
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Paw E, Vangaveti V, Zonta M, Heal C. Protocol for an open randomised controlled trial investigating Fibrin Glue in Skin grafts for Skin cancer (FiGSS). BMJ Open 2022; 12:e064431. [PMID: 36351733 PMCID: PMC9644346 DOI: 10.1136/bmjopen-2022-064431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Skin cancer is a common disease in the tropics, and oncological resection typically requires reconstruction with skin grafts. Fibrin glue, initially established as a haemostatic agent, has been studied extensively as an adhesive for skin grafts in burns. This study aims to investigate the use of fibrin as an adhesive for split skin grafts in skin cancers. METHODS AND ANALYSIS The study design is a prospective randomised controlled trial with the aim of investigating the impact of two different methods of split skin graft fixation. The intervention of fibrin glue will be compared with the control of staples or sutures. The trial will be conducted at two sites, a public hospital and a private hospital in Townsville, Australia, over a 24-month period with 334 participants to be recruited. Consecutive patients presenting for skin excisions and grafting will be eligible to participate in this study. Randomisation will be on the level of the patient. The primary outcome is graft take based on wound healing at 1 month. Secondary outcomes will be pain on dressing changes and operative time. ETHICS AND DISSEMINATION The study has been approved by The Townsville University Hospital Human Research Ethics Committee. Findings will be disseminated in conference presentations and journals and through online electronic media. TRIAL REGISTRATION NUMBER ACTRN12618000484246.
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Affiliation(s)
- Ekta Paw
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Mark Zonta
- Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Clare Heal
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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Dai J, Niyazi M, Xie J. Tissue Engineering Scaffold Slowly Releasing Neurotrophic Factors to Bridge Long Peripheral Nerve Defect. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Consistent application of neurotropic factors is necessary in peripheral nerve regeneration, yet challenging to achieve. Here we used a novel neurotropic factor controlled release system consisted of fibrin, fibronectin and hydrogel to slowly release two neurotrophic factors. At the
same time, physiological saline and reverse nerve suturing were used as negative and positive control. A year after surgery, animals which were treated by neurotrophic factor slow release system achieved far better neural regeneration and myelination, as well as superior recovery of hindfoot
than the negative control group. In the meanwhile, the results in the experimental group are still inferior to the nerve allograft group. In can be concluded from those results that, consistent releasing of neurotrophic factors can significantly promote long peripheral nerve regeneration,
but still short of achieving the results same as the gold standard of autologous nerve grafting.
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Affiliation(s)
- Jie Dai
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 86830001, China
| | - Maimaitiaili Niyazi
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 86830001, China
| | - Jiang Xie
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 86830001, China
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Patel BJ, Asher CM, Bystrzonowski N, Healy C. Safeguarding Skin Grafts: An Evidence-Based Summary of Fixation Techniques. Ann Plast Surg 2021; 87:e180-e188. [PMID: 34117134 DOI: 10.1097/sap.0000000000002937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective skin graft fixation is vital in preventing sheering forces, seroma, and hematoma from compromising graft take. Yet, selecting the ideal technique for securing skin grafts remains a contentious subject, with significant variation in practice existing between surgeons. There is, therefore, benefit to be derived from assessing the literature for evidence-based recommendations to guide the decision-making process. METHODS A search of Medline and Embase was performed using appropriate key terms, yielding 419 articles. Reference lists were analyzed. Inclusion and exclusion criteria were composed. Level I to III studies, as defined by the Centre for Evidence-Based Medicine, that compared skin graft fixation methods were analyzed. Rayyan QCRI was used for abstract and title screening. After full text screening, 41 studies were included for qualitative analysis. All included randomized control trials (RCTs) were assessed for risk of bias using the Cochrane Risk-of-Bias 2 (ROB2) tool. RESULTS We identified 4 groups of fixation technique: "tie-over bolster" (TOB), "no TOB," "adhesive glues," and "negative pressure wound therapy" (NPWT). Twelve studies compared TOB with no TOB, with no difference in graft take demonstrated. Sixteen studies compared adhesive glues with traditional methods, with no difference in graft take demonstrated. Thirteen studies compared NPWT with traditional methods, with enhanced graft take demonstrated. Risk of bias was deemed low in 1 of 13 RCTs. CONCLUSIONS Based on the current evidence, only NPWT is associated with enhanced graft take. However, there is a scarcity of robust level I evidence comparing different fixation techniques, meaning that strong recommendations cannot be made. We propose examples of hypothesis-driven RCTs, in predetermined clinical settings, based on the theoretical benefits of the techniques that would add value to clinical practice.
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Affiliation(s)
- Benjamin J Patel
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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