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Shah A, Taupin P. Strategies for extremity reconstruction with exposed bones and tendons using acellular dermal matrices: concept of sequential vascularization. Case Reports Plast Surg Hand Surg 2022; 9:7-14. [PMID: 34993271 PMCID: PMC8725911 DOI: 10.1080/23320885.2021.2011289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report 3 cases of patients treated with Bilayer Wound Matrix over exposed structures. In all patients, dermal matrices revascularization occurred sequentially over the course of 6–12 weeks, leading to successful wound closure. Acellular dermal matrices allow more difficult areas with poor vascularity to be covered from the ‘inside-out’.
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Affiliation(s)
- Ajul Shah
- The Plastic Surgery Center, Institute for Advanced Reconstruction, Shrewsbury, NJ, USA
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Zhang H, Wang S, Lei C, Li G, Wang B. Experimental study of negative pressure wound therapy combined with platelet-rich fibrin for bone-exposed wounds. Regen Med 2021; 17:23-35. [PMID: 34905932 DOI: 10.2217/rme-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the efficacy of negative pressure wound therapy (NPWT) combined with platelet-rich fibrin (PRF) in treating bone-exposed wounds and explore its possible mechanism. Materials & methods: A bone-exposed wound was created in a total of 32 healthy Sprague-Dawley rats, which were divided into either control group, NPWT group, PRF group or both (N + P group). The bone-exposed area, skin contraction rate and granulation coverage and the level of growth factors in granulation tissue were determined on days 4, 7 and 10. Results: The N + P group showed significantly higher wound closure rate than that achieved with others respectively. Four factors were significantly higher in N + P group than in the other three groups. Conclusion: Combination of NPWT and PRF can repair bone-exposed wounds effectively and accelerate wound healing.
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Affiliation(s)
- Hong Zhang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China.,Department of Pediatric Surgery, Fujian Children's Hospital, Fuzhou Fujian, 350000, PR China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou Fujian, 350000, PR China.,Fujian Maternity & Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Songyu Wang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Chen Lei
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Guanmin Li
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Biao Wang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
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Matsuura Y, Kawai K. The surgical strategy of Purpura fulminans triggered by pyothorax associated with lung cancer. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:1-6. [PMID: 32002466 PMCID: PMC6968497 DOI: 10.1080/23320885.2019.1704290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/08/2019] [Indexed: 11/24/2022]
Abstract
Purpura fulminans is a rare disease that usually causes sepsis and is accompanied by disseminated intravascular coagulation and symmetric gangrene of distal extremities. We had to consider the most appropriate surgery approach. The most important point was attempting to rescue the patient’s ability to walk under his own power.
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Affiliation(s)
- Yoshitaka Matsuura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuya Kawai
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Plastic and Reconstructive Surgery, Nagahama Red Cross Hospital, Shiga, Japan
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Preliminary results of the new lipogluing technique plus full-thickness skin graft in post traumatic lower limb reconstructive surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery. Plast Reconstr Surg 2018; 142:807e-808e. [PMID: 30512006 DOI: 10.1097/prs.0000000000004940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miyanaga T, Haseda Y, Daizo H, Yamashita M, Yamashita A, Kishibe M, Shimada K. A Perifascial Areolar Tissue Graft With Topical Administration of Basic Fibroblast Growth Factor for Treatment of Complex Wounds With Exposed Tendons and/or Bones. J Foot Ankle Surg 2018; 57:104-110. [PMID: 29268895 DOI: 10.1053/j.jfas.2017.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 02/03/2023]
Abstract
The management of wounds with tendon and/or bone exposure is challenging because of the insufficient blood supply to the wound bed. We describe our experience with 19 patients using a perifascial areolar tissue (PAT) graft with topical administration of basic fibroblast growth factor (bFGF) in the treatment of complex wounds with exposed tendons and/or bones in the extremities. Using a PAT graft is minimally invasive and technically easy, and the donor site is relatively preserved. However, PAT grafts for the treatment of a complex wound with large areas of exposed tendons and/or bones have sometimes failed to survive because of insufficient vascularization of the wound bed. Therefore, topical administration of bFGF, which promotes angiogenesis, was added to the graft. All grafts showed good graft survival and successfully covered the tendons and bones. Topical administration of bFGF accelerated vascularization in the PAT graft and facilitated wound healing by increasing the blood supply to the wound bed and achieved success with the PAT graft. In conclusion, using a PAT graft with topical administration of bFGF is a suitable option for the treatment of complex wounds with a large proportion of exposed tendons and/or bones. With minimal damage to the tissues near the wound, the PAT graft can be a useful option for limb salvage and could become a valuable tool for reconstructive surgeons.
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Affiliation(s)
- Toru Miyanaga
- Associate Professor, Department of Plastic Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan.
| | - Yasuo Haseda
- Plastic Surgeon, Department of Plastic Surgery, Kouseiren Takaoka Hospital, Toyama, Japan
| | - Haruhisa Daizo
- Plastic Surgeon, Department of Plastic Surgery, Kouseiren Takaoka Hospital, Toyama, Japan
| | - Masanobu Yamashita
- Associate Professor, Department of Plastic Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Akiko Yamashita
- Associate Professor, Department of Plastic Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Miyuki Kishibe
- Associate Professor, Department of Plastic Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Kennichi Shimada
- Professor, Department of Plastic Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan
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Acellular dermal matrix and heel reconstruction: a new prospective. J Appl Biomater Funct Mater 2017; 15:e376-e381. [PMID: 28525675 DOI: 10.5301/jabfm.5000357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Heel reconstruction represents a challenge for all plastic surgeons due to the anatomical and functional features of this weight-bearing area. In the last decade a combined use of acellular dermal matrices and skin grafts has been proposed as a reliable and less invasive alternative for complex wound management; nevertheless only a few cases have been reported in the literature. METHODS We describe the long-term outcome of 2 cases of severe degloving trauma of the plantar region with massive soft tissue defects of the foot, that underwent surgical reconstruction with artificial dermis and skin grafts. At the fifth year of follow-up, both patients underwent a clinical and a computerized gait analysis to study their functional outcomes and the kinematics of their gait. RESULTS Both patients recovered functional ambulation and returned to their own work and vocational activities, showing a symmetric gait and parameters of upright posture fully comparable to normality. CONCLUSIONS Despite the initial concerns about the use of acellular dermal matrices and skin grafts for this kind of injury, they seem to be a simple and safe alternative for weight-bearing reconstruction of the degloved foot. The authors believe that the current study yields useful information and reassurance about their long-term reliability.
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One-Stage Reconstruction of Scalp after Full-Thickness Oncologic Defects Using a Dermal Regeneration Template (Integra). BIOMED RESEARCH INTERNATIONAL 2015; 2015:698385. [PMID: 26649312 PMCID: PMC4663323 DOI: 10.1155/2015/698385] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/24/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
The use of Dermal Regeneration Template (DRT) can be a valid alternative for scalp reconstruction, especially in elderly patients where a rapid procedure with an acceptable aesthetic and reliable functional outcome is required. We reviewed the surgical outcome of 20 patients, 14 (70%) males and 6 (30%) females, who underwent application of DRT for scalp reconstruction for small defects (group A: mean defect size of 12.51 cm2) and for large defects (group B: mean defect size of 28.7 cm2) after wide excision of scalp neoplasm (basal cell carcinoma and squamous cell carcinoma). In group A, the excisions were performed to the galeal layer avoiding pericranium, and in group B the excisions were performed including pericranium layer with subsequent coverage of the exposed bone with local pericranial flap. In both the groups (A and B) after the excision of the tumor, the wound bed was covered with Dermal Regeneration Template. In 3 weeks we observed the complete healing of the wound bed by secondary intention with acceptable cosmetic results and stable scars. Scalp reconstruction using a DRT is a valid coverage technique for minor and major scalp defects and it can be conducted with good results in elderly patients with multiple comorbidities.
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Shamian B, Hinds RM, Capo JT. Novel Use of Synthetic Acellular Dermal Matrix for Coverage of a Tibial Defect Following Resection of an Osteochondroma: A Case Report. INT J LOW EXTR WOUND 2015; 15:82-5. [PMID: 26353822 DOI: 10.1177/1534734615604279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The application of an artificial dermal matrix (Integra Life Sciences, Plainsboro, NJ) in the management of substantial burn injuries has been extensively documented. Use of an artificial dermal matrix has resulted in excellent outcomes and is free of the morbidity associated with harvesting free-tissue flaps. However, coverage of bony defects where the periosteum has been removed is often challenging. In the current report, we present a case wherein the use of an acellular synthetic dermis combined with split-thickness skin grafting resulted in successful coverage of a tibial defect following resection of an osteochondroma.
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Affiliation(s)
| | | | - John T Capo
- NYU Hospital for Joint Diseases, New York, NY, USA
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Weigert R, Leclere FM, Delia G, De Luca L, Al Mutairi K, Casoli V. Long-term patient-reported functional and cosmetic outcomes following severe traumatic foot and ankle wound reconstruction with acellular dermal matrix. J COSMET LASER THER 2015; 17:321-9. [DOI: 10.3109/14764172.2015.1027231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Snider TH, Perry MR, Richter WR, Plahovinsak JL, Rogers J, Reid FM, Graham JS. A dynamic system for delivering controlled bromine and chlorine vapor exposures to weanling swine skin. Cutan Ocul Toxicol 2013; 33:161-7. [PMID: 23808400 DOI: 10.3109/15569527.2013.806524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Assessing the hazards of accidental exposure to toxic industrial chemical (TIC) vapors and evaluating therapeutic compounds or treatment regimens require the development of appropriate animal models. OBJECTIVE The objective of this project was to develop an exposure system for delivering controlled vapor concentrations of TICs to the skin of anesthetized weanling pigs. Injury levels targeted for study were superficial dermal (SD) and deep dermal (DD) skin lesions as defined histopathologically. MATERIALS AND METHODS The exposure system was capable of simultaneously delivering chlorine or bromine vapor to four, 3-cm diameter exposure cups placed over skin between the axillary and inguinal areas of the ventral abdomen. Vapor concentrations were generated by mixing saturated bromine or chlorine vapor with either dried dilution air or nitrogen. RESULTS Bromine exposure concentrations ranged from 6.5 × 10(-4) to 1.03 g/L, and exposure durations ranged from 1 to 45 min. A 7-min skin exposure to bromine vapors at 0.59 g/L was sufficient to produce SD injuries, while a 17-min exposure produced a DD injury. Chlorine exposure concentrations ranged from 1.0 to 2.9 g/L (saturated vapor concentration) for exposures ranging from 3 to 90 min. Saturated chlorine vapor challenges for up to 30 min did not induce significant dermal injuries, whereas saturated chlorine vapor with wetted material on the skin surface for 30-60 min induced SD injuries. DD chlorine injuries could not be induced with this system. CONCLUSION The vapor exposure system described in this study provides a means for safely regulating, quantifying and delivering TIC vapors to the skin of weanling swine as a model to evaluate therapeutic treatments.
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Affiliation(s)
- Thomas H Snider
- Battelle, Biomedical Research Center , Columbus, OH , USA and
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Abstract
BACKGROUND The treatment of bone-exposed wounds with artificial dermis is not widely accepted in burn patients because of uncertain clinical results. This article aimed to review our clinical experience with this technique. METHODS We implanted artificial dermis in 11 bone-exposed burns. Implantation was directly performed on bones with periosteum, whereas bones without periosteum were trephinated or burred before implantation. All wounds were closed by secondary skin grafting. RESULTS The mean patient age was 49 years. Lower extremity is the most common site of bone exposure. The mean bone exposed area was 55.6 cm, whereas the mean Integra-implanted area was 86.7 cm. The overall implant take rate was 91%, and the skin grafting success rate was 80%. No secondary breakdown was noted after a 2-year follow-up. CONCLUSIONS This study confirms that artificial dermis can be an alternative treatment tool for burns with exposed bones, especially in patients with limited donor sites.
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Fujioka M, Hayashida K, Murakami C. Artificial dermis is not effective for resurfacing bone-exposing wounds of Gustilo-Anderson III fracture. J Plast Reconstr Aesthet Surg 2012; 66:e119-21. [PMID: 23266016 DOI: 10.1016/j.bjps.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/01/2012] [Indexed: 11/25/2022]
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Wollina U, Bayyoud Y. Reconstruction of a large scalp defect by the sequential use of dermal substitute, self-filling osmotic tissue expander and rotational flap. J Cutan Aesthet Surg 2011; 3:106-10. [PMID: 21031071 PMCID: PMC2956951 DOI: 10.4103/0974-2077.69023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Large scalp defects pose a challenge for the surgeon. Here, we present a 31-year-old male patient with a soft tissue defect on the temple with exposed bone. To allow reconstruction, we placed a self-filling osmotic expander in the subgaleal pocket for 12 weeks. The final volume of the tissue expander was 300 mL. In the last step, a rotational flap was created after removal of the tissue expander from its pocket. Thereby, a tension-free suturing was possible. The post-surgical healing was uncomplicated. Osmotic tissue expanders are a valuable tool for the closure of large tissue defects without the necessity of repeated filling procedures.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Section of Neurosurgery, Reconstructive and Hand Surgery, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Wollina U, Meseg A, Weber A. Use of a collagen-elastin matrix for hard to treat soft tissue defects. Int Wound J 2011; 8:291-6. [PMID: 21449935 DOI: 10.1111/j.1742-481x.2011.00785.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As deep soft tissue defects with exposed bone, cartilage or tendons are not suitable for wound closure with skin mesh grafts, other techniques are needed. We report on six patients, one female and five males, aged between 32 and 89 years, and deep soft tissue defects with exposed tendons, cartilage or bone. The aetiology of these defects was vascular (n = 3), tumour surgery (2), and post-traumatic (1). Wounds were treated with a collagen-elastin matrix applied above the exposed structures. In five patients, the procedure was combined with mesh graft transplantation in the same setting. Follow-up varied between 12 and 40 weeks. Wound healing was uncomplicated in all transplanted patients until first dressing change after 7 days. All but one transplant showed a 100% take rate and the transplant was stable within 10-14 days. A complete wound closure was also achieved without transplantation, but this took 8 weeks. No adverse effects were noted. There was no skin contracture of the skin grafts. Collagen-elastin matrix with split-thickness skin grafts is a useful tool in deep soft tissue. The time to heal can be reduced.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, Dresden, Germany.
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