Porcine xenografts for surgical defects: Experience of a single center with 128 cases

Engineered Skin Substitutes in Dermatologic Surgery: A Systematic Review

BACKGROUND

Artificial skin substitutes are a flexible alternative to autografting in Mohs micrographic surgery (MMS), but the characteristics and clinical outcomes of skin substitutes are not well defined.

OBJECTIVE

Summarize clinical data of skin substitutes in MMS for cutaneous malignancy.

METHODS

A MEDLINE/Embase/Web of Science search was conducted. Articles with original data on outcomes after skin substitute use in MMS for cutaneous malignancy were included. Articles not in English or without original data were excluded. Bias was assessed using the Oxford CEBM Levels of Evidence Table. Outcomes were synthesized using weighted averages. This study was prospectively registered in PROSPERO.

RESULTS

Of 1,007 articles, 40 met eligibility for inclusion. In total, 898 patients who underwent MMS and received a skin substitute were included. Xenografts were most commonly used ( n = 613). Semi-synthetic grafts (∼$<1/cm 2 ) and xenografts (∼$10/cm 2 ) are most affordable. Overall, outcomes were excellent for all skin substitutes, with a small proportion of patients experiencing correctable complications.

CONCLUSION

Skin substitutes are highly effective in MMS, with enormous potential. While the data demonstrate positive outcomes, they predominately draw from small, retrospective studies or case reports. There is also a scarcity of data comparing skin substitutes with each other or controls. Prospective studies are recommended.

Hyperbaric and topical oxygen therapies in thermal burn wound healing: a review

OBJECTIVE

This review aims to evaluate the effectiveness of the two most commonly used oxygen delivery methods for the treatment of thermal burn wound healing: hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT).

METHOD

The PubMed database was searched for articles discussing the use of HBOT or TOT in the treatment of thermal burns.

RESULTS

The search yielded 43,406 articles, of which 28 (23 HBOT, 5 TOT) met the inclusion criteria. Both experimental and clinical studies have demonstrated conflicting results after treating thermal burns with HBOT or TOT. Overall, 14/23 studies demonstrated positive results for HBOT on the healing of burn wounds and associated complications, such as oedema and pain. Findings from these studies showed it can reduce morbidity and mortality in certain high-risk groups such as those with diabetes or extensive burns. Although the five studies (one human and four animal trials) reviewing TOT showed promising outcomes, this therapeutic modality has not been well investigated.

CONCLUSION

Therapeutic use of HBOT in thermal burns has been popular in the past but its use remains controversial due to inconsistent results, serious side-effects, lack of convenience and high costs. The use of TOT in the management of burns needs further exploration by scientists and clinicians alike, in addition to the implementation of a standardised treatment protocol.

Application expansion of small intestinal submucosa extracellular matrix in complex and surgical wounds

A wound is hard-to-heal or complex when the defect fails to progress through the normal stages of wound healing in a timely fashion. Hard-to-heal wounds such as diabetic foot or venous leg ulcers can be long-lasting conditions. Alternatively, complex acute wounds that occur from trauma, burns, postoperative, necrosis and some dermatological diseases can also result in hard-to-heal wounds. This article reviews important considerations in the management of complex acute wounds, such as time to wound closure, pain, scarring, patient satisfaction and identification of options that can promote healing of grafts and flaps, while reducing donor-site morbidity. Primary research has demonstrated the inherent benefits of small intestinal submucosa extracellular matrix (SIS-ECM), a naturally occurring porcine matrix that promotes development of dermis-like tissue in both complex acute and hard-to-heal wounds. Presently, the literature provides mostly case studies demonstrating the benefits of SIS-ECM in the management of complex acute wounds. The available case series suggest emerging clinical benefits including rapid time to coverage, avoidance of donor-site complications and development of granulation tissue in locations of low circulation, which improves poor graft sites, potentially reducing dehiscence and providing support for reconstruction flaps and grafts.

Skin substitutes for the management of mohs micrographic surgery wounds: a systematic review

The data on skin substitute usage for managing Mohs micrographic surgery (MMS) wounds remain limited. This systematic review aimed to provide an overview of skin substitutes employed for MMS reconstruction, summarize clinical characteristics of patients undergoing skin substitute-based repair after MMS, and identify advantages and limitations of skin substitute implementation. A systematic review of Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science databases, from inception to April 7, 2021, identified all cases of MMS defects repaired using skin substitutes. A total of 687 patients were included. The mean patient age was 70 years (range: 6-98 years). Commonly used skin substitutes were porcine collagen (n = 397), bovine collagen (n = 78), Integra (n = 53), Hyalofill (n = 43), amnion/chorion-derived grafts (n = 40), and allogeneic epidermal-dermal composite grafts (n = 35). Common factors influencing skin substitute selection were cost, healing efficacy, cosmetic outcome, patient comfort, and ease of use. Some articles did not specify patient and wound characteristics. Skin substitute usage in MMS reconstruction is not well-guided. Blinded randomized control trials comparing the efficacy of skin substitutes and traditional repair methods are imperative for establishing evidence-based guidelines on skin substitute usage following MMS.

"POMELO PROJECT" - a simple and low cost simulator for harvesting skin graft by plastic surgery residents

BACKGROUND

Harvesting partial thickness skin grafts is an important technical skill the training plastic surgeon is required to hone. Historically accomplished via manual dermatome (Humby's knife) or the modern day electric dermatome.

OBJECTIVE

Presenting a means of practicing the use of Humby's knife for novice surgeons.

METHODS

15 plastic surgeons comprising 8 seniors and 7 residents, in a single tertiary center participated. Each utilised a Humby knife to harvest 4 skin grafts from a Pomelo. The graft areas were measured via computerised image processing, comparing measures of graft harvest consistency across groups of surgeons.

RESULTS

In the resident surgeon group, the average relative difference between exact graft area and encompassing area was 0.45, as compared with 0.15 in the Senior surgeon group, indicating a greater degree of inconsistency in graft harvest. Comparisons across groups yielded significant differences per each of the 4 grafts harvested (p <=0.005).

LIMITATIONS

single center and small cohort (inherent to the sparsity of plastic surgeons), marginal statistical evidence.

CONCLUSIONS

Citrus Maxima (Pomelo) is a useful substrate to instruct and practice the use of Humby knife effectively, allowing novice surgeons to practice the manual manoeuvres required therefore as well as increase confidence in its subsequent operative use.