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Kim D, Lee JH, Park MS, Ahn MR, Jun D, Lee JH. Managing Vascular Pedicle Exposure in Free Tissue Transfer Using a Reprocessed Micronized Dermal Substitute in Lower Extremity Reconstructions. Bioengineering (Basel) 2024; 11:241. [PMID: 38534515 DOI: 10.3390/bioengineering11030241] [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: 02/02/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.
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Affiliation(s)
- Daheui Kim
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Jun Hyeok Lee
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Min Suk Park
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Ma Rhip Ahn
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Daiwon Jun
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
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Zhu Z, Yuan ZQ, Huang C, Jin R, Sun D, Yang J, Luo XS. Construction of a dermis-fat composite in vivo: Optimizing heterogeneous acellular dermal matrix with in vitro pretreatment. J Tissue Eng Regen Med 2019; 14:215-228. [PMID: 31729841 DOI: 10.1002/term.2986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/22/2019] [Accepted: 10/05/2019] [Indexed: 12/14/2022]
Abstract
Dermis-fat composite tissues have been widely used in plastic and reconstructive surgery and were previously constructed using hydrogel-type scaffolds. The constructs can be used for in vitro cosmetic and pharmaceutical testing but are not mechanically strong enough for in vivo applications. In this study, we used heterogeneous (porcine) acellular dermal matrix (PADM) as dermal layer scaffold. PADM was pretreated with the laser micropore technique and then precultured with rat adipose-derived stem cells (rADSCs) in vitro. rADSCs proliferated well on pretreated/unpretreated PADM, showing increased expression of genes associated with inflammatory regulation, proangiogenesis, and stemness, indicating that pretreated/unpretreated PADM both provide a beneficial microenvironment for rADSCs to exert their paracrine function. After in vitro processing, the rADSCs-polyporous PADM and PADM without pretreatments were implanted into the back of rats respectively, followed by adipose tissue transplantation. After implantation, the inflammation induced by pretreated PADM was significantly attenuated and localized compared to the unpretreated group. Moreover, the vascularization was faster, and more adipose tissue was formed in the pretreated group. Sound dermis-fat composite tissue was constructed with sufficient strength, which can potentially be used for actual repair application.
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Affiliation(s)
- Zhu Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhao-Qi Yuan
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Cheng Huang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Rui Jin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xu-Song Luo
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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The Use of Integra® Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost-Benefit Analysis. Aesthetic Plast Surg 2017; 41:472-473. [PMID: 28127661 DOI: 10.1007/s00266-016-0765-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
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Schiavon M, Francescon M, Drigo D, Salloum G, Baraziol R, Tesei J, Fraccalanza E, Barbone F. Response to Letter: The Use of Integra Dermal Regeneration Template versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost-Benefit Analysis. Aesthetic Plast Surg 2017; 41:474. [PMID: 28144753 DOI: 10.1007/s00266-016-0768-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/26/2022]
Affiliation(s)
- M Schiavon
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy.
| | - M Francescon
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - D Drigo
- Istituto di Igiene ed Epidemiologia Clinica, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - G Salloum
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - R Baraziol
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - J Tesei
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - E Fraccalanza
- Struttura Operativa Complessa di Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - F Barbone
- Istituto di Igiene ed Epidemiologia Clinica, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
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