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Hihara M, Himejima T, Takeji K, Fujita M, Fukui M, Matsuoka Y, Mitsui T, Kuro A, Kakudo N. A novel intervention for wound bed preparation in severe extremity trauma: Highly concentrated carbon dioxide bathing. JPRAS Open 2024; 41:88-97. [PMID: 38979443 PMCID: PMC11228637 DOI: 10.1016/j.jpra.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/19/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and Methods The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. Results We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. Conclusions Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.
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Affiliation(s)
- Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Tomoki Himejima
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Kota Takeji
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Maako Fujita
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Michika Fukui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Yuki Matsuoka
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
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Lee WG, Christopher AN, Ralph DJ. Commentary: Bioengineered dermal matrix reduces donor site morbidity in total phallic construction with RAFFF. Int J Impot Res 2024:10.1038/s41443-024-00953-z. [PMID: 38997583 DOI: 10.1038/s41443-024-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Affiliation(s)
- W G Lee
- University College London Hospitals NHS Foundation Trust, London, UK.
- St Peter's Andrology, London, UK.
- Division of Surgery and Interventional Sciences, University College London, London, UK.
| | - A N Christopher
- University College London Hospitals NHS Foundation Trust, London, UK
- St Peter's Andrology, London, UK
| | - D J Ralph
- University College London Hospitals NHS Foundation Trust, London, UK
- St Peter's Andrology, London, UK
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3
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Makkawi KW, Beaineh PT, Habr NT, Ibrahim AE. Use of Dermal Substitute Matrices for Coverage of Exposed Limb Vascular Repairs: A Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5855. [PMID: 38841527 PMCID: PMC11150027 DOI: 10.1097/gox.0000000000005855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Background Prompt coverage of vascular repairs in the extremities is needed to protect from desiccation and trauma. In the absence of local soft tissues to provide early coverage pending demarcation of the tissues and the zone of injury, there is no clear data in the literature on the ideal coverage method. This article is the first to review the use of dermal substitutes for temporary coverage of extremity vascular repairs pending definitive coverage. Methods We conducted a review of the literature to identify previous articles indexed in PubMed and Ovid using these search terms: [(skin) OR (artificial skin) OR (Integra) OR (dermal substitute) OR (dermal substitute matrix) OR (dermal regeneration) OR (dermal regeneration matrix) OR (dermal regeneration template)] AND [(bypass) OR (graft) OR (vascular surgery) OR (revascularization) OR (salvage) OR (limb salvage) OR (vascular repair) OR (artery repair) OR (arterial repair)] AND [(limb) OR (extremity) OR (leg) OR (arm) OR (vascular injury) OR (amputation)]. Results Of the 32 articles retrieved for initial review, five case reports with six patients of dermal substitute use for direct coverage of extremity repairs were identified. In all cases, the dermal substitute was able to provide stable coverage pending definitive coverage or was allowed to heal secondarily. Conclusions Dermal substitute matrices are a potential means of temporary coverage of exposed extremity vascular repairs when there is a paucity of local soft tissues pending more definitive coverage.
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Affiliation(s)
- Kareem W. Makkawi
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paul T. Beaineh
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Natasha T. Habr
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amir E. Ibrahim
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Waldron OP, El-Mallah JC, Lochan D, Wen C, Landmesser ME, Asgardoon M, Dawes J, Horchler SN, Schlidt K, Agrawal S, Wang Y, Ravnic DJ. Ushering in the era of regenerative surgery. Minerva Surg 2024; 79:166-182. [PMID: 38088753 DOI: 10.23736/s2724-5691.23.10113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Tissue loss, irrespective of etiology, often requires extensive reconstruction. In many instances, the need exceeds what current treatments and technologies modern medicine can offer. Tissue engineering has made immense strides within the past few decades due to advances in biologics, biomaterials, and manufacturing. The convergence of these three domains has created limitless potential for future surgical care. Unfortunately, there still exists a disconnect on how to best implant these 'replacement parts' and care for the patient. It is therefore vital to develop paradigms for the integration of advanced surgical and tissue engineering technologies. This paper explores the convergence between tissue engineering and reconstructive surgery. We will describe the clinical problem of tissue loss, discuss currently available solutions, address limitations, and propose processes for integrating surgery and tissue engineering, thereby ushering in the era of regenerative surgery.
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Affiliation(s)
- Olivia P Waldron
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
| | - Jessica C El-Mallah
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dev Lochan
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
| | - Connie Wen
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Mary E Landmesser
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mohammadhossein Asgardoon
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jazzmyn Dawes
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
| | - Summer N Horchler
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
| | - Kevin Schlidt
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
| | - Shailaja Agrawal
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yong Wang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Dino J Ravnic
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, USA -
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
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Šuca H, Čoma M, Tomšů J, Sabová J, Zajíček R, Brož A, Doubková M, Novotný T, Bačáková L, Jenčová V, Kuželová Košťáková E, Lukačín Š, Rejman D, Gál P. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res 2024; 296:383-403. [PMID: 38309220 DOI: 10.1016/j.jss.2023.12.043] [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: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024]
Abstract
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
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Affiliation(s)
- Hubert Šuca
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Matúš Čoma
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Júlia Tomšů
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jana Sabová
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Robert Zajíček
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Antonín Brož
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Doubková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkině and Masaryk Hospital, Ústí nad Labem, Czech Republic; Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lucie Bačáková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Věra Jenčová
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Eva Kuželová Košťáková
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Štefan Lukačín
- Department of Heart Surgery, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Dominik Rejman
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Gál
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic; Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic; Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovak Republic.
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Gupta S, Moiemen N, Fischer JP, Attinger C, Jeschke MG, Taupin P, Orgill DP. Dermal Regeneration Template in the Management and Reconstruction of Burn Injuries and Complex Wounds: A Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5674. [PMID: 38510326 PMCID: PMC10954069 DOI: 10.1097/gox.0000000000005674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/22/2024]
Abstract
Background Dermal scaffolds have created a paradigm shift for burn and wound management by providing improved healing and less scarring, while improving cosmesis and functionality. Dermal regeneration template (DRT) is a bilayer membrane for dermal regeneration developed by Yannas and Burke in the 1980s. The aim of this review is to summarize clinical evidence for dermal scaffolds focusing on DRT for the management and reconstruction of burn injuries and complex wounds. Methods A comprehensive search of PubMed was performed from the start of indexing through November 2022. Articles reporting on DRT use in patients with burns, limb salvage, and wound reconstruction were included with focus on high-level clinical evidence. Results DRT has become an established alternative option for the treatment of full-thickness and deep partial-thickness burns, with improved outcomes in areas where cosmesis and functionality are important. In the management of diabetic foot ulcers, use of DRT is associated with high rates of complete wound healing with a low risk of adverse outcomes. DRT has been successfully used in traumatic and surgical wounds, showing particular benefit in deep wounds and in the reconstruction of numerous anatomical sites. Conclusions Considerable clinical experience has accrued with the use of DRT beyond its original application for thermal injury. A growing body of evidence from clinical studies reports the successful use of DRT to improve clinical outcomes and quality of life across clinical indications at a number of anatomical sites.
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Affiliation(s)
| | | | | | | | - Marc G. Jeschke
- Hamilton Health Sciences, Hamilton, Ontario, Canada and McMaster University, Hamilton, Ontario, Canada
| | | | - Dennis P. Orgill
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
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Austin HK, Gamboa GM, Waters-Hollingsworth C. Excision of Invasive Squamous Cell Carcinoma Complicated by Osteomyelitis and Tobacco Use: A Case Report. Cureus 2024; 16:e54629. [PMID: 38524043 PMCID: PMC10959414 DOI: 10.7759/cureus.54629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Squamous cell carcinoma (SCC) is a common type of skin cancer that can be treated through surgical excision using Mohs micrographic surgery (MMS) which results in minimal scarring and low complications. Soft tissue defects as a result of MMS that are too large to be primarily closed can be repaired with secondary intention healing through the use of biologic prosthetics that promote dermal regeneration and tissue remodeling with high success rates. Other non-surgical treatment options include chemotherapy (topical or systemic), radiation, or immunotherapy for advanced skin cancers. In this case, our patient is a 76-year-old male with a history of tobacco use who presented with ulcerative SCC and developed a necrotic soft-tissue infection of Pseudomonas aeruginosa complicated by calvarial osteomyelitis six weeks following wide excision of scalp SCC and wound defect repair with application of Integra® Bilayer Wound Matrix (Integra LifeSciences, Princeton, New Jersey, United States) to promote re-vascularization and tissue regrowth. The patient is currently recovering well after the excision of the necrotic scalp lesion and second-stage reconstruction with right scalp fasciocutaneous flap and full-thickness skin graft with proper antibiotic administration. Complications were likely due to delayed wound healing from post-operative cigar use increasing his risk for infection and application of biologic prosthetics that potentially served as a nidus for bacterial adherence and biofilm production of P. aeruginosa, which led to osteomyelitis, an exceedingly rare complication for patients that undergo MMS.
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Affiliation(s)
- Harriet Kaye Austin
- Plastic and Reconstructive Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Gloria M Gamboa
- Plastic and Reconstructive Surgery, Orlando Veterans Affairs Medical Center, Orlando, USA
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Wu SS, Wells M, Ascha M, Gatherwright J, Chepla KJ. Upper Extremity Wounds Treated with Biodegradable Temporizing Matrix versus Collagen-Chondroitin Silicone Bilayer. J Hand Microsurg 2023; 15:340-350. [PMID: 38152680 PMCID: PMC10751194 DOI: 10.1055/s-0042-1749077] [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] [Indexed: 10/18/2022] Open
Abstract
Objective This study aims to compare outcomes between Novosorb Biodegradable Temporizing Matrix (BTM) and Integra collagen-chondroitin silicone for upper-extremity wound reconstruction. Methods This retrospective study analyzed adult patients who underwent wound reconstruction with either BTM or Integra at our institution between 2015 and 2020. Results Forty-eight patients were included: 31 (64.6%) BTM and 17 (35.4%) Integra. Mean age was 44.0 (range: 18-68) years. Age, race, sex, smoking, comorbidities, and defect size were similar between groups. Wound etiologies included 12 (25.0%) burn, 22 (45.8%) trauma, and others. Median template size was 133 cm 2 for BTM and 104 cm 2 for Integra ( p = 0.526). Skin grafting was performed after 14 (45.2%) and 14 (82.4%) wounds treated with BTM and Integra, respectively ( p = 0.028). Template complications of infection and dehiscence were comparable. Skin-graft complications occurred in five (35.7%) and three (21.4%) wounds in BTM and Integra, respectively ( p = 0.031). Skin-graft failure rates were comparable ( p = 0.121). Mean number of secondary procedures required after template placement was higher in the Integra group (BTM, 1.0; Integra, 1.9; p = 0.090). Final healing was achieved in 17 (54.8%) BTM and 11 (64.7%) Integra wounds ( p = 0.694). Median time to healing was 4.1 months after BTM and 2.6 months after Integra placement ( p = 0.014). Conclusion Compared with Integra, BTM achieved comparable wound healing and complication rates. Fewer secondary procedures and skin grafts were observed in BTM wounds, likely as a result of the coronavirus disease 2019 pandemic. At our institution, 100 cm 2 of product costs $850 for BTM and $3,150 for Integra, suggesting BTM as an economical alternative to fulfill the high functional and aesthetic requirements of upper-extremity wounds.
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Affiliation(s)
- Shannon S. Wu
- Department of Education, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States
| | - Michael Wells
- Department of Education, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Mona Ascha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - James Gatherwright
- Division of Plastic Surgery, Department of Surgery, Cleveland Clinic Akron General, Akron, Ohio, United States
| | - Kyle J. Chepla
- Division of Plastic Surgery, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, United States
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Cormican MT, Creel NJ, Bosque BA, Dowling SG, Rideout PP, Vassy WM. Ovine Forestomach Matrix in the Surgical Management of Complex Volumetric Soft Tissue Defects: A Retrospective Pilot Case Series. EPLASTY 2023; 23:e66. [PMID: 38045101 PMCID: PMC10690777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Volumetric soft tissue loss is an urgent surgical issue and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised vital structures, and contamination. Ovine forestomach matrix (OFM) has demonstrated clinical success in the surgical management of soft tissue defects, especially in contaminated fields, and provides an effective option for immediate coverage of exposed vital structures before definitive closure. Methods This retrospective pilot case series (n = 13 defects) evaluated the clinical effectiveness of OFM (graft and/or particulate formats) in the surgical management of contaminated volumetric soft tissue defects. Patients presented with significant soft tissue loss, often with exposed viscera, tendon, bone, or muscle, and were treated with OFM as part of their inpatient surgical management. All patients had at least 1 significant comorbidity with the potential to complicate their healing trajectory. The primary study endpoint was time to 100% granulation tissue coverage (days), and the secondary endpoint was any device-related postoperative complications. Results A total of 13 volumetric soft tissue defects were evaluated in 10 patients who underwent surgical reconstruction. Mean defect age was 3.5 ± 5.6 weeks, and mean area was 217.3 ± 77.9 cm2. Most defects had exposed structures (85%), and all defects were Centers for Disease Control and Prevention grade 2 or higher. Mean time to 100% granulation tissue formation was 23.4 ± 9.2 days, with a median product application of 1.0. Staged reconstruction was used in 7 of 13 defects, with the remainder (6 of 13) left to heal via secondary intention using standard wound care protocols. There were no major postoperative infections or adverse events (mean follow-up, 7.4 ± 2.4 weeks.). Conclusions This retrospective pilot case series builds on a growing body of evidence that OFM can be utilized to facilitate the formation of functional, well-vascularized soft tissue in large contaminated volumetric soft tissue defects.
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Affiliation(s)
- Michael T Cormican
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
| | - Nathan J Creel
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
| | | | | | - Phillip P Rideout
- Northeast Georgia Medical Center, Northeast Georgia Physicians Group Vascular Center, Gainesville, Georgia
| | - William M Vassy
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
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Luong D, Weisel A, Cohen R, Spector JA, Sapir-Lekhovitser Y. Successful reconstruction of full-thickness skin defects in a swine model using simultaneous split-thickness skin grafting and composite collagen microstructured dermal scaffolds. Wound Repair Regen 2023; 31:576-585. [PMID: 37314212 DOI: 10.1111/wrr.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Reconstitution of normal skin anatomy after full-thickness skin loss may be accomplished using a combination of a dermal regeneration template (DRT) and a split thickness skin graft (STSG). However, because of the relatively low rate of cell infiltration and vascularisation of currently available DRTs, reconstruction is almost always performed in a two-step procedure over the course of several weeks, resulting in multiple dressing changes, prolonged immobilisation and increased chance of infection. To mitigate the potential complications of this prolonged process, the collagen-based dermal template DermiSphere™ was developed and tested in a single-step procedure wherein DermiSphere and STSG were implanted simultaneously. When evaluated in a porcine, full thickness, excisional wound model, DermiSphere successfully supported simultaneous split thickness skin graft take and induced functional neodermal tissue deposition. When compared to a market leading product Integra Bilayer Wound Matrix, which was used in a multistep procedure (STSG placed 14 days after product implantation according to the product IFU), DermiSphere induced a similar moderate and transient inflammatory response that produced similar neodermal tissue maturity, thickness and vascularity, despite being implanted in a single surgical procedure leading to wound closure 2 weeks earlier. These data suggest that DermiSphere may be implanted in a single-step procedure with an STSG, which would significantly shorten the time course required for the reconstruction of both dermal and epidermal components of skin after full thickness loss.
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Affiliation(s)
- Derek Luong
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Adam Weisel
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Rachael Cohen
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Jason A Spector
- FesariusTherapeutics, Inc., New York City, New York, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York City, New York, USA
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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Fadilah NIM, Riha SM, Mazlan Z, Wen APY, Hao LQ, Joseph B, Maarof M, Thomas S, Motta A, Fauzi MB. Functionalised-biomatrix for wound healing and cutaneous regeneration: future impactful medical products in clinical translation and precision medicine. Front Bioeng Biotechnol 2023; 11:1160577. [PMID: 37292094 PMCID: PMC10245056 DOI: 10.3389/fbioe.2023.1160577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Skin tissue engineering possesses great promise in providing successful wound injury and tissue loss treatments that current methods cannot treat or achieve a satisfactory clinical outcome. A major field direction is exploring bioscaffolds with multifunctional properties to enhance biological performance and expedite complex skin tissue regeneration. Multifunctional bioscaffolds are three-dimensional (3D) constructs manufactured from natural and synthetic biomaterials using cutting-edge tissue fabrication techniques incorporated with cells, growth factors, secretomes, antibacterial compounds, and bioactive molecules. It offers a physical, chemical, and biological environment with a biomimetic framework to direct cells toward higher-order tissue regeneration during wound healing. Multifunctional bioscaffolds are a promising possibility for skin regeneration because of the variety of structures they provide and the capacity to customise the chemistry of their surfaces, which allows for the regulated distribution of bioactive chemicals or cells. Meanwhile, the current gap is through advanced fabrication techniques such as computational designing, electrospinning, and 3D bioprinting to fabricate multifunctional scaffolds with long-term safety. This review stipulates the wound healing processes used by commercially available engineered skin replacements (ESS), highlighting the demand for a multifunctional, and next-generation ESS replacement as the goals and significance study in tissue engineering and regenerative medicine (TERM). This work also scrutinise the use of multifunctional bioscaffolds in wound healing applications, demonstrating successful biological performance in the in vitro and in vivo animal models. Further, we also provided a comprehensive review in requiring new viewpoints and technological innovations for the clinical application of multifunctional bioscaffolds for wound healing that have been found in the literature in the last 5 years.
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Affiliation(s)
- Nur Izzah Md Fadilah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shaima Maliha Riha
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zawani Mazlan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adzim Poh Yuen Wen
- Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Looi Qi Hao
- My Cytohealth Sdn Bhd Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Blessy Joseph
- Business Innovation and Incubation Centre, Mahatma Gandhi University, Kottayam, Kerala, India
| | - Manira Maarof
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sabu Thomas
- International and Inter University Centre for Nanosciences and Nanotechnology, Mahatma Gandhi University, Kottayam, Kerala, India
| | - Antonella Motta
- Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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12
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Abstract
Autologous skin grafting has permitted survival and restoration of function in burn injuries of ever larger total body surface area (TBSA) sizes. However, the goal of replacing "like with like" skin structures is often impossible because full-thickness donor harvesting requires primary closure at the donor site for it to heal. Split-thickness skin grafting (STSG), on the other hand, only harvests part of the dermis at the donor site, allowing it to re-epithelialize on its own. The development of the first dermal regenerative template (DRT) in the late 1970s represented a major advance in tissue engineering that addresses the issue of insufficient dermal replacement when STSGs are applied to the full-thickness defect. This review aims to provide an overview of currently available DRTs in burn management from a clinician's perspective. It focuses on the main strengths and pitfalls of each product and provides clinical pearls based on clinical experience and evidence.
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Affiliation(s)
| | - Tam N Pham
- University of Washington, Regional Burn Center at Harborview, USA
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13
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De Decker I, Hoeksema H, Verbelen J, De Coninck P, Speeckaert M, De Schepper S, Blondeel P, Pirayesh A, Monstrey S, Claes KEY. A single-stage bilayered skin reconstruction using Glyaderm® as an acellular dermal regeneration template results in improved scar quality: an intra-individual randomized controlled trial. BURNS & TRAUMA 2023; 11:tkad015. [PMID: 37143955 PMCID: PMC10152996 DOI: 10.1093/burnst/tkad015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/17/2022] [Accepted: 03/06/2023] [Indexed: 05/06/2023]
Abstract
Background Absence of almost the entire reticular dermal layer is inherent to the use of autologous split-thickness skin grafting (STSG) to close full-thickness wounds, often resulting in hypertrophic scars and contractures. Many dermal substitutes have been developed, but unfortunately most have varying results in terms of cosmetic and/or functional improvement as well as patient satisfaction, in addition to high costs. Bilayered skin reconstruction using the human-derived glycerolized acellular dermis (Glyaderm®) has been reported to result in significantly improved scar quality using a two-step procedure. Unlike the necessary two-step procedure for most commercially available dermal substitutes, in this study we aimed to investigate the use of Glyaderm® in a more cost-effective single-stage engrafting. This is a method which, if autografts are available, is preferred by the majority of surgeons given the reduction in costs, hospitalization time and infection rate. Methods A prospective, randomized, controlled, intra-individual, single-blinded study was performed, investigating the simultaneous application of Glyaderm® and STSG vs. STSG alone in full-thickness burns or comparable deep skin defects. During the acute phase, bacterial load, graft take and time to wound closure were assessed and were the primary outcomes. Aesthetic and functional results (secondary outcomes) were evaluated at 3, 6, 9 and 12 months follow-up using subjective and objective scar measurement tools. Biopsies for histological analysis were taken at 3 and 12 months. Results A total of 66 patients representing 82 wound comparisons were included. Graft take (>95%), pain management and healing time were comparable in both groups. At 1 year follow-up, the overall Patient and Observer Scar Assessment Scale assessed by the patient was significantly in favour of sites where Glyaderm® was used. Not infrequently, patients attributed this difference to improved skin sensation. Histological analysis showed the presence of a well-formed neodermis, with donor elastin present for up to 12 months. Conclusions A single-stage bilayered reconstruction with Glyaderm® and STSG results in optimal graft take without loss of Glyaderm® nor the overlaying autografts due to infection. The presence of elastin in the neodermis was demonstrated during long-term follow-up in all but one patient, which is a crucial factor contributing to the significantly improved overall scar quality as evaluated by the blinded patients. Trial registration The trial was registered on clinicaltrials.gov and received the following registration code: NCT01033604.
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Affiliation(s)
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Petra De Coninck
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marijn Speeckaert
- Department of Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Phillip Blondeel
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Ali Pirayesh
- Plastic surgeon in private practice in Amsterdam, Amsterdam, The Netherlands
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14
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Reconstruction of a Near-total Scalp Avulsion with NovoSorb Biodegradable Temporizing Matrix: Pediatric Case Report. Plast Reconstr Surg Glob Open 2022; 10:e4717. [PMID: 36583166 PMCID: PMC9750680 DOI: 10.1097/gox.0000000000004717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Traumatic dog bites of the face and head are common among the pediatric population, although injuries resulting in total or subtotal scalp avulsions are rare and life-threatening. Standard treatment in these cases includes attempts at replantation or free tissue transfer; however, these procedures may not always be possible. An alternative treatment option involves the use of dermal substitutes, such as Integra (Integra LifeScience Corporation), with subsequent skin grafting. More recently, an alternative skin substitute called NovoSorb Biodegradable Temporizing Matrix (BTM) (PolyNovo North America LLC) has displayed favorable reconstructive outcomes in recent burn literature. NovoSorb BTM is a novel, fully synthetic bilayer scaffold made of biodegradable polyurethane matrix covered with a sealing membrane. In this report, the authors describe a 3-year-old boy who presented emergently with a severe dog bite avulsion to the subpericranial level of approximately 80% of his scalp, which was not replantable. The surgical plan involved a staged reconstruction using Integra and later skin grafting. Purulent infection ensued and required removal of Integra less than 2 weeks from application. Upon clearing of the infection, the wound was successfully closed with BTM and subsequent skin grafting. With proper wound management and over 6 months of follow-up, the patient experienced excellent healing of the graft with stable calvarial coverage and an acceptable aesthetic outcome. He will undergo tissue expansion of the remaining hair-bearing scalp in the future.
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15
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Sugimoto R, Yamanaka H, Tsuge I, Katayama Y, Katsube M, Sakamoto M, Morimoto N. Two-stage skin grafting using a basic fibroblast growth factor-impregnated artificial dermis. Regen Ther 2022; 21:258-262. [PMID: 36092498 PMCID: PMC9420932 DOI: 10.1016/j.reth.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
For traditional artificial dermises, a waiting period of approximately three weeks is required after the first implantation before they are adequately vascularized. The objective of this retrospective case series was to investigate whether full-thickness skin defects, requiring surgical reconstruction, could be successfully treated by implantation of a basic fibroblast growth factor (bFGF)-impregnated artificial dermis and secondary skin grafting with a shorter waiting period. Between January 2019 and January 2021, 19 skin defects in 14 patients (7 male and 7 female) were treated with two-stage skin grafting using bFGF-impregnated collagen-gelatin sponge (CGS). All of them were included in this case series, and the waiting period for skin grafting, success rate of skin grafting, infection during the waiting period, and scar quality 6–12 months postoperatively were retrospectively investigated. As a result, all skin grafting surgeries were successfully performed with a waiting period of 13.3 ± 4.3 days. Infection during the waiting period was observed in three lesions (15.8%); however, all infections were controllable. Postoperative scar quality was acceptable (Vancouver Scar Scale score range, 1–8). In conclusion, compared to traditional artificial dermises, bFGF-impregnated CGSs have the potential to shorten the waiting period without decreasing the success rate of skin grafting. Further studies are required to confirm this finding. We previously developed a novel artificial dermis which is capable of sustained release of bFGF. Skin defects were successfully treated by two-stage skin grafting using bFGF-impregnated CGS. The use of bFGF-impregnated CGS allowed for a short waiting period for secondary skin grafting.
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16
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Barker T, Wagstaff M, Ricketts S, Bruscino-Raiola F. Use of a bilayer biodegradable synthetic dermal matrix for the management of defects arising from necrotising fasciitis. J Wound Care 2022; 31:724-732. [PMID: 36113547 DOI: 10.12968/jowc.2022.31.9.724] [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: 11/11/2022]
Abstract
The aim of this article is to provide a brief overview of necrotising fasciitis, including causative factors, incidence, diagnosis and clinical outcomes. Various surgical treatment options are outlined, including methods of soft tissue reconstruction after wide excision of infected and necrotic tissues. The role of dermal matrices, including a synthetic biodegradable temporising matrix made of polyurethane, are described in terms of wound bed preparation, surgical application and clinical outcomes.
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Affiliation(s)
- Timothy Barker
- PolyNovo Biomaterials Pty Ltd, 2/320 Lorimer Street, Port Melbourne, VIC 3207, Australia
| | - Marcus Wagstaff
- Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia.,Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia
| | - Sophie Ricketts
- Plastic, Hand and Faciomaxillary Surgery, The Alfred, Commercial Road, Melbourne, VIC 3004 Australia
| | - Frank Bruscino-Raiola
- Plastic, Hand and Faciomaxillary Surgery, The Alfred, Commercial Road, Melbourne, VIC 3004 Australia
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17
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Bellomo TR, Lee S, McCarthy M, Tong KPS, Ferreira SS, Cheung TP, Rose-Sauld S. Management of the Diabetic Foot. Semin Vasc Surg 2022; 35:219-227. [DOI: 10.1053/j.semvascsurg.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
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18
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Dibbs RP, Depani M, Thornton JF. Technical Refinements with the Use of Biologic Healing Agents. Semin Plast Surg 2022; 36:8-16. [PMID: 35706558 PMCID: PMC9192159 DOI: 10.1055/s-0042-1742749] [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: 10/19/2022]
Abstract
Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390
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19
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Parham MJ, Grush AE, Smerica A, Wen YE, Depani M, Ferry AM, Jones LM, Thornton JF. Overview of Biologic Agents Used in Skin and Soft Tissue Reconstruction. Semin Plast Surg 2022; 36:3-7. [PMID: 35706560 PMCID: PMC9192156 DOI: 10.1055/s-0042-1742736] [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: 10/19/2022]
Abstract
Wound healing is a highly complex process mediated by cellular interactions at the microscopic level. Increased understanding of wound healing physiology has served as the foundation for translational research to develop biologic wound care technologies that have profoundly affected patient care. As the reader will see throughout this series in Seminars in Plastic Surgery , biologic wound technologies have broad applications and have greatly impacted the reconstructive ladder. Despite their frequent use, many surgeons lack familiarity with the myriad of products available on the market along with each product's relative advantages and shortcomings. This overview will discuss the classification of biologic wound agents used to reconstruct defects of the skin and soft tissue along with the advantages and disadvantages associated with their use.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Abel Smerica
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Y. Edward Wen
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390-9132
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20
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Kuang B, Pena G, Cowled P, Fitridge R, Greenwood J, Wagstaff M, Dawson J. Use of Biodegradable Temporising Matrix (BTM) in the reconstruction of diabetic foot wounds: A pilot study. Scars Burn Heal 2022; 8:20595131221122272. [PMID: 36157311 PMCID: PMC9500262 DOI: 10.1177/20595131221122272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Complex diabetes-related foot wounds are at high risk of infection and subsequent major amputation unless healed expediently. Biodegradable Temporising Matrix (BTM) is a synthetic matrix that facilitates the organisation of the extracellular matrix, resulting in a neodermis layer over these difficult-to-heal areas. The aim of this study was to evaluate the efficacy of using BTM in the reconstruction of challenging diabetic foot wounds. Methods Eighteen patients with complex diabetic foot wounds (exposed tendon, fascia, joint, bone), or chronic ulcers at high shear stress locations had BTM applied. Indications for BTM application were high shear stress location (66.6%), exposed bone (16.6%), exposed fascia (5.6%), exposed tendon (5.6%) and chronic non-healing wound (5.6%). The time to complete healing, infection rate and incidence of subsequent wound breakdown was analysed. Discussion Thirteen of 18 patients completed the BTM treatment regime with all these patients achieving complete wound healing at a median time of 13 weeks. One patient had partial treatment with BTM and four patients were withdrawn from the study following BTM application. The rate of infection and re-ulceration were both 15.4%. Conclusion This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic diabetic foot wounds with exposed deep structures and chronic wounds subject to high shear stress. The re-ulceration and infection rates were relatively low for this high-risk population. BTM may also offer promise as an alternative to free flaps. Lay Summary The prevalence of diabetes and its complications, including foot ulcers and wounds, have significantly increased worldwide over the last 40 years. Increasingly patients are admitted to hospital for antibiotics, debridements and subsequent amputations from these wounds. Complex diabetes-associated wounds are those at highest risk of these complications or necessitating more extensive, complex operations such as free flaps. These wounds may have exposed deep structures, be at risk of high shear stress or be chronic non-healing wounds. Temporisers are a type of material which integrates into the wound and promotes in-growth of tissue, ideal for healing over these difficult to heal areas. Biodegradable Temporising Matrix (BTM) is a synthetic temporising matrix which has demonstrated positive outcomes in facilitating healing in burns and plastics wounds, but its effectiveness in diabetic foot wounds has not yet been proven. This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic complex diabetic foot wounds and potentially avoiding more complex operations.
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Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Guilherme Pena
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - John Greenwood
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marcus Wagstaff
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joseph Dawson
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
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21
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Cottone G, Amendola F, Strada C, Bagnato MC, Brambilla R, De Francesco F, Vaienti L. Comparison of Efficacy among Three Dermal Substitutes in the Management of Critical Lower-Limb Wounds: The Largest Biases-Reduced Single-Center Retrospective Cohort Study in Literature. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121367. [PMID: 34946312 PMCID: PMC8708540 DOI: 10.3390/medicina57121367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
Abstract
Background and objectives: The skin recently became the main focus of regenerative medicine and, in this context, skin substitutes are fully entering into the plastic surgeon’s armamentarium. Among the various types of skin substitutes, dermal substitutes (DSs) are the most used. Our study aims to retrospectively compare three renowned and extremely similar DS in the management of critical lower limb wounds in the largest cohort analysis currently present in literature. Materials and Methods: We followed a strict protocol of application and evaluation of the DS for each patient and wound and, after a meticulous bias reduction process, we compared final outcomes in terms of efficacy and speed in achieving the defect coverage. Results: Among patients who did not receive a skin graft after the DS, we registered a wound healed surface of 50% for Pelnac, 52% for Integra, and 19% for Nevelia, after 30 days from the external silicon layer removal; among those who received a skin graft after the DS, we observed a significantly lower mean percentage of graft take after 7 days with Pelnac (53%) compared to Integra and Nevelia (92% and 80%, respectively). The overall percentage of wound healed surface obtained after 30 days from the external silicon sheet removal, either with or without skin graft, was 71% for Pelnac, 63% for Integra and 63% for Nevelia. We also ran a sub-group analysis only including grafted wounds with a negative microbiological test and the mean percentage of graft take was similar this time. Eventually, we assessed the influence of the wound’s “chronicity” on its healing, comparing the mean graft take only in “acute” wounds who received a skin graft and it resulted 63% for Pelnac, 91% for Integra and 75% for Nevelia. Conclusions: Integra demonstrates the highest rate of skin graft viability and the highest rate of skin graft takes after 7 days. Pelnac shows the quickest induction of secondary healing in acute wounds. Nevelia is not different from Integra and shows a superior graft take compared to Pelnac, but features the lowest secondary healing induction rate. No differences exist between the three DSs in terms of wound healing after 30 days from the skin graft or from the removal of the external silicon layer.
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Affiliation(s)
- Giuseppe Cottone
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Francesco Amendola
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Carlo Strada
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Maria Chiara Bagnato
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Roberto Brambilla
- Istituti Clinici Zucchi, Via Bartolomeo Zucchi 24, 20052 Monza, Italy;
| | - Francesco De Francesco
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-0715963945
| | - Luca Vaienti
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
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22
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Mogedas-Vegara A, Agut-Busquet E, Yébenes Marsal M, Luelmo Aguilar J, Escuder de la Torre Ò. Integra as Firstline Treatment for Scalp Reconstruction in Elderly Patients. J Oral Maxillofac Surg 2021; 79:2593-2602. [PMID: 34391723 DOI: 10.1016/j.joms.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Large scalp defects pose a reconstructive problem especially in elderly patients. The purpose of the study is to describe our experience of oncologic scalp reconstruction using a dermal matrix (Integra). MATERIAL AND METHODS We conducted a retrospective cohort study (January 2007 to March 2021) of patients who had undergone scalp tumor excision and reconstruction using Integra and a split-thickness skin graft (STSG). The primary end point was Integra and STSG success (defined by ≥75% percent take) and the secondary end point was postoperative complications. Both end points were assessed by the surgeon during follow-up. Demographic data, tumor characteristics, average defect size, time between stages and full-thickness scalp defects were characterized using descriptive statistics. Univariate and multivariate logistic regression models were used to evaluate the association between variables and end points. RESULTS The sample included 70 patients with a mean (SD) age of 83.3 (7.0) years, 75.7% men and 92.9% with comorbidities. Mean (SD) defect area was 23 (17.0) cm2 and the mean (SD) first-to-second phase interval was 30.6 (8.4) days. Sixty-four patients (91.4%) underwent outpatient surgery. Integra and STSG success rates were 87.1% (95% CI: 77.69 to 93.74%) and 100%, respectively. The complications rate was 18.6% (95% CI: 9 to 28%). Mean (SD) follow-up was 18 (16.7) months. Univariate and multivariate logistic regression analysis showed no association between variables and the primary and secondary end points. CONCLUSIONS Reconstruction of oncologic scalp defects using Integra can be performed under sedation and local anesthesia. Integra should be considered as firstline treatment for the reconstruction of scalp defects in elderly patients with comorbidities, given the low postoperative major complications rate and Integra and STSG take success.
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Affiliation(s)
- Alfonso Mogedas-Vegara
- Consultant, Oral and Maxillofacial Surgery Department, Consorcio Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Spain
| | - Eugènia Agut-Busquet
- Consultant, Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Mireia Yébenes Marsal
- Consultant, Dermatology Department, Consorcio Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Spain
| | - Jesús Luelmo Aguilar
- Department Head, Dermatology Department, Consorcio Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Spain
| | - Òscar Escuder de la Torre
- Department Head, Oral and Maxillofacial Surgery Department, Consorcio Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Spain
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23
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An Alternative Dermal Template for Reconstruction of Complex Upper Extremity Wounds. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3674. [PMID: 34262837 PMCID: PMC8274801 DOI: 10.1097/gox.0000000000003674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
The management of upper extremity soft-tissue defects with full-thickness skin loss and denuded tendon and/or bone traditionally requires vascularized tissue reconstruction. Herein, we present patient outcomes utilizing Novosorb Bio-degradable Temporizing Matrix (PolyNovo, Wilmington, Del.), a novel bilaminar dermal regenerative template, followed by skin grafting, for reconstruction of complex upper extremity injuries with exposed tendon and/or bone. We retrospectively reviewed all patients treated at our Level I trauma center with upper extremity trauma and exposed tendon and/or bone who had application of Novosorb Bio-degradable Temporizing Matrix over a 1-year period. At the time of surgery, all nonviable tissue was debrided, and the product was applied according to the manufacturer’s instructions. If required, split thickness skin grafting was performed once neodermis appeared perfused, or after the sealing layer delaminated spontaneously. Six patients (four men, two women) with an average age of 49.8 (35–60) years were included in the study. Average defect size measured 97 cm2 (10–440). Average time to complete healing was 45 days (27–57). Three patients reepithelialized spontaneously and did not require grafting; average defect size in these patients was 26 cm2 (10–42). There were no infections and no loss of the dermal matrix or skin graft, when performed. All patients healed without complication after grafting and did not require further surgical treatment. Therefore, we contend that Novosorb BTM is a dermal regenerative template that shows potential as an alternative option to flap reconstruction in select patients after upper extremity trauma and soft-tissue defects with exposed tendon and/or bone. Further studies will be required to refine indications and evaluate outcomes.
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Lipový B, Raška F, Kocmanová I, Hanslianová M, Hladík M, Holoubek J, Bezdíček M, Macháček C. Trichoderma longibrachiatum and Aspergillus fischeri Infection as a Cause of Skin Graft Failure in a Patient with Critical Burns after Liver Transplantation. J Fungi (Basel) 2021; 7:jof7060487. [PMID: 34207136 PMCID: PMC8234584 DOI: 10.3390/jof7060487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Infectious complications are responsible for the majority of mortalities and morbidities of patients with critical burns. Although bacteria are the predominant etiological agents in such patients, yeasts and fungi have become relatively common causes of infections over the last decade. Here, we report a case of a young man with critical burns on 88% TBSA (total body surface area) arising as a part of polytrauma. The patient's history of orthotopic liver transplantation associated with the patient's need to use combined immunosuppressant therapy was an additional complication. Due to deep burns in the forearm region, we have (after a suitable wound bed preparation) applied a new bi-layered dermal substitute. The patient, however, developed a combined fungal infection in the region of this dermal substitute caused by Trichoderma longibrachiatum and Aspergillus fischeri (the first case ever reported). The infection caused the loss of the split-thickness skin grafts (STSGs); we had to perform repeated hydrosurgical and mechanical debridement and a systemic antifungal treatment prior to re-application of the STSGs. The subsequent skin transplant was successful.
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Affiliation(s)
- Břetislav Lipový
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- CEITEC—Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic
| | - Filip Raška
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Iva Kocmanová
- Department of Clinical Microbiology, University Hospital Brno, 625 00 Brno, Czech Republic;
| | - Markéta Hanslianová
- Department of Clinical Microbiology, Vyškov Hospital, 628 01 Vyškov, Czech Republic;
| | - Martin Hladík
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- Correspondence: ; Tel.: +420-532-232-206
| | - Jakub Holoubek
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Matěj Bezdíček
- Centre of Molecular Biology and Gene Therapy, Department of Internal Medicine—Hematology and Oncology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Ctirad Macháček
- Department of Pathology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
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Abboud L, Leclerc-Mercier S, Bodemer C, Guéro S. Hand surgery in recessive dystrophic epidermolysis bullosa: Our experience with dermal substitutes. J Plast Reconstr Aesthet Surg 2021; 75:314-324. [PMID: 34253486 DOI: 10.1016/j.bjps.2021.05.056] [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: 10/09/2019] [Revised: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Deformities of the hands occur in most patients with recessive dystrophic epidermolysis bullosa. All structures of the hand may be involved. To restore hand function, it is necessary to identify the proper method of treatment. PATIENTS AND METHODS We conducted a retrospective review of 18 patients for a total of 30 surgically treated hands. The data were collected between 1998 and 2016 at Hôpital Necker Enfants Malades (Paris, France) and Institut de la Main (Paris, France). The postoperative follow-up period ranged between 22 months and 168 months, with an average duration of 76 months. The procedure performed on all of these patients involved a first web release for the thumb and pseudosyndactyly release for the remaining digits. A full thickness skin graft was used at the level of the first commissure and palm of the hand, while acellular dermal substitutes (Integra® or Matriderm®) were used to cover the remaining commissures, digits, and the remainder of the hand, followed by a split thickness skin graft. Postoperative rehabilitation ensued. RESULTS Long-term results are encouraging, demonstrating maintenance of function greater than 3 years in 57% of cases, and greater than 5 years in 33% of cases. CONCLUSION We believe that good surgical technique followed by good rehabilitation, combined with an interdisciplinary overall management of these patients, allowed us to succeed in maintaining a very satisfactory, esthetic, and functional result exceeding 5 years for one-third of patients. The resultant psychological benefit is very important.
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Affiliation(s)
| | - Stéphanie Leclerc-Mercier
- Dermatology department, Hôpital Necker Enfants Malades, Université René Descartes, 149 rue de Sèvres, 75015 Paris
| | - Christine Bodemer
- Dermatology department, Hôpital Necker Enfants Malades, Université René Descartes, 149 rue de Sèvres, 75015 Paris
| | - Stéphane Guéro
- Institut de la Main, 22 rue Georges Bizet, 75116 Paris; Pediatric Orthopaedic department, Hôpital Necker Enfants Malades, Université Paris Descartes, 149 rue de Sevres, 75015 Paris.
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Tan CT, Liang K, Ngo ZH, Dube CT, Lim CY. Application of 3D Bioprinting Technologies to the Management and Treatment of Diabetic Foot Ulcers. Biomedicines 2020; 8:E441. [PMID: 33096771 PMCID: PMC7589916 DOI: 10.3390/biomedicines8100441] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. Diabetic foot ulcers (DFUs) are a serious complication of DM. It is estimated that 15-25% of DM patients develop DFU at least once in their lifetime. The lack of effective wound dressings and targeted therapy for DFUs often results in prolonged hospitalization and amputations. As the incidence of DM is projected to rise, the demand for specialized DFU wound management will continue to increase. Hence, it is of great interest to improve and develop effective DFU-specific wound dressings and therapies. In the last decade, 3D bioprinting technology has made a great contribution to the healthcare sector, with the development of personalized prosthetics, implants, and bioengineered tissues. In this review, we discuss the challenges faced in DFU wound management and how 3D bioprinting technology can be applied to advance current treatment methods, such as biomanufacturing of composite 3D human skin substitutes for skin grafting and the development of DFU-appropriate wound dressings. Future co-development of 3D bioprinting technologies with novel treatment approaches to mitigate DFU-specific pathophysiological challenges will be key to limiting the healthcare burden associated with the increasing prevalence of DM.
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Affiliation(s)
- Chew Teng Tan
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore; (C.T.T.); (K.L.); (Z.H.N.); (C.T.D.)
| | - Kun Liang
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore; (C.T.T.); (K.L.); (Z.H.N.); (C.T.D.)
| | - Zong Heng Ngo
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore; (C.T.T.); (K.L.); (Z.H.N.); (C.T.D.)
| | - Christabel Thembela Dube
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore; (C.T.T.); (K.L.); (Z.H.N.); (C.T.D.)
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Chin Yan Lim
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore 138648, Singapore; (C.T.T.); (K.L.); (Z.H.N.); (C.T.D.)
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore
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