The Combined Use of Negative-Pressure Wound Therapy and Dermal Substitutes for Tissue Repair and Regeneration

Dermal Regeneration Template in the Management and Reconstruction of Burn Injuries and Complex Wounds: A Review

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.

Effects of skin flap grafting combined with vacuum sealing drainage on ulcer area, pain level, and serum inflammation in diabetic foot patients

OBJECTIVE

To study the effects of skin flap grafting combined with vacuum sealing drainage (VSD) on ulcer area, pain level and serum inflammation in patients with diabetic foot (DF).

METHODS

In this retrospective study, 121 patients with DF who were treated in the Affiliated Hospital of Xinyang Vocational and Technical College between April 2018 and April 2022 were included as study subjects, including 50 cases receiving skin flap grafting (control group) and 71 cases receiving skin flap grafting combined with VSD (research group). Information on clinical efficacy, survival rate of the grafted flap, amputation and complications, ulcer area, rehabilitation (granulation tissue formation time, ulcer wound healing time), pain level (Visual Analogue Scale [VAS]), and serum inflammatory factors (interleukin [IL]-6, tumor necrosis factor [TNF]-α, and C-reactive protein [CRP]) were collected for comparative analyses. Univariate and multivariate analyses were conducted to screen the risk factors for patients' prognosis.

RESULTS

The overall response rate and the survival rate of the grafted flap in the research group were markedly higher compared with the control group, while the amputation rate was significantly lower (all P<0.05). Besides, the research group exhibited an evidently smaller post-treatment ulcer area, lower VAS, IL-6, TNF-α and CRP levels, and shorter granulation tissue formation time and ulcer wound healing time than the control group (all P<0.05). Neither group of patients experienced significant complications. The use of skin flap grafting + VSD was a protective factor for postoperative outcome.

CONCLUSIONS

Skin flap grafting combined with VSD is effective in treating DF patients, which can validly reduce ulcer area and inhibit serum inflammation after treatment, thus accelerating rehabilitation.

The Effects of Negative Pressure Wound Therapy on Vegf and Angiogenesis in Deep Dermal Burn Injury: An Experimental Study

Burn injuries are the fourth most common type of trauma worldwide, after traffic injuries, falls and interpersonal violence. Vascular endothelial growth factor (VEGF) is one of the most critical proangiogenic factors. Failure in angiogenesis is often associated with chronic, non-healing wounds. This study aimed to compare the effect of sterile gauze with normal saline (NaCl) 0.9%, intermittent negative pressure wound therapy (NPWT), continuous NPWT, and silver sulfadiazine dressing on increasing VEGF and angiogenesis in deep dermal burn injury. This experimental laboratory study involved six Yorkshire pigs. Twenty burns were made on each pig's flank and dorsum areas, which were divided into four treatment groups: sterile gauze with NaCl 0.9%, intermittent NPWT, continuous NPWT, and silver sulfadiazine dressing. Skin biopsies were done on days 1, 3, 7, 14 and 21 to evaluate VEGF histoscore and mean microvascular density (MVD). We used immunohistochemical staining of VEGF-165 as VEGF's protein marker and hematoxylin-eosin (HE) to count the MVD. There was a significant difference in mean VEGF histoscore on evaluation day 14, in which continuous NPWT had the highest score compared to sterile gauze with NaCl 0.9%, intermittent NPWT, and silver sulfadiazine. The elevated VEGF histoscore could significantly increase the MVD.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

Regenerative Approaches for Chronic Wounds

Chronic skin wounds are commonly found in older individuals who have impaired circulation due to diabetes or are immobilized due to physical disability. Chronic wounds pose a severe burden to the health-care system and are likely to become increasingly prevalent in aging populations. Various treatment approaches exist to help the healing process, although the healed tissue does not generally recapitulate intact skin but rather forms a scar that has inferior mechanical properties and that lacks appendages such as hair or sweat glands. This article describes new experimental avenues for attempting to improve the regenerative response of skin using biophysical techniques as well as biochemical methods, in some cases by trying to harness the potential of stem cells, either endogenous to the host or provided exogenously, to regenerate the skin. These approaches primarily address the local wound environment and should likely be combined with other modalities to address regional and systemic disease, as well as social determinants of health. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Complex Multidisciplinary Cranial and Scalp Reconstruction for Patient Salvage

OBJECTIVE/BACKGROUND

Patients can develop scalp and cranial defects as a result of neoplasm, trauma, or infection. Reconstruction of these defects can be difficult in some patients and may require a multidisciplinary approach using creative solutions usually used for disease processes in other areas of the body, such as severe burns.

METHODS

A series of 9 patients were treated using multidisciplinary techniques for reconstruction of complex cranial and scalp defects. Data on patient characteristics, initial treatment, and preparatory and definitive reconstructive treatment were retrospectively collected. Outcomes were measured as full solution, partial solution, or failure.

RESULTS

Three patients had a full solution/wound closure, 5 had a partial solution, and 1 failed reconstructive attempt. Full solution patients tended to be younger, received reconstruction treatment modalities for longer periods of time, and had more definitive surgeries. Initial and preparatory surgeries did not tend to promote a full solution, though having fewer preparatory surgeries that were not related to wound vacuum-assisted closure use tended to be associated with a better outcome. Infection of the scalp or cranium did not tend to change the result.

CONCLUSIONS

Reconstructive salvage of complex cranial and scalp defects takes time, so patience and earlier recognition of need for atypical reconstruction is beneficial. Patient characteristics may influence outcomes, but judicious choice of materials and techniques is more critical to patient success. Use of a multidisciplinary approach to complex cranial and scalp reconstruction is a beneficial option for many patients for whom standard reconstruction methods are not viable.