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Gorman N, McCrossan S, Kelly J. Excision of a large trichilemmal carcinoma of the back with staged reconstruction using biodegradable temporizing matrix (BTM): A case report. JPRAS Open 2024; 41:104-109. [PMID: 38984323 PMCID: PMC11231511 DOI: 10.1016/j.jpra.2024.05.010] [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: 04/04/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024] Open
Abstract
Trichilemmal carcinomas (TC) are rare skin malignancies that arise from the external root sheet of a hair follicle. Their incidence increases with advanced age and they most commonly occur on sun exposed skin or areas of significant hair growth. They vary significantly in size and appearance. Surgical excision is the most common treatment option. We report the case of a large trichilemmal carcinoma of the back occurring in a woman with poorly controlled diabetes mellitus. The lesion was excised resulting in a very large defect, which was reconstructed in a staged process using biodegradable temporising matrix (BTM) and split-skin grafting. There was 95 % graft take at first graft check and the wound was fully healed at 6 weeks post grafting. BTM, already an established adjunct in the reconstruction of burns, degloving injuries and soft tissue infections, provided an enhanced aesthetic outcome and successful wound healing in this complex skin lesion excision.
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Affiliation(s)
- Niamh Gorman
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Susan McCrossan
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Jason Kelly
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland
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März V, Vogt PM, Schlottmann F. [Reconstruction options for infection-related defects : Plastic surgery armamentarium]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:567-572. [PMID: 38748218 DOI: 10.1007/s00113-024-01439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The occurrence of infections has always been feared in all surgical disciplines. Plastic reconstructive surgery faces the challenge of treating infection-related defects on a patient-specific basis, which requires a multidisciplinary treatment concept. Satisfactory treatment success can only be achieved through radical debridement for infection cleansing, optimization of the perfusion situation paired with targeted anti-infective treatment and, if necessary, with soft tissue reconstruction by plastic surgery. OBJECTIVE This article presents the current possibilities of plastic and reconstructive surgery with respect to the reconstruction of infection-related defects. MATERIAL AND METHODS Proven and reliable strategies are presented and supplemented by promising experimental approaches. RESULTS Due to the often multilayered defect situation caused by infections, from the epidermis to cancellous bone, the entire armamentarium of plastic and reconstructive surgery is used for reconstruction. CONCLUSION The early involvement of plastic surgery in the treatment of infections and the interdisciplinary and multimodal treatment approach have proven their worth in the treatment of complex infection situations.
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Affiliation(s)
- Vincent März
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Peter M Vogt
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Frederik Schlottmann
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Tapking C, Thomas BF, Hundeshagen G, Haug VFM, Gazyakan E, Bliesener B, Bigdeli AK, Kneser U, Vollbach FH. NovoSorb® Biodegradable Temporising Matrix (BTM): What we learned from the first 300 consecutive cases. J Plast Reconstr Aesthet Surg 2024; 92:190-197. [PMID: 38547552 DOI: 10.1016/j.bjps.2024.02.065] [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: 11/16/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Extensive full-thickness soft-tissue defects remain a challenge in reconstructive surgery. NovoSorb® Biodegradable Temporising Matrix (BTM) represents a novel dermal substitute and was evaluated in wounds deriving from different aetiologies and to highlight risk factors for poor take rates. METHODS All patients treated with BTM at our department between March 2020 and October 2022 were included. Differences in univariate and linear regression models identified predictors and risk factors for take rates of BTM and split-thickness skin grafts (STSG). RESULTS Three hundred patients (mean age 54.2 ± 20.1 years, 66.3% male, 59.7% burns, 19.7% trauma and 20.6% others) were evaluated. Mean take rates of BTM and STSG after BTM delamination were 82.7 ± 25.2% and 86.0 ± 22.6%, respectively. Multiple regression analyses showed that higher body mass index (BMI, OR 0.43, 95% CI 0.86, -0.01, p = 0.44), prior allograft transplantation (OR 15.12, 95% CI 26.98, -3.31, p = 0.041), longer trauma-to-BTM-application intervals (OR 0.01, 95% CI 0.001, -0.001, p = 0.038), positive wound swabs before BTM (OR 7.15, 95% CI 13.50, -0.80, p = 0.028) and peripheral artery disease (OR 10.80, 95% CI 18.63, -2.96, p = 0.007) were associated with poorer BTM take. Higher BMI (OR 0.40, 95% CI 0.76, -0.08, p = 0.026), increasing BTM graft surface areas (OR 0.58, 95% CI -1.00, -0.17, p = 0.005), prior allograft (OR 12.20, 95% CI -21.99, -2.41, p = 0.015) or autograft transplantations (OR 22.42, 95% CI 38.69, -6.14, p = 0.001), tumour as the aetiology of the wound (OR 37.42, 95% CI 57.41, -17.83, p = 0.001), diabetes (OR 6.64, 95% CI 12.80, -0.48, p = 0.035) and impaired kidney function (OR 5.90, 95% CI 10.94, -0.86, p = 0.021) were associated with poorer STSG take after delamination of BTM, whereas higher BTM take rates were associated with better STSG take (OR 0.40, 95% CI 0.31,0.50, p < 0.001). CONCLUSION Extensive complex wounds of different aetiologies unsuitable for immediate STSG can be successfully reconstructed by means of two-staged BTM application and subsequent skin grafting. Importantly, presence of wound contamination or infection and prior allograft coverage appear to jeopardise good BTM and STSG take.
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Affiliation(s)
- Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Benjamin Felix Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Valentin Felix Michel Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Björn Bliesener
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Amir Khosrow Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany
| | - Felix Hubertus Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, RLP, Germany; Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilians University (LMU), Munich, BY, Germany.
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Tapking C, Panayi AC, Hundeshagen G, Thomas BF, Gazyakan E, Bliesener B, Bigdeli AK, Kneser U, Vollbach FH. The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases. J Clin Med 2024; 13:2661. [PMID: 38731190 PMCID: PMC11084148 DOI: 10.3390/jcm13092661] [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: 03/31/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: Addressing extensive and deep burn wounds poses considerable challenges for both patients and surgeons. The NovoSorb® Biodegradable Temporizing Matrix (BTM) emerged as a novel dermal substitute and has been subjected to evaluation in large burn wound cases, with a specific focus on identifying risk factors associated with suboptimal take rates. Methods: All patients with burn wounds greater than 10% body surface that underwent BTM treatment between March 2020 and November 2023 were eligible for inclusion. Univariate analyses and linear regression models were employed to discern risk factors and predictors influencing the take rates of both the BTM and split-thickness skin grafts (STSGs). Results: A total of 175 patients (mean age 56.2 ± 19.8 years, 70.3% male) were evaluated. The mean take rates of the BTM and STSGs were 82.0 ± 24.7% and 87.3 ± 19.0%, respectively. There were significant negative correlations between BTM take and the number of surgeries before BTM application (r = -0.19, p = 0.01), %TBSA and STSG take (r = -0.36, p = <0.001) and significant positive correlations between BTM and STSG take (r = 0.41, p ≤ 0.001) in addition to NPWT and STSG take (r = 0.21, p = 0.01). Multivariate regression analyses showed that a larger number of surgeries prior to BTM application (OR -3.41, 95% CI -6.82, -0.03, p = 0.04) was associated with poorer BTM take. Allograft treatment before BTM application (OR -14.7, 95% CI -23.0, -6.43,p = 0.01) and failed treatment with STSG before BTM application (OR -20.8, 95% CI -36.3, -5.23, p ≤ 0.01) were associated with poorer STSG take, whereas higher BTM take rates were associated with overall higher STSG take (OR -0.15, 95% 0.05, 0.26, p = 0.01). The Meek technique was used in 24 patients and showed similar take rates (BTM: 76.3 ± 28.0%, p = 0.22; STSG: 80.7 ± 21.1, p = 0.07). Conclusions: This study summarizes our findings on the application of a BTM in the context of large burn wounds. The results demonstrate that successful treatment can be achieved even in patients with extensive burns, resulting in satisfying take rates for both the BTM and STSG. The data underscore the importance of promptly applying a BTM to debrided wounds and indicate good results when using Meek.
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Affiliation(s)
- Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Benjamin F. Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Bjoern Bliesener
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Amir K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
| | - Felix H. Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, 67071 Ludwigshafen, Germany; (C.T.); (A.C.P.); (G.H.); (B.F.T.); (E.G.); (B.B.); (A.K.B.); (U.K.)
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), 80539 Munich, Germany
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Tapking C, Panayi A, Haug V, Palackic A, Houschyar KS, Claes KEY, Kuepper S, Vollbach F, Kneser U, Hundeshagen G. Use of the modified meek technique for the coverage of extensive burn wounds. Burns 2024; 50:1003-1010. [PMID: 38383170 DOI: 10.1016/j.burns.2024.01.005] [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: 06/21/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Autologous split thickness skin grafting using meshing technique remains the preferred option for the management of deep dermal and full thickness burns. The limited donor site availability seen in patients with extensive burns, however, restricts use of the mesh grafting technique for skin expansion. Meek micrografting was developed to allow for greater expansion, and, therefore, more reliable treatment of extensive burns. This study aimed to present our outcomes using the Meek micrografting technique and identify risk factors for graft failure. METHODS A retrospective review of patients admitted to our large academic hospital who were treated with the Meek micrografting technique from 2013 to 2022 was conducted. Patient demographics, surgical characteristics and outcomes were reported. Regression analyses were performed to identify factors that influence graft take and reoperation rate. RESULTS A total of 73 patients with a mean age of 45.7 ± 19.9 years and mean burn size of 60.0 ± 17.8%TBSA, with 45.3 ± 14.9% TBSA being third degree burns, received Meek transplantation. The mean graft take after removal of the pre-folded polyamide gauze at the tenth post-operative day was 75.8 ± 14.7%. Pre-treatment with use of an allograft, longer waiting time between admission and Meek grafting and transplantation over a dermal matrix were identified as positive predictors for graft take, while age was established as a negative predictor. CONCLUSION By examining the outcomes of the Meek micrografting technique in extensive burn wounds we identified that preconditioning of the wound bed, through allograft or negative pressure wound therapy application, positively correlates with improved outcomes, including higher graft take. At the same time, older age was seen to negatively correlate with graft take. Overall, Meek transplantation displays a favorable safety profile with promising outcomes. Future prospective studies and clinical trials can optimize the procedure and help establish it as the golden standard for extensive and complex burns.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - A Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - V Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - A Palackic
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - K S Houschyar
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
| | - K E Y Claes
- Burn Center, Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S Kuepper
- Burns Center and Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - F Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany.
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Xu R, Fang Y, Zhang Z, Cao Y, Yan Y, Gan L, Xu J, Zhou G. Recent Advances in Biodegradable and Biocompatible Synthetic Polymers Used in Skin Wound Healing. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5459. [PMID: 37570163 PMCID: PMC10419642 DOI: 10.3390/ma16155459] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
The treatment of skin wounds caused by trauma and pathophysiological disorders has been a growing healthcare challenge, posing a great economic burden worldwide. The use of appropriate wound dressings can help to facilitate the repair and healing rate of defective skin. Natural polymer biomaterials such as collagen and hyaluronic acid with excellent biocompatibility have been shown to promote wound healing and the restoration of skin. However, the low mechanical properties and fast degradation rate have limited their applications. Skin wound dressings based on biodegradable and biocompatible synthetic polymers can not only overcome the shortcomings of natural polymer biomaterials but also possess favorable properties for applications in the treatment of skin wounds. Herein, we listed several biodegradable and biocompatible synthetic polymers used as wound dressing materials, such as PVA, PCL, PLA, PLGA, PU, and PEO/PEG, focusing on their composition, fabrication techniques, and functions promoting wound healing. Additionally, the future development prospects of synthetic biodegradable polymer-based wound dressings are put forward. Our review aims to provide new insights for the further development of wound dressings using synthetic biodegradable polymers.
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Affiliation(s)
- Ruojiao Xu
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Yifeng Fang
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Zhao Zhang
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Yajie Cao
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Yujia Yan
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Li Gan
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
| | - Jinbao Xu
- School of Materials and Energy, Guangdong University of Technology, Guangzhou 510030, China
| | - Guoying Zhou
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou 310053, China; (R.X.); (Y.F.); (Z.Z.); (Y.C.); (Y.Y.); (L.G.)
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