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Journal of Wound Care Jan 2023Spontaneous wound repair is a complex process that involves overlapping phases of inflammation, proliferation and remodelling, co-ordinated by growth factors and... (Review)
Review
Spontaneous wound repair is a complex process that involves overlapping phases of inflammation, proliferation and remodelling, co-ordinated by growth factors and proteases. In extensive wounds such as burns, the repair process would not be achieved in a timely fashion unless grafted. Although spontaneous wound repair has been extensively described, the processes by which wound repair mechanisms mediate graft take are yet to be fully explored. This review describes engraftment stages and summarises current understanding of molecular mechanisms which regulate autologous skin graft healing, with the goal of directing innovation in permanent wound closure with skin substitutes. Graftability and vascularisation of various skin substitutes that are either in the market or in development phase are discussed. In doing so, we cast a spotlight on the paucity of scientific information available as to how skin grafts (both autologous and engineered) heal a wound bed. Better understanding of these processes may assist in developing novel methods of wound management and treatments.
Topics: Humans; Skin Transplantation; Wound Healing; Skin; Burns; Skin, Artificial
PubMed: 36630112
DOI: 10.12968/jowc.2023.32.1.55 -
Expert Opinion on Biological Therapy 2023Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision... (Review)
Review
INTRODUCTION
Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages.
AREAS COVERED
Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns.
EXPERT OPINION
Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.
Topics: Humans; Wound Healing; Debridement; Burns; Treatment Outcome; Skin Transplantation
PubMed: 37833828
DOI: 10.1080/14712598.2023.2270903 -
The Journal of Craniofacial SurgeryThe scalp defect was a clinical common constructive challenge. This research verified the efficacy of the skin-stretching device in the treatment of scalp defect and...
BACKGROUND
The scalp defect was a clinical common constructive challenge. This research verified the efficacy of the skin-stretching device in the treatment of scalp defect and assessed the associated complications.
METHODS
The clinical data of 12 patients with scalp defect treated with skin-stretching device from January 2020 to January 2021 were collected. We used EASApprox skin-stretching device for the treatment of scalp defect. We described a detailed reconstruction procedure for this treatment. We collected the site, distance from wound edge and other characteristics of the wound, and recorded the number of stretching cycles, operation time, closed state, healing time, and observed postoperative complications and wound healing status.
RESULTS
In this research, the scalp defect was mainly caused by pressure ulcer, and mainly located in the parietooccipital site. The average distance from wound edge was 3.2 cm, the average stretching cycles was 4.2 times during the operation, and the average operation time was 43.5 minutes. Ten patients were directly sutured after stretching, and 2 patients underwent first-stage stretching to reduce the wound. The average time of wound healing was 13.5 days. Postoperative follow-up of 3 months, no patients had wound tear, necrosis, 1 patient suffered from wound exudation and infection due to poor nutrition. Skin function and final scar was acceptable.
CONCLUSION
The treatment of skin-stretching device was effective for scalp defect and has the advantages of convenient operation, acceptable functional results, without severe complications. In addition to traditional treatment, this was a promising treatment. However, more clinical and preclinical research of the skin-stretching device were required.
Topics: Humans; Scalp; Skin Transplantation; Treatment Outcome; Skin; Plastic Surgery Procedures
PubMed: 36214652
DOI: 10.1097/SCS.0000000000008856 -
Wounds : a Compendium of Clinical... Jun 2020Early excision and split-thickness skin autografts (STSGs) have become standard care for full-thickness burns, but healing the donor site challenges these patients who... (Review)
Review
Early excision and split-thickness skin autografts (STSGs) have become standard care for full-thickness burns, but healing the donor site challenges these patients who are already at metabolic and microbial risks, increasing with the total body surface area (TBSA) burned. Engineered skin substitutes containing 1 or more cellular or acellular components of the epidermis, dermis, or hypodermal components have been designed to function as potential STSG replacements, supplementing the barrier or scaffold functions of lost skin. They have reduced the area of STSG tissue needed, helping to improve mortality and healing of patients with large-area, full-thickness burns. Randomized clinical trials (RCTs) continue to explore new ways to optimize scarring, healing, tissue viability, timing, costs, and infection for patients with full-thickness burns2 or chronic wounds. Results for chronic wounds were often inconclusive, based on small studies using varied standards of care with non-blinded outcome evaluation, but evidence on burns is becoming more compelling. This Evidence Corner reviews recent studies that support further improvement of clinical or patient-centered outcomes for hospitalized patients with deep burn wounds managed with STSGs and autologous cultured epidermal cells5 or non-cultured autologous skin cell suspensions.
Topics: Burns; Humans; Skin Transplantation; Wound Healing
PubMed: 32804661
DOI: No ID Found -
Plastic and Aesthetic Nursing
Topics: Skin Transplantation
PubMed: 36450051
DOI: 10.1097/PSN.0000000000000461 -
Annals of Plastic Surgery Oct 2023Cultured epithelial autografts (CEAs) have been used for decades as a treatment for massive burn injuries. Cultured epithelial autografts allow for wounds to heal by...
Cultured epithelial autografts (CEAs) have been used for decades as a treatment for massive burn injuries. Cultured epithelial autografts allow for wounds to heal by taking a small sample and growing a patient's own epithelium in culture to create large, graftable sheets. This technique is especially useful in large wounds where donor sites are limited compared with conventional skin grafting. However, CEAs have a variety of uses in wound healing and reconstruction and have the potential to aid in the closure of several types of defects. Cultured epithelial autografts have shown applicability in large burns, chronic nonhealing wounds, ulcerating wounds of various etiologies, congenital defects, wounds requiring specialized epithelium to replace like by like, and wounds in critically ill patients. Several factors must be considered when using CEAs, such as time, cost, and outcomes. In this article, we detail the various clinical applications of CEAs and how they can be situationally advantageous outside of their original purpose.
Topics: Humans; Autografts; Epithelium; Skin; Burns; Skin Transplantation; Cells, Cultured; Transplantation, Autologous
PubMed: 37157145
DOI: 10.1097/SAP.0000000000003558 -
Tissue Engineering. Part C, Methods Mar 2022Skin is a multilayer organ consisting of several tissues and appendages residing in a complex niche. Adequate and physiologically regulated vascularization is an...
Skin is a multilayer organ consisting of several tissues and appendages residing in a complex niche. Adequate and physiologically regulated vascularization is an absolute requirement for skin homeostasis, regeneration, and wound healing. The lack of vascular networks and ischemia results in delayed wound closure. In addition, vascularization is critical for the prolonged function and survival of skin grafts and tissue-engineered skin substitutes. This study highlights the clinical challenges associated with the limited vascularization in the cutaneous wounds. Then, we highlight the novel approaches for the development of vascular networks in the skin autografts, allografts, and artificial substitutes. Also, the future directions to overcome the existing vascularization complications in skin grafting and synthetic skin substitutes are presented. Statement of Significance Delayed closure of large dermal wounds, such as burn injuries, results from the lack of vascular networks and ischemia. The amount of blood supply in the skin graft is the primary factor determining the quality of the transplanted grafts. The current skin grafts and their fabrication methods lack the appropriate features that contribute to the vascularization and integration of the wound bed and graft and adherence to the skin layers. Therefore, the new generation of skin grafts should consider advanced technologies to induce vascularization and overcome current challenges.
Topics: Skin; Skin Transplantation; Skin, Artificial; Tissue Engineering; Wound Healing
PubMed: 35172639
DOI: 10.1089/ten.TEC.2021.0213 -
Journal of Burn Care & Research :... Sep 2022Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment...
Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data, and cumulative survival were statistically analyzed. One hundred and twenty-seven patients (91 in group A and 36 in group B) were included in the study. There was no significant difference in the baseline data, the length of hospital stay, and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there was no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures), and cumulative survival between the two groups. Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinemia, hypoalbuminemia, and low platelet counts after adequate resuscitation.
Topics: Burns; Humans; Length of Stay; Retrospective Studies; Skin; Skin Transplantation
PubMed: 34902020
DOI: 10.1093/jbcr/irab241 -
International Journal of Pediatric... Mar 2022Complications, including framework exposure, infections, and reconstructed auricle deformation, may occur after auricular reconstruction. However, reports on surgical...
OBJECTIVES
Complications, including framework exposure, infections, and reconstructed auricle deformation, may occur after auricular reconstruction. However, reports on surgical methods for cases with unsatisfactory outcomes after auricular reconstruction using an autologous costal cartilage are insufficient. Herein, we summarized retreatment casesfor poor ear morphology in patients who had undergone auricular reconstruction in our department for 5 years and discussed other techniques.
METHODS
Between September 2014 and September 2019, 24 ears of 24 patients with poor morphology, unsatisfactory macroscopic characteristics and anatomical structures, and unsatisfactory outcomes of local repair after auricular reconstructive surgery were treated. Patients were divided into the following three groups: type 1 (9 ears), with intact and sufficient hairless skin in the mastoid region behind the reconstructed ear; type 2 (7 ears), with intact, but insufficient, hairless skin in the mastoid region behind the reconstructed ear; and type 3 (8 ears), with hairless skin in the mastoid region behind the reconstructed ear with impaired skin integrity.
RESULTS
Twenty-two (91.6%) patients successfully completed the surgical treatment and recovered well; one experienced delayed wound healing and another developed hypertrophic scarring at the incision site at 3 months postoperatively. All patients were followed for 0.5-4 (mean, 2.8) years. The macrostructure of the reconstructed ear post-revision was stable and significantly improved in terms of morphology and structure.
CONCLUSIONS
In patients with unsatisfactory outcomes after auricular reconstruction, the appropriate technique for the revision surgery should consider the local soft tissue conditions of the reconstructed ear to obtain satisfactory results.
Topics: Congenital Microtia; Ear Auricle; Humans; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Treatment Outcome
PubMed: 35063805
DOI: 10.1016/j.ijporl.2022.111043 -
Journal of Plastic, Reconstructive &... Jul 2022Degloving injury is a common and intractable injury with the bone and tendon exposed and contamination, the stripped skin cannot be replanted immediately and will be...
Degloving injury is a common and intractable injury with the bone and tendon exposed and contamination, the stripped skin cannot be replanted immediately and will be discarded, although auto-graft is needed for subsequent wound repair. In this study, autologous skin cryopreservation technique was applied to the treatment of severe limb degloving injuries. The clinical data of 9 patients from January 2016 to December 2018 were analyzed retrospectively. Among the 9 cases, 1 case developed necrosis due to wound infection, and the rest survived 60-100%. The replanted cryopreserved skin were soft and resilient, with poor sensory recovery, varying degrees of discoloration and no hair growth. Cryopreservation provides more time for improving the wound and whole-body condition. The frozen skin had good quality and high survival rate. Our study can effectively use the degloving skin, reduce the damage of the donor area.
Topics: Cryopreservation; Degloving Injuries; Humans; Plastic Surgery Procedures; Replantation; Retrospective Studies; Skin Transplantation; Treatment Outcome
PubMed: 35508521
DOI: 10.1016/j.bjps.2022.04.006