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Journal of Tissue Engineering and... Dec 2022Full thickness skin loss is a debilitating problem, most commonly reconstructed using split thickness skin grafts (STSG), which do not reconstitute normal skin thickness...
Full thickness skin loss is a debilitating problem, most commonly reconstructed using split thickness skin grafts (STSG), which do not reconstitute normal skin thickness and often result in suboptimal functional and esthetic outcomes that diminish a patient's quality of life. To address the minimal dermis present in most STSG, engineered dermal templates were developed that can induce tissue ingrowth and the formation of neodermal tissue. However, clinically available dermal templates have many shortcomings including a relatively slow rate and degree of neovascularization (∼2-4 weeks), resulting in multiple dressing changes, prolonged immobilization, and susceptibility to infection. Presented herein is a novel composite hydrogel scaffold that optimizes a unique scaffold microarchitecture with native hydrogel properties and mechanical cues ideal for promoting neovascularization, tissue regeneration, and wound healing. In vitro analysis demonstrated the unique combination of improved mechanical attributes with native hydrogel properties that promotes cell invasion and remodeling within the scaffold. In a novel 2-stage rat model of full thickness skin loss that closely mimics clinical practice, the composite hydrogel induced rapid cell infiltration and neovascularization, creating a healthy neodermis after only 1 week onto which a skin graft could be placed. The scaffold also elicited a gradual and favorable immune response, resulting in more efficient integration into the host. We have developed a dermal scaffold that utilizes simple but unique collagen hydrogel architectural cues that rapidly induces the formation of stable, functional neodermal tissue, which holds tremendous promise for the treatment of full thickness skin loss.
Topics: Rats; Animals; Hydrogels; Quality of Life; Collagen; Wound Healing; Skin Transplantation
PubMed: 36219532
DOI: 10.1002/term.3356 -
Burns : Journal of the International... Nov 2022Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging;... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique.
PATIENTS AND METHODS
A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively.
RESULTS
The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001).
CONCLUSION
The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.
Topics: Humans; Child; Skin Transplantation; Burns; Cicatrix; Prospective Studies; Skin
PubMed: 35248428
DOI: 10.1016/j.burns.2022.01.016 -
Journal of Cosmetic Dermatology Jul 2022The ear is one of the face areas most affected by skin cancers, and the surgical reconstruction is often challenging because of tumor- and patient-related factors....
BACKGROUND
The ear is one of the face areas most affected by skin cancers, and the surgical reconstruction is often challenging because of tumor- and patient-related factors. Reconstructive options are essentially skin flaps and grafts or their combinations. The use of preauricular translocation (PAT) flap for auricular reconstructions is constantly increasing.
AIM AND METHODS
This retrospective study reports the comparison between the PAT flap and the full-thickness skin grafts (FTSGs) for surgical auricular defect reconstruction in elderly population (≥65 years) that typically shows poor compliance in the postoperative wound care management.
RESULTS
A total of 52 FTSGs (Group A) and 39 PAT (Group B) were performed between April 2007 and July 2020. The aim was to investigate, compare, and define advantages and disadvantages of both techniques. Visual Analogue Scale (VAS) was used to evaluate the overall patients' satisfaction. The mean surgical and healing times were longer in Group A (p < 0.05). No complications occurred in the PAT group, and all the flaps survived. In the FTSG group, the overall complication rate was 17.3% (four partial and three total graft failure, and two graft infections). T test was used to compare the VAS scores: Patients with PAT flap were more satisfied than those with FTSG (p < 0.05).
CONCLUSIONS
Preauricular translocation flap is a reproducible, safe, and quick option for auricular defects reconstruction in the ≥65 years population, associated with an easier patient management, high patient satisfaction, and excellent aesthetic result.
Topics: Aged; Ear Neoplasms; Humans; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Treatment Outcome
PubMed: 34648688
DOI: 10.1111/jocd.14519 -
The Journal of Hand Surgery Mar 2022Contracture involving flexor aspect of the fingers is one of the common sequelae encountered after burns, infection, and trauma. In the treatment of contractures, the... (Review)
Review
Contracture involving flexor aspect of the fingers is one of the common sequelae encountered after burns, infection, and trauma. In the treatment of contractures, the surgeon is often challenged by the paucity of skin flaps to cover the joint area. It is then covered with skin grafts, leading to recurrence. When there is a large discrepancy between the required and the available length of skin, traditional Z-plasty techniques fail to overcome this deficiency of the skin. We employ 2 long skin flaps to cover the joint, using all the available skin around the contracture and leaving areas on the sides of the digit that are covered by full-thickness skin grafts.
Topics: Burns; Cicatrix; Contracture; Fingers; Humans; Skin Transplantation; Surgical Flaps
PubMed: 34602336
DOI: 10.1016/j.jhsa.2021.08.005 -
Dermatologic Surgery : Official... Dec 2019
Topics: Humans; Skin; Skin Transplantation; Surgical Tape; Transplant Donor Site
PubMed: 31765339
DOI: 10.1097/DSS.0000000000001788 -
The Journal of Hand Surgery Feb 2023To introduce toe-to-hand transplantation performed with the assistance of both bone and soft tissue modeling using 3-dimensional printing technology.
PURPOSE
To introduce toe-to-hand transplantation performed with the assistance of both bone and soft tissue modeling using 3-dimensional printing technology.
METHODS
From May 2015 to October 2018, 31 patients (group A, 24 thumbs and 7 fingers) were included. Computed tomography scans were acquired using a spiral computed tomography scanner, and the data were processed with software. Bone, skin, and nail models were created for tailoring the flap taken from the great toe. The impact of foot pathology in terms of pain, disability, and activity restriction was assessed using the Foot Function Index. For comparison, we included 35 patients (group B) who underwent toe-to-hand transplantation without the assistance of 3-dimensional computer-aided modeling.
RESULTS
The mean duration of follow-up of groups A and B was 26 months (range, 24-31 months) and 27 months (range, 24-33 months), respectively. The mean Foot Function Index of groups A and B was 5 (range: 0-15) and 17 (range, 0-39), respectively.
CONCLUSIONS
Three-dimensional computer-aided modeling and printing provide geometric accuracy in toe-to-hand transplantation. It also may reduce the donor foot morbidity by accurate flap designing and harvesting.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Toes; Hand Transplantation; Finger Injuries; Amputation, Traumatic; Skin Transplantation; Computer-Aided Design; Printing, Three-Dimensional
PubMed: 35012797
DOI: 10.1016/j.jhsa.2021.09.034 -
Advances in Skin & Wound Care Aug 2022
Topics: Humans; Lacerations; Skin; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps
PubMed: 35856613
DOI: 10.1097/01.ASW.0000835124.90642.ce -
Atlas of the Oral and Maxillofacial... Mar 2020
Review
Topics: Face; Humans; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps
PubMed: 32008703
DOI: 10.1016/j.cxom.2019.11.006 -
Injury Jul 2022Historically, the degloved finger with the total loss of nail and skin had been resurfaced with an expanded great toe wrap-around flap transfer for better outcomes. The...
BACKGROUND
Historically, the degloved finger with the total loss of nail and skin had been resurfaced with an expanded great toe wrap-around flap transfer for better outcomes. The purpose of this study aims to present our experience with a related modified design, with total preservation of a weight-bearing plantar skin.
METHOD
From April 2016 to September 2019, nine fingers (5 index and 4 middle fingers) in nine cases, with skin loss to the base of the proximal phalangeal or metacarpophalangeal (MCP) joint level, were reconstructed with combined great toe dorsal nail-skin flap and medial plantar artery perforator (MPAP) flap. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. The cutaneous nerves were preserved within both flaps. Standardized assessment of outcome in terms of sensory, functional, and esthetic performance of the reconstructed fingers was completed.
RESULTS
Flap survival was achieved in all cases. The contour of the reconstructed digits was comparable with the contralateral one. The fingers were available for a mean follow-up of 28 months (ranged, 22-39 months). The mean dimension of the great toe dorsal nail-skin flap was 8.5 × 4.0 cm (ranged, 6.5 × 3.5-11.0 × 4.5 cm). The average size of the MPAP flap was 6.5 × 4.5 cm (ranged, 5.0 × 3.5-8.0 × 5.5 cm). At the last follow-up, the functional and aesthetic consequences were satisfactory, as well as the restored sensory.
CONCLUSION
Reconstruction of degloved fingers with the great toe dorsal nail-skin flap combined MPAP flap, preserving a plantar weight-bearing area, results in excellent contour and functional outcome. Donor-site morbidity in the foot was minimal.
Topics: Finger Injuries; Finger Phalanges; Hallux; Humans; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation; Treatment Outcome
PubMed: 35613969
DOI: 10.1016/j.injury.2022.05.020 -
Journal of Burn Care & Research :... May 2023Loss of skin grafts can be a dangerous complication during the early postoperative course of patients with extensive burns. A major risk factor for impaired healing of...
Loss of skin grafts can be a dangerous complication during the early postoperative course of patients with extensive burns. A major risk factor for impaired healing of grafts is local wound infection due to bacterial colonization. Burn wounds are particularly prone to bacterial colonization. In this retrospective cohort study, we analyzed correlations between bacteria isolates from burn wounds and loss of skin grafts after surgical treatment. A cohort of patients with burn wounds who received split-skin grafts for wound coverage was divided into groups with and without loss of skin grafts. Demographics, comorbidities, trauma characteristics and bacterial isolates from wound cultures were reviewed and compared. Bacterial colonization isolated from burn wounds upon hospital admission was found to be a significant predictor of skin-graft loss. Additionally, an Abbreviated Burn Severity Index greater 6 predicted graft loss. When comparing bacterial swab results from admission with isolates from revision surgery after graft loss, causative pathogens were found to have changed.
Topics: Humans; Burns; Retrospective Studies; Wound Healing; Skin Transplantation; Debridement; Bacteria
PubMed: 36044197
DOI: 10.1093/jbcr/irac129