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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 -
International Wound Journal Apr 2023Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform...
Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full-thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG.
Topics: Humans; Cicatrix; Skin; Skin Transplantation; Subcutaneous Fat; Wound Healing
PubMed: 36330586
DOI: 10.1111/iwj.13975 -
Medicine Dec 2023Using the skin of the lateral malleolus region for reconstruction of smaller areas of the palm may yield better outcomes than using the skin of the groin region....
Using the skin of the lateral malleolus region for reconstruction of smaller areas of the palm may yield better outcomes than using the skin of the groin region. However, no previous study has provided long-term data comparing the groin and lateral malleolus regions as donor sites for full-thickness skin grafts (FTSGs) in palmar reconstruction. Therefore, this study aimed to compare the groin and lateral malleolus regions as donor sites for FTSGs in palmar reconstruction over a long-term follow-up period. The patients were classified into groin and lateral malleolus region groups (n = 15 each). Measurements were obtained at the graft site, the contralateral site corresponding to the graft site, and the donor site. A chromameter was used to measure skin color, and the Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the scar at the skin graft site. Compared to the groin region group, the lateral malleolus region group showed skin colors that were closer to the original color of the palm in terms of lightness and red/green values. Additionally, the lateral malleolus region group received better esthetic ratings in the POSAS. Our results revealed that using the lateral malleolus region for FTSGs in palmar reconstruction resulted in better outcomes than using the groin region, even over a long period.
Topics: Humans; Skin Transplantation; Groin; Cicatrix; Skin; Hand
PubMed: 38115368
DOI: 10.1097/MD.0000000000036487 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2023To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and... (Review)
Review
OBJECTIVE
To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice.
METHODS
The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed.
RESULTS
This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications.
CONCLUSION
Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Topics: Animals; Abdominal Wall; Vascularized Composite Allotransplantation; Transplantation, Homologous; Skin Transplantation; Hematopoietic Stem Cell Transplantation
PubMed: 37460189
DOI: 10.7507/1002-1892.202302077 -
Journal of Investigative Surgery : the... Dec 2023Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic... (Review)
Review
BACKGROUND
Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction.
METHODS
Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session.
RESULTS
The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient.
CONCLUSION
PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.
Topics: Humans; Middle Aged; Surgical Flaps; Skin Transplantation; Burns; Tendons; Lower Extremity; Treatment Outcome
PubMed: 37004999
DOI: 10.1080/08941939.2023.2192786 -
Trends in Biotechnology Jun 1998Driven by the need for donor tissue for patients suffering from extensive burns, alternatives to autologous and cadaver-derived tissue have been under development for... (Review)
Review
Driven by the need for donor tissue for patients suffering from extensive burns, alternatives to autologous and cadaver-derived tissue have been under development for the past 20 years. Unilayered and bilayered models representing the skin's epidermal and/or dermal components have been developed using both cells and matrix materials. In addition to their use in patients with extensive burns, trials using these products on refractory and challenging patients with both acute and chronic wounds have led to the commercial availability of some of these products.
Topics: Cell Transplantation; Cells, Cultured; Epidermal Cells; Humans; Skin Transplantation
PubMed: 9652135
DOI: 10.1016/s0167-7799(98)01196-2 -
The Israel Medical Association Journal... Jan 2013
Topics: Circumcision, Male; Humans; Male; Penis; Postoperative Hemorrhage; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps
PubMed: 23484239
DOI: No ID Found -
Hand Clinics May 2014Elbow and forearm wounds have distinct reconstructive requirements, but both require a durable and pliable solution. Pedicle, free fasciocutaneous and muscle, and... (Review)
Review
Elbow and forearm wounds have distinct reconstructive requirements, but both require a durable and pliable solution. Pedicle, free fasciocutaneous and muscle, and distant (2-stage) flaps have a role in wound reconstruction in these unique areas. This article presents practical surgical cases as a guide to soft tissue reconstruction of the elbow and forearm.
Topics: Fascia; Forearm Injuries; Humans; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Elbow Injuries
PubMed: 24731607
DOI: 10.1016/j.hcl.2013.12.005 -
BMJ (Clinical Research Ed.) Aug 1996
Topics: Cryopreservation; Humans; Skin; Skin Transplantation; Tissue Banks; Transplantation, Homologous
PubMed: 8776302
DOI: 10.1136/bmj.313.7055.439 -
The Journal of Investigative Dermatology Oct 1963
Review
Topics: Aging; Allergy and Immunology; Endocrine Glands; Fetus; History; Humans; Neoplasms; Neoplasms, Experimental; Skin Transplantation; Thymus Gland; Transplantation
PubMed: 14066595
DOI: 10.1038/jid.1963.94