First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

Abstract Background Early excision and skin grafting are commonly used to treat deep dermal burns (DDBs) of the dorsum of the hand. Partial-thickness debridement (PTD) is one of the most commonly used procedures for the excision of burned tissue of the dorsum of the hand. In contrast, full-thickness debridement (FTD) has also been reported. However, it is unclear whether PTD or FTD is better. Methods In this hospital-based retrospective study, we compared the outcomes of PTD followed by a medium split-thickness skin graft (STSG) with FTD followed by a thick STSG to treat a DDB of the dorsum of the hand in Japanese patients. To evaluate postoperative pigmentation of the skin graft, quantitative analyses were performed using the red, green, and blue (RGB) and the hue, saturation, and brightness (HSB) color spaces. We have organized the manuscript in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Data from 11 patients were analyzed. Six hands (five patients) received grafts in the PTD group and eight hands (six patients) received grafts in the FTD group. Graft take was significantly better in the FTD group (median 98 %, interquartile range 95–99) than in the PTD group (median 90 %, interquartile range 85–90) (P < 0.01). Quantitative skin color analyses in both the RGB and HSB color spaces showed that postoperative grafted skin was significantly darker than the adjacent control area in the PTD group, but not in the FTD group. Conclusions There is a possibility that FTD followed by a thick STSG is an option that can reduce the risk of hyperpigmentation after surgery for DDB of the dorsum of the hand in Japanese patients. Further investigation is needed to clarify whether the FTD or the thick STSG or both are the factor for the control of hyperpigmentation.

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Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02224-7 ◽

2021 ◽

Author(s):

Maximilian Lempert ◽

Sascha Halvachizadeh ◽

Clara Charlotte Salfelder ◽

Valentin Neuhaus ◽

Hans-Christoph Pape ◽

...

Keyword(s):

Cohort Study ◽

Soft Tissue ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Skin Grafting ◽

Full Thickness ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Significant Difference ◽

The Impact

Abstract Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. Methods In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, and Pearson’s chi-squared test were used. Results There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: − 2.25 (1.89); OF: − 1.9 (1.37); ST: − 2.6 (2.2)). Conclusion MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.

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Restoring full-thickness defects with spray skin in conjunction with dermal regenerate template and split-thickness skin grafting: a pilot study

Journal of Tissue Engineering and Regenerative Medicine ◽

10.1002/term.2264 ◽

2017 ◽

Vol 11 (12) ◽

pp. 3523-3529 ◽

Cited By ~ 6

Author(s):

Daniel Hammer ◽

Juan L. Rendon ◽

Jennifer Sabino ◽

Kerry Latham ◽

Mark E. Fleming ◽

...

Keyword(s):

Pilot Study ◽

Skin Grafting ◽

Full Thickness ◽

Thickness Skin ◽

Split Thickness Skin Grafting

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Treatment of Full-Thickness Abdominal and Chest Wall Losses With Split-Thickness Skin Grafting

Archives of Surgery ◽

10.1001/archsurg.1977.01370020111015 ◽

1977 ◽

Vol 112 (2) ◽

pp. 217 ◽

Cited By ~ 2

Author(s):

Bernard M. Barrett

Keyword(s):

Chest Wall ◽

Skin Grafting ◽

Full Thickness ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Wall Losses

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Simultaneous coverage of full thickness burn wounds with Matriderm® dermal substitute and split thickness skin grafting

Burns ◽

10.1016/j.burns.2006.10.171 ◽

2007 ◽

Vol 33 (1) ◽

pp. S72 ◽

Cited By ~ 3

Author(s):

P. Kolokythas ◽

Vogt P.M. ◽

P. Boorboor ◽

Bund T.R. ◽

Spies M.

Keyword(s):

Skin Grafting ◽

Dermal Substitute ◽

Full Thickness ◽

Burn Wounds ◽

Thickness Skin ◽

Split Thickness Skin Grafting

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95 Early Clinical Experience with an Autologous Homologous Skin Construct to Treat Deep Partial-thickness and Full-thickness Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.098 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S62-S62

Author(s):

Michael J Feldman ◽

Jinfeng Han ◽

Andreea C Marcu ◽

Sarah E Burkey ◽

Melissa M McLawhorn ◽

...

Keyword(s):

Adverse Events ◽

Donor Site ◽

Skin Grafting ◽

Hair Follicles ◽

Contact Friction ◽

Full Thickness ◽

Burn Wounds ◽

Graft Take ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Introduction Split-thickness skin grafting (STSG) is the standard of care for treating deep burns. They often contract, have limited cosmesis, lack dermal appendages, and result in painful, conspicuous donor sites. An Autologous Homologous Skin Construct (AHSC) has been shown to result in full-thickness skin formation.1,2 This study examined the safety profile, graft take, and quality of healing of a pilot group of AHSC-treated burn wounds. Methods Following IRB approval and informed consent, patients with deep-partial/full-thickness burns requiring grafting underwent side-by-side treatment with AHSC and STSG. A 2cm2 full-thickness harvest was processed into AHSC at an FDA-registered facility, returned within 48 hours, and applied to a 4cm2 area alongside a STSG. AHSC donor site was closed primarily. Wounds were evaluated for healing with digital photography and investigator assessments for 90 days. All adverse events (AEs) were recorded. Results Eight patients with 12% TBSA [range 2–40%] burn wounds were treated; 5 Caucasian and 3 African American with an average BMI of 26.8. Injury was due to predominantly flame burn, with additional injury from grease, scald, contact, friction, and flash. Mean time between injury and AHSC treatment was 11 days [range 5–35 days]. All patients had graft take and complete epithelialization by the end of the study. Patients required one application of AHSC and no other additional surgical procedures at the application sites. The most common AEs for STSG-treated wounds included hypertrophic scarring, pruritus, and insomnia. One non-infected AHSC harvest site experienced a mechanical dehiscence. There were no other AEs related to AHSC treatment. Conclusions No related adverse events at the treatment sites were noted in this study. However, the size of the treatment area limited the ability to comment on the presence of complex dermal elements including hair follicles. Additional investigation with application to larger areas is warranted to evaluate the utility of AHSC for the treatment of acute burn wounds. Applicability of Research to Practice Novel therapy may provide an alternative treatment for burns requiring skin grafting however larger studies are needed.

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One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay

Burns & Trauma ◽

10.1186/s41038-019-0157-0 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 2

Author(s):

Tong Liu ◽

Chao Qiu ◽

Chi Ben ◽

Haihang Li ◽

Shihui Zhu

Keyword(s):

Wound Healing ◽

Healing Rate ◽

Skin Grafting ◽

Skin Defect ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Background Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss. However, for patients with extensive burns, split-thickness skin grafting is limited by donor skin availability. Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality. Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds, but their application currently requires two surgeries. The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model. Methods A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old. The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac, respectively, were overlaid on minced split-thickness skin grafts to repair the defects. Wound healing rate and quality were compared between the two groups. For better illustration of the quality of wound healing, some results were compared with those obtained for normal skin of rats. Results We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis. In addition, this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation. Conclusions Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of full-thickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

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