scholarly journals Prevascularization of dermal substitutes with adipose tissue-derived microvascular fragments enhances early skin grafting

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Florian S. Frueh ◽  
Thomas Später ◽  
Christina Körbel ◽  
Claudia Scheuer ◽  
Anna C. Simson ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Skin Grafting ◽  
Dermal Substitutes

The Crucial Role of Vascularization and Lymphangiogenesis in Skin Reconstruction

2018 ◽  
Vol 59 (3-4) ◽  
pp. 242-254 ◽  
Author(s):  
Florian S.  Frueh ◽  
Nadia Sanchez-Macedo ◽  
Maurizio Calcagni ◽  
Pietro Giovanoli ◽  
Nicole Lindenblatt
Keyword(s):  
Clinical Practice ◽  
Skin Grafting ◽  
Lymphatic Drainage ◽  
Skin Grafts ◽  
Skin Substitutes ◽  
Microvascular Network ◽  
Skin Defects ◽  
Dermal Substitutes ◽  
Skin Reconstruction

Background: The treatment of extensive skin defects and bradytrophic wounds remains a challenge in clinical practice. Despite emerging tissue engineering approaches, skin grafts and dermal substitutes are still the routine procedure for the majority of skin defects. Here, we review the role of vascularization and lymphangiogenesis for skin grafting and dermal substitutes from the clinician’s perspective. Summary: Graft revascularization is a dynamic combination of inosculation, angiogenesis, and vasculogenesis. The majority of a graft’s microvasculature regresses and is replaced by ingrowing microvessels from the wound bed, finally resulting in a chimeric microvascular network. After inosculation within 48–72 h, the graft is re-oxygenated. In contrast to skin grafts, the vascularization of dermal substitutes is slow and dependent on the ingrowth of vessel-forming angiogenic cells. Preclinical angiogenic strategies with adipose tissue-derived isolates are appealing for the treatment of difficult wounds and may markedly accelerate skin reconstruction in the future. However, their translation from bench to bedside is still restricted by major regulatory restrictions. Finally, the lymphatic system contributes to edema reduction and the removal of local wound debris. Therapeutic lymphangiogenesis is an emerging field of research in skin reconstruction. Key Messages: For the successful engraftment of skin grafts and dermal substitutes, the rapid formation of a microvascular network is of pivotal importance. Hence, to understand the biological processes behind revascularization of skin substitutes and to implement this knowledge into clinical practice is a prerequisite when treating skin defects. Furthermore, a functional lymphatic drainage crucially contributes to the engraftment of skin substitutes.

643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Laura Cooper ◽  
Phillip Kemp Bohan ◽  
Anders H Carlsson ◽  
Rodney K Chan ◽  
Tyler Everett
Keyword(s):  
Graft Survival ◽  
Skin Graft ◽  
Skin Grafting ◽  
Dermal Substitute ◽  
Skin Grafts ◽  
Pressure Therapy ◽  
Nutrient Supplementation ◽  
Successful Model ◽  
Dermal Substitutes ◽  
Graft Take

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p< 0.01, p=0.02, p< 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.

scholarly journals Dermal Substitutes Use in Reconstructive Surgery for Skin Tumors: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mariane Campagnari ◽  
Andrea S. Jafelicci ◽  
Helio A. Carneiro ◽  
Eduard R. Brechtbühl ◽  
Eduardo Bertolli ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Reconstructive Surgery ◽  
Treatment Options ◽  
Tumor Resection ◽  
Skin Grafting ◽  
Lower Limbs ◽  
Skin Tumor ◽  
Single Center ◽  
Dermal Substitutes ◽  
Single Center Experience

Reconstructive surgery following skin tumor resection can be challenging. Treatment options after removing the tumor are skin grafting, local pedicled and axial flaps, or microsurgery for complex and extensive wounds correction. Recently, the use of dermal substitutes has been extended to reconstructive surgery in cutaneous oncology. Objectives. To report both a single-center experience using dermal substitutes in reconstructive surgery for skin malignancies and reconstructive surgery’s outcomes. Methods and Results. Among thirteen patients, seven (53.8%) were male with mean age of 62.6 years. Regarding diagnosis, there were five cases (38.5%) of basal cell carcinoma (BCC), two (15.4%) of melanoma in situ, two (15.4%) of dermatofibrosarcoma protuberans, one (7.7%) of squamous cell carcinoma (SCC), one (7.7%) of angiosarcoma, and one (7.7%) of eccrine carcinoma (EC). The most common site of injury was scalp (53.8%) and lower limbs (23.1%). Seven (53.8%) patients used NPWT and six (46.2%) patients underwent Brown’s dressing. The most frequent complication of the first stage was wound contamination (38.5%). Average time to second-stage skin grafting was 43.9 days. Three (23%) patients developed tumor recurrence and one died. Conclusions. Use of dermal substitutes in oncology can be an option for reconstruction after extended resections, providing good aesthetical and functional results.

scholarly journals Liposuction Treatment of Lymphedema

2018 ◽  
Vol 32 (01) ◽  
pp. 042-047 ◽  
Author(s):  
Mark Schaverien ◽  
D. Munnoch ◽  
Håkan Brorson
Keyword(s):  
Adipose Tissue ◽  
Skin Grafting ◽  
Functional Results ◽  
Western World ◽  
Compression Garments ◽  
Pressure Therapy ◽  
Complete Reduction ◽  
Surgical Treatments ◽  
Subcutaneous Adipose

AbstractIn the Western world, lymphedema most commonly occurs following treatment of cancer. Limb reductions have been reported utilizing various conservative therapies including manual lymph and pressure therapy, as well as by microsurgical reconstruction involving lymphovenous shunts and transplantation of lymph vessels or nodes. Failure of these conservative and surgical treatments to provide complete reduction in patients with long-standing pronounced lymphedema is due to the persistence of excess newly formed subcutaneous adipose tissue in response to slow or absent lymph flow, which is not removed in patients with chronic non-pitting lymphedema. Traditional surgical regimes utilizing bridging procedures, total excision with skin grafting, or reduction plasty seldom achieved acceptable cosmetic and functional results. Liposuction removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction, and this reduction is maintained long-term through constant (24 h) use of compression garments postoperatively. This article describes the techniques and evidence basis for the use of liposuction for treatment of lymphedema.

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