107 Esterified Hyaluronic Acid Matrix in Lower Extremity Wound Reconstruction

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S70-S71
Author(s):  
Sai R Velamuri ◽  
Steven D Kozusko ◽  
Ammar Mahmood ◽  
David M Hill ◽  
Kalyan C Dadireddy
Keyword(s):  
Hyaluronic Acid ◽  
Lower Extremity ◽  
Chronic Wounds ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Dermal Substitute ◽  
Medical Comorbidities ◽  
Burn Center ◽  
Mean Time

Abstract Introduction Esterified hyaluronic acid matrix (eHAM) skin substitutes have been applied to burn wounds, chronic wounds, and even congenital syndactyly release. eHAM consists of a controlled release form of hyaluronic acid (HA) in a matrix covered with a silicone layer. HA draws water into the wound bed, allowing for capillary ingrowth and cellular invasion. Angiogenesis and dermal regeneration with endothelial cells and fibroblasts promotes tissue regeneration. Methods We performed a retrospective review of patients treated with an eHAM at the regional burn center in the past year. A total of fifteen patients were identified. Their charts were reviewed to assess demographics, time to graft, follow-up duration, mechanism, comorbidities, outcomes, and complications. Additionally, photographic images were obtained from the burn center camera for each patient to assess clinical progression of healing. Results The mean patient age was 45.8 years. Mean time to split-thickness skin graft was 22.9 days, with a range of 14 to 36 days. The medium follow-up for this study was 12 weeks. Six patients sustained an injury due to either a thermal or electrical burn, and seven patients had diabetes mellitus. Nine patients were active smokers. Eight patients had hypertension and four had kidney disease. Coverage included tibia, calcaneus, Achilles tendon, and dorsal foot extensor tendons. One patient received bedside application of HM. One patient received a second OR application of HM. This series consisted of fifteen patients with multiple medical comorbidities and exposed critical structures, thirteen of which were successfully treated with eHAM. Conclusions When critical structures such as bone and tendon are exposed, dermal coverage is often needed prior to skin-grafting. Dermal coverage is necessary to prevent infection, desiccation, and osteomyelitis. eHAM is a modality that create a granulation bed that covers critical structures, allowing for subsequent skin-grafting in a properly selected and challenging population. eHAM can be used as a dermal substitute in complex wound cases as a bridge to definitive coverage with autologous skin-grafting. This study has demonstrated successful coverage of tendons, bones, and chronic wounds in mean time of three to four weeks in a population with multiple medical comorbidities, complex lower extremity wounds, and contraindications to local and free flap coverage. Applicability of Research to Practice This research is based on clinical practice. We have salvaged thirteen of fifteen wounds that were at risk for amputation or further delayed healing, desiccation, and infection.

Utility of Porcine-Derived Xenograft as an Adjunct to Split-Thickness Skin Grafting in Lower-Extremity Wounds

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Jenna C. Bekeny ◽  
Christopher Kennedy ◽  
Jon D. Turissini ◽  
Iram Naz ◽  
Elliot T. Walters ◽  
...  
Keyword(s):  
Wound Healing ◽  
Lower Extremity ◽  
Hemoglobin A1c ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Patient Reported ◽  
Wound Bed Preparation ◽  
Future Work

Objective Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30- and 60-day outcomes were collected. Results There was no difference in healing outcomes between the PXBD (n = 27) and no preparation (n = 39) groups. At 30- and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P30 = .818; 82.2% versus 80.9%, P60 = .422). Mean wound sizes at these follow-up periods were not different (4.4 cm2 versus 5.1 cm2, P30 = .902; 1.2 cm2 versus 1.1 cm2, P60 = .689). The PXBD group had a higher mean ± SD hemoglobin A1c level (8.3 ± 3.5 versus 6.9 ± 1.6; P = .074) and age (64.9 ± 12.8 years versus 56.3 ± 11.9 years; P = .007) versus the no preparation group. Conclusions Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct.

scholarly journals Versatile use of dermal substitutes: A retrospective survey of 127 consecutive cases

2018 ◽  
Vol 51 (01) ◽  
pp. 046-053 ◽  
Author(s):  
Giovanni Nicoletti ◽  
Marco Mario Tresoldi ◽  
Alberto Malovini ◽  
Marco Visaggio ◽  
Angela Faga ◽  
...  
Keyword(s):  
Chronic Wounds ◽  
Healing Process ◽  
Three Dimensional ◽  
Clinical Indication ◽  
Clinical Variable ◽  
Split Thickness Skin Graft ◽  
Radical Excision ◽  
Dermal Substitute ◽  
Dermal Substitutes ◽  
Scalp Defects

ABSTRACT Background: Dermal substitutes are currently largely used for the treatment of huge skin loss in patients in critical general health conditions, for the treatment of severe burns and to promote the healing process in chronic wounds. Aims: The authors performed a retrospective assessment of their experience with bioengineered skin to possibly identify the most appropriate clinical indication and management for each substitute. Materials and Methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes over a 9 years period, from 2007 to 2016. Hyalomatrix® was used in 63 defects, whereas Integra® and Nevelia® were used in 56 and 8 defects, respectively. Results: The statistical analysis failed to reveal a correlation between the choice of a specific dermal substitute and any possible clinical variable except in the soft-tissue defects of the scalp where Hyalomatrix® was electively used. Conclusions: In the authors’ experience, the scalp defects followed a radical excision of skin tumours that included the periosteum. Here, the preliminary cover with a hyaluronan three-dimensional scaffold constantly allowed for the regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. Nevertheless, the authors still prefer Integra® when the goal is a better cosmetic outcome and Hyalomatrix® when a faster wound healing is required, especially in the management of deep wounds where the priority is a fast obliteration with a newly formed tissue with a rich blood supply. However, these clinical indications still are anecdotally based.

scholarly journals Vacuum-assisted closure dressing in split-thickness skin grafting

2019 ◽  
Vol 10 (3) ◽  
pp. 1735-1740
Author(s):  
Ali A Ali ◽  
Yasir N Qassim ◽  
Ali N Areef
Keyword(s):  
Skin Graft ◽  
Chronic Wounds ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Vacuum Assisted Closure ◽  
Wound Site ◽  
Graft Take ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Vacuum-assisted closure (VAC) has been applied to a variety of acute and chronic wounds that are difficult to manage, and is associated with improved wound healing outcomes. It involves the application of sub-atmospheric pressure in a controlled way to secure a split-thickness skin graft on the wound that has been sealed with an occlusive dressing.A study was conducted on the patients with a variety of indications for skin grafting, admitted to Azadi Teaching Hospital between March 2010 and August 2017. After the application of split-thickness skin graft, a closed, controlled suction was applied on the wound. The graft was then continuously observed, and the dressing was changed as needed.A total of 39 split-thickness skin grafting procedures were performed on 37 patients (20 male, 17 female), the age of the patients ranging between 7 and 68 years. The average grafted area was 12±70 cm2, and the percent graft take ranged from 90 - 100%.Vacuum-assisted closure opposes the graft firmly on the wound bed, sucks out the seroma and/or hematoma, prevents shearing of the graft and aids in immobilization of the grafted part; thus improving the quantity and quality of the graft take. This study also established that VAC was particularly useful when the wound site is difficult to access, the wound is highly contoured and the conditions are less-than-ideal for complete graft take.

scholarly journals Esterified Hyaluronic Acid Matrix in Lower Extremity Reconstruction With Exposed Tendon and Bone: A Retrospective Review

2020 ◽  
Vol 41 (4) ◽  
pp. 828-834
Author(s):  
Steven D Kozusko ◽  
Mahmoud Hassouba ◽  
David M Hill ◽  
Xiangxia Liu ◽  
Kalyan Dadireddy ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Lower Extremity ◽  
Tissue Regeneration ◽  
Skin Graft ◽  
Endothelial Cell Migration ◽  
Split Thickness Skin Graft ◽  
Novel Technologies ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Exposed Bone

Abstract Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases.

Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: a novel technique based on the regenerative model

2014 ◽  
Vol 39 (9) ◽  
pp. 994-1000 ◽  
Author(s):  
A. Landi ◽  
L. Garagnani ◽  
A. Leti Acciaro ◽  
M. Lando ◽  
H. Ozben ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Skin Grafting ◽  
Parental Satisfaction ◽  
Minimal Degree ◽  
Promising Alternative ◽  
Novel Technique ◽  
Skin Defects ◽  
Scar Quality ◽  
Cosmetic Outcomes

Syndactyly release may require skin grafting to fill the skin defects, which might lead to complications or poor cosmetic outcomes. A simple graftless technique for syndactyly release with a hyaluronic acid (HA) scaffold used to cover the bare areas is described. Between 2008 and 2011, release of 26 webs in 23 patients was performed. All skin defects were covered with Hyalomatrix® PA. One patient was excluded due to early post-operative infection that required HA scaffold removal before its integration. Web creep, secondary deformities, scar quality, and patient and parental satisfaction were assessed. Mean follow-up of the group of 22 patients was 24 months. There were no secondary deformities and minimal degree of web creep. All patients had close to normal pigmentation and good pliability at the sites of scaffold application. The results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery.

Outcomes of Split Thickness Skin Grafting on Lower Extremity Wounds in Diabetics

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 111-OR
Author(s):  
ELLIOT WALTERS ◽  
GREG STIMAC ◽  
NEHA RAJPAL ◽  
IRAM NAZ ◽  
TAMMER ELMARSAFI ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

Cryogenic Refrigerant Burns: A Rare Occupational Hazard

2020 ◽  
pp. 216507992096553
Author(s):  
Suvashis Dash ◽  
Vamseedharan Muthukumar ◽  
Rajkumar R ◽  
Durga Karki
Keyword(s):  
Exposure Time ◽  
Treatment Plan ◽  
Hand Function ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Air Conditioners ◽  
Burn Center ◽  
Adequate Knowledge ◽  
Treatment Measures ◽  
Burn Depth

Background Cryogenic burns induced by coolant gases used in refrigerators and air conditioners are rarely encountered, despite the wide use of these gases. To date, only a few cases have been reported in the literature. This study examined the occupational circumstances leading to such injuries, relevant injury sites, types of chemicals involved, and treatment measures. Methods This study was conducted in a tertiary burn center in India between March 2015 and March 2019. The demographic details, chemicals involved, and burn regions and characteristics were analyzed. Findings There were 15 burn cases all involving injury to the hand. All injuries were managed initially with dressings and nonoperative management. One patient required anti-edema therapy with limb elevation and fingertip debridement, while another patient required skin grafting. All patients had satisfactory hand function after treatment. Conclusions/Application to Practice Cryogenic burn injuries caused by refrigerants are rare, and their etiology varies considerably. Exposure time is the primary factor that determines burn depth and severity; hence, reducing exposure time is important in first aid. Our findings suggest that after exposure, the patient should be treated in a specialized burn center. Adequate knowledge regarding the pathophysiology of these types of burn injuries and their management is necessary; otherwise, misjudgments in the treatment plan can lead to adverse consequences.

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