Intermediate Skin Substitutes Are Unnecessary in Small (<10% TBSA) Burns

2020 ◽  
Vol 41 (5) ◽  
pp. 926-928
Author(s):  
Alexandra Michelle Lacey ◽  
Ellen Maniago ◽  
Timothy Justin Gillenwater ◽  
Haig Yenikomshian ◽  
Warren Louis Garner
Keyword(s):  
Graft Failure ◽  
Wound Care ◽  
Graft Loss ◽  
Complete Healing ◽  
Single Stage ◽  
Skin Substitute ◽  
Split Thickness Skin Graft ◽  
Limited Data ◽  
Skin Substitutes ◽  
Thickness Skin

Abstract The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However, there is limited data for their use in relatively small burn wounds (&lt;10% TBSA). In this study, we analyzed the outcomes of 100 consecutive patients who underwent autografting for burns &lt;10% TBSA at our American Burn Association-verified burn unit in the absence of intermediate skin substitute use. We retrospectively analyzed 100 patients who underwent split thickness skin graft autografting for burns &lt;10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (&gt;50% graft failure), and time to complete healing (no further wound care required). Twelve patients (12%) had unpredictable graft beds, and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared with 9.1% rate of graft failure in the primarily grafted group (P = .004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (P = .496 and P = .571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, P = .014). In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention. Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting. The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.

535 Intermediate Skin Substitutes Are Unnecessary in Small (< 10% TBSA) Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S105-S106
Author(s):  
Alexandra M Lacey ◽  
Justin Gillenwater ◽  
Ellen Maniago ◽  
Haig A Yenikomshian ◽  
Warren L Garner
Keyword(s):  
Graft Failure ◽  
Wound Care ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Complete Healing ◽  
Single Stage ◽  
Skin Substitute ◽  
Split Thickness Skin Graft ◽  
Skin Substitutes ◽  
Time From Injury

Abstract Introduction The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However there is limited data for their use in relatively small burn wounds (&lt; 10% total body surface area, TBSA). In this study, we analyzed the outcomes of one hundred consecutive patients who underwent autografting for burns &lt; 10% TBSA at our ABA verified burn unit in the absence of intermediate skin substitute use. Methods We retrospectively analyzed one hundred patients who underwent split thickness skin graft autografting for burns &lt; 10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (&gt;50% graft failure), and time to complete healing (no further wound care required). Results Twelve patients (12%) had unpredictable graft beds and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared to 9.1% rate of graft failure in the primarily grafted group (p=0.004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (p=0.496 and p=0.571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, p=0.014). Many of the patients with these small burns were first managed outpatient and then brought in for autografting leading to a longer time from injury to surgery; while the staged group often presented with wounds that appeared infected and required urgent debridement. In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention. Conclusions Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting. Applicability of Research to Practice The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.

632 How A Recurring Problem Prompted the Combination of Technologies. Our Institutional Experience with The Simultaneous Application of Poly Lactic Acid Polymer Dressings After Application of Suspension Epidermal Autografts.

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S172-S172
Author(s):  
Tracee Short
Keyword(s):  
Lactic Acid ◽  
Wound Care ◽  
Graft Loss ◽  
Case Series ◽  
Standard Of Care ◽  
Poly Lactic Acid ◽  
Skin Substitute ◽  
Skin Substitutes ◽  
Simultaneous Application ◽  
Data Points

Abstract Introduction Our institution has utilized the suspension epidermal autograft solution since a first application with FDA compassionate use protocol. We have since used this commercially available technology for the management of deep partial thickness and full thickness burn wounds. There is a non-adherent dressing in the commercially available kits to cover the suspension in a semi-porous fashion. We often would have beautifully dressed extremities and trunks only to find that in positions of function the non-adherent layer would pop through the intact staples. We then investigated the source of this discrepancy and found the non-elastic property of the dressing the likely culprit. We then began the process to determine an alternative dressing that could work more efficiently. Methods In an effort to determine if the institutional standard of care could be benefitted by this patient-based observation, the charts of patients that underwent simultaneous application of the epidermal autograft suspension and the poly lactic acid polymer dressing were interrogated. The data was identified by the institutional tissue tracker. Once the patient was identified, the chart was then reviewed to determine the desired data points. We evaluated the charts of patients that were recorded as utilizing the suspension epidermal autograft charge as wells charges for the poly lactic acid polymer skin substitute. The charts were then evaluated to determine if there were any deviations from our expected outcomes using the suspension alone. Results Our preliminary results indicate that the patients were able to discharge sooner as the wound care associated with the polymer skin substitute is more streamlined. It did not reflect any areas of graft loss but did in 2 instances remained in place longer than our standard. The wound was healed beneath but the skin substitute remained adhered. Conclusions The simultaneous use of suspension epidermal autografts and poly lactic acid skin substitutes has become common place for our institution. A quick review as a QI project has resulted in the desire to delve further into comparative data points. A formal retrospective review of the charts will be undertaken for a case series of about 20 patients.

scholarly journals Development of a Novel Pre-Vascularized Three-Dimensional Skin Substitute Using Blood Plasma Gel

2018 ◽  
Vol 27 (10) ◽  
pp. 1535-1547 ◽  
Author(s):  
Niann-Tzyy Dai ◽  
Wen-Shyan Huang ◽  
Fang-Wei Chang ◽  
Lin-Gwei Wei ◽  
Tai-Chun Huang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Human Plasma ◽  
Three Dimensional ◽  
Skin Substitute ◽  
Strength Analysis ◽  
Full Thickness ◽  
Skin Substitutes ◽  
Full Thickness Skin ◽  
Post Surgery ◽  
Thickness Skin

Skin substitutes with existing vascularization are in great demand for the repair of full-thickness skin defects. In the present study, we hypothesized that a pre-vascularized skin substitute can potentially promote wound healing. Novel three-dimensional (3D) skin substitutes were prepared by seeding a mixture of human endothelial progenitor cells (EPCs) and fibroblasts into a human plasma/calcium chloride formed gel scaffold, and seeding keratinocytes onto the surface of the plasma gel. The capacity of the EPCs to differentiate into a vascular-like tubular structure was evaluated using immunohistochemistry analysis and WST-8 assay. Experimental studies in mouse full-thickness skin wound models showed that the pre-vascularized gel scaffold significantly accelerated wound healing 7 days after surgery, and resembled normal skin structures after 14 days post-surgery. Histological analysis revealed that pre-vascularized gel scaffolds were well integrated in the host skin, resulting in the vascularization of both the epidermis and dermis in the wound area. Moreover, mechanical strength analysis demonstrated that the healed wound following the implantation of the pre-vascularized gel scaffolds exhibited good tensile strength. Taken together, this novel pre-vascularized human plasma gel scaffold has great potential in skin tissue engineering.

scholarly journals Outcome of honey dressing on pain relief and re-epithelization of donor site wound of split thickness skin graft.

2020 ◽  
Vol 27 (08) ◽  
pp. 1697-1702
Author(s):  
Abdul Malik Mujahid ◽  
Farrukh Aslam Khalid ◽  
Kashif Khan Niazi ◽  
Hina Nabi Ahmed ◽  
Ghulam Yaseen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Outcome Measures ◽  
Skin Graft ◽  
Donor Site ◽  
Case Series ◽  
Visual Analogue Score ◽  
Complete Healing ◽  
Split Thickness Skin Graft ◽  
Thickness Skin ◽  
Surgery Department

Objectives: To determine the frequency of pain relief and re-epithelization of the donor site wound of split thickness skin graft with the use of honey dressing. Study Design: Descriptive Case Series. Setting: Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Centre Lahore. Period: From 1st January, 2019 to 30th November, 2019. Material & Methods: A total of 100 patients with healthy granulating wound were included in the study. All patients undergone operations under general anaesthesia by the same surgeon. The dressing was done by a layer of honey on gauze piece, wrapped around the donor wound site of split thickness skin graft. Patients were followed at the 7th post-operative day and outcome measures were noted. Pain was scored by the use of Visual analogue score (VAS) and re-epithelization was complete healing of the wound. Results: A total of 100 patients were enrolled with mean age of 33.11±9.72 years and there were 45% (45) females and 55% (55) male patients. Mean wound size was 7.70±1.83 cm2. At the 7th post-operative day follow up; pain relief was seen in 74% patients and re-epithelization was seen in 78% of patients. Both the outcome measures i.e. pain relief and re-epithelialization was effectively controlled with the use of honey dressing. Conclusion: Honey dressing is useful and effective on split thickness skin graft donor site in terms of pain relief and re-epithelization.

scholarly journals Allogeneic Skin Substitutes Versus Human Placental Membrane Products in the Management of Diabetic Foot Ulcers: A Narrative Comparative Evaluation of the Literature

2019 ◽  
Vol 18 (1) ◽  
pp. 10-22 ◽  
Author(s):  
Joshua Luck ◽  
Timo Rodi ◽  
Alexander Geierlehner ◽  
Afshin Mosahebi
Keyword(s):  
Diabetic Foot ◽  
Wound Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Foot Ulcers ◽  
Skin Substitute ◽  
Diabetic Foot Ulcers ◽  
Skin Substitutes

Outcomes following standard wound care (SWC) for diabetic foot ulcers (DFUs) remain suboptimal. Supplementing SWC with tissue engineered allogeneic cellular wound therapies represents an emerging treatment strategy. This review aimed to evaluate the efficacy and safety of allogeneic skin substitutes and human placental membrane allografts in the management of DFUs. Ovid MEDLINE and Embase databases were searched from inception to October 2017. Any randomized controlled trial (RCT) with an allogeneic skin substitute or placental membrane allograft intervention group was included. Our primary outcome measure was the proportion of completely healed ulcers. Secondary outcome measures included time to complete wound healing and local adverse event rates. Each study was assessed for risk of bias and the quality of evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Moderate quality evidence from 11 included RCTs demonstrated that both allogeneic cellular approaches improve the proportion of completely healed ulcers at 6 and 12 weeks. One RCT showed that a placental membrane allograft was superior to an allogeneic skin substitute, although this has yet to be repeated in other studies. The addition of allogeneic cellular wound products to SWC improves DFU outcomes. Further studies are required to conclusively establish if placental membrane allografts are superior to allogeneic skin substitutes.

scholarly journals Major Risk Factors Contributing to Split Thickness Skin Graft Failure

2019 ◽  
Author(s):  
Jon D Turissini ◽  
Tammer Elmarsafi ◽  
Karen K Evans ◽  
Paul J Kim
Keyword(s):  
Risk Factors ◽  
Skin Graft ◽  
Graft Failure ◽  
Split Thickness Skin Graft ◽  
Thickness Skin

The Ideal Donor Site Dressing: A Comparison of a Chitosan Based Gelling Dressing to Traditional Dressings

2021 ◽  
Author(s):  
Nkemjika Uke ◽  
Simran Singh ◽  
Grant E Sorensen ◽  
Joshua Frost ◽  
Amanda Venable ◽  
...  
Keyword(s):  
Skin Graft ◽  
Wound Care ◽  
Low Cost ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Application Rate ◽  
Care Plan ◽  
Wound Management ◽  
Split Thickness Skin Graft ◽  
Thickness Skin

Abstract Introduction Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7-14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. Methods We conducted a retrospective chart review of patients who received CBGD as part of their post-operative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. Results One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. Conclusions CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

Comparison of Autologous Full-Thickness Gingiva and Skin Substitutes for Wound Healing

2008 ◽  
Vol 17 (10-11) ◽  
pp. 1199-1209 ◽  
Author(s):  
Abraham P. Vriens ◽  
Taco Waaijman ◽  
Henk M. Van Den Hoogenband ◽  
Edith M. De Boer ◽  
Rik J. Scheper ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Wound Healing ◽  
Chronic Wounds ◽  
Clinical Applications ◽  
Skin Substitute ◽  
Full Thickness ◽  
Skin Substitutes ◽  
Differentiation Markers ◽  
Full Thickness Skin ◽  
Thickness Skin

Ideally tissue-engineered products should maintain the characteristics of the original tissue. For example, skin represents orthokeratinized epithelium and oral gingiva represents parakeratinized epithelium. The aim of this study was to develop an autologous full-thickness gingiva substitute suitable for clinical applications and to compare it with our autologous full-thickness skin substitute that is routinely used for healing chronic wounds. Autologous full-thickness skin and gingiva substitutes were constructed under identical culture conditions from 3-mm punch biopsies isolated from the upper leg or gingiva tissue, respectively. Both consisted of reconstructed epithelia on acellular dermis repopulated with fibroblasts. To compare the characteristics of the original and reconstructed tissue, differential morphological observations and expression of differentiation markers (keratins 6, 10, and 17 and stratum corneum precursors involucrin, loricrin, and SKALP) were determined. Skin and gingiva substitutes were transplanted onto therapy-resistant leg ulcers or tooth extraction sites in order to determine their effects on wound healing. The tissue-engineered constructs maintained many of the differential histological and immunohistochemical characteristics of the original tissues from which they were derived. The skin substitute was orthokeratinized, and the gingiva substitute was parakeratinized. Transplantation of skin (n = 19) and gingiva substitutes (n = 3) resulted in accelerated wound healing with no adverse effects. As identical culture systems were used to generate both the skin and gingiva substitutes, the differences observed in tissue (immuno)histology can be attributed to intrinsic properties of the tissues rather than to environmental factors (e.g., air or saliva). This study emphasizes the importance of closely matching donor sites with the area to be transplanted. Our results represent a large step forward in the area of clinical applications in oral tissue engineering, which have until now greatly lagged behind skin tissue engineering.

scholarly journals Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

2017 ◽  
Author(s):  
Elton Mathias ◽  
Madhu Srinivas Murthy
Keyword(s):  
Wound Repair ◽  
Wound Care ◽  
Point Of View ◽  
Burn Injuries ◽  
Skin Substitute ◽  
Future Prospects ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Basic Care

Burns is a pervasive and oppressive basic care issue. In children, burn injuries are a major reason for bleakness and mortality. The quirks in the physiology of liquid and electrolyte taking care of, the vital necessity and the distinctions in the different body extends in children direct that the pediatric wounds administration ought to be brought with an alternate point of view than for adults. Notwithstanding, for the intensivist, challenges regularly exist that muddle quiet help and adjustment. Moreover, burn injuries are mind-boggling and can show exceptional challenges that require deep-rooted recovery. Investigation in burn wound care has yielded progressions that will keep on improving practical recuperation. What's more, pain management all through this period is essential. Managing these wounds requires escalated therapeutic treatment for multi-organ dysfunction, and forceful surgical treatment to forestall sepsis and other inconveniences. The biological therapeutic bilayered skin substitutes with a long shelf life that recapitulates the normal barrier function of the intact human skin and stimulate wound repair and skin regeneration. A definitive objective is to accomplish a perfect skin substitute that gives a successful and without scar wound recuperating. This review article features the headway in pediatric burn wounds with an emphasis on the pathophysiology and treatment of burn wounds.

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