554 A Comparison of Intact Piscine Skin, Split-thickness Skin Graft, and Lactic Acid Membrane in Treating Superficial and Deep Burn Wounds Following Enzymatic Debridement

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S125-S126
Author(s):  
Christoph Wallner ◽  
Jana Holtermann ◽  
Marius Drysch ◽  
Johannes Maximilian Wagner ◽  
Mehran Dadras ◽  
...  
Keyword(s):  
Wound Healing ◽  
Lactic Acid ◽  
Skin Graft ◽  
Healing Process ◽  
Split Thickness Skin Graft ◽  
Burn Wounds ◽  
Thickness Skin ◽  
Follow Up Care ◽  
Enzymatic Debridement

Abstract Introduction The optimal therapy for deep burn wounds is based on the principle of rapid necrectomy and coverage in order to achieve healing that is as scar-free as possible. The available infrastructure and the patient’s condition represent limitations. With enzymatic debridement, selective bedside debridement can now be performed, however the optimal cover after enzymatic debridement has not been elucidated to date. In this study we compare superficial dermal and deep dermal wounds, which are either covered with lactic acid membrane, piscine skin, or split-thickness skin graft. To validate our approach the healed burn wounds were examined for objective (elasticity, water content, sebum, wound healing) and subjective skin quality as part of our standard follow-up care. Methods In this study, 12 patients who had received piscine skin, lactic acid membrane, or split-thickness skin graft after enzymatic debridement were retrospectively examined objectively and subjectively for scar quality as part of follow-up care 12 months after the accident. The wound healing process was also documented. Results Acceleration of wound healing was observed with the application of piscine skin vs split-thickness skin graft or lactic acid membrane. Skin elasticity was comparable to that of split-thickness skin graft but significantly better than lactic acid membrane. The sebum production in wounds treated with piscine skin was higher compared to lactic acid membrane covered wounds. The water storage capacity in the piscine skin treated wounds was also significantly higher than in lactic acid membrane or split-thickness skin graft treated wounds. Using the POSAS score, an improvement in elasticity, thickness, pigmentation, and relief was shown in piscine skin treated wounds, as well as a reduction in pain and itching, compared to split-thickness skin graft or lactic acid membrane. Conclusions The use of intact piscine skin immediately following enzymatic debridement in burn wounds results in faster wound healing and better patient outcomes compared to split-thickness skin graft or lactic acid membrane.

Fibrin sealant for split-thickness skin graft fixation in burn wounds - An ancillary postulated role in scar modulation

2020 ◽  
Vol 31 ◽  
pp. 100197
Author(s):  
Vamseedharan Muthukumar ◽  
Suvashis Dash ◽  
Ahmad Faraz Danish ◽  
Srushti Sheth ◽  
Deepak Nanda ◽  
...  
Keyword(s):  
Skin Graft ◽  
Fibrin Sealant ◽  
Graft Fixation ◽  
Split Thickness Skin Graft ◽  
Burn Wounds ◽  
Thickness Skin

scholarly journals Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

2005 ◽  
Vol 38 (02) ◽  
pp. 123-127
Author(s):  
J Joshua ◽  
V Chakraborthy
Keyword(s):  
Skin Graft ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Thickness Skin ◽  
Secondary Defect ◽  
Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

scholarly journals CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexandra Poinas ◽  
Pierre Perrot ◽  
Judith Lorant ◽  
Olivier Nerrière ◽  
Jean-Michel Nguyen ◽  
...  
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Fetal Fibroblasts ◽  
Biological Dressing ◽  
Graft Donor

Abstract Background Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. Methods/design We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. Discussion This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. Trial registration ClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

Biological versus non-biological dressings in the management of split-thickness skin-graft donor sites: a systematic review and meta-analysis

2020 ◽  
Vol 29 (10) ◽  
pp. 604-610
Author(s):  
Shafiq Rahman ◽  
Benjamin Langridge ◽  
Ahmed Al-Hadad ◽  
Rehman Ali Khan ◽  
Muhammad Hyder Junejo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Healing ◽  
Skin Graft ◽  
Meta Analysis ◽  
Healing Time ◽  
Conclusive Evidence ◽  
Split Thickness Skin Graft ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Thickness Skin

Objective: There are currently no definitive guidelines regarding the management of split-thickness skin-graft (STSG) donor sites. The literature reports biological and non-biological dressings as the two main groups; however, there is no conclusive evidence regarding the ideal type. A systematic review and meta-analysis of existing clinical trials was performed to compare biological and non-biological dressings in managing STSG donor sites. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards was used to conduct this study. Electronic databases including MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched by two authors (SR and BL). Data analysis was performed with RevMan 5.3. Results: In total, 10 studies, consisting of eight randomised controlled trials and two observational assessments, were identified. Wound healing time was faster with biological dressings compared to non-biological dressings (mean difference -5.44 days; p<0.05). A higher epithelialisation rate was also noted for biological dressings. There was no difference in the infection rate between the two study groups (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.15–1.04) or wound exudation (OR 0.31; 95% CI 0.01–8.28). The pain level experienced during dressing changes in both groups was reported to be similar. Conclusion: The rate of epithelialisation and wound healing is greater for STSG donor sites when treated with biological dressings, but they offer no difference in terms of reducing pain, limiting infection or exudation.

scholarly journals Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

2021 ◽  
Author(s):  
James R. Furr ◽  
Eric S. Wisenbaugh ◽  
Joel Gelman
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Skin Graft ◽  
Long Term Results ◽  
Split Thickness Skin Graft ◽  
Thickness Skin ◽  
Patient Reported ◽  
Early Success

Abstract Purpose To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods  We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results  Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

scholarly journals Efficiency of Bromelain-Enriched Enzyme Mixture (NexoBrid™) in the Treatment of Burn Wounds

2021 ◽  
Vol 11 (17) ◽  
pp. 8134
Author(s):  
Mihaela Pertea ◽  
Vladimir Poroch ◽  
Petru Ciobanu ◽  
Alexandru Filip ◽  
Natalia Velenciuc ◽  
...  
Keyword(s):  
Skin Graft ◽  
Good Alternative ◽  
Surgical Debridement ◽  
Control Group ◽  
Split Thickness Skin Graft ◽  
Safety Measures ◽  
Thickness Skin ◽  
Tissue Selectivity ◽  
Unaffected Skin ◽  
Enzymatic Debridement

Background: The use of bromelain for the removal of eschar in deep burns is considered to be effective because it does not affect the unaffected skin and leaves a clean dermis after use. The main objective of this study is to find out whether bromelain is a good alternative to surgical debridement. In order to achieve that, we aim to evaluate its indications, limitations, and safety measures. Methods: The current study was conducted on a group of 30 patients with deep burn lesions, aged 20 to 56 years, from which 15 underwent enzymatic debridement and 15 patients acted as a control group in which primary surgical debridement was used. The mixture of enzymes enriched in bromelain, meant to dissolve burn eschar, was provided by NexoBrid™. The inclusion criteria were in agreement with the manufacturer’s protocols, but the application protocol was slightly modified in order to implement a better intern protocol and to assess its efficiency. Results: Complete eschar debridement was obtained in 13 of the 15 cases, from which 10 patients went through spontaneous healing and 3 needed to be covered with a skin graft. In the other 2 cases, partial eschar debridement was associated with surgical debridement and coverage with split-thickness skin graft in the same operation. The results obtained in the two groups were assessed with the Vancouver Scar Scale. Conclusions: Even though early excision followed by coverage with split-thickness skin graft remains the gold standard for the treatment of deep burns, enzymatic debridement can provide a series of advantages when the inclusion and exclusion criteria are respected. Bromelain is an alternative to surgical debridement that provides speed, tissue selectivity, safety, and less blood loss.

scholarly journals Application of Honey and Transparent Dressing to Split Thickness Skin Graft Donor Site and Its Effect on Epithelialization Rate

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Teuku A. ◽  
Nandita Melati P. ◽  
Gentur Sudjatmiko ◽  
Asrofi S. ◽  
Ishandono D.
Keyword(s):  
Clinical Trial ◽  
Wound Healing ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Parallel Design ◽  
Thickness Skin ◽  
Graft Donor ◽  
The Mean ◽  
Clinical Photograph

Background: Split thickness skin graft (STSG) is one of the modalities used to close a defect. The donor site can be healed secondarily with tulle grass and moist gauze after 14 days and with transparent dressing will take about 10-13 days. Recently the wound healing by using honey application has been used. Whether or not using honey application with transparent dressing will hasten the epithelialization rate of the STSG donor site is now in question. Method: This research is an open, non-randomized clinical trial with a parallel design and intervention using honey application with transparent dressing. A total of 19 patients (7 female and 8 male) were included in this study. The reapplication of honey was done every two days. The patients was followed up every day, with clinical photograph taken and complaints such as pain, odor and infection noted. Results: The mean epithelialization rate of the donor site treated with honey and transparent dressing was 9,74 (+0,24) days compared to 10,79 (+1,23) days in the transparent-dressing-only group (p=0,00). Conclusion: The application of honey with transparent dressing to cover for STSG donor site led to a faster epithelialization rate, less odor and less pain. Commercial honey was used, and readily available.

Principles of plastic surgery

2011 ◽  
Author(s):  
P. Baguley
Keyword(s):  
Wound Healing ◽  
Skin Graft ◽  
Split Thickness Skin Graft ◽  
Skin Flaps ◽  
Full Thickness Skin Graft ◽  
Local Skin ◽  
Secondary Intention ◽  
Normal Wound Healing ◽  
Reconstructive Ladder ◽  
Thickness Skin

Introduction 760Anatomy of the integument 762Normal wound healing 764Abnormal wound healing 766Keloids and hypertrophic scars 768Reconstructive ladder 770Primary and secondary intention healing 772Skin grafts 774Split thickness skin graft 776Full thickness skin graft 780Flaps 782Types of local skin flaps ...

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