560 Vacuum Assisted Dressing can be Used as an Effective Dressing Over Non-cultured, Autologous Skin Cell Suspension (ASCS) Combined with Wide Meshed Split Thickness Autografts (mSTSG)

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S129-S130
Author(s):  
Joe A Olivi ◽  
Megan D Rodgers
Keyword(s):  
Cell Suspension ◽  
Wound Closure ◽  
Surgical Debridement ◽  
Closure Device ◽  
Vacuum Assisted Closure ◽  
Dermal Matrix ◽  
Good Function ◽  
Skin Cell ◽  
Graft Take ◽  
Negative Outcome

Abstract Introduction There are accounts of various dressings being applied over epidermal spray cell suspension graft(s) (SCSG) with varying success and no one perfect dressing. We present 3 patients with ASCS grafts used in combination with mSTSG that were treated with vacuum assisted dressing with excellent outcomes. Methods All 3 of our patients received surgical debridement, down to healthy viable tissue with exposed tendon. BTM Dermal matrix was used in 2 of the 3 patients with exposed tendon. All three patients had mSTSG with ACSS autografts. All grafts were covered with telfa ™ clear, followed by tacky macroporous silver dressing, then a vacuum assisted closure device. These were left undisturbed until post operative day (POD) 5. Results All patients had their dressings taken down on POD #5 with excellent results. The interstices were closed quickly with no negative outcome noted from the vacuum dressings. All patients had excellent wound closure and good function postoperatively. Conclusions Vacuum assisted closure devices can be used to cover ASCS and wide meshed grafts with good outcomes. They provide patients with a stable dressing that does not need to be changed and leads to excellent graft take and wound closure.

666 Autologous Skin Cell Therapy After Dermal Matrix with STSG in a 5-year-old African-American Female - How Adjunct Therapies are Refining the Dogmatic Treatment Approach to Burns

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S189-S190
Author(s):  
Alexandra Coward
Keyword(s):  
African American ◽  
Cell Suspension ◽  
Healing Time ◽  
African American Female ◽  
Full Thickness ◽  
Dermal Matrix ◽  
Skin Cell ◽  
Thickness Skin ◽  
Dermal Regeneration

Abstract Introduction Split-thickness skin grafting (STSG) is the standard of care for the treatment of full thickness skin injuries. Skin grafts are associated with long-term morbidity including graft loss, adjacent structural injury, anesthetic complications, scarring, and scar contractures. Large surface area burns are additionally challenging due to limited donor site availability. Autologous skin cell suspension (ASCS) is a new adjunct for STSG using device that provides a suspension of non-cultured, autologous skin cells applied overtop of STSG. Dermal matrix templates are placed on wounds after burn excision and induces dermal regeneration in preparation for STSG, allowing for a thinner graft to be harvested and applied. This technique has been shown to require both smaller areas of donor skin as well as thinner skin harvest which improves both healing time and aesthetic outcomes of donor sites, enhancing the time-tested and well accepted technique of STSG. Methods We present the case of a 5-year-old African American female who suffered 18% TBSA deep partial thickness burns and full thickness burns to her abdomen, trunk and left back after her shirt was accidentally lit on fire at home. She was transferred from a local hospital to our burn center for further evaluation. She was evaluated by both the burn surgery and pediatric teams and admitted for wound cares and surgical planning. Results On hospital day five she underwent burn excision and placement of acellular dermal regeneration template. She returned to the operating room on hospital day 22 after daily wound cares for autografting with autologous skin cell suspension application to anterior and posterior torso and left arm, as well as to back and thigh donor sites. Her takedown on hospital day 29 showed excellent graft take. She was ultimately discharged on hospital day 47. She continued to undergo wound care in the outpatient burn clinic and daily physical and occupational therapy. Conclusions This case illustrates the use of dermal matrix and ASCS on a large burn with excellent aesthetic outcomes and improved healing time. This case is unique in highlighting the versatility of this therapy in a darker skinned patient. There are significant challenges with long term morbidity from STSG and the use of both dermal regenerative matrix and ASCS may provide surgeons with new approaches to decreasing depth and size of donor sites, as well as improving the length of hospital stay and overall aesthetic outcomes of donor and graft sites, specifically in darker skinned patients.

Comparison of lower extremity fasciotomy wound closure techniques in children: vacuum-assisted closure device versus temporary synthetic skin replacement

2018 ◽  
Vol 45 (5) ◽  
pp. 809-814 ◽  
Author(s):  
Hannah Rachel Bussell ◽  
Christoph Alexander Aufdenblatten ◽  
Corina Gruenenfelder ◽  
Stefan Altermatt ◽  
Sasha Job Tharakan
Keyword(s):  
Lower Extremity ◽  
Wound Closure ◽  
Closure Device ◽  
Vacuum Assisted Closure ◽  
Wound Closure Techniques ◽  
Skin Replacement

659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Soft Tissue ◽  
Cell Suspension ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Case Series ◽  
Dermal Substitute ◽  
Wound Therapy ◽  
Skin Cell ◽  
Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

The Vacuum-Assisted Closure Device as a Bridge to Sternal Wound Closure

2001 ◽  
Vol 46 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Robert E. Hersh ◽  
Jason M. Jack ◽  
Mohammed I. Dahman ◽  
Raymond F. Morgan ◽  
David B. Drake
Keyword(s):  
Wound Closure ◽  
Closure Device ◽  
Vacuum Assisted Closure

658 Early Interventions with Autologous Skin Cell Suspension Leads to Positive Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Nicole M Kopari
Keyword(s):  
Cell Suspension ◽  
Early Treatment ◽  
Wound Closure ◽  
Delayed Presentation ◽  
Average Hospital ◽  
Burn Care ◽  
Skin Cell ◽  
Partial Thickness ◽  
Small Pore ◽  
Partial Thickness Burns

Abstract Introduction Following initial stabilization, the primary goal of burn care is rapid wound closure to restore the barrier function and mechanical integrity of the skin. Time to wound closure is an important consideration when establishing the treatment plan, with a goal of re-epithelialization by 21 days to reduce the risks of hypertrophic scars (HTS), however, new research suggests that HTS can occur when healing is achieved as early as day 8. Early treatment of deep partial-thickness burns with autologous skin cell suspension (ASCS) was implemented at our burn center to achieve early wound closure and decrease hospital length of stay (LOS). Methods An IRB-approved, retrospective chart review of patients admitted between January 2020 to July 2020 was completed to evaluate the effectiveness of ASCS when applied as an early treatment defined as within 3 days of injury. Burn patients were excluded with delayed presentation >7 days, patients who only received ASCS to donor sites, and patients who died from unrelated comorbidities. Patients were excised to viable tissue. Patients with intact dermis were treated with ASCS. Patients without intact dermis were treated with ASCS and widely meshed autograft. Non-absorbent, small pore dressings were applied to the wound then covered with bismuth-petrolatum dressing, dry gauze, and compression bandage. Patients appropriate for discharge were followed-up in clinic for the first dressing change.   Results Twenty-three patients were treated with ASCS utilizing this early intervention approach with 16 patients meeting inclusion criteria. Patients ranged from 15 months to 73 years of age and included 6 females and 10 males. The median total body surface area (TBSA) was 7.3% (range 2-23). Patients were taken for ASCS application between post burn day 0-3 (average 1.5). Average hospital LOS was 2.4 days. Operative dressings were removed between day 7-12 and >90% re-epithelization was noted between day 7-18 (mean 11). The mean LOS/%TBSA was 0.3. No patients required re-operation for closure of their wounds or reconstructive interventions for scarring. Conclusions Early excision of deep partial-thickness burns with application of ASCS allowed for healing to be achieved in a timely fashion. Implementation of an early operative approach to burn care allowed for a decrease in LOS and a decreased overall number of dressing changes.

scholarly journals Uncommon Locations of Gas Gangrene Treated Successfully With Surgical Debridement and the Vacuum-Assisted Closure Device

2016 ◽  
Vol 101 (11-12) ◽  
pp. 517-523
Author(s):  
Evangelos P. Misiakos ◽  
Nick Zabras ◽  
George Bagias ◽  
Panagiotis Tzanetis ◽  
Lignos Michail ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Gas Gangrene ◽  
Surgical Debridement ◽  
Closure Device ◽  
Surgical Wound ◽  
Vacuum Assisted Closure ◽  
Lateral Abdominal Wall ◽  
Threatening Condition ◽  
Life Threatening ◽  
Closure Method

Gas gangrene is a life-threatening condition implying necrosis of dermis and hypodermis, along with necrosis of the superficial muscular aponeurosis. Fournier s gangrene is a subtype of the disease affecting the perineal and genital area. The aim of this study is to analyze the clinical presentation, diagnosis, medical, and surgical treatment of three cases of gas gangrene affecting uncommon locations in the human body, treated with extensive surgical debridement followed by the vacuum assisted closure method in two of these cases. Three cases of gas gangrene affecting uncommon locations treated surgically in our Department are presented. In one case the perineal and scrotal region was infected with invasion of the lateral abdominal wall and the peritoneal cavity. In the second case the axillary regions were infected bilaterally and in the third case the left axillary and subscapular regions were infected after a left arm disarticulation. All cases were treated successfully with successive surgical debridement and/or the vacuum-assisted closure method. Gas gangrene is a curable disease if diagnosed early and treated effectively with successive surgical wound cleaning and debridement. The vacuum assisted closure method can be helpful in promoting wound healing.

35 Outcomes for Hand Burns Treated with Autologous Skin Cell Suspension in 20% TBSA and Smaller Injuries

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S27-S28
Author(s):  
George M Taylor ◽  
Jeffrey E Carter ◽  
Charles T Tuggle ◽  
Scott Barnett ◽  
Herb A Phelan
Keyword(s):  
Cell Suspension ◽  
Wound Closure ◽  
Total Body Surface Area ◽  
Exclusion Criterion ◽  
Categorical Variables ◽  
Dermal Substitute ◽  
Continuous Variables ◽  
Exact Test ◽  
Skin Cell ◽  
Hand Burns

Abstract Introduction Our group has previously reported our experience with autologous skin cell suspension (ASCS) in the treatment of all subjects with hand burns regardless of the total body surface area (TBSA) involved. In order to better address the confounder of TBSA on burn outcomes, we sought to analyze our experience in a cohort of subjects whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with a 2:1 meshed autograft would provide comparable outcomes to hand burns treated with smaller meshed autograft alone. Methods A retrospective review was conducted for deep 2nd and 3rd degree hand burns treated with split thickness autograft (STAG) at our urban verified burn center between April 2018 to September 2020. Exclusion criterion was a TBSA greater than 20%. The cohorts were those subjects treated with ASCS in combination with STAG (ASCS(+)) versus those treated with STAG alone (ASCS(-)). All ASCS(+) subjects were treated with 2:1 meshed STAG and ASCS overspray while all ASCS(-) subjects had 1:1 or piecrust mesh only. Outcomes included demographics, proportion returning to work (RTW), length of time for RTW, and time to wound closure. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as median and interquartile range. Results Fifty-one subjects fit the study criteria (ASCS(+) n=31, ASCS(-) n=20). The ASCS(+) group was significantly older than the ASCS(-) cohort (44 yrs. [32, 54] vs 32 [27.5, 37], p=0.009) with larger %TBSA burns (15% [9.5, 17] vs 2% [1, 4], p < 0.0001), and larger size hand burns (190 cm2 [120, 349.5] vs 126 cm2 [73.5, 182], p=0.015). Comparable results were seen between ASCS(+) and ASCS(-), respectively, for time to wound closure (9 days [7, 13] vs 11.5 [6.75, 14], p=0.63), proportion RTW (61% vs 70%, p=0.56), and days for RTW among those returning (35 [28.5, 57] vs 33 [20.25, 59], p=0.52). The ASCS(+) group had two graft infections with no reoperations, while ASCS(-) had one infection with one reoperation. No subjects in either group had a dermal substitute placed. Conclusions Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure and return to work as subjects treated with 1:1 or pie-crust meshed STAG. Our group plans to follow this work with scar assessments for a more granular picture of pliability and reconstructive needs.

Endoscopic Transnasal Eustachian Tube Closure using the V-LOC Wound Closure Device

2020 ◽  
Author(s):  
Andrew J. Thomas ◽  
Sachin Gupta ◽  
Aclan Dogan ◽  
Timothy L. Smith ◽  
Justin Cetas ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Wound Closure ◽  
Closure Device ◽  
Tube Closure

Comparative Clinical Study of the Sure-Closure Device with Conventional Wound Closure Techniques

1995 ◽  
Vol 35 (5) ◽  
pp. 485-491 ◽  
Author(s):  
Krishna Narayanan ◽  
J William Futrell ◽  
Michael Bentz ◽  
Dennis Hurwitz
Keyword(s):  
Clinical Study ◽  
Wound Closure ◽  
Closure Device ◽  
Wound Closure Techniques ◽  
Comparative Clinical Study
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