Combined Complex Skin Repair in Patient With Extensive Burns: A Case Report

2021 ◽  
Author(s):  
Xingxin Gao ◽  
Min Zhang ◽  
Yuan Lin ◽  
Dehui Li ◽  
Liming Zhang
Keyword(s):  
Recombinant Human Growth Hormone ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Human Growth ◽  
Skin Grafting ◽  
Current Treatment ◽  
Limiting Factors ◽  
Split Thickness Skin Graft ◽  
Skin Repair ◽  
Extensive Burns

Abstract Auto-skin grafting is the current treatment of choice for extensive burns. Nevertheless, the lack of donor sites for skin grafting remains one of the greatest limiting factors for the treatment of extensively burned patients. We present the case of a 53-year-old male patient with deep and full thickness burns on 91% of the total body surface area. We used the Meek technique for split-thickness skin graft expansion to treat this patient. In order to obtain sufficient skin for grafting, we repeatedly harvested the same anatomical areas. Acceleration of burn wounds, recipient, and donor site healing was achieved by systemic treatment with recombinant human growth hormone and topical recombinant human epidermal growth factors. This combined, complex treatment modality contributed to the successful skin repair in this patient.

scholarly journals A paradigm shift in practice—the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision

2020 ◽  
Vol 48 (2) ◽  
pp. 93-100
Author(s):  
John E Greenwood
Keyword(s):  
Skin Graft ◽  
Paradigm Shift ◽  
Burn Injury ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Graft Harvest ◽  
Major Burn ◽  
Early Closure ◽  
Total Body

After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%–100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.

scholarly journals A systematic review of the scalp donor site for split-thickness skin grafting

2020 ◽  
Vol 47 (6) ◽  
pp. 528-534
Author(s):  
Suk Joon Oh
Keyword(s):  
Donor Site ◽  
Age Distribution ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Late Complications ◽  
Total Rate ◽  
Thickness Skin ◽  
Pubmed Database ◽  
Split Thickness Skin Grafting ◽  
Scalp Skin

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

A Prospective Clinical Study of the Effect of Recombinant Human Growth Hormone in Wound Healing of Severely Burned Children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah Nasser Mohamed ◽  
Nahed Samir Boghdady ◽  
Mina Agaiby Estawrow ◽  
Mariam Loutfy Ahmed Mohamed
Keyword(s):  
Growth Hormone ◽  
Wound Healing ◽  
Recombinant Human Growth Hormone ◽  
Total Body Surface Area ◽  
Human Growth ◽  
Control Group ◽  
P Value ◽  
Significant Difference ◽  
The Mean ◽  
Total Body

Abstract Background A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, depth and extent of burn . Objectives The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their probable effect on accelerating burn wound healing. Patients and Methods This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU. Results The comparison between the GH group and the control group showed that that there was statistically significant difference found between the two studied groups regarding TBSA of burn at 3rd week. The mean TBSA in GH group was ( 9.06 ± 7.47 ) while in the control group (13.94 ± 11.96) with P value (0.041). There was highly statistically significant difference found between the two studied groups regarding Insulin like growth factor .the mean Insulin like growth factor in GH group was (16.48 ± 11.40) while in the control group(2.77 ± 0.64) with P value(0.000). Conclusion The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the total body surface area of burn(TBSA) as the patient received the growth hormone showed a decrease total body surface area of burn(TBSA) than the control group. This may be accounted for the faster wound healing and readiness for grafting .

Complex approach to skin repair in an extensively burned child: a case study

2020 ◽  
Vol 29 (8) ◽  
pp. 458-463
Author(s):  
Robert Zajicek ◽  
Richard Kubok ◽  
Nikola Petrova ◽  
Monika Tokarik ◽  
Eva Matouskova ◽  
...  
Keyword(s):  
Donor Site ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cells ◽  
Skin Repair ◽  
Thickness Skin ◽  
Complex Approach ◽  
Total Body

The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3–4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a ‘sandwich’ technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.

scholarly journals Novel Surgical Treatment for Refractory Heel Ulcers in Werner’s Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Keisuke Oe ◽  
Masahiko Miwa ◽  
Yoshitada Sakai ◽  
Masahiro Kurosaka
Keyword(s):  
Surgical Treatment ◽  
Skin Graft ◽  
Donor Site ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Leg Ulcers ◽  
Werner’S Syndrome ◽  
Werner's Syndrome ◽  
Thickness Skin ◽  
Chronic Leg Ulcers

Patients with Werner’s syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

Recruited Minced Skin Grafting for Improving the Skin Appearance of the Donor Site of a Split-Thickness Skin Graft

2012 ◽  
Vol 38 (4) ◽  
pp. 654-660 ◽  
Author(s):  
Ruka Simizu ◽  
Kazuo Kishi ◽  
Keisuke Okabe ◽  
Yumiko Uchikawa ◽  
Yoshiaki Sakamoto ◽  
...  
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Thickness Skin

scholarly journals Necrotising fasciitis—A rare complication of split-thickness skin graft donor area

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Rahul Bamal ◽  
Rakesh Kain
Keyword(s):  
Rare Complication ◽  
Donor Site ◽  
Skin Grafting ◽  
Necrotising Fasciitis ◽  
Split Thickness Skin Graft ◽  
Successful Management ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Donor Area ◽  
Graft Donor

<p class="Default">Split-thickness skin grafting (STSG) is commonly used to cover raw areas of various aetiologies. Donor sites are known to get infected sometimes, but necrotising fasciitis is not often reported. We report here a case of donor-site necrotising fasciitis and its successful management. There is a need for surgeons to stay vigilant for this rare but probable complication of skin grafting.</p>

scholarly journals Effects of Recombinant Human Growth Hormone on Donor-site Healing in Severely Burned Children

1990 ◽  
Vol 212 (4) ◽  
pp. 424-431 ◽  
Author(s):  
DAVID N. HERNDON ◽  
ROBERT E. BARROW ◽  
KELLY R. KUNKEL ◽  
LYLE BROEMELING ◽  
RANDI L. RUTAN
Keyword(s):  
Growth Hormone ◽  
Human Growth Hormone ◽  
Recombinant Human Growth Hormone ◽  
Donor Site ◽  
Human Growth
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