The use of a dermal substitute and thin skin graft in the cure of lower limbs wounds from vasculitis: observational study

Abstract Introduction Deep Full thickness burns require tangential excision of the burned tissues down to viable tissue. This often leaves exposed muscle, tendon and bone. Coverage of these areas is vital to limb salvage. Multiple modalities are necessary with these type of patients, such as, dermal matrix graft, split thickness skin graft, sprayed autologous cell suspension (ACS) and wound vacuum therapy(VAC). A dermal matrix provides a scaffold for tissue and vascular en growth that is suitable for accepting a skin graft and also provides a layer between the muscle, tendon, bone and the skin graft which improves movement and produces a more pliable graft. Biodegradable temporizing matrix(BTM), produced by PolyNovo Ltd, was used to cover the muscle, bone and tendon. This product has a silicone backing which can be delaminated once it has matured with tissue and vascular en growth for auto grafting. A combination of a wide meshed skin graft at 3:1 ratio and a sprayed ACS allows for faster healing and less donor site usage which decreases the overall wound burden. Methods A 73 y/o male with total body surface area burn of 24 % suffered deep full thickness burns to the bilateral lower legs. He underwent multiple debridements with management of the right leg with irrigating wound vacuum therapy. The deeper right leg had a wound base with that consisted of muscle from the thigh down onto the foot with exposed tendons and anterior tibial bone. The open wounds to the right leg were grafted with BTM for dermal substitute coverage. Once the BTM was mature it was delaminated, and the wound surface was covered with a 3:1 ratio split thickness skin graft (STSG) and sprayed on autologous cell suspension. This resulted in using less donor skin than a 1.5 or 2:1 meshed graft STSG which decreased his wound burden. Donor sites were also sprayed with ACS. Results We had nearly 100% take of the STSG and sprayed autologous suspension epidermal graft. There was a small area over the patella tendon where the BTM did not incorporate. This is though to be because of lack of immobilization of his knee and a pseudomonal infection. Donor sites healed faster and there were minimal open areas to the graft POD 11 excluding the patella area. Conclusions BTM can be used to provide a suitable dermal substitute in complex wounds when muscle, tendon and/or bone are exposed. Immobilization of the joints is necessary to allow the tissue en growth into the dermal matrix. Wide meshed graft with sprayed ACS can be used with good results with wound vacuum therapy. Decreased wound burden and time to heal open wounds of the graft and donor sites. Applicability of Research to Practice Use of a dermal matrix, wide mesh split thickness graft and sprayed epidermal ACS with wound vacuum therapy is a good option for limb salvage when vital structures are exposed.

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An analysis of post traumatic leg and foot defects

International Surgery Journal ◽

10.18203/2349-2902.isj20192363 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2041

Author(s):

Gopalan G. ◽

Dhanaraju S.

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Traffic Accidents ◽

Lower Limbs ◽

Split Thickness Skin Graft ◽

Soft Tissue Coverage ◽

Durable Good ◽

Skin Defect ◽

Early Recovery ◽

Thickness Skin

Background: Management of lower extremity trauma with bone and soft tissue injury is a challenging task with the aim of giving early recovery and durable good quality skin cover according to the skin defect and analyze various reconstructive options at various levels of injury. Our aim of the study is to analyze various reconstructive options for traumatic skin loss involving lower limbs especially knee and below knee, and analyze the incidence of age, sex and etiology of traumatic defects.Methods: Prospective study in our plastic surgery department in the period of 24 months, with all the cases of traumatic defects of leg and foot where included. All age and sex patients were included.Results: Most common cause for traumatic leg and foot defects are road traffic accidents followed by accidental fall and others, most commonly in males amounting 73%, children 10% and females 17%, among the skin and soft tissue defects upper and lower 1/3 leg defects are predominant. Among the soft tissue coverage split thickness skin graft dominating about 60% of cases, flaps 30% of cases, among the flaps 70% are fasciocutaneous flaps predominantly inferiorly based and 30% are muscle and musculocutaneous flaps, among the muscle predominantly soleus muscle flap was used to cover the defect.Conclusions:Road traffic accidents dominating the cause for leg and foot defects , males are more commonly affected and upper one third leg defects are predominant for soft tissue coverage split thickness skin graft are commonest procedures followed that cutaneous and muscle flaps.

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A prospective observational study to analyse clinical profile of varicose vein cases treated in a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20190516 ◽

2019 ◽

Vol 6 (3) ◽

pp. 769

Author(s):

Maragadha Mani ◽

Anand A.

Keyword(s):

Observational Study ◽

Clinical Presentation ◽

Vascular System ◽

Varicose Veins ◽

Demographic Data ◽

Tertiary Care ◽

Lower Limbs ◽

Leg Pain ◽

Care Hospital ◽

Presenting Symptoms

Background: Varicose veins are common vascular disorder. The study was conducted to analyse the clinical presentation, treatment options and complications of varicose veins.Methods: This observational study was conducted in Thanjavur Medical College Hospital. Adults with clinically diagnosed unilateral or bilateral varicose veins of lower limbs were studied in surgical wards between August 2013 to July 2014. The demographic data and presenting symptoms, signs and previous treatment were collected using a structured proforma. Thorough clinical examination, duplex scan and abdominal and pelvic examination were done in all cases to find out the secondary causes. Peripheral vascular system was examined. All the patients were followed regularly for the period of one month to one year after treatment.Results: A total of 60 cases were included. Most participants belonged to 2nd and 3rd decade of life. 55 (91%) participants were male and5 (9%) participants were females. 45 (75%) participants were agriculturists. 10 (17%) participants had bilateral involvement. Most participants 30 (50%) participants had 1 to 5 years duration of disease, most common clinical presentation of the study participants was varicosity with 70.0%, followed by lipodermo sclerosis, leg pain, hyperpigmentation, pruritus as 63.0%, 56.0%, 15% and 11.6% respectively. 17 (28.33%) patients were present with a venous ulcer. 32 (53%) participants were managed surgically, and 28 (47%) participants were managed conservatively. Most participants were treated with multiple ligation 21.8% followed by trendelenburg operation+ stripping18.75%.Conclusions: Regarding the treatment, surgery is the treatment of choice for primary varicose veins and conservative treatment for secondary varicose veins.

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Treatment with type-I collagen scaffolds in patients with venous ulcers. Case report

Case reports ◽

10.15446/cr.v6n2.83815 ◽

2020 ◽

Vol 6 (2) ◽

pp. 128-136

Author(s):

Martha Isabel González-Duque ◽

Julián Daniel Hernández-Martínez ◽

Marta Raquel Fontanilla ◽

Sofía Elizabeth Muñoz-Medina

Keyword(s):

Type I Collagen ◽

Low Cost ◽

Adult Population ◽

Lower Limbs ◽

Collagen Membrane ◽

Type I ◽

Dermal Substitute ◽

Collagen Scaffolds ◽

Venous Ulcers

Introduction: Chronic venous insufficiency affects about 5% of the global adult population. Venous leg ulcers are one of the most frequent complications of this pathology, with a global prevalence of 2%. This disease affects both the quality of life of patients and, due to the high cost of the treatment, the health system. Compressive therapy and moist wound healing have been the gold standard treatment. However, when complications occur, they may not be effective.Case report: This is the case of a 66-year-old female patient with venous ulcers on her lower limbs and symptoms of fever and local pain that did not respond to conventional therapies. The patient was treated with a new dermal substitute made of an acellular type-I collagen membrane, which promotes the closure of the ulcer by stimulating the replacement of injured tissue with tissue similar to the healthy one. The condition of the patient improved at 16 weeks, and after 8 months of treatment there was no recurrence of the lesions.Conclusions: Acellular type-I collagen membrane developed by the Tissue Engineering Working Group of the Department of Pharmacy of the Universidad Nacional de Colombia is effective in treating venous ulcers of the lower limbs. Its low cost facilitates the access of the whole population to therapies based on its application.

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Bilayer Wound Matrix Dermal Substitute Allows Survival of Split-Thickness Skin Graft in Necrotizing Fasciitis Defects: A Retrospective, Uncontrolled Case Study

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.12.060 ◽

2020 ◽

Author(s):

Charles A. MessaIV ◽

Cody L. Mullens ◽

Robyn B. Broach ◽

Irfan A. Rhemtulla ◽

John P. Fischer

Keyword(s):

Necrotizing Fasciitis ◽

Skin Graft ◽

Split Thickness Skin Graft ◽

Dermal Substitute ◽

Thickness Skin ◽

Wound Matrix

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262 DORSAL INLAY THIN-SKIN GRAFT FOR ANTERIOR URETHRAL RECONSTRUCTION WITH A FOLLOW-UP OF 3 YEARS

European Urology Supplements ◽

10.1016/s1569-9056(10)60262-x ◽

2010 ◽

Vol 9 (2) ◽

pp. 110

Author(s):

P. Rehder ◽

M.J. Mitterberger ◽

R. Pichler ◽

A. Kerschbaumer ◽

F. Frauscher

Keyword(s):

Skin Graft ◽

Urethral Reconstruction ◽

Thin Skin

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Rapid onset of squamous cell carcinoma in a thin skin graft donor site

Annales de Dermatologie et de Vénéréologie ◽

10.1016/j.annder.2015.03.027 ◽

2016 ◽

Vol 143 (6-7) ◽

pp. 457-461 ◽

Cited By ~ 2

Author(s):

C. Herard ◽

D. Arnaud ◽

D. Goga ◽

P. Rousseau ◽

B. Potier

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Skin Graft ◽

Donor Site ◽

Rapid Onset ◽

Thin Skin ◽

Graft Donor

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643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.263 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S167-S168

Author(s):

Laura Cooper ◽

Phillip Kemp Bohan ◽

Anders H Carlsson ◽

Rodney K Chan ◽

Tyler Everett

Keyword(s):

Graft Survival ◽

Skin Graft ◽

Skin Grafting ◽

Dermal Substitute ◽

Skin Grafts ◽

Pressure Therapy ◽

Nutrient Supplementation ◽

Successful Model ◽

Dermal Substitutes ◽

Graft Take

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p< 0.01, p=0.02, p< 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.

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