scholarly journals One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay

2019 ◽  
Vol 7 ◽  
Author(s):  
Tong Liu ◽  
Chao Qiu ◽  
Chi Ben ◽  
Haihang Li ◽  
Shihui Zhu
Keyword(s):  
Wound Healing ◽  
Healing Rate ◽  
Skin Grafting ◽  
Skin Defect ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Abstract Background Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss. However, for patients with extensive burns, split-thickness skin grafting is limited by donor skin availability. Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality. Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds, but their application currently requires two surgeries. The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model. Methods A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old. The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac, respectively, were overlaid on minced split-thickness skin grafts to repair the defects. Wound healing rate and quality were compared between the two groups. For better illustration of the quality of wound healing, some results were compared with those obtained for normal skin of rats. Results We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis. In addition, this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation. Conclusions Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of full-thickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

Skin Grafting

2019 ◽  
pp. 65-72
Author(s):  
Stephen M. Milner
Keyword(s):  
Skin Grafting ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preoperative Preparation ◽  
Scar Contracture ◽  
Skin Defects ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Contracture Release

Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.

scholarly journals Conservative Management of Full-Thickness Skin Defect on Foot Dorsal Region: A Report of 2 Cases Receiving Modified Moist Wound Healing Method

2010 ◽  
Vol 59 (3) ◽  
pp. 541-544
Author(s):  
Katsuro Fukuyama ◽  
Masaaki Imabayashi ◽  
Hirohumi Ohsako ◽  
Yuichiro Yazaki ◽  
Takashi Murayama ◽  
...  
Keyword(s):  
Wound Healing ◽  
Conservative Management ◽  
Skin Defect ◽  
Full Thickness ◽  
Dorsal Region ◽  
Full Thickness Skin ◽  
Thickness Skin

Tie-Over Bolster Dressings vs Basting Sutures for the Closure of Full-Thickness Skin Grafts: A Review of the Literature

2018 ◽  
Vol 22 (6) ◽  
pp. 602-606 ◽  
Author(s):  
William Kromka ◽  
Michael Cameron ◽  
Ramin Fathi
Keyword(s):  
Skin Grafting ◽  
Skin Grafts ◽  
Full Thickness ◽  
Review Of The Literature ◽  
Advantages And Disadvantages ◽  
Full Thickness Skin ◽  
Improved Outcomes ◽  
Thickness Skin ◽  
Wide Range ◽  
Cosmetic Outcomes

Background: Full-thickness skin grafting is a well-established technique in the reconstruction of various tissue defects and wounds. However, lack of uniformity in the procedure of closing and securing the grafts has led to a wide range of different techniques. Objective: This article reviews the use of tie-over bolster dressings compared to basting sutures for the fixation and postsurgical immobilization of full-thickness skin grafts (FTSGs), discusses details of each method, and proposes a practice guideline for the closure of FTSGs. Methods: A traditional review of the literature was performed through a search of PubMed using the following keywords: full-thickness skin graft, FTSG, closure, suture, tie-over bolster, quilting, and bolster. Results: The current literature regarding tie-over bolster dressings does not demonstrate improved outcomes compared to quilting sutures. The 2 techniques appear equivalent in terms of utility and outcome, both possessing distinct advantages and disadvantages. Conclusion: Despite minimal head-to-head studies between tie-over bolsters and quilting, the best evidence from the literature appears to show comparable results regarding graft take, cosmetic outcomes, and postoperative complications. Ultimately, the choice of using a tie-over bolster technique or quilting sutures relies on surgeon preference and anatomic location.

scholarly journals Full-Thickness Skin Grafts and Quilting Sutures for the Reconstruction of Internal Nasal Lining

2020 ◽  
Vol 36 (03) ◽  
pp. 297-304
Author(s):  
PD Dr. med. Antoniu-Oreste Gostian ◽  
Dr. med. Matthias Balk ◽  
Dr. med. Achim Stegmann ◽  
Prof. Dr. med. Dr. h.c. Heinrich Iro ◽  
Prof. Dr. med. Jochen Wurm
Keyword(s):  
Skin Grafting ◽  
Free Flaps ◽  
Nasal Reconstruction ◽  
Skin Grafts ◽  
Full Thickness ◽  
Forehead Flap ◽  
Full Thickness Skin ◽  
Nicotine Abuse ◽  
Thickness Skin ◽  
Feasible Option

AbstractRestoration of the inner nasal lining is an essential factor in successful nasal reconstruction. Among various methods, free full-thickness skin grafting represents a readily available and feasible technique. A prerequisite for success is a secure and immobile fixation to the undersurface of the nourishing forehead flap. This retrospective study aims to evaluate the results of multiple quilting sutures to secure free full-thickness skin grafts for the reconstruction of the inner nasal lining in partial and extended nasal reconstruction. Between February 1, 2015, and December 31 2018, 16 patients underwent three-stage nasal reconstruction of all three layers using a forehead flap. All full-thickness free flaps were harvested from either the neck or inguinal area and fixated to the undersurface of the distal part of the forehead flap by multiple quilting sutures. All but one free skin grafts healed well (seven ♀; mean: 63 years; range: 52–81). Four patients developed minor complications that resolved completely through conservative treatment. One patient with a history of stroke, extensive nicotine abuse, and arterial hypertension developed flap necrosis that required two surgical revisions and ended up with a stenosis of the left nostril. The follow-up time averaged 18.4 months (range: 3–55 months). Multiple quilting sutures are an effective and feasible option to fixate full-thickness free skin grafts on the undersurface of the forehead flap for the reconstruction of the inner nasal lining. They are not associated with increased risks for necrosis and can be applied even to extended full-thickness nasal defects in selected cases.

scholarly journals Experimental evaluation of the effectiveness of adipose mesenchymal stem cells in full-thickness skin wounds

2021 ◽  
Vol 9 (2) ◽  
pp. 175-181
Author(s):  
Ilya V. Artsimovich ◽  
Evgenii V. Zinoviev ◽  
Aleksander V. Gostimskii ◽  
Marat S. Asadulaev ◽  
Sergey V. Vissarionov ◽  
...  
Keyword(s):  
Stem Cells ◽  
Wound Healing ◽  
Mesenchymal Stem Cells ◽  
Control Group ◽  
Skin Defect ◽  
Full Thickness ◽  
Skin Defects ◽  
Full Thickness Skin ◽  
Healing Index ◽  
Thickness Skin

BACKGROUND: Currently, numerous techniques or medical devices that allow complete or partial restoration of the lost skin within a short time remain as subjects of development. Many studies have shown the effectiveness of using stem cells in the treatment of full-thickness skin defects, but their use remains very limited. At present, there is no consensus among researchers about the advisability of the use of stem cells in the treatment of burns as well as about the method of their introduction. AIM: This study aimed to examine the possibility of accelerating the reparative histogenesis of tissues in the zone of deep skin burns using cultures of adipogenic mesenchymal cells, as well as to evaluate the effectiveness of various methods of introducing cultures of these cells into the defect zone. MATERIALS AND METHODS: An experimental study was carried out on small laboratory animals (rats). After simulating a grade III burn, mesenchymal stem cells were transplanted and superficially applied to the wound surface or injected under the fascia. In the control group, no wound treatment was performed. To assess the effectiveness of the wound-healing preparations, the appearance of wounds was assessed daily, the nature of the discharge and presence and type of granulations were noted, and the timing of scab rejection and wound healing was recorded. The wound area was assessed using a planimetric method. A histological examination of wound biopsies was carried out on days 7, 14, 21, and 28 of observation. RESULTS: The application of adipogenic mesenchymal stem cells demonstrated the greatest efficiency on the developed burn model. Subfascial administration was less effective, but this method achieved a significant acceleration of wound healing in comparison with the control group. An increase in the healing index by 56.6% demonstrates the highest intensity of reparative regeneration in animals applied with adipogenic mesenchymal stem cells. CONCLUSIONS: The preliminary results show that the application of adipogenic mesenchymal stem cells on the skin defect is more effective than subfascial administration based on the healing index. The use of adipogenic mesenchymal stem cells may substantially increase the effectiveness of the treatment of full-thickness skin defects.

scholarly journals Study on the mechanism of microporous sheep ADM combined with hUCMSC in promoting wound healing

2021 ◽  
Vol 8 (3) ◽  
pp. 15
Author(s):  
Xiao-yan Yang ◽  
Chun-guang Hao ◽  
Jun-liang Li ◽  
Xue Fu ◽  
Lingfeng Wang
Keyword(s):  
Wound Healing ◽  
Healing Rate ◽  
Collagen I ◽  
Expression Level ◽  
Human Umbilical Cord ◽  
Full Thickness ◽  
Skin Injury ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Wound Healing Rate

Objective: To explore the therapeutic mechanism of microporous sheep acellular dermal matrix (ADM) combined with human umbilical cord mesenchymal stem cell (hUCMSC) to promote the healing of full-thickness skin defect.Methods: hUCMSC was co-cultured on microporous sheep ADM to form composite biological dressings. Seventy-two nude mice were selected to make full-thickness skin injury models and randomly divided into 3 groups (hUCMSC + microporous sheep ADM group, sheep ADM group and iodophor gauze group), with 24 mice in each group. The wound healing rate of each group was detected at 14 d, 21 d and 28 d after operation, qRT-PCR technique was used to detect the expression of Bax and Bcl-2 in the wound tissues, and the immunohistochemical staining technique was used to detect the expression of Collagen I and vascular endothelial growth factor (VEGF). Data were analyzed with one-way ANOVA and t test.Results: At 14 d after operation, the wound healing rate of the hUCMSC + microporous sheep ADM group was (65.34 ± 14.72)%, which was significantly higher than that of the iodophor gauze group [(37.54 ± 10.21)%], and higher than that of the sheep ADM group [(49.08 ± 11.16)%], the differences were statistically significant (t = 19.52, 14.72; p < .05). With the gradual healing of the wound, at 28 d after operation, the wound healing rate of the hUCMSC + microporous sheep ADM group was (98.63 ± 15.41)%, which was significantly higher than that of the iodophor gauze group [(81.74 ± 16.27)%], and higher than that of the sheep ADM group [(63.47 ± 14.80)%], the differences were statistically significant (t = -16.42, 20.35; p < .05). The expression of Bax in the wound tissues of the hUCMSC + microporous sheep ADM group was significantly reduced, especially at 21 d after operation, the expression level was 0.25 ± 0.06, which was significantly lower than the iodophor gauze group (0.53 ± 0.16) and the sheep ADM group (0.41 ± 0.12), the differences were statistically significant (t = 3.52, -2.83; p < .05). The expression of Bcl-2 in the wound tissues of the hUCMSC + microporous sheep ADM group was significantly higher than those ofthe other two groups, especially at 21 d after operation, the expression level was 0.63 ± 0.19, which was significantly higher than the iodophor gauze group (0.34 ± 0.09) and the sheep ADM group (0.46 ± 0.13), the differences were statistically significant (t = 5.31, -6.07; p < .05). Immunohistochemical detection showed that the expression of Collagen I and VEGF in the hUCMSC + microporous sheep ADM group was slightly more than that of the sheep ADM group and the iodophor gauze group, but the effect was not remarkable.Conclusions: hUCMSC + microporous sheep ADM composite dressing can promote the healing of the full-thickness skin injury and reduce the production of apoptotic cells by carrying hUCMSC.

scholarly journals Reconstruction of post burns facial contractures and deformities: an Indian perspective

2018 ◽  
Vol 5 (6) ◽  
pp. 2170 ◽  
Author(s):  
Niyati Lakhani ◽  
Ashwin Lakhani
Keyword(s):  
Skin Grafting ◽  
Burn Injuries ◽  
Treatment Modalities ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Fitting In ◽  
Orbital Region ◽  
Oral Commissure

Background: Reconstruction of facial burns contracture is one of the most important surgeries in cosmetic and reconstructive surgery. This study was aimed to assess the different modalities used in facial reconstruction and their outcome.Methods: This retrospective study involved 20 patients with extensive burning facial scars. Patients were treated with different reconstructive modalities like split/full thickness skin grafts or flaps etc. Outcome of different modalities as per the area of face involved, graft taken up and complications were analyzed.Results: Majority patients were of age between 20-30 years. 72.22% patients had other associated burn injuries with facial involvement. Most patients (18, 90%) were treated after 9 months post burns duration. All patients had multiregional involvement on face but cheek being the largest unit, was most commonly involved (18, 90%) followed by involvement of oral commissure and lips in 8 (40%) and orbital region in 7 (35%) patients. Full thickness skin graft (FTSG) and split thickness skin grafts (STSG) were most commonly performed procedures. Patient with forehead scarring was treated with abdominal tube transferred in stages. Two patients with eyelid ectropion treated with release and STSG. Gillies up and down forehead flap were used for nose reconstruction due to non-availability of tissue expanders. Linear scars on chick not fitting in relaxed skin tension line were treated with excision and primary “z” plasty. Hypertrophic scar of ear was excised and STSG was applied. Common complications included hyperpigmentation and hypopigmentation, contour distortion and obliteration of labiomental sulcus.Conclusions: Facial reconstructive procedure for burns scars should be selected based on region of face involved. Skin grafting is an effective method for reconstruction especially in areas with non-availability of advanced treatment modalities.

scholarly journals Effects of allogeneic mouse adipose-derived mesenchymal stem cell-microporous sheep acellular dermal matrix on healing of wound with full-thickness skin defect in mouse and the related mechanism

2019 ◽  
Vol 6 (2) ◽  
pp. 26
Author(s):  
Shengjun C ◽  
Lingfeng W ◽  
Te B ◽  
Xue F ◽  
Fang L ◽  
...  
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Acellular Dermal Matrix ◽  
Control Group ◽  
Skin Defect ◽  
Full Thickness ◽  
Dermal Matrix ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Acellular Dermal

Objective: To explore the effects of allogeneic mouse adipose-derived mesenchymal stem cell (ADSC)-microporous sheep acellular dermal matrix (ADM) on wound healing of full-thickness skin defect in mice and the related mechanism.Methods: One Kunming mouse was sacrificed by cervical dislocation to collect adipose tissue from the inguinal region. Mouse ADSCs were isolated from the adipose tissue and cultured in vitro. Cells in the third passage were identified by cell adipogenic and osteogenic differentiation. The expressions of CD34, CD73, CD90, and CD105 were analyzed by flow cytometer. After one sheep was sacrificed with the skin of its back cut off, microporous sheep ADM was prepared by using acellular processing and freeze-thaw method. A round and full-thickness skin defect wound, with a diameter of 12 mm, was made on the back of each of 36 Kunming mice. The wounds were covered by microporous sheep ADM. The mice were divided into ADSC group and control group with 18 mice in each group according to the random number table method after surgery. A volume of 0.2 ml of DMEM/F12 culture medium containing 1 × 106 ADSCs was injected between microporous sheep ADM and the wound of each mouse in ADSC group, while 0.2 ml of DMEM/F12 culture medium was injected between microporous sheep ADM and the wound of each mouse in control group. At post-surgery day (PSD) 12 and 17, the wound healing rate in each group was calculated respectively; wound vascularization in 2 groups of mice was observed under the reverse irradiation of back light; and the granulation tissue in the wound in ADSC group was observed by means of hematoxylin-eosin staining. At PSD 7, the thickness of the granulation tissue in the wound was measured in each group of mice. At PSD 12 and 17, the immunohistochemical method was used to detect the expression of VEGF in each group of mice. The number of samples was 6 in each group at each time point in the above experiments. The data obtained were processed with t-test and factorial design ANOVA.Results: (1) After 7 days of adipogenic induction, red lipid droplets were observed in the cytoplasm with oil red O staining. After 21 days of osteogenic induction, black calcium deposition was observed in the medium stained with silver nitrate. The expression levels of CD73, CD90, CD 105 and CD34 in cells were 97.82%, 99.32%, 97.35% and 5.88% respectively. The cells were identified as ADSCs. (2) The wound healing rates of ADSC group at PSD 12 and 17 [(78 ± 6)%, (98 ± 3)%] were significantly higher than those of control group at PSD 12 and 17 [(60 ± 9)%, (90 ± 4)%, t = 4.26, 4.46, p< .01]. (3) At PSD 7, no vessels obviously grew into the center of the wound in both groups of mice, while the granulation tissue already covered the wound in ADSC group. At PSD 12, the wound in ADSC group was more well-perfused than control group. At PSD 17, it was observed that large vessels were crossing through the whole wound in ADSC group, while large vessels were observed without crossing through the whole wound in control group. (4) In ADSC group, at PSD 7, the wound was covered with thin granulation tissue, and the granulation tissue was obviously thickened at PSD 12. At PSD 17, the granulation tissue was covered by epidermis. At PSD 7, the thickness of the granulation tissue in the wound in ADSC group [(0.62 ± 0.05) mm] was significantly greater than that in control group [(0.31 ± 0.04) mm, t = 12.27, p < .01]. (5) At PSD 12 and 17, the expression levels of VEGF in the wound in ADSC group [(80.7 ± 2.2), (102.8 ± 2.6)/mm2] were significantly than those in control group [(59.5 ± 2.4), (81.5 ± 2.6)/mm2, t = 15.95, 14.14, p < .01].Conclusions: Allogeneic mouse ADSC-microporous sheep ADM can promote angiogenesis and the growth of granulation tissue in the wound with full-thickness skin defect in mice, thus accelerating wound healing. The mechanism is probably related with the increase in the expression of VEGF.

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