Extracellular matrix graft for reconstruction over exposed structures: a pilot case series

2020 ◽  
Vol 29 (12) ◽  
pp. 742-749
Author(s):  
Gregory A Bohn ◽  
Abigail E Chaffin
Keyword(s):  
Extracellular Matrix ◽  
Soft Tissue ◽  
Skin Graft ◽  
Granulation Tissue ◽  
Case Series ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Dermal Matrix ◽  
Dermal Matrices ◽  
Tissue Defects

Objective: Soft tissue defects, especially those involving exposed vital structures, present a reconstructive challenge because poor vascularity of such defects typically makes immediate skin grafting unviable. Where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for defects with denuded vital structures. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine-derived extracellular matrix graft in the reconstruction of complex soft tissue defects involving exposed vital structures. Method: Six cases of soft tissue defects exhibiting denuded vital structures underwent reconstruction using an ovine forestomach matrix graft as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporised defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialisation were monitored until closure and the final aesthetic and functional outcomes were evaluated. Results: Complete healing was achieved in all cases, with defect granulation becoming observable within one to two weeks and complete granulation occurring within one to six weeks. Granulation tissue resulting from the graft was suitable for skin grafting, with 100% take of skin grafts after one week and complete re-epithelialisation in two to three weeks in the four cases that received a skin graft. Good cosmetic, functional and patient satisfaction outcomes were achieved in all cases. Conclusion: The present series demonstrates our initial use of an extracellular matrix-based dermal matrix in reconstructing defects with exposed vital structures. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.

scholarly journals Case Report: A Novel Ventilated Thermoplastic Mesh Bandage for Post-operative Management of Large Soft Tissue Defects: A Case Series of Three Dogs Treated With Autologous Platelet Concentrates

2021 ◽  
Vol 8 ◽  
Author(s):  
Priscilla Berni ◽  
Fabio Leonardi ◽  
Virna Conti ◽  
Roberto Ramoni ◽  
Stefano Grolli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Granulation Tissue ◽  
Healing Process ◽  
Case Series ◽  
Operative Management ◽  
Wound Healing Process ◽  
Soft Tissue Defects ◽  
Platelet Concentrates ◽  
Autologous Platelet ◽  
Tissue Defects

A ventilated thermoplastic mesh bandage was used for the post-operative management of large soft tissue defects in three dogs. Once the granulation tissue appeared, the wounds were treated with liquid or jellified autologous platelet concentrates, Platelet Rich Plasma (PRP) and Platelet Lysate (PL), to improve the wound healing process. After cleaning the wound with sterile physiological solution, a dressing was performed with several layers of cotton. A window through the layers of cotton was opened above the wound. Then, the platelet concentrate was topically applied, and the bandage was completed by placing, over the access window, a ventilated thermoplastic mesh modeled according to the size and shape of the wound. After 24 h, it was replaced by a low adhesion bandage. The thermoplastic mesh avoids the direct contact between the wound and the external layers of the bandage, preventing the drainage of the topical agent and the removal of the growing healthy granulation tissue. The bandage proposed in this study is easily applied by the veterinarian and well-tolerated by the animal, ensuring high welfare standards in stressed patients presenting compromised clinical conditions.

Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes

2018 ◽  
Vol 43 (10) ◽  
pp. 1019-1029 ◽  
Author(s):  
David Elliot ◽  
Roberto Adani ◽  
Sang Hyun Woo ◽  
Jin Bo Tang
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Soft Tissue Defects ◽  
Flap Transfer ◽  
Less Invasive ◽  
Defect Site ◽  
Venous Flaps ◽  
Occlusive Dressings ◽  
Recent Developments ◽  
Tissue Defects

We review recent developments in using occlusive dressings, dermal templates, and venous flaps for less invasive approaches to treat soft tissue defects of the forearm and fingers. Occlusive dressings can be used for thumb tip or fingertip trauma with soft tissue defects of small or moderate sizes. They permit skin regeneration without use of skin graft or a flap transfer. This is currently a popular way to treat tip soft tissue defects in European countries. Extensive soft tissue defects in the thumb, fingers, hand and forearm require flap transfers traditionally, but in recent years, surgeons use dermal templates to cover the defect site to allow regeneration of subcutaneous tissues, over which a skin graft is used in lieu of a flap. Transfer of a venous flap is currently a reliable procedure and is less invasive compared with conventional flaps, which usually damage a named artery in the donor. We advocate that less invasive methods should be considered for soft tissue defects in the hand and forearm.

Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation

2009 ◽  
Vol 118 (8) ◽  
pp. 546-551 ◽  
Author(s):  
M. Boyd Gillespie ◽  
Thomas S. Dozier ◽  
Terry A. Day ◽  
Bonnie Martin-Harris ◽  
Shaun A. Nguyen
Keyword(s):  
Soft Tissue ◽  
Vocal Fold ◽  
Case Series ◽  
Soft Tissue Defects ◽  
Retrospective Case ◽  
Vocal Rehabilitation ◽  
Calcium Hydroxylapatite ◽  
The Voice ◽  
Tissue Defects

Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.

scholarly journals MANAGEMENT OF ACQUIRED SOFT TISSUE DEFECTS OF GROIN AND GENITALIA

2020 ◽  
pp. 1-4
Author(s):  
Ratnakar Sharma ◽  
Mir Adnan Samad ◽  
Kumar Sourav Dogra ◽  
Shaarang Gupta
Keyword(s):  
Soft Tissue ◽  
Road Traffic ◽  
Past History ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Detailed History ◽  
Flap Coverage ◽  
Split Thickness Skin Grafting ◽  
History Of ◽  
Tissue Defects

Background: The defects of the groin and the genitalia are complex and pose a challenge to the reconstructive surgeon. These defects may arise out of a variety of insults which include – extirpative oncologic surgeries, necrotizing fasciitis, post burn defects, post traumatic defects including road traffic accidents and animal bites etc. Objectives: To study the epidemiology of the acquired soft tissue defects of the groin and genitalia. To evaluate the role of various reconstructive modalities for the acquired soft tissue defects of groin and genitalia. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 25 patients admitted with acquired soft-tissue defects of groin and genitalia over a period extending from November 2018 to October 2019 (Prospective study). Personal and demographic data of the patient was noted. A detailed history regarding the cause of the defect along with history of trauma, discharge and bleed from the site was taken. Any past history of surgery and irradiation of the region was noted. The patients having soft tissue defects of the groin and genitalia secondary to the release of post burn contracture were subjected to the detailed history as regards cause of burn, treatment taken and time taken for burn wounds to heal. Examination included general physical examination along with the local wound condition which included site, size, discharge, slough, granulation tissue and any exposed vital structures such as vessels/ nerves. A hemogram, assessment of blood sugar, renal function (blood urea nitrogen and serum creatinine), coagulation profile, blood grouping, viral markers, chest x-ray and ECG were done as a part of routine pre-operative investigations. Wound swab was sent for culture. Biopsy was taken wherever required. Analysis of report of any previously taken biopsy was done. Split thickness skin grafting was the modality of coverage utilized in 56% cases followed by flap coverage in 32% cases. 12% of the defects were closed primarily. Results: Majority of the patients had durable coverage of the defects of groin/genitalia and the coverage modality was acceptable to the patient as regards aesthesis and functional outcome. No major complication was encountered in any of the patients. Conclusion: The reconstruction of the soft tissue defects of groin and genitalia need a meticulous examination and planning of reconstructive modality which may include skin grafting or a flap coverage.

Definitive reconstruction of complex maxillofacial trauma with wide-spread soft-tissue defects: A case series

2021 ◽  
Author(s):  
Hong Loi Nguyen
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Maxillofacial Trauma ◽  
Soft Tissue Defects ◽  
Wide Spread ◽  
Severe Injuries ◽  
Tissue Defects

The mаnаgement of soft tissue injury аfter complex fаciаl trаumа poses unique chаllenges to the plаstic surgeon, given the speciаlized nаture of fаciаl tissue аnd the аesthetic importаnce of the fаce. We report 8 cаses with wide-spreаd soft-tissue defects due to complex fаciаl trаumаwho presented аt Odontostomаtology center - Hue centrаl hospitаl during the yeаr 2018.Of these cаses were surgicаlly mаnаged by fixаtion аnd fаciаl reconstructionаt Odonto-stomаtology center - Hue centrаl hospitаl;аnd they were very well recovery in function аnd аesthetics. The generаl principles of trаumа mаnаgement аnd wound cаre аre аpplied in аll cаses. The mаnаgement of severe injuries to the fаce is discussed in relаtion to the locаtion аnd the mechаnism of injury.

Reverse Sural Fascio-Cutaneous Flap for Management of Patients with Distal Third of Lower Limb Soft Tissue Defects Referring to the Emergency Department Following Traumatic Events; A Review of 13 Cases

2021 ◽  
Author(s):  
Hosseinali Abdorrazzaghi ◽  
Babak Hajibarati ◽  
Fateme Mohammadi
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Lower Limb ◽  
Daily Life ◽  
Case Series ◽  
Lower Limbs ◽  
Soft Tissue Defects ◽  
Daily Life Activities ◽  
Cutaneous Flap ◽  
Tissue Defects

Introduction: Soft tissue defects over the distal leg and/or heel are probable injuries that need a flap. Various coverage techniques have been described in this regard. It seems that applying Reverse Sural Fascio-Cutaneous Flap (RSFCF) for reconstructing soft tissue defects of lower limbs has superiorities over other techniques. Objective: We intend to present a case series with soft tissue defect over the distal third of lower limb, covered using RSFCF technique.   Methods: This is a case series and longitudinal study in which patients with crush injuries who referred to the emergency department (Sina hospital, Tehran, Iran) from 2013 until 2020 and were treated with RSFCF technique were included. The data were collected using patients’ charts, by interviewing the patients, and from hospital records. The patients' wounds were prepared, examined, and the surgery was done. Tendon and bone defects were repaired, and wounds were closed using reverse sural Fascio-Cutaneous Flap. Results: A total of 13 patients were eligible during the 6-year study period. Men were more commonly affected with no conclusive gender trend. The posterolateral part of the foot of the right leg was the most frequently injured part (53.8%). Only 1 patient had mentioned complications after surgery including mild congestion and abnormal sensory and motor examination. Patients were followed by the surgeons until 3 months after the operation and all of them had been able to resume their daily life activities by then. Conclusion: According to our findings, almost all of the patients (except one) had received their flaps without any complications. All the patients had been able to resume their daily life activities three months after the surgery. This may show that RSFCF, which can be quickly performed and does not need microsurgical skills, could be a suitable option for the coverage of distal third of lower limb soft tissue defects caused mainly by trauma

Sequential propeller flaps in the treatment of post-traumatic soft tissue defects of the lower limb – a case series

Injury ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 2922-2929 ◽  
Author(s):  
Alberto Franchi ◽  
Elmar Fritsche ◽  
Mario F. Scaglioni
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Case Series ◽  
Soft Tissue Defects ◽  
Post Traumatic ◽  
Tissue Defects

Palmar Resurfacing of the Hand With Porcine Urinary Bladder Extracellular Matrix Following Traumatic Injury

2021 ◽  
Vol 33 (7) ◽  
pp. E46-E42
Author(s):  
Cy Daneshfar ◽  
Joash Suryavanshi ◽  
Hillary Powers Wall ◽  
Cameron Cox ◽  
Brendan MacKay
Keyword(s):  
Extracellular Matrix ◽  
Soft Tissue ◽  
Urinary Bladder ◽  
Tissue Expansion ◽  
Free Flaps ◽  
Soft Tissue Coverage ◽  
Soft Tissue Defects ◽  
Valuable Adjunct ◽  
Reconstructive Ladder ◽  
Tissue Defects

Introduction. Complex wounds of the hand often result in soft tissue defects that are not amenable to primary closure, vacuum-assisted closure, or tissue expansion. Injuries presenting with large defects involving multiple levels of tissue must be addressed by using techniques at higher rungs on the reconstructive ladder, such as split-thickness grafting, pedicled flaps, or free flaps. When repairing palmar tissue, these techniques fall short due to their failure to approximate structure and function of specialized skin. More recently, dermal substitutes containing a decellularized extracellular matrix (ECM) have been used in reconstruction of soft tissue defects, acting as a structural scaffold for the regrowth of native cells. Extracellular matrix products have been shown to improve functional and sensory outcomes in areas requiring highly specialized skin. Urinary bladder matrix (UBM), a porcine ECM scaffold, is unique in that it contains an intact epithelial basement membrane that promotes more organized regrowth through layered structure. Case Report. This case presents a novel use of this product in resurfacing 80% of a palm after postoperative necrosis following a table saw injury to the right volar palm at the distal crease. The patient had intact sensation and near normal functional outcomes at most recent follow up. Conclusions. The UBM may be a valuable adjunct to achieve soft tissue coverage in large, complex hand wounds, particularly those involving the palmar surfaces.

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