Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage—Clinical Outcome of 34 Patients

Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length ( W/ L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables ( P < .05 Kruskal–Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A ( W/ L ＞ 0.5) were more difficult to close than in group B ( W/ L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.

Adjustable, Skin-Stretching External Fixation Device and Negative Pressure Wound Therapy Application for Infected Full-Thickness Skin Defects: A Case Series Study

Introduction. Skin defects—especially infected, massive full-thickness defects—can be challenging to manage. Traditionally, defects are repaired using free flaps or musculocutaneous flaps. Many side effects and complications are associated with flaps, however, such as infection, pain, donor site pain, and poor cosmesis. Objective. This case series evaluates the use of an adjustable, skin-stretching external fixation device and negative pressure wound therapy (NPWT) to repair soft tissue defects. Materials and Methods. In this retrospective series, 7 patients with skin defects were treated with an adjustable, skin-stretching external fixation device and NPWT between January 2014 and December 2017. All patients were followed until complete healing was achieved. Each patient’s age, sex, defect size, mechanism of injury, healing time, results, and complications were recorded. Results. The average patient age was 37.43 years ± 10.47 SD (range, 26–55 years). The average skin defect area was 14.5 cm2 ± 5.26 * 23.25 ± 9.01 cm2 (range, 7–15 cm2 * 10–30 cm2), and average healing time was 3.29 months ± 1.60 (range, 1–6 months). All defects healed, and 2 patients developed ulcers. Conclusions. This series showed the adjustable, skin-stretching external fixation device and NPWT to be a simple, safe, and effective means of managing skin defects, with minimal complications.

Investigating the role of interleukin-17 in radiation dermatitis.

e24094 Background: Up to 95% of patients receiving radiation therapy (RT) develop radiation dermatitis (RD), which can be therapy-limiting and detrimental to quality of life. Despite its ubiquity, no evidence-based gold standard for the management of RD exists, which highlights the inadequate understanding of its pathogenesis. Prior studies have suggested a role of the pro-inflammatory cytokine interleukin 17 (IL-17) in RD pathogenesis. Its pathway is known to be vital in other inflammatory dermatoses and anti-IL-17 antibodies are already in clinical use. Our goal is to mechanistically understand how RT leads to inflammation in the skin and demonstrate that we can inhibit these pathways and effectively manage RD. Methods: To test the effect of irradiation on the IL-17 pathway, mice were anesthetized and flank skin was stretched to form an exposure area. A single dose of 25 Gy was given. Controls were sham-irradiated and subjected to the same anesthesia and skin stretching. Three weeks after irradiation, we analyzed mRNA levels of IL-17 target genes by qRT-PCR. Furthermore, we utilized single cell RNA-sequencing (scRNA-seq) to profile cells from sham and irradiated skin. To elucidate the role of IL-17, we tested the effect of IL-17A blockade on RD severity in our mouse model. Of note, IL-17A utilizes IL-17 Receptor Type C (IL-17RC) as the membrane-bound receptor in its signaling cascade. Three treatment groups were established: sham receiving no radiation or drug, control receiving saline and radiation, and experimental receiving IL-17A neutralizing antibody and radiation. Mice receiving saline or neutralizing antibody had an intravenous infusion prior to irradiation and weekly thereafter. At the end of week 4, radiated skin was dissected and used for gene expression analysis and histology. To more meticulously study the contribution and requirement of keratinocyte IL-17RC for the development of RD, we generated keratinocyte-specific IL-17RC knockout mice and applied the abovementioned protocol to knockout and control cohorts. RD severity was assessed 8 weeks post irradiation. Results: mRNA levels of S100a8 and S100a9, markers of IL-17 pathway activation, are upregulated in irradiated skin and their expression strongly correlates with increased RD severity ( P < 0.001). From the scRNA-seq, we found that CD103+ dendritic cells and natural killer cells, known immunologic cell types of cutaneous radiation syndrome, were more abundant in irradiated skin. We also identified a novel keratinocyte subtype with abundant IL-17RC mRNA that was exclusive to the irradiated group. Mice receiving IL-17A neutralizing antibody as well as keratinocyte-specific IL-17RC knockout mice, showed a significant reduction in RD severity as compared to controls ( P = 0.0022). Conclusions: The IL-17 pathway plays a significant role in the pathogenesis of RD. Inhibition of this signaling within keratinocytes prevented the development of severe RD in a murine model.

Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

The management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

Management of complex diabetic foot wounds with large skin defects poses a challenge for surgeon. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 to October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm² (range: 4.71 -66.76 cm²).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 days to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm² per day, ranging from 0.29 cm² per day to 8.35 cm² per day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistically difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach for complex diabetic foot wounds. Nevertheless, more attentions should be paid for the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

Morphofunctional characteristics of cutaneous connective tissue scars in women with past history of childbirth after cesarian delivery

The inevitable outcome of skin injuries caused by a variety of external factors is the formation of a connective tissue scar. A scar can deform when exposed to stretching, pressure or repeat surgeries and undergo structural changes leading to its dehiscence. Scar dehiscence is a common problem seen in women with a past history of cesarean delivery. There have been comprehensive studies of uterine scars formed after the C-section, but the morphology of cutaneous C-section scars has not yet been investigated. The aim of this study was to look into the morphology of connective tissue scars in multiparas with a past history of cesarean delivery. Specimens of cutaneous scars were collected from 30 women after the C-section. Within one age group, fiber thickness was directly proportional to the number of previous deliveries. Comparison of different age groups with the same number of previous deliveries revealed the thinning of collagen fibers and the increased density of type III collagen fibers. The most pronounced changes were observed in women with a history of 3 or more deliveries. We hypothesize that a connective tissue scar undergoes structural transformation, becomes thinner, and its fibers dissociate due to repeated skin stretching, which might indirectly suggest the dehiscence of the postoperative scar.

A novel skin-stretching device for closing large skin-soft tissue defects after soft tissue sarcoma resection

Background Closure of large skin-soft tissue defects following soft tissue sarcoma (STS) resection has been a great challenge. The objective of this study was to evaluate the effectiveness of a novel, simple, and cheap skin-stretching device (bidirectional regulation-hook skin closure system, BHS) for closing large skin-soft tissue defects resulting from the removal of STS and the complications associated with the use of the BHS. Methods From January 2017 to September 2018, 25 patients with STS underwent BHS therapy after tumor resection. BHS was used for two main clinical applications: securing wound closure after high-tension suture closure and delayed wound closure. We described a detailed reconstruction procedure regarding this therapy. Wound closure and complications associated with BHS therapy were recorded. We also analyzed tumor recurrence and metastases. Results All patients were observed for 16–36 months with an average follow-up of 25.6 months. During the follow-up period, no significant functional restriction was observed and the final scar was aesthetically acceptable. Superficial wound infection occurred in six patients, wound edge ischemia in two patients, and small skin tears in two patients. Two patients developed pulmonary metastasis, two patients had a local recurrence, and one patient died of pulmonary metastasis. Conclusions BHS therapy can effectively close large skin-soft tissue defects following STS resection and obtain acceptable functional results, without severe complications. However, larger studies are required to further evaluate the effectiveness, indications, and complications of BHS therapy.