A Multicentre Study: The Use of Micrografts in the Reconstruction of Full-Thickness Posttraumatic Skin Defects of the Limbs-A Whole Innovative Concept in Regenerative Surgery.

Michele Riccio,Andrea Marchesini,Nicola Zingaretti,Maria Giuseppina Onesti,Pier Camillo Parodi,Luca Vaienti,Francesco De Francesco,Sara Carella,Diego Ribuffo,Letizia Senesi

doi:10.1155/2019/5043518

Abstract

The skin graft is a surgical technique commonly used in the reconstructive surgery of the limbs, in order to repair skin loss, as well as to repair the donor area of the flaps and cover the dermal substitutes after engraftment. The unavoidable side effect of this technique consists of unaesthetic scars. In order to achieve the healing of posttraumatic ulcers by means of tissue regeneration and to avoid excessive scarring, a new innovative technology based on the application of autologous micrografts, obtained by Rigenera technology, was reported. This technology was able to induce tissue repair by highly viable skin micrografts of 80 micron size achieved by a mechanical disaggregation method. The specific cell population of these micrografts includes progenitor cells, which in association with the fragment of the Extracellular Matrix (ECM) and growth factors derived by patients' own tissue initiate biological processes of regeneration enhancing the wound healing process. We have used this technique in 70 cases of traumatic wounds of the lower and upper limbs, characterized by extensive loss of skin substance and soft tissue. In all cases, we have applied the Rigenera protocol using skin micrografts, achieving in 69 cases the complete healing of wounds in a period between 35 and 84 days. For each patient, the reconstructive outcome was evaluated weekly to assess the efficacy of this technique and any arising complication. A visual analogue scale (VAS) was administered to assess the amount of pain felt after the micrografts' application, whereas we evaluated the scars according to the Vancouver scale and the wound prognosis according to Wound Bed Score. We have thus been able to demonstrate that Rigenera procedure is very effective in stimulating skin regeneration, while reducing the outcome scar.

Highlights

Complex injuries of the limbs, causing crushing and loss of skin and soft tissue, occur frequently due to common injuries, both domestic and at work
In order to achieve the healing of posttraumatic ulcers by means of tissue regeneration and to avoid excessive scarring, a new innovative technology based on the application of autologous micrografts, obtained by Rigenera technology, was reported
A visual analogue scale (VAS) was administered to assess the amount of pain felt after the micrografts’ application, whereas we evaluated the scars according to the Vancouver scale and the wound prognosis according to Wound Bed Score

Summary

Introduction

Complex injuries of the limbs, causing crushing and loss of skin and soft tissue, occur frequently due to common injuries, both domestic and at work. When the injury causes wide and deep loss of the skin and soft tissue, with bone fracture exposed, in order to achieve a functional reconstruction, using free flaps is preferable [1,2,3], while a useful option is covering the wound with a dermal template [4, 5]. To avoid unaesthetic scars, considered an inevitable side effect of this technique, and to allow at the same time tissue regeneration of the injured site, a new innovative technology based on the application of autologous micrografts obtained by Rigenera® technology, able to induce tissue repair by highly viable skin micrografts achieved by a mechanical disaggregation method [6,7,8], was recently reported. In the last few years, micrograft technology was applied in plastic and reconstructive surgery where micrografts derived from the cartilage were used for treatment of osteochondral lesion of the nose [17] and for enrichment of adipose tissue from human lipoaspirates [18]

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