Abstract
Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling; and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.
Highlights
Between 10% and 15% of trauma laparotomies are performed utilizing damage-control surgery techniques [1]
If early primary fascial closure is not practical or feasible, techniques have been reported for management of the open abdominal defect including closure with an absorbable mesh to provide a scaffold for visceral granulation tissue formation and cutaneous coverage by split-thickness skin graft (STSG) [6] [7]
Ten patients with persistent visceral distension with or without abdominal wall tissue loss preventing direct fascial closure were managed with split-thickness skin grafting of visceral granulation tissue
Summary
Between 10% and 15% of trauma laparotomies are performed utilizing damage-control surgery techniques [1]. If early primary fascial closure is not practical or feasible, techniques have been reported for management of the open abdominal defect including closure with an absorbable mesh to provide a scaffold for visceral granulation tissue formation and cutaneous coverage by split-thickness skin graft (STSG) [6] [7]. The timing of definitive abdominal wall reconstruction following visceral skin grafting is determined by evaluating the characteristic adherence of the split-thickness skin graft to the underlying viscera. Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
