Autogenous Skin Grafts Research Articles

Mini-autogenous skin grafts with skin homografts versus autogenous skin graft for covering post burn wounds in children

Mini-autogenous skin grafts with skin homografts versus autogenous skin graft for covering post burn wounds in children

Mini-Autogenous Skin Grafts with Skin Homografts Versus Autogenous Skin Graft for Covering Post Burn Wounds in Children

Introduction: Burns, as a common type of injury in children,have many developed techniques for management of itswounds, but still have many obstacles which meet plasticsurgeons. One of these is the lack of the donor sites forautogenous skin grafting especially in large body surface areaburns which are unfortunately common in developing countrieswith limited technical and financial resources. Finding asuitable methodology to address this problem was our mainhypothesis in this project. A mixed grafting technique basedon using mini-autogenous skin grafts covered with largehomogenous skin graft had been investigated for this purpose.Patients and Methods: This study is a prospective studyof 20 patients with post burn raw areas who were treated asinpatients at the Burn Unit of Assiut University Hospital,Egypt between September 2017 and September 2019. Patientswere divided into 2 groups. Group: 1 with 10 children treatedby covering the wounds with mini autogenous skin grafts andskin homo grafts and Group: 2 with 10 children treated bythe conventional autogenous skin grafts only.Results: The mean age was 6.8±2.3 years, 15 males and5 females. The mean of the harvested skin in group 1 was1.7±0.67% vs. 3.3±1.06% for group 2 (p < 0.001). Althoughthe mean time of surgery was significantly longer for patientsof group 1, these patients showed significant less bleedingfrom the site of the donor than the 2nd group. There werenon-significant differences between both groups regardingthe take of the graft at the recipient site (p=0.476). Thehyperpigmentation was significantly higher among patientsof group 2 (p=0.024).Conclusion: From this study we advocate the use of miniautogenous skin grafts covered with skin homografts forcovering the extensive post burn raw areas in children. Itprovides the covering for wide raw areas in presence ofshortage of the donor sites. It is a valid reliable procedurewith easier and less expensive aspects suitable for developingand low-income countries where large wound burns are socommon.No specific grants were received by this research fromfunding agencies in the commercial, public, or not-for-profitsector.

Repair of complex wounds on hands after burns or trauma

Objective: To explore the repair methods and effects of the complex wounds on hands after burns or trauma. Methods: From January 2008 to December 2017, 45 patients (28 males and 17 females, aging 8 to 58 years) with severe hand injuries after burns or trauma combined with deep tissue exposure were admitted to our hospital. Two patients had whole-fingers degloving injuries, 27 patients had dorsal hand injuries, and 16 patients had palmar injuries. After debridement, the area of soft tissue defects was 7 cm×6 cm to 19 cm×12 cm combined with 0.5 cm×0.4 cm to 10.0 cm×4.0 cm of single deep tissue exposure. Different repairing methods were adopted according to the area and location of deep tissue exposure. Five patients with small area exposure were treated with artificial dermis+ vacuum sealing drainage (VSD)+ autogenous skin grafting. Thirty-eight patients with unilateral large area exposure on palm or dorsum were treated with segmented ligation of abdominal thin flaps (with area of 8 cm×7 cm to 15 cm×9 cm). Two patients with bilateral large area exposure in dorsal and palmar hands were treated with modified abdominal bag-shaped delayed thin flaps (with area of 12 cm×5 cm to 12 cm×9 cm and 12 cm×6 cm to 14 cm×9 cm). The donor sites were directly sutured or repaired with intermediate split-thickness skin or adjacent flap. The survival of grafts and flaps was observed, number of operations, wound healing time, and follow-up were recorded. Results: (1) Among the patients receiving artificial dermis+ VSD+ autogenous skin grafting, the wounds of 3 patients were healed after 2 operations, and 2 patients had artificial dermis infection and lysis, and tendon necrosis, which were healed after 3 operations. The wound healing time of 5 patients was 14 to 33 days post injury. During the follow-up of 3 months, the affected hands were in good shape with soft texture and fewer scars, and functional evaluation of hand was good in 3 cases and modest in 2 cases. (2) The patients receiving segmented ligation of abdominal thin flaps all underwent 2 operations without flap necrosis. The wound healing time was 2 to 3 weeks post injury. Thirty-five patients underwent one to six-years' follow-up, which showed that the flaps were in good shape and color with soft texture, and the functional evaluation of hand was excellent in 25 cases, good in 7 cases, and modest in 3 cases. Three patients were lost to follow-up. (3) In the 2 patients receiving modified abdominal bag-shaped delayed thin flaps, all flaps survived after 5 operations, the wounds were healed on post injury day 22 and 24 respectively, the shape and texture of the affected hands was good with no bloated appearance after separating fingers and revision. During the follow-up of 2 years, the functional evaluation of hand was good in 2 cases. Conclusions: For the complex wounds on hands after burns or trauma, if the area of deep tissue exposure is small, artificial dermis+ VSD+ autogenous skin grafting should be adopted, which has good effects. If the area of unilateral deep tissue exposure is large, segmented ligation of abdominal thin flap should be adopted; if the area of bilateral deep tissue exposure is large, modified abdominal bag-shaped delayed thin flap should be adopted. These methods can reduce the number of operations, shorten wound healing time, and obtain good shape and function of hands.

A Comparison Between Autogenous Skin Graft and Alloskin Graft in Dogs

A Comparison Between Autogenous Skin Graft and Alloskin Graft in Dogs

Encapsulation and Characterization of Gentamicin Sulfate in the Collagen Added Electrospun Nanofibers for Skin Regeneration.

In the current practice, the clinical use of conventional skin substitutes such as autogenous skin grafts have shown several problems, mainly with respect to limited sources and donor site morbidity. In order to overcome these limitations, the use of smart synthetic biomaterials is tremendously diffusing as skin substitutes. Indeed, engineered skin grafts or analogues frequently play an important role in the treatment of chronic skin wounds, by supporting the regeneration of newly formed tissue, and at the same time preventing infections during the long-term treatment. In this context, natural proteins such as collagen—natively present in the skin tissue—embedded in synthetic polymers (i.e., PCL) allow the development of micro-structured matrices able to mimic the functions and to structure of the surrounding extracellular matrix. Moreover, the encapsulation of drugs, such as gentamicin sulfate, also improves the bioactivity of nanofibers, due to the efficient loading and a controlled drug release towards the site of interest. Herein, we have done a preliminary investigation on the capability of gentamicin sulfate, loaded into collagen-added nanofibers, for the controlled release in local infection treatments. Experimental studies have demonstrated that collagen added fibers can be efficaciously used to administrate gentamicin for 72 h without any toxic in vitro response, thus emerging as a valid candidate for the therapeutic treatment of infected wounds.

Cultured Human Epidermis Combined With Meshed Skin Autografts Accelerates Epithelialization and Granulation Tissue Formation in a Rat Model.

IntroductionAs the take rate of cultured epidermal autografts in burn wound treatment is variable, widely expanded meshed auto skin grafts are often used in combination with cultured epidermal autograft to increase the take rate and achieve definitive wound coverage. However, a long time (3–4 weeks) required to prepare a cultured epidermis sheet is a disadvantage. Allogeneic cultured epidermis can be prepared in advance and cryopreserved to be used in combination with auto meshed skin grafts for treating third-degree burns. Nevertheless, the human cultured epidermis (hCE) has not been proved to accelerate wound healing after meshed skin grafting. Here, we investigated the effect of hCE on wound healing in a rat model of meshed skin grafting.Materials and MethodsHuman cultured epidermis was prepared from human neonatal foreskin and assessed by the release of growth factors into the culture medium using enzyme-linked immunosorbent assay. Skin wounds were inflicted on male F344 rats and treated by the application of widely meshed (6:1 ratio) autogenous skin grafts with or without hCE (n = 8 rats per group). Wound area, neoepithelium length, granulation tissue formation, and neovascularization were evaluated on day 7 postgrafting.ResultsHuman cultured epidermis secreted IL-1α, Basic fibroblast growth factor, platelet-derived growth factor-AA, TGF-α, TGF-β1, and vascular endothelial growth factor in vitro. In rats, hCE accelerated wound closure (P = 0.003), neoepithelium growth (P = 0.019), and granulation tissue formation (P = 0.043), and increased the number of capillaries (P = 0.0003) and gross neovascularization area (P = 0.008) compared with the control group.ConclusionsThe application of hCE with meshed grafts promoted wound closure, possibly via secretion of growth factors critical for cell proliferation and migration, suggesting that hCE can enhance the healing effect of widely expanded skin autografts.

Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting.

In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

Eyelid reconstruction with the penile skin

Objective To evaluate the effects of dermatoplasty of dissociative prepuce in the management of male blepharocoloboma patients to restore eyelid function and appearance.Methods 32 male blepharocoloboma patients were involved from January 2003 to August 2011.The autogenous penile free skin graft was cut off and made corresponding bed size,if insufficient,the skin flap around the eyelid was used to repair and restore the blepharocoloboma.Results 32 patients recovered basic eyelid function and appearance in the follow up of 6 ～ 24 months.Conclusion Dermatoplasty of dissociative prepuce is effective in the treatment of male blepharocoloboma. Key words: Eyelid; Skin defect; Dissociative prepuce; Dermatoplasty

Substitutos cutâneos: conceitos atuais e proposta de classificação

Feridas complexas podem resultar na perda completa do revestimento cutâneo. A solução consagrada pela cirurgia plástica é a enxertia de pele autógena, porém há casos em que ocorre escassez de área doadora cutânea, um problema ainda não totalmente solucionado. Assim, atualmente há muito interesse por materiais sintéticos ou biológicos que possam ser utilizados como substitutos cutâneos. O objetivo deste estudo foi introduzir uma forma mais didática de agrupar diferentes tipos de substitutos cutâneos. Acreditamos que esses produtos podem ser classificados de forma mais abrangente se forem divididos segundo três critérios: camada substituída da pele, subdivididos em epidérmicos (E), dérmicos (D) e compostos dermoepidérmicos (C); duração no leito da ferida, subdivididos em temporários (T) e permanentes (P); e origem do material constituinte, subdivididos em biológicos (b), biossintéticos (bs) e sintéticos (s).

Management of Combined Soft Tissue and Osseous Defect of the Midfoot with a Free Osteocutaneous Radial Forearm Flap: A Case Report

Extensive soft tissue and osseous defects of the foot are difficult to manage and often result in amputation. Most of these wounds are created by trauma, but other causes, such as infection and malignancy, can create similar defects. A variety of wound management options exist for the treatment of these challenging wounds, including negative pressure wound therapy, autogenous skin grafting, and the use of skin substitutes, as well as internal and external fixation methods. In the present report, we describe the use of a free osteocutaneous radial forearm flap to manage a 10-cm × 5-cm dorsal soft tissue defect and a 2.5-cm second metatarsal diaphyseal defect in an adult male.

Skin Grafts and Local Flaps

Expedited healing of skin wounds is essential regardless of surgical specialty. Any skin deficiency will thwart this basic intent, and an alternative must be sought. The autogenous skin graft or local flap has long had a major role in satisfying this objective. Various forms of autogenous skin grafts are to be differentiated from local flaps, primarily on the basis of vascularization. The indications for either, their surgical anatomy, harvest techniques, and limitations, including pitfalls, need to be outlined. Skin grafts are the simplest means to restore skin integrity. If skin grafts are contraindicated, a flap may be essential. For this purpose, the "top ten" local "workhorse" flaps are briefly described in this article. Accompanying videos further elaborate the requisite surgical anatomy and harvest techniques. As a problem-solving specialty, it is incumbent upon us to first prevent, then be able to provide rapid, efficient, and efficacious healing of, any surgical wound, iatrogenic or otherwise. Skin grafts and local flaps are fundamental elements for achieving this goal when healing by primary or secondary intent is not possible. Whether one is a "reconstructive" or "aesthetic" plastic surgeon, knowledge of these basic tenets will ensure maintenance of competency.

The long-term efficacy and clinical application of acellular allograft dermal with autogenous skin grafts in wound repair

Objective To find an ideal cover material for repairing of deep-burned functional part and scar deformity. Methods The wound of ulcer,scar and wound of the deep-burned functional part excised were covered with acellular allograft derma plus autogenous split-thickness skin graft. Results 30 cases were included in this study. The survival rate of the composite skin grafts was 100%. All the composite skin grafts were smooth and soft,had good elasticity, and the joint functions were good. Conclusion Acellular allograft dermal with autologous skin is an ideal covering material for repairing wound of function parts Key words: Acellular allograft dermal; Autogenous split-thickness skin; Wound repair

Experimental study of tissue-engineered skin loaded with keratinocyte growth factor nanocapsules for skin defect

To study the effect of tissue-engineered skin loaded with keratinocyte growth factor (KGF) nanocapsules for skin defect on athymic mice. The acellular dermal matrix (ADM) loaded with KGF-ADM was constructed by means of phacoemulsification solvent evaporation and low temperature drying. The human epidermal stem cells and fibroblasts were captured and identified, then cultivated on the surface of the KGF-ADM. The cell growth was observed. The tissue-engineered skin without KGF was used as sham group. The autogenous skin graft was used as control group. 2 and 6 weeks after the skin was transplanted to the back of athymic mice, the contraction and histological healing of the transplanted skins were observed respectively. Then the immunofluorescence examination with anti-human K10-FITC and beta1-integrin-Cy3 were applied to detect the origin, growth and differentiation of epidermal and dermal cells in tissue-engineered skin. The epidermal stem cells grew well and attached tightly on KGF-ADM. There were small round stem cells and polygonal terminally-differentiated cells, which appeared a partly cloning growth and a tendency of merging. The tissue-engineered skin with KGF nanocapsules gained better result in repairing the skin defects as compared with the blank group and the control group 2 and 6 weeks after transplantation. The regenerative skin cells could connect and mix closely with the athymic mouse skin cells on the border of skin defect. Meanwhile, the regenerative skin existed some contraction. The histological observation with HE staining showed that the regenerative skin possessed intact epidermis with several cell layers and normal keratose stratum, among which there were still some beta1-integrin (+) cells which represented epidermal stem cells or transient amplifying cells when they were tested by immunofluorescence after 6 weeks of transplantation. The tissue-engineered skin loaded with KGF nanocapsules had a better result in repairing athymic mice skin defects than common tissue-engineered skin without KGF nanocapsules or skin auto-graft.

Artificial Dermis Graft on the Mandible Lacking Periosteum After Excision of an Ossifying Fibroma: A Case Report

Collagen-based grafts have often been used as artificial tissue substitutes for the repair of tissue and organ defects. It is common surgical knowledge that autogenous or artificial skin grafts take well on the intact periosteum of bone. However, many experienced surgeons indicate that autogenous or artificial skin grafts subsist poorly on the bone surface without periosteum. Therefore, primary closure is usually recommended in the wound healing of exposed bone. Vestibuloplasty might be needed to create enough depth of vestibule in the future. In this case report, we describe a peripheral ossifying fibroma surgically excised leaving a bony defect, which was covered by a piece of artificial dermis. Satisfactory result of the repaired surgical defect showed no need of vestibuloplasty after 6 years of follow-up.

Cicatrização conduzida e enxerto de pele parcial no tratamento de feridas

The present study compared the treatment of skin wounds by means of conducted healing (an innovative method for treatment of secondary healing) and autogenous skin graft. Seventeen rabbits were submitted to removal of two skin segments, one on each side of the dorsum. The graft donor area was left as a wound for conducted healing (A) and was submitted only to debridement, local care and dressings. The skin removed from the above mentioned side was implanted as a graft (B) to cover the wound on the other side. Thus, each animal received the two types of treatment on its dorsum (A and B). Rabbits were divided into two groups according to size of the wounds: Group 1--A and B (4 cm2) and Group 2--A and B (25 cm2). Healing time was of 19 days for Group 1 and of 35 days for Group 2. The final macro- and microscopic aspects of healing were comparatively analyzed in the four subgroups. Presence of inflammatory cells, of epidermal cysts and of giant cells was assessed by histology. Data were statistically analyzed by the nonparametric Fisher, Kruskal-Wallis and Wilcoxon tests. No macro- or microscopic difference was observed between conducted healing and skin graft, although conducted healing led to a more rapid wound healing. Conducted healing seems to be a good therapeutic option for skin wounds in rabbits.

The Application of Split-Thickness Skin Graft as an Autogenous Arterial Conduit in a Goat (Capra Hircus) Model

Adequate autogenous vein is often the limiting factor in achieving a successful infrainguinal bypass. Attempts have been made to find alternative conduits; however, these alternatives have demonstrated inferior patency rates. We attempt to show that a split-thickness skin graft conduit provides a feasible autogenous arterial conduit. Neoconduits were prepared with an autogenous split-thickness skin graft (STSG) tubularized for a length of 5-6 centimeters with an appropriate caliber match to native artery. The deep dermal side of the graft was randomized to form either the external surface or the luminal surface. The neoconduit was placed as an interposition graft in the left common carotid artery. Grafts were studied in vivo with duplex ultrasonography and ex vivo by histopathology and immunohistochemistry. Feasibility study involved 4 animals with grafts harvested for study at 24 hours (n = 2) and 7 days (n = 2). Two subsequent groups were studied to evaluate 3-month (n = 8) and 6-month (n = 5) patency. All grafts (n = 4) in the feasibility phase of the study were patent at the time of harvest without evidence of aneurysmal degeneration. In the subsequent 8 goats, grafts with the deep dermal side forming the extraluminal surface (n = 4) had a propensity to ulcerate and rupture or to become aneurysmal (75%). The patency rate of these grafts at 6 weeks was 25%. In contrast, grafts with the deep dermal side forming the intraluminal surface (n = 4) demonstrated 75% patency at 6 weeks. Because of these results the remaining goats underwent placement of neoconduits with the deep dermal side forming the luminal surface. These grafts maintained a patency rate of 80% at 6 months. Neoconduits implanted with a diameter greater than 1.5 times the native arterial diameter became aneurysmal. Histopathology demonstrated neointimal formation in all grafts patent for longer than 7 days. Immunohistochemical staining for Factor VIII/von Willebrand's factor (vWF) was reactive in the endoluminal cells of these grafts. Immunohistochemical staining for a-smooth muscle actin demonstrated reactivity in conduits patent for greater than 1 month. Split-thickness skin may provide a feasible source for autogenous conduit in arterial reconstructions and warrants further study. Technical factors affecting patency include orientation of the deep dermal surface of the STSG and the diameter of the neoconduit at the time of implantation.

A technique for creating a skin-lined hemithorax.

Abstract Prosthetic lungs could permanently occupy the pleural space which must first be lined with silicone ‘skin’, i.e., Dacron-backed silicone membrane (Peirce, 1966). Initial experiments in dogs showed that the pleural membrane would not readily accept silicone ‘skin’; rather, the solution lay in the use of autogenous skin-grafts. A readily reproducible technique has been eveloped for transforming the left hemithorax of SPF rats into stable skin-lined cavities which can be opened to atmospheric pressure without embarrassing breathing in the contralateral lung. Authogenous skin was formed into 35 × 20-mm. sacs and grafted into the left pleural spaces of 150 male SPF rats of mean weight 240±30 g. One hundred and thirty-two (88 per cent) survived 4 weeks or more. In these the skin-lined cavity grew to occupy the hemithorax, displacing the left lung. In 75 rats the cavity was opened to the exterior and sutured to the skin, thereby creating a permanent 5–8-mm. opening directly through the chest wall. Fifty-nine of the 75 rats so exposed survied. The mean pressure in the cavity was +2.9±0.6 cm. H2O before it was opened to the exterior; after the creation of the stoma the mean pressure in the cavity became −2.5±0.6 cm. H2O (P &amp;lt; 0.001), and the new pressure was in phase with and was similar in magnitude to the oesophageal pressure. The skin-lined hemithorax is presented as the model of a cavity which could be employed to house prosthetic organs designed for permanent implantation insie the chest cavity.

Effect of fibrin glue derived from snake venom on the viability of autogenous split-thickness skin graft

The aim of this study was to analyze the effect of snake venom derived from fibrin glue on the viability of split-thickness skin graft. Nine crossbreed dogs were used. Full-thickness skin segments measuring 4 x 4 cm were bilaterally excised from the proximal radial area on each dog. A split-thickness skin graft was harvestedfrom left lateral thoracic area using a freehand graft knife, and was secured to the left recipient bed using several simple interrupted sutures of 3-0 nylon (sutured graft). A split-thickness skin graft was harvested from the right lateral thoracic area using a graft knife. Fibrin glue derived from snake venom was applied to the recipient bed, and 8 equidistant simple interrupted sutures of 3-0 nylon were used to secure the skin graft (glued graft). Viable and nonviable areas were traced on a transparent sheet and measured using a Nikon Photomicroscope connected to a KS-300 image analysis system. The skin graft and recipient bed were collected from three dogs at day 7, 15, and 30 postoperative. The glued grafts had statistically higher graft viability than sutured grafts. Histological examination showed that the tissue repair process in the glued grafts was more accentuated than sutured grafts. It was possible to conclude that fibrin glue derived from snake venom increased survival of autogenous split-thickness skin graft.

Autogenous Skin Graft in the Treatment of Large Incisional Lumbar Hernias and Bulges

Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture. Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula. No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges. The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.

Topical oxygenation in face and neck autogenous skin graft repair

Topical oxygenation in face and neck autogenous skin graft repair