Epidermal Skin Grafts Research Articles

The Use of Dermal Substitute in the Treatment of Burns as a Complication of Type 2 Diabetes Mellitus and Diabetic Foot Syndrome.

Diabetic Foot Syndrome is a complex and challenging clinical condition associated with high risk of mortality and lower limb amputation. The distal lesions represent the epiphenomenon of this syndrome and request a multidisciplinary care and an appropriate therapeutic path to ensure their healing. This case report describes the management of burns in a patient with type 2 diabetes mellitus, end stage renal disease and Diabetic Foot Syndrome. The lesions were treated with autologous epidermal skin graft until healing. Products that stimulate or replace extracellular matrix, which has a central role in wound healing, can be consider in the treatment of burns and offer a simpler and less disabling reconstructive possibility for the patient.

An Innovative Single‐Stage Approach of High‐Tension Keloid Excision and Reconstruction Using Acellular Dermal Matrix and Epidermal Skin Grafting

The treatment of keloids, particularly in high‐tension areas, is challenging due to their extension beyond the original wound boundaries and high recurrence rates, thereby rendering traditional treatments ineffective. In this study, we investigated the effectiveness of a novel single‐stage treatment approach that combined acellular dermal matrix (ADM) with keloid‐specific epidermal skin grafting. To further prevent recurrence after neo‐skin formation, the treatment was followed by fractionated laser and radiation therapy (LCR). Seven patients with high‐tension keloids, including one with keloids at two locations, were treated and followed‐up for an average of 15.9 months. The patients showed significant improvements in wound healing and skin appearance, with a marked reduction in the Patient and Observer Scar Assessment Scale (POSAS) (scores from 91.1 ± 5.6 to 23.8 ± 6.1 (p < 0.001)). This approach effectively minimizes tension, reduces the likelihood of keloid recurrence, and serves as a viable alternative to conventional methods that often involve challenges related to donor‐site acquisition. No recurrence was observed during the follow‐up period, indicating a promising innovation in the management of extensive keloids and offering improved healing and esthetic outcomes, particularly in high‐tension areas.

Immune tolerance of allogeneic haematopoietic cell transplantation supports donor epidermal grafting of recessive dystrophic epidermolysis bullosa chronic wounds.

Chronic wounds, a common morbidity in recessive dystrophic epidermolysis bullosa (RDEB), lack definitive therapies. To assess allogeneic epidermal skin grafts in terms of wound healing and durability over time. In a prospective, open-label clinical trial for postallogeneic haematopoietic cell transplantation (post-alloHCT) patients with RDEB, up to nine chronic wounds per patient were grafted over 1year. Epidermal grafts measuring 5 cm2 were obtained from related alloHCT donors in the outpatient setting using the CELLUTOMETM Epidermal Harvesting System. Wounds were photographed and symptom inventories completed at baseline and 6, 12 and 52weeks after grafting. The trial was registered at ClinicalTrials.gov (NCT02670837). Between August 2016 and January 2019, eight patients with RDEB received a total of 35 epidermal allografts at a median of 1157days (range 548-2884) post-alloHCT. The median (interquartile range) percentage reductions in wound surface area were 75% (52-94), 95% (72-100) and 100% (97-100) at 6, 12 and 52weeks postgraft, respectively, each significantly reduced from baseline (P<0·001). Donor harvest sites healed quickly without scarring. Biopsy evaluation at 1year of an epidermal allograft site revealed wildtype type VII collagen (immunofluorescence), anchoring fibrils (electron microscopy), and full-thickness skin whole-DNA donor chimerism of 42% (compared with 16% in concurrently biopsied native skin). This strategy subsequently supported release of RDEB pseudosyndactyly. The immune tolerance established by alloHCT supports successful adoptive transfer of donor epidermal grafts. Persistence of donor grafts in a single patient beyond 1year and observed migration of donor-grafted cells into adjacent wound suggest that epidermal allografts include nonterminally differentiated cells and/or trigger recruitment of donor bone-marrow-derived cells to mediate wound healing.

577 Successful allogeneic epidermal grafting of chronic recessive dystrophic epidermolysis bullosa wounds from hematopoietic cell donors in the outpatient setting

Chronic wounds, or non-healing epidermal erosions present >6 weeks, are common, contribute to morbidity, and lack definitive therapy in recessive dystrophic epidermolysis bullosa (RDEB). The immune tolerance established by allogeneic hematopoietic cell transplantation (HCT) permits adoptive transfer of donor epidermal grafts and establishment of induced mosaicism. In a prospective, open label clinical trial for post-HCT RDEB patients with stable peripheral blood donor chimerism of ≥5%, up to 3 chronic wounds were grafted. Epidermal skin grafts measuring 5 cm2 were obtained from related HCT donors in the outpatient setting using the CelluTomeTM Epidermal Harvesting System. Wound size was measured at baseline, 6, 12, and 52 weeks. Nine patients received a total of 23 epidermal grafts at a median of 1207 days (range 267-3111) post-HCT. The mean (±SD) percent reduction in wound surface area achieved was 61.8% (±31.3), 85.1% (±20.3), and 90.9% (±16.8), at 6, 12, and 52 weeks, respectively, each significantly reduced compared to baseline (p < 0.0001). Donor harvest sites healed quickly with no scarring, though mild hypopigmentation was noted in 5 of 9. Recipient reported benefits include absence of blistering, touch sensation equivalent to native skin, and normal temperature regulation at donor sites. Evaluation of one graft following completion of the study at 1 year revealed wild-type type VII collagen staining by immunofluorescence, normal ultrastructure including intact anchoring fibrils at the dermal-epidermal junction by electron microscopy, and full thickness skin whole DNA donor chimerism of 42% (compared to 16% in concurrently biopsied native skin). Persistence of the donor graft beyond 1 year and observed migration of donor-grafted cells into adjacent wound suggest the epidermal grafts include non-terminally differentiated cells.

Use of human acellular dermal matrix for wound healing in a patient with necrotizing fasciitis, after failure of autologous dermal / epidermal skin graft: A case report

Use of human acellular dermal matrix for wound healing in a patient with necrotizing fasciitis, after failure of autologous dermal / epidermal skin graft: A case report

Use of epidermal skin grafts in chronic wounds: a case series.

In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3-180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.

Wound Healing of Chronic Leg Ulcers Is Stimulated by Wound Edge Continuity with Adult Cultured Epidermal Autografts

Abstract Epidermal stem cells isolated from adult human skin present an opportunity to heal a variety of chronic wounds. Significant progress has been made in the serum-free culture of adult keratinocytes and their use to produce living three-dimensional cultured epidermal autologous skin grafts for treatment chronic leg ulcers. We present new retrospective studies showing that rapid healing of chronic venous stasis leg ulcers is stimulated by close association of living cultured autograft implant edges with host ulcer wound edges.

Epidermal skin grafting.

Autologous skin grafts, such as full- and split-thickness, have long been part of the reconstructive ladder as an option to close skin defects. Although they are effective in providing coverage, they require the need for a trained surgeon, use of anaesthesia and operating room and creation of a wound at the donor site. These drawbacks can be overcome with the use of epidermal skin grafts (ESGs), which can be harvested without the use of anaesthesia in an office setting and with minimal to no scarring at the donor site. ESGs consist only of the epidermal layer and have emerged as an appealing alternative to other autologous grafts for the treatment of acute and chronic wounds. In this article, we provide an overview of epidermal grafting and its role in wound management.

A Novel Approach to Keloid Reconstruction with Bilaminar Dermal Substitute and Epidermal Skin Grafting.

Keloids represent a challenging problem. Surgical excision remains the definitive treatment for immediate lesion debulking, but recurrence rates are reported to be 45 to 100 percent. The authors present a staged reconstructive approach using a dermal regeneration substrate and epidermal grafting to minimize recurrence and donor-site morbidity. Keloids were completely excised down to normal subcutaneous tissue or perichondrium. A bilaminar dermal regeneration matrix was approximated to the entire wound, with the silicone lamina oriented superficially. Reconstruction was delayed for at least 21 days to allow for neodermal ingrowth. The silicone lamina was then removed, and an epidermal skin graft was harvested from the thigh and secured to the neodermis with nonocclusive dressing. Reconstructed defects and donor sites were assessed for recurrence of keloids and scar appearance. Five patients underwent treatment; two had keloids involving the superior helix of the ear (average area, 2.6 cm), two had keloids involving the chest (average area, 28 cm), and one had a keloid in the pubic region (area, 10 cm). All had failed at least one previous treatment with direct excision and steroid injections. Mean follow-up was 48.8 weeks (range, 38 to 60 weeks). Average time to complete wound epithelialization was 5.5 weeks. There were no infections or cellulitis. All reconstructed defects were aesthetically acceptable and remained flat without significant widening. There were no long-term complaints of pruritus or pain and there was no evidence of donor-site scarring. Epidermal grafting provides significant advantages when used with a dermal regeneration matrix. This approach obviates reliance on skin creep and flap undermining to achieve primary closure. Exclusion of dermis and significant extracellular matrix components limits contracture, further facilitating tension-free wound healing. Scarring response within the donor site and graft is also minimized. Therapeutic, IV.

Epidermal fractional skin grafting: An experience in 10 patients with typical and atypical skin wounds

Epidermal fractional skin grafting: An experience in 10 patients with typical and atypical skin wounds

Fractional epidermal skin grafting.

British Journal of DermatologyVolume 172, Issue 4 p. 853-854 Commentary Fractional epidermal skin grafting M. Romanelli, M. Romanelli m.romanelli@med.unipi.it orcid.org/0000-0002-4127-0141 Department of Dermatology, Wound Healing Research Unit, University of Pisa, Via Roma 67, 56126 Pisa, ItalySearch for more papers by this authorV. Dini, V. Dini Department of Dermatology, Wound Healing Research Unit, University of Pisa, Via Roma 67, 56126 Pisa, ItalySearch for more papers by this author M. Romanelli, M. Romanelli m.romanelli@med.unipi.it orcid.org/0000-0002-4127-0141 Department of Dermatology, Wound Healing Research Unit, University of Pisa, Via Roma 67, 56126 Pisa, ItalySearch for more papers by this authorV. Dini, V. Dini Department of Dermatology, Wound Healing Research Unit, University of Pisa, Via Roma 67, 56126 Pisa, ItalySearch for more papers by this author First published: 01 April 2015 https://doi.org/10.1111/bjd.13580Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume172, Issue4April 2015Pages 853-854 RelatedInformation

Treatment of traumatically cutaneous necrosis of buttocks using vacuum sealing drainage combined with ileostomy.

The purpose of this study is to evaluate the surgical technique and review the therapeutic effect of vacuum sealing drainage combined with ileostomy treating patients of traumatically buttock skin necrosis. 26 patients with buttock wounds were dressed and 6-12 days later, buttock skin necrosis boundaries were clear and debridement was performed. General surgeons were invited to perform the ileostomy. Thorough debridement was conducted and vacuum sealing drainage (VSD) devices were used to cover buttock wounds. Debridement and VSD were operated every 5-7 days until the granulation tissue of buttock wound was fresh. Then epidermal skin graft from thigh was performed to cover the granulation wound. About 3 months later after skin graft survival completely, the ileum was reversed by general surgeons and the patients recovered defecation using anus. The granulation tissues of all patients were fresh after debridement and VSD 2-3 times. In 20 cases, transplanted epidermal skin grew well. In six cases, necrosis was observed at the margins of the flap and further debridement and skin graft were conducted. During the follow-up period of approximate 6 months, the flaps grew well and the patients defecated normally from anus. Treating traumatically cutaneous necrosis of buttocks with vacuum sealing drainage and ileostomy can gain good therapeutic effect.

Reconstruction After Complex Facial Trauma

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

The Ultrastructure of Cadaverous Skin after Cryopreservation with Polyethylene Oxide-400

Abstract The cryopreservation is the method of selection of long-term skin preservation used for the closure of large wound defects and the only possibility of long preservation of graft skin material in the viable state. For the lowtemperature preservation of human skin was successfully used cryoprotectant Polyethylene oxide -400, which was confirmed by the clinical evaluation during autotransplantation /1/. At the same time many aspects of the influence of low temperatures on the ultrastructural skin components were unclear /2/. The investigation of subcellular elements during step of low-temperature preservation specifies mechanisms of influence on the tissue preservation factors and determine the condition of skin cellular elements /3,4,5/. The aim of this work is to study ultrastructural characteristics of human cadaverous skin during the stages of low-temperature preservation by PEO-400. In this investigation epidermal skin grafts with the thickness of 0.4-0.6 mm were studied in 6 hours after the accidental death divided in 3 series:

Use of Autogenous Split-Thickness Dermal Graft for Reconstruction of the Lining of the Exenterated Orbit

A surgical technique using an exposed dermal graft to line the exenterated orbit has been successful in nine patients. Eight of the nine patients had undergone total maxillectomy at the time of exenteration. A split-thickness (epidermal) skin graft is harvested with a dermatome and hinged at one end. A second split-thickness dermal graft is harvested from the dermal bed of the first graft. The hinged epidermal graft is sutured into its donor site, and the deeper free dermal graft is used to line the orbital cavity. The latter graft tends to be more viable than a split-thickness epidermal graft. Also, because the dermal graft can self-epithelialize or be epithelialized by adjacent tissues, it may be placed adjacent to skin or a mucous membrane.