Skin Autografts Research Articles

Decellularized Scaffolds for Skin Repair and Regeneration

The skin is the largest organ in the body, fulfilling a variety of functions and acting as a barrier for internal organs against external insults. As for extensive or irreversible damage, skin autografts are often considered the gold standard, however inherent limitations highlight the need for alternative strategies. Engineering of human-compatible tissues is an interdisciplinary and active field of research, leading to the production of scaffolds and skin substitutes to guide repair and regeneration. However, faithful reproduction of extracellular matrix (ECM) architecture and bioactive content capable of cell-instructive and cell-responsive properties remains challenging. ECM is a heterogeneous, connective network composed of collagens, glycoproteins, proteoglycans, and small molecules. It is highly coordinated to provide the physical scaffolding, mechanical stability, and biochemical cues necessary for tissue morphogenesis and homeostasis. Decellularization processes have made it possible to isolate the ECM in its native and three-dimensional form from a cell-populated tissue for use in skin regeneration. In this review, we present recent knowledge about these decellularized biomaterials with the potential to be used as dermal or skin substitutes in clinical applications. We detail tissue sources and clinical indications with success rates and report the most effective decellularization methods compatible with clinical use.

The benefits of early surgical treatment of deep cervical burns in children

Background. The frequency of deep cervical burns in children is four times higher than that of deep face burns. Currently, there is no consensus on the methods for surgical treatment of deep burns in cervical areas; meshed skin autografts continue to be used.
 Aim. To evaluate the benefits of early surgical treatment of deep сervical burns in children between the third and fifth days from the moment of injury.
 Materials and methods. Case-control study. Surgical treatment was performed in 81 children with deep cervical burns. The main group with early surgical treatment included 46 children and underwent surgical treatment at 3.37 0.14 days from the moment of injury; the control group received autograft during stage treatment for 35 children at 27.17 0.18 days. The treatment results were evaluated by the following indicators: the number of dressing changes, the period of skin restoration, and the area of graft success. In the long term, functional and cosmetic treatment results were evaluated.
 Results. In the study and control groups, 7.93 0.45 and 18.75 0.61 dressings were required to complete the treatment, respectively (p 0.001). The skin restoration periods were 16.54 0.68 and 36.94 0.89 days, respectively (p 0.001). The graft success areas were 99.50% 0.13% in the main group and 93.91% 2.68% in the control (p 0.001). During the staged surgical treatment, one patient showed a loss of 90% of the graft, which required regrafting. Other complications in the treatment process have not been noted. When assessing long-term cosmetic results using the Vancouver Scar Scale, the average score was 4.0 0.26 points in the main group and 7 0.28 points in the control (p 0.001). The presence of post-burn cicatricial contracture in the main group was noted in 12 (26%) people and the absence in 34 (74%) children. In the control group, 20 (57%) patients required surgical removal of post-burn deformity, and 15 (43%) children did not need further surgical interventions.
 Conclusions. Early surgical treatment of deep cervical burns in children on the third and fifth days from injury allows not only to accelerate the process of restoration of the skin but also to directly affect the cosmetic and functional results in a better way.

The Use of Dermal Substitute in Deep Burns of Functional/Mobile Anatomic Areas at Acute Phase After Early Excision and Subsequent Skin Autografting: Dermal Substitute Prevents Functional Limitations.

We aimed to evaluate the results of dermal substitute implantation after early excision in the acute phase of major burn cases within the scope of efforts to reduce contractions and scar formation in functional anatomic areas (face, neck, axilla, elbow, popliteal). Twelve patients with major burn who were treated in the burn center between September 2017 and September 2018 were included in the study. In these patients, Nevelia® dermal substitute was implanted into 24 functional areas with deep partial or full-thickness burns after surgical debridement of the wound. Autologous split-thickness skin graft was applied to these areas after 14 to 21 days. The patients were followed for 4 to 14 months (mean 6 months). Postoperative scar formation was assessed by the Vancouver Scar Scale at the end of the follow-up period. A simple qualitative staging system was used for aesthetic and functional evaluation. The time from burn injury to dermal substitute implantation was 3 to 21 days. Skin graft take was complete in 22 of 24 regions and partial in one of them, while graft loss developed in one region. In the implantation sites, the Vancouver Scar Scale ranged from 1 to 7. The aesthetic and functional evaluation showed excellent/good results in 21 of 24 anatomic regions, moderate results in 2 regions, and poor results in 1 region. The use of dermal substitute in deep burns of functional/mobile anatomic areas at the acute phase after early excision and subsequent skin autografting has opened a new alternative area in the burn surgery arena to prevent contractures and functional limitations.

Application of 3D Printed Models of Complex Hypertrophic Scars for Preoperative Evaluation and Surgical Planning.

BackgroundComplex hypertrophic scar is a condition that causes multiple joint contractures and deformities after trauma or burn injuries. Three-dimensional (3D) printing technology provides a new evaluation method for this condition. The objective of this study was to print individualized 3D models of complex hypertrophic scars and to assess the accuracy of these models.MethodsTwelve patients with complex hypertrophic scars were included in this study. Before surgery, each patient underwent a computed tomography (CT) scan to obtain cross-sectional information for 3D printing. Mimics software was used to process the CT data and create 3D printed models. The length, width, height, and volume measurements of the physical scars and 3D printed models were compared. Experienced surgeons used the 3D models to plan the operation and simulate the surgical procedure. The hypertrophic scar was completely removed for each patient and covered with skin autografts. The surgical time, bleeding, complications, and skin autograft take rate were recorded. All patients were followed up at 12 months. The surgeons, young doctors, medical students, and patients involved in the study completed questionnaires to assess the use of the 3D printed models.ResultsThe 3D models of the hypertrophic scars were printed successfully. The length, width, height, and volume measurements were significantly smaller for the 3D printed models than for the physical hypertrophic scars. Based on preoperative simulations with the 3D printed models, the surgeries were performed successfully and each hypertrophic scar was completely removed. The surgery time was shortened and the bleeding was decreased. On postoperative day 7, there were two cases of subcutaneous hemorrhage, one case of infection and one case of necrosis. On postoperative day 12, the average take rate of the skin autografts was 97.75%. At the 12-month follow-up, all patients were satisfied with the appearance and function.ConclusionAccurate 3D printed models can help surgeons plan and perform successful operations, help young doctors and medical students learn surgical methods, and enhance patient comprehension and confidence in their surgeons.

Design and biofabrication of dermal regeneration scaffolds: role of oligomeric collagen fibril density and architecture.

Aim: To evaluate dermal regeneration scaffolds custom-fabricated from fibril-forming oligomeric collagen where the total content and spatial gradient of collagenfibrils was specified. Materials & methods: Microstructural and mechanical features were verified by electron microscopy and tensile testing. The ability of dermal scaffolds to induce regeneration of rat full-thickness skin wounds was determined and compared with no fill control, autograft skin and a commercial collagen dressing. Results: Increasing fibril content of oligomer scaffolds inhibited wound contraction and decreased myofibroblast marker expression. Cellular and vascular infiltration of scaffolds over the 14-day period varied with the graded density and orientation of fibrils. Conclusion: Fibril content, spatial gradient and orientation are important collagen scaffold design considerations for promoting vascularization and dermal regeneration while reducing wound contraction.

Method for Determining Microcirculatory Hemodynamics by Laser Speckle Interferometry in Small Animals.

We performed experimental evaluation of various positions (ear, paw, and tail) of the of dynamic light scattering sensor of near-infrared laser radiation (840 nm) using speckle interferometry in rats. Dynamic monitoring of the reactions to prolonged ultrasound exposure (7 days) showed that the base of the tail is most suitable for this purpose. Additionally, analysis of microcirculation parameters on the surface of skin autograft was performed. The method of analysis of hemodynamics in humans was adapted for animals.

Wound pH and autograft taking in burn wounds: An experimental study

Background: The appropriateness of the wound bed for autograft transplantation is routinely evaluated based on the surgeon's judgment, which might not be reliable in some situations. Therefore, this study was designed to evaluate the association between wound pH, wound temperature, and wound culture results with autograft taking. Materials and Methods: In this prospective, cross-sectional study, the body core temperature, wound pH, and local wound temperature at the beginning of operation and after burn wound excision were measured in 50 patients with burn wounds. Swab culture specimen was obtained from the burn wound after dressing removal and after the completion of wound excision. Autograft taking was evaluated on days 3 and 7 postoperative. Results: There was a statistically significant reverse association between autograft taking on day 3 and wound pH at the beginning of operation (P = 0.016). Besides, there was a statistically significant association between core body temperature and autograft taking on days 3 (P = 0.035) and 7 (P = 0.002). However, there was no significant association between local wound temperature and autograft taking. A positive result for wound culture after excision, even when the colony count was Conclusions: Wound pH measurement after dressing removal in the operation room may be a simple and available modality to evaluate the appropriateness of burn wound for skin autografting.

Features of plastic surgery with a full-thickness skin autograft in patients with traumatic skin detachment depending on clinical state and soft tissue destruction

Features of plastic surgery with a full-thickness skin autograft in patients with traumatic skin detachment depending on clinical state and soft tissue destruction

A 10-year experience of facial plastic surgery with one full thickness skin autograft

A 10-year experience of facial plastic surgery with one full thickness skin autograft

Comparative long-term study between two dermal regeneration templates for the reconstruction of burn scar contractures in humans: Clinical and histological results

The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.

Long-term results of plasty of granulating wounds of the distal extremities with mesh and solid skin autografts of burn wounds in children

Background. The widespread and not always justified use of mesh autografts in children with burns leads to the development of severe contractures and dislocations in the joints in the first year after the restoration of the skin. Aim. In this study, the long-term results of plasty of granulating wounds of the distal extremities with mesh skin autografts in children with burns were evaluated. Materials and methods. In Turner Institute’s clinic of trauma sequale, from 2012 to 2018, we treated a total of 153 children who developed scar deformities of the hands and feet after plastic surgery with continuous and mesh skin autografts. The control group (42 patients) consisted of patients after wound plasty with skin autografts. The study included patients with a total area of deep burns within 1%–15% of the body surface. The follow-up period ranged from 7 months to 3 years. Objective examination with anamnestic and radiological data analysis was used. The classification by B.V. Parin (1946) was used to estimate the degree of limitation of the range of motion in the joint. A set of standard analysis tools included in SPSS Statistics v23 ×64 was used to carry out statistical data processing. Results. The number of deformities formed on the background of the surviving mesh autograft is 2 times more than after the plasty of granulating wound with a solid skin autograft (54.4% and 20.6%, respectively). Dislocations in the wrist joints on the background of mesh plasty of wounds with a skin autograft developed in a mean time of 15.33 ± 1.28 months. Moreover, dislocations in the metatarsophalangeal joints of the foot under the extensor contracture were diagnosed after a mean of 7.52 ± 0.23 months ( p < 0.05), with flexion contracture at 7.00 ± 0.38 months, and multiplanar deformity with dislocation at the subtalar and metatarsophalangeal joints was observed to form at 34.0 ± 10.0 months. Conclusion. There was a 3 times higher rate of visit among patients with scar deformities developed after the use of mesh autografts in the area of the joints of the hand and foot, and the development of deformities was 4–6 months shorter than in the plasty of granulating wounds with solid skin autografts. The lack of a differentiated approach to the choice of the restoration method of the skin and conservative preventive therapy in children with burns leads to the need for reconstructive treatment in the near future.

IL-1β–Primed Mesenchymal Stromal Cells Improve Epidermal Substitute Engraftment and Wound Healing via Matrix Metalloproteinases and Transforming Growth Factor-β1

Since the 1980s, deep and extensive skin wounds and burns are treated with autologous split-thickness skin grafts, or cultured epidermal autografts, when donor sites are limited. However, the clinical use of cultured epidermal autografts often remains unsatisfactory because of poor engraftment rates, altered wound healing, and reduced skin functionality. In the past few decades, mesenchymal stromal cells (MSCs) have raised much attention because of their anti-inflammatory, protrophic, and pro-remodeling capacities. More specifically, gingival MSCs have been shown to possess enhanced wound healing properties compared with other tissue sources. Growing evidence also indicates that MSC priming could potentiate therapeutic effects in diverse invitro and invivo models of skin trauma. In this study, we found that IL-1β-primed gingival MSCs promoted cell migration, dermal-epidermal junction formation, and inflammation reduction invitro, as well as improved epidermal substitute engraftment invivo. IL-1β-primed gingival MSCs had different secretory profiles from naive gingival MSCs, characterized by an overexpression of transforming growth factor-β and matrix metalloproteinase (MMP) pathway agonists. Eventually, MMP-1, MMP-9, and transforming growth factor-β1 appeared to be critically involved in IL-1β-primed gingival MSC mechanisms of action.

Benefits of cryopreserved human amniotic membranes in association with conventional treatments in the management of full-thickness burns.

The use of split-thickness skin autografts (STSA) with dermal substitutes is the gold standard treatment for third-degree burn patients. In this article, we tested whether cryopreserved amniotic membranes could be beneficial to the current treatments for full-thickness burns. Swines were subjected to standardised full-thickness burn injuries, and then were randomly assigned to treatments: (a) STSA alone; (b) STSA associated with the dermal substitute, Matriderm; (c) STSA plus human amniotic membrane (HAM); and (d) STSA associated with Matriderm plus HAM. Clinical and histological assessments were performed over time. We also reported the clinical use of HAM in one patient. The addition of HAM to classic treatments reduced scar contraction. In the presence of HAM, skin wound healing displayed high elasticity and histological examination showed a dense network of long elastic fibres. The presence of HAM increased dermal neovascularization, but no effect was observed on the recruitment of inflammatory cells to the wound. Moreover, the use of HAM with classical treatments in one human patient revealed a clear benefit in terms of elasticity. These results give initial evidence to consider the clinical application of HAM to avoid post-burn contractures and therefore facilitate functional recovery after deep burn injury.

Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study

Background: Since the development of the meshed skingrafts and the availability of different meshing expansionsizes, the sizes of the meshed skin grafts interstices like allopen wounds became a problem because they increase themetabolic needs and put the patients at the risk of infection.The amniotic membrane satisfies most of the criteria for anideal biological wound dressing to solve such a problem.Aim of Study: To determine the rate of healing of theinterstices of meshed skin autograft of 1:3 meshing sizeapplied to post burn raw areas when covered by fresh amnioticmembranes.Patients and Methods: This study was conducted on 30patients who had post burn raw areas with TBSA less than30% divided into 2 groups Group (1): Used meshed STSG(1:3) without amniotic membrane coverage Group (2): Usedmeshed STSG 1:3 then covered with fresh amniotic membrane.Biopsies were taken and examined. Patient and Observer ScarAssessment Scale (POSAS) was used to evaluate the aestheticout come.Results: Amniotic Membrane (AM) did not improve skingraft take but it improved the macroscopic healing of theinterstices which showed significant p-value 0.005* andregistered valuable decrease in all items of Patient and ObserverScar Assessment Scale (POSAS) that showed significant pvalues.Also, AM accelerated the healing process histologically:The chronic inflammatory cells started to appear early (pvalue:0.003*). In the 10th day both the maturation of theepithelium and the transformation of newly formed capillariesinto mature ones showed p-values (0.006*).Conclusion: Amniotic membrane enhanced maturationof epithelium, increased the transformation of the newlyformed capillaries into mature ones, accelerated the initiationof the proliferative phase of wound healing, promoted the reepithelializationof the interstices of the meshed graft andled to a better cosmetic outcome.

355 Establishing Ovine Model of Burn Wounds Grafted with Cadaver Skin

Shortage in autograft skin to cover burn wounds require a frequent use of cadaver skin as a temporary cover. Cadaver skin graft prevents infection and dehydration and prepares the wound bed for subsequent skin autograft or application of autologous tissue engineered skin constructs. The aim of this study was to establish an ovine model of burn wound healing using ovine cadaver skin. Quality and efficacy of fresh and frozen cadaver skins were evaluated comparing to skin autograph. Cadaver skin samples were harvested from sheep used for different studies at necropsy. The cadaver skin preparation process consisted of 4 steps: preparation for recovery by wool shaving and applying primary disinfection, collection, disinfection, and cryopreservation. First, to fully characterize fresh and frozen cadaver skin, the harvested skin was evaluated based on microbial screening, skin thickness, viability, and cell proliferation in in vitrocondition. The froze skin was evaluated after 10 and 40 days of freezing. Then we compared acceptance/rejection of autograft, freshly prepared and frozen cadaver skins overlaid onto burn ovine wounds. Full thickness skin burns (5X5cm) were induced in sheep dorsum. After 24 hrs, burned skins were excised and wounds were allocated to following groups: 1) Fresh ovine cadaver skin, 2) Frozen cadaver skin, 3) Autograft, 4) No cover. Pictorial record and skin biopsies were collected 7, 14 and 20 days after grafting cadaver skin. Prepared cadaver (fresh & frozen) skins were negative for bacterial growth. Thethickness was comparable between the freshly prepared and frozen skins for 10 or 40 days. Significant reduction in skin viability was detected in frozen skin after freezing for 40 days. Histological analysis of burn wounds biopsies showed that skin autograft maintains normal skin structure at different time points. However, fresh cadaver skin graft showed signs (vacuoles in epidermis) of rejection starting from day 7 as evidenced by microscopic analysis. At day 14, the epidermis was mostly rejected, and the rejection was completed by day 20. Histologically, signs of immunoreaction and presence of many immune cells were noted. Frozen Cadaver skin followed the same pattern of fresh cadaver skin rejection rate. Viability of fresh frozen cadaver skin before grafting was significantly higher vs. frozen (40 days). However, on average both fresh or frozen ovine cadaver skins were rejected within 8.5 days that mimics rejection time in humans (~8.4 days), suggesting that ovine model of burn wound grafted with cadaver skin can successfully be used in burn wound research mimicking clinical scenario. Establishing a clinically relevant ovine model for burn wounds grafted with cadaver skin is a potential contribution to the burn research.

Promotion of Human Epidermal Keratinocyte Expansion in Feeder Cell Co-culture.

Co-culture of human epidermal keratinocytes with mouse 3T3-J2 feeder cells, developed by Green and colleagues, has been used worldwide to generate skin autografts since the early 1980s. In addition, co-culture with 3T3-J2 cells has served as a fundamental tool in skin stem cell biology as it allows the evaluation of self-renewal capacity of epidermal stem cells. This chapter describes a recent improvement in the Green method to promote further the expansion of human epidermal keratinocytes utilizing a small-molecule inhibitor of TGF-β signaling. This new protocol enables more rapid expansion of human epidermal keratinocytes in co-culture with not only 3T3-J2 cells but also other feeder cells including human dermal fibroblasts and human preadipocytes, two major alternatives to 3T3-J2 cells, with a long-term goal of developing customized skin autografts.

Calciphylaxie dans un contexte de maladie de Basedow : à propos d’un cas

BackgroundCalciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple. CaseWe report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves’ disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist. Complex and multidisciplinary therapeutic management (daily hemodialysis, sodium thiosulfate therapy, treatment of hypercalcemia by denosumab, hyperbaric oxygen therapy, meshed skin autograft) allowed complete healing of the lesions. ConclusionThis is the first description of AUC secondary to hyperthyroidism in a dialysis patient. Multidisciplinary care is essential to achieve clinical improvement in those critical situations.

Autologous bilayered self-assembled skin substitutes (SASSs) as permanent grafts: a case series of 14 severely burned patients indicating clinical effectiveness.

Split-thickness skin autografts (AGs) are the standard surgical treatment for severe burn injuries. However, the treatment of patients with substantial skin loss is limited by the availability of donor sites for skin harvesting. As an alternative to skin autografts, our research group developed autologous self-assembled skin substitutes (SASSs), allowing the replacement of both dermis and epidermis in a single surgical procedure. The aim of the study was to assess the clinical outcome of the SASSs as a permanent coverage for full-thickness burn wounds. Patients were recruited through the Health Canada's Special Access Program. SASSs were grafted on debrided full-thickness wounds according to similar protocols used for AGs. The graft-take and the persistence of the SASS epithelium over time were evaluated. 14 patients received surgical care with SASSs. The mean percentage of the SASS graft-take was 98 % (standard deviation = 5) at 5 to 7 d after surgery. SASS integrity persisted over time (average follow-up time: 3.2 years), without noticeable deficiency in epidermal regeneration. Assessment of scar quality (skin elasticity, erythema, thickness) was performed on a subset of patients. Non-homogeneous pigmentation was noticed in several patients. These results indicated that the SASS allowed the successful coverage of full-thickness burns given its high graft-take, aesthetic outcome equivalent to autografting and the promotion of long-term tissue regeneration. When skin donor sites are in short supply, SASSs could be a valuable alternative to treat patients with full-thickness burns covering more than 50 % of their total body surface area.

Inflammatory response and biomechanical properties of coaxial scaffolds for engineered skin in vitro and post-grafting

Engineered skin (ES) offers many advantages over split-thickness skin autografts for the treatment of burn wounds. However, ES, both in vitro and after grafting, is often significantly weaker, less elastic and more compliant than normal human skin. Biomechanical properties of ES can be tuned in vitro using electrospun co-axial (CoA) scaffolds. To explore the potential for coaxial scaffold-based ES use in vivo, two CoA scaffolds were fabricated with bioactive gelatin shells and biodegradable synthetic cores of polylactic acid (PLA) and polycaprolactone (PCL), and compared with gelatin monofilament scaffolds. Fibroblast and macrophage production of inflammatory cytokines interleukin 6 (IL-6) and transforming growth factor β-1 was significantly higher when cultured on PLA and PCL monofilament scaffolds compared to gelatin monofilament scaffolds. The core-shell fiber configuration significantly reduced production of pro-inflammatory cytokines to levels similar to those of gelatin monofilament scaffolds. In vitro, ES mechanical properties were significantly enhanced using CoA scaffolds; however, after grafting CoA- and gelatin-based ES to full-thickness excisional wounds on athymic mice, the in vitro mechanical advantage of CoA grafts was lost. A substantially increased inflammatory response to CoA-based ES was observed, with upregulation of IL-6 expression and a significant M2 macrophage presence. Additionally, expression of matrix metalloproteinase I was upregulated and collagen type I alpha 1 was downregulated in CoA ES two weeks after grafting. These results suggest that while coaxial scaffolds provide the ability to regulate biomechanics in vitro, further investigation of the inflammatory response to core materials is required to optimize this strategy for clinical use. Statement of SignificanceEngineered skin has been used to treat very large burn injuries. Despite its ability to heal these wounds, engineered skin exhibits reduced biomechanical properties making it challenging to manufacture and surgically apply. Coaxial fiber scaffolds have been utilized to tune the mechanical properties of engineered skin while maintaining optimal biological properties but it is not known how these perform on a patient especially with regards to their inflammatory response. The current study examines the biomechanical and inflammatory properties of coaxial scaffolds and uniaxial scaffolds in vitro and in vivo. The results show that the biological response to the scaffold materials is a critical determinant of tissue properties after grafting with reduced inflammation and rapid scaffold remodeling leading to stronger skin.

Chronic leg ulcers in hospitalized patients in Lomé, Togo: 125cases.

The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125cases of CLU were identified during the study period. The patients' mean age was 56.6years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9weeks (range: 7 weeks to 4 years). They were mainly associated with a history of diabetes (32cases), arterial hypertension (16cases), varicose veins (14cases), and malnutrition (14cases). The main causes were: ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122patients (67 on the right and 55 on the left) and bilateral in 3patients. The locations were the foot in 56cases, the leg in 37cases, and leg and foot in 32cases. In addition to dressings, surgical debridement was performed in 23patients, followed by skin autografts for 16. Amputation was performed for 31patients. Sixteen (12.8%) of the 125patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.