Skin Graft Survival Rate Research Articles

Application of autogenous adipose concentrate combined with split-thickness skin graft in repair of venous ulcer

Objective To explore the feasibility and clinical effect of autologous fat concentrate combined with split-thickness skin grafts in the repair of venous ulcer. Methods From January 2015 to December 2018, a total of 16 patients diagnosed with venous ulcer were admitted to our department, and all patients received symptomatic and supportive treatment such as local debridement and dressing change. After the granulation tissue grew well, all patients received autologous adipose concentrate combined with spilit-thickness skin graft for repair. Results All the grafted skin survived well, and the survival rate of grafted skin at 2 weeks after surgery was 86% to 99%. All patients were followed up to 6 months after surgery. The wounds of all patients were healed during the follow-up period. One patient suffered local ulcer recurrence due to repeated friction after healing and the ulcer recovered after dressing changing treatment. All the other patients had no recurrence during the follow-up period. The scar hyperplasia in the skin transplantation area was not obvious and the healing quality was good. No significant surgical complications occurred. Conclusions Autologous lipoconcentrate combined with split-thickness skin grafts is an effective and safe method in the repair of venous ulcer, and the application of autologous lipoconcentrate can effectively improve the survival rate and healing quality of skin grafts. Key words: Ulcer; Veins; Reconstructive surgical procedures; Auto lipo-concentrate; Split-thickness skin graft

Clinical value of autologous skin-grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dissection for early esophageal cancer

Objective To assess the efficacy and safety of autologous skin-grafting surgery (ASGS) in the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection (ESTD) for early esophageal cancer. Methods Between January 2018 and March 2018, five patients with early esophageal cancer underwent complete circular ESTD and ASGS in Chinese PLA General Hospital. The skin-graft survival situation, and occurrence of esophageal stenosis and complications were observed by endoscopy follow-up. Results Complete circular ESTD and ASGS were successfully performed in all 5 patients, and no complications including perforation, bleeding, wound infection or stent migration occurred. The mean skin-graft survival rate was 86.0%. Four patients did not experience esophageal stenosis over the mean follow-up of 9.5 months. One patient experienced esophageal stenosis after operation, and underwent endoscopic balloon dilatation.No stenosis occurred in 8 months of follow-up. Conclusion ASGS is a safe and effective method to prevent esophageal stenosis after complete circular ESTD Key words: Esophageal stenosis; Transplantation, autologous; Efficacy; Safety; Early esophageal cancer; Endoscopic submucosal tunnel dissection

Effects of Meek skin grafting on patients with extensive deep burn at different age groups

Objective: To investigate the effect of Meek skin grafting on patients with extensive deep burn at different age groups. Methods: Eighty-four patients with extensive deep burns conforming to the study criteria were hospitalized in our unit from April 2011 to April 2015. Patients were divided into children group (C, with age less than 12 years old), young and middle-aged group (YM, with age more than 18 years and less than 50 years old), and old age group (O, with age more than 55 years old) according to age, with 28 patients in each group. All patients received Meek skin grafting treatment. The use of autologous skin area, operation time, wound healing time, and hospitalization time were recorded. The survival rate of skin graft on post operation day 7, complete wound healing rate in post treatment week 2, and the mortality were calculated. Data were processed with one-way analysis of variance, t test, and χ(2) test. Results: The use of autologous skin area of patients in group C was (5.1±1.0)% total body surface area (TBSA), significantly less than (8.3±1.0)%TBSA and (8.3±1.4)%TBSA in groups YM and O, respectively (with t values 32.900 and 52.624, respectively, P values below 0.05). The operation time, wound healing time, and hospitalization time of patients in group C were (1.368±0.562) h, (9.6±0.6) and (32±11) d, significantly shorter than those in group YM [(3.235±0.011) h, (16.9±2.6) and (48±12) d, respectively] and group O [(3.692±0.481) h, (17.3±2.6) and (46±13) d, respectively, with t values from 4.350 to 21.160, P values below 0.05]. The survival rate of skin graft of patients on post operation day 7 in group C was (92±15)%, significantly higher than (81±10)% and (72±12)% in groups YM and O, respectively (with t values 5.509 and 3.229, respectively, P values below 0.05). The above indexes in groups YM and O were similar (with t values from 0.576 to 22.958, P values above 0.05). Complete wound healing rate in post treatment week 2 and the mortality of patients in group C were similar to those in groups YM and O (with χ(2) values 0.365 and 0.122, respectively, P values above 0.05). Conclusions: Meek skin grafting can be used in the treatment of patients with extensive deep burns at different age groups, compared with the young and middle-aged and old patients, the effect in children was better.

Efficacy of a hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn

To explore the efficacy of a hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn prospectively. Seventy-six severely burned patients with extensive residual wounds after treatment were admitted into Department of Burn Surgery of Changhai Hospital of the Second Military Medical University from May 2012 to November 2015. The patients were divided into hydrosurgery system debridement group (HD, n=34) and traditional debridement group (TD, n=42) according to the random number table, and their residual wounds were debrided by a hydrosurgery system and conventional surgical instruments respectively. The wounds of patients in two groups were repaired with stamp-like grafts made from split-thickness autoskin after debridement. Second time of debridement and skin grafting as above was performed if necessary. The time used in debriding 1% TBSA wound in the first surgery, positive rate of bacterial culture of wound exudate on post first surgery day (PFSD) 3, survival rate of skin grafts on PFSD 7, second debridement rate, and wound healing time of patients in two groups were compared. Data were processed with two independent-sample t test and chi-square test. The time used in debriding 1% TBSA wound of patients in the first surgery in group HD was (1.2±0.3) min, which was significantly shorter than that in group TD[(1.9±0.4) min, t=-9.098, P<0.001]. On PFSD 3, positive rate of bacterial culture of wound exudate of patients in group HD was 11.76% (4/34), which was significantly lower than that in group TD[38.10% (16/42), χ(2)=6.718, P=0.010]. On PFSD 7, the survival rate of skin grafts of patients in group HD was (90±8)%, which was significantly higher than that in group TD[(83±15)%, t=2.334, P=0.022]. The second debridement rate of patients in group HD was 5.88% (2/34), which was significantly lower than that in group TD[23.81% (10/42), χ(2)=4.542, P=0.033]. The wound healing time of patients in group HD was (10.6±1.5) d, which was significantly shorter than that in group TD[(13.3±2.5) d, t=-5.442, P<0.001]. The hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn is thorough and highly efficient, which is beneficial to improving the survival rate of skin grafts and accelerating wound healing.

The Effect of Adipose-Derived Stem Cells on Full-Thickness Skin Grafts.

Background. The purpose of this study was to evaluate the effects of ASCs on full-thickness skin grafts. Specifically, we investigated the anti-inflammatory effects of ASCs that are mediated via regulation of the phenotypes of activated macrophages. Methods. ASCs were isolated, cultured, and injected under full-thickness skin grafts in 15 rats (ASC group). An additional 15 rats served as controls (PBS group). Skin graft survival assessment and vascularization detection were assessed with H&E staining and laser Doppler blood flowmetry (LDF). The effects of ASCs on angiogenesis, anti-inflammation, collagen accumulation-promoting, and antiscarring were assessed. Results. We found that the skin graft survival rate was significantly increased in the ASC group. The neovascularization, collagen deposition, collagen type I to type III ratio, and levels of VEGF and TGF-β3 in the ASC group were markedly higher than those in the PBS group at day 14. Additionally, in the ASC group, the levels of iNOS, IL-1β, and TNF-α were remarkably decreased, whereas the levels of IL-10 and Arg-1 were substantially increased. Conclusions. Our results confirm that ASCs transplantation can effectively improve full-thickness skin graft survival. Additionally, the anti-inflammatory role of ASCs may indirectly contribute to skin graft survival via its effect on macrophage polarization.

EASEPort NPWT System to Enhance Skin Graft Survival--A Simple Assembly.

Skin graft has been known to be prone to failure. This study was aimed to make a simplification of the negative pressure wound therapy (NPWT), which follows EASEPort (effective, affordable, safe, easily handled, and portable) concept to support the take of skin graft. The design of the EASEPort-NPWT was then made and technically verified. Thereafter, an animal experimental study comparing the EASEPort-NPWT to the classic tie-over technique on skin graft over exudative wound was conducted. The EASEPort-NPWT was verified to be able to yield and sustain the subatmospheric pressure needed. In the animal study, the treatment group showed better skin graft survival rate (97.55 ± 11.18% take) than the control group (54.88 ± 19.73%) on day-7. Histopathology examination showed good quality of the skin structures taken from the treatment group, which was better than the structures of the skin in the control group. In summary, this study has been able to fulfill its objective to create a device following EASEPort concept. Subsequently, the EASEPort-NPWT was able to enhance skin graft survival rate in exudative wound.

Using negative pressure wound therapy on microskin autograft wounds

BackgroundMicroskin autografts with conventional wrap and compression are used extensively in the treatment of skin and tissue defects. This comparative study aimed at investigation of the clinical application of negative pressure wound therapy (NPWT) in combination with microskin autografts for repair of acute and chronic wounds. MethodsA prospective case-control study was performed from December 1, 2010–December 31, 2013 in Changhai Hospital, Shanghai. We compared a study group of patients received microskin autografting covered by NPWT with that of a control group of patients received microskin autografting covered by a conventional gauze. ResultsA total of 81 patients were in this study, 27 patients were allocated to the study group and 54 patients to the control group. The study group exhibited significant low infection rate and pain score during removal of inner layer at first dressing change after skin grafting compared with those of the control group (P < 0.05). The time interval between skin grafting and first postoperative change was longer in the study group than that in the control group (P < 0.01), the study group showed a significant shorter 95% wound healing time (P < 0.05), and survival rate of microskin autografts in the study group was higher than that in the control group (P < 0.05). ConclusionsNPWT is beneficial for wound closure after microskin autografts, which prolongs the interval between skin transplantation and first postoperative dressing change, reduces pain during removal of inner layer dressing, increases skin graft survival rate, and shortens wound healing time. Therefore, NPWT can be recommended for repair of acute and chronic wounds with microskin autografts.

Application of composite skin grafts consisting of allogeneic acellular dermal matrix and autologous scalp to the repair of defects after excision of giant pigmented nevi in children

Objective To evaluate the efficacy of composite skin grafts consisting of allogeneic acellular dermal matrix and autologous scalp in the repair of defects after excision of giant pigmented nevi in children.Methods Eighteen children with giant pigmented nevi were included in this study.All the patients received excision of giant pigmented nevi.The defects were repaired using composite skin grafts consisting of allogeneic acellular dermal matrix and autologous razor-thin scalp grafts in 10 children from June 2009 to October 2012 (test group),and using autologous thin or intermediate-thickness skin grafts in 8 children from March 2006 to May 2009 (control group).Donor site healing time,skin graft survival rate,and the degree of scar proliferation were compared between the two groups.Results Significant differences were observed at donor sites between the test group and control group in healing time ((5.31 ± 1.45) vs.(11.63 ± 1.69) days,P ＜ 0.05) and scar score (1.62 ± 0.38 vs.6.38 ± 0.58,P ＜ 0.05).At recipient sites,the survival rate of skin grafts was similar between the test group and control group ((94.44 ± 2.56)％ vs.(95.13 ± 3.13)％,P ＞ 0.05),while scar score was significantly different (5.38 ±0.62 vs.8.40 ± 0.41,P ＜ 0.05).Conclusion Composite skin grafts consisting of allogeneic acellular dermal matrix and autologous scalp appear to be a good option for the repair of defects after excision of giant pigmented nevi in children,with minor donor-site injuries and satisfying cosmetic and functional outcomes at recipient sites. Key words: Nevus; Child; Skin transplantation; Dermis

Plastic and reconstructive surgery of cicateicial cryptotia

Objective To probe the definition of cicateicial cryptotia and its plastic and reconstructive surgery.Methods Local skin flaps combined with full-thickness skin graft by zonation grafting technique were used to treat twenty-six patients with thirty-three cicateicial cryptotia.A cicateicial adhesion between auricle and cranial wall and mastoidea was removed,cranioaural angle was reformed,and helix and auricular lobule were reconstructed.Results All skin flaps survived,and the survival rate of skin grafts reached over 95 ％.The appearance of auricle was very good,its major constructions might be noted,and cranioaural angle nearly returned to normal.The follow-up results from three months to one year post-operation showed that the appearance of auricle kept well,and the patients felt satisfactory.Conclusions In view of deformity characteristics of cicateicial cryptotia,it might be an effective approach to treat cicateicial cryptotia to take a seris of appropriate surgical procedures. Key words: Cryptotia; Cicateicial adhesion; Auricle reconstruction; Helix reconstruction; Auricular lobule reconstruction

Mycophenolic acid derivative 118 improves outcome of skin grafts by suppressing IL-17 production

To investigate the effects and underlying mechanisms of 118, a novel derivative of mycophenolic acid, in a murine allogeneic skin graft model. Skin grafts were conducted by grafting BALB/c donor tail skin into C57BL/6 skin beds (allograft) or by grafting female C57BL/6 donor tail skin into female C57BL/6 skin beds (syngraft). The mice were treated with the derivative 118 (40 mg·kg(-1)·d(-1), po) for 13 d (3 d before and 10 d after transplantation). Skin grafts, splenocytes and graft-infiltrated lymphocytes were isolated and examined ex vivo. The effects of the derivative 118 on naive CD4(+) T cell differentiation were examined in vitro. Treatment with the derivative 118 dramatically increased the survival rate of murine allogeneic skin grafts. Flow cytometric analysis and H&E staining showed that the derivative significantly decreased inflammatory cell infiltration into the grafts. The levels of the chemokines CXCL1, CXCL2, CCL7, and CCL2 were reduced in the derivative 118-treated grafts. Additionally, the derivative 118 significantly suppressed the IL-17 levels in the grafts but did not affect the differentiation of systemic helper T cells in the murine allogeneic skin graft model. Furthermore, IL-23p19 expression was suppressed in the grafts from the derivative 118-treated group, which might be due to decreases in TLR4 and MyD88 expression. Finally, the derivative 118 did not exert direct influences on helper T cell differentiation in vitro. Treatment with the mycophenolic acid derivative 118 improves murine allogeneic skin grafts by decreasing IL-23 expression and suppressing local IL-17 secretion in the grafts, rather than directly inhibiting Th17 differentiation.

Retrospective study of negative pressure wound therapy promoting survival of the skin grafts

Objective To observe the effects of negative pressure wound therapy (NPWT) on survival of the blade-thickness free skin grafts. Methods Sixty-five patients with skin defects were divided into NPWT treatment group ( Group Ⅰ,n =35) and conventional treatment group ( Group Ⅱ,n =30) according to different postoperative fixation methods.The patients in Group Ⅰ were fixed with the aid of NPWT after blade-thickness free skin grafting,and the patients in Group Ⅱ were fixed with tie-over bolster dressing. Results The survival rate of the skin grafts of Group Ⅰ was significantly higher than that of Group Ⅱ at day5 postoperatively [ (80.59 ±10.30)％ vs (71.46 ±10.68)％,P＜0.05].The survival period for the skin grafts of Group Ⅰ was shorter than that of Group Ⅱ[ (5.34 ± 0.87) days vs ( 11.20 ± 1.65) days,P ＜ 0.01].The duration of postoperative hospital stay of Group Ⅰ was obviously shorter than that of Group Ⅱ (P ＜ 0.01 ).The cost of antibiotics of Group Ⅰ was less than that of Group Ⅱ [ ( 1 765.71 ± 164.39) RMB yuan vs (2 700.00 ±221.28) RMB yuan,P ＜0.01].The dressing frequency and cost of group Ⅰ were less than those of group Ⅱ [(3.11 ± 0.32) times,(249.14 ±25.82) RMB yuan vs (4.53 ±0.68) times,(362.67 ±54.52) RMB yuan,P＜0.01]. Conclusions The application of NPWT to the postoperative period of skin grafting can promote the survival of the skin grafts,shorten the duration of hospitalization and reduce antibiotics use and dressing frequency. Key words: Surgical flaps; Transplantation; Negative pressure wound therapy

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

Survival of Full-Thickness Skin Graft on the Prelaminated Expanded Polytetrafluoroethylene in Spraque-Dawley Rats

The purpose of this study is to evaluate and compare the survival and deformity of a full-thickness skin graft over the flap prelaminated by Gore-tex (ePTFE, expanded polytetrafluoroethylene, Gore-tex Soft Tissue Patch, Gore & Assoc Inc, Flagstaff, AZ, USA) in Spraque-Dawley (S-D) rats. The materials were implanted subcutaneously for prelamination of a 2-, 4-, and 6- week period. A pedicle flap enveloping the implant was then elevated. After applying Biobrane under the composite flap, the harvested full-thickness skin was grafted onto the composite flap. The survival of the FTSG and deformity of synthetic materials were evaluated at the time of one week after skin graft surgery. In this study, the survival of skin graft in the Gore-tex group was about 32%. Microscopically, the Gore-tex scaffold was integrated by fibroneovascular tissue. Based on the survival rate of the skin graft, this study demonstrates that prelamination with Gore-tex can produce a relatively lower survival rate of in-situ skin graft on composite tissue flap, and less implant expulsion was observed. The Gore-tex scaffold allowed growth of fibroneovascular tissue but showed visible deformity. The secondary deformity of the Gore-tex scaffold and lower survival of skin graft neglected the clinical usage of this synthetic flap.

The effects of supplemental glutamine dipeptide on gut integrity and clinical outcome after major escharectomy in severe burns: a randomized, double-blind, controlled clinical trial

Summary Objective : To evaluate the effects of glutamine dipeptides on gut permeability, plasma endotoxin and outcome variables following extensive eschar excision on severe burns. Methods : Thirty patients with severe burns (total body surface burns, 30–50% and third degree burns, 15–25%) were investigated in a prospective, randomized, double-blind clinical trial, to receive parenteral nutrition with (test group) or without (control group) glutamine dipeptide supplementation. Protocol was approved by the local ethical committee and the informed consents were obtained. Parenteral iso-energetic and iso-nitrogenous nutrition was initiated on postoperative day 1 (POD+1) and was administered to both groups until postoperative day 12 (POD+12). Glutamine dipeptide supplement (Dipeptiven ® , Fresenius Kabi, Bad Homburg, Germany) corresponded to 0.5g/kg bw/d (equal to 0.35g glutamine kg bw/d). Plasma glutamine (gln-p), serum endotoxin concentrations, and the lactulose/mannitol absorption ratio (L/M, which reflects gut permeability) were measured throughout the clinical course. Survival rate of skin graft, wound healing time and infection rate were assessed and length of hospital stay and total costs were determined at discharge. Results : The concentrations of gln-p remained low in the control group, but increased in the supplemented group (POD+1: control, 321±40μmol/l, vs. test 431±52μmol/l, P 0.001 ; POD+12: control, 397±38μmol/l, vs. test 532.1±48.9μmol/l, P 0.001 ). L/M ratio was initially increased in both groups, reflecting enhanced intestinal permeability; the levels being normalized at POD+12. Endotoxin levels were equally elevated in both groups at commencement (POD+1), but decreased significantly in patients receiving gln (POD+12: control, 0.141±0.045 vs. test 0.112±0.026, P 0.043 ). Wound healing time was significantly shorter in the gln group compared to controls (32±3 days vs. 37±6, P 0.012 ). Infection rate revealed an obviously lower tendency (control: 26% vs. test 13% NS), yet without approaching a significant difference. Total cost of hospitalization was 45.300±5.500 RMB (about 5500 US$) in controls vs. 41.400±3.400 RMB (about 5000 US$) in the gln group, P 0.029 ; although it should be emphasized that the cost of glutamine supplementation was accounted for in the calculation. The skin graft survival rate and length of hospital stay were not significantly different between the groups. Conclusion : Supplementation with glutamine dipeptide was associated with enhanced gln plasma concentrations, decreased gut permeability and endotoxin levels as well as wound healing time and lower cost of hospitalization.

A new method for tolerance induction: busulfan administration followed by intravenous injection of neuraminidase-treated donor bone marrow.

The portal venous (p.v.) administration of foreign cells induces donor-specific tolerance. Recently, we have demonstrated that the p.v. administration of donor cells elicits donor-specific tolerance across major histocompatibility complex barriers. In the present study, utilizing the intrahepatic tolerance-inducing system, we have established a new method for organ transplantation using both busulfan ([Bu] to provide a sufficient "space" for the donor hematopoietic cells to expand in the recipient) and neuraminidase ([Neu] to enhance the trapping of i.v.-injected cells in the liver). Radiolabeled bone marrow cells (BMCs) were found to exclusively accumulate in the livers of the recipients as a result of the Neu treatment. Furthermore, hematopoietic progenitors (forming hematopoietic foci) in the accumulated BMCs were retained in the recipient livers for at least 18 days. C57BL/6 (B6) mice that had been transplanted with skins of BALB/c mice immediately after the injection of BALB/c BMCs showed a 90% skin graft survival rate over 400 days as a result of using the combination of injecting 50 mg/kg Bu into the B6 mice and treatment of the BALB/c BMCs with 0.25 U/ml Neu (50 Bu + 0.25 Neu). However, the survival rate significantly decreased when either the Bu or Neu treatment was omitted. In tolerant recipients, microchimerism was observed in the various hematolymphoid organs. T cells collected from the tolerant recipients suppressed proliferative responses to the donor-alloantigens but enhanced the production of Th2 and Th3 cytokines. These findings suggest that the enhanced retention of donor BMCs in the recipient livers as a result of the Bu and Neu treatments efficiently induces tolerance induction. Therefore, this "single-day protocol" would be of great advantage for human organ transplantation.

A novel strategy for organ allografts using sublethal (7 Gy) irradiation followed by injection of donor bone marrow cells via portal vein.

A new strategy for organ allografts that does not require recourse to immunosuppressants is established in mice. The strategy includes sublethal (7 Gy) irradiation followed by the injection of donor bone marrow cells (BMCs) via the portal vein (P.V.) and organ allografts 1 day after irradiation. Irradiation doses (< or =7 Gy) are found to allow the recipients to survive without the need to reconstitute the BMCs, as the recipient hematolymphoid cells can gradually recover. One hundred percent of recipients irradiated with 7 Gy followed by either P.V. or i.v. injection of donor BMCs accept organ allografts (the skin, pancreas, and adrenal glands) for more than 1 year. However, organ allograft survival rates decrease when irradiation doses are reduced; the skin graft survival rate of mice treated with 6.5 Gy and P.V. injection of BMCs is 79%, whereas that of mice treated with 6.5 Gy and i.v. injection is 50%, indicating that the P.V. injection of BMCs induces persistent tolerance more effectively than the i.v. injection. H-2 typing reveals that almost all the hematolymphoid cells (>98%) in the peripheral blood and hematolymphoid organs are donor-derived even 1 year after the treatment (7 Gy and P.V.). The T cells are tolerant to both donor-type and host-type MHC determinants. The major mechanism underlying the persistent tolerance induced by this strategy seems to be because of clonal deletion. This simple and safe strategy would be of great advantage for human organ transplantation.