Split-thickness Skin Graft Research Articles

Anterolateral Thigh Phalloplasty With Staged Skin Graft Urethroplasty: Technique and Outcomes

1) To describe the authors' technique of ALT phalloplasty with staged skin graft urethroplasty and 2) to report the surgical outcomes and complications of this technique in a preliminary patient cohort. Following IRB approval, retrospective chart review identified all patients undergoing primary three stage ALT phalloplasty by the senior authors. Stage I involves single tube, pedicled ALT transfer. Stage II involves vaginectomy, pars fixa urethroplasty, scrotoplasty, and opening the ALT ventrally and construction of a urethral plate with split thickness skin graft. Stage III involves tubularization of the urethral plate to create the penile urethra. Data collected included patient demographics, intraoperative details, postoperative courses, and complications. Twenty-four patients were identified. Twenty-two patients (91.7%) underwent ALT phalloplasty prior to vaginectomy. All patients underwent staged split thickness skin grafting for the penile urethra reconstruction. Twenty-one patients (87.5%) achieved standing micturition at the time of data collection. Eleven patients (44.0%) experienced at least one urologic complication requiring additional operative intervention, most commonly urethrocutaneous fistulae (8 patients, 33.3%), and urethral strictures (5 patients, 20.8%). ALT phalloplasty with split thickness skin grafting for urethral lengthening is an alternative technique to achieve standing micturition with an acceptable complication rate in gender affirming phalloplasty.

Through a New Lens: Skin-Grafted Free Flaps and Objective Facial Skin Color Matching.

Background: Head and neck ablative surgery can impose aesthetic disfigurement, particularly when severe color mismatch exists between native and reconstructed facial skin. To date, the accuracy, objectivity, and modifiability of facial skin color matching remains poorly understood. Objective: To measure skin color match outcomes after head and neck reconstruction using handheld colorimetry. Methods: Patients undergoing complex head and neck reconstruction involving facial skin were included. A variety of skin paddle donor sites were studied, including split-thickness skin graft (STSG) placement over myocutaneous or adipofasciocutaneous free flaps after de-epithelization. Skin color match (deltaE) was measured during follow-up using a handheld colorimeter. Results: Forty-seven patients were included, with median age 69. The most common flap type was the anterolateral thigh (n = 31, 66%). Twenty patients underwent STSG to the skin paddle. DeltaE measurements among the patients with STSGs demonstrated better color match (lowest deltaE), compared with patients with unaltered skin paddles (3.4 ± 1.0 vs. 6.5 ± 2.5, p < 0.0001). Conclusion: We found the use of STSGs over de-epithelialized myogenous or adipofasciocutaneous flaps improves color match, as measured by handheld colorimetry.

Development of novel hierarchical designs for skin graft simulants with high expansion potential

Skin graft designs play an essential role in healing severe burn injuries. Split-thickness skin grafting (STSG) is one of the commonly used techniques for treating large burn injuries. In STSG, parallel cuts are projected onto a small portion of excised healthy skin for expansion and covering a larger burn area. To date, expansions reported for STSG are very low and insufficient to cover large burn areas. In this work, novel traditional and auxetic hierarchical cuts were designed on skin graft simulants, which were mechanically tested to study their expansion potential. Additive manufacturing and a two-part polymeric material were employed to fabricate the skin graft simulants. The nonlinear mechanical behavior of the hierarchical skin graft simulants was characterized using hyperelastic models. The effective Poisson’s ratio, meshing ratios, and induced stresses in first and second-order hierarchical cut patterns were estimated across all skin graft simulants for up to 300% strain. Also, Statistical analysis was performed to calculate the significance among the groups. From the analysis, the skin graft simulants with second-order auxetic incision patterns were found to exhibit the lowest induced stresses and maximum expansion of approximately four times, at 300% strain. To date, traditional skin grafts have only been able to achieve up to three times expansion. Therefore, the expansions realized with the novel hierarchical skin graft simulants is unprecedented, with the potential to generate ground-breaking advances in burn injury treatment.

Efficacy of bioabsorbable dressing combined with antibacterial spray for treatment of third-degree burns.

To evaluate the clinical efficacy of a bioabsorbable dressing in combination with antibacterial spray in treating third-degree burns. Patients with third-degree burns in our hospital from February 2019 to February 2020 were enrolled and divided into an experimental group and a control group. In all patients, two wound repair surgeries were performed. During the first surgery, bioabsorbable dressing (PELNAC, Gunze Medical Equipment (Shenzhen) Co. Ltd., China) was used for wound treatment. During the second surgery, autologous split-thickness skin graft was performed. For patients in the experimental group, bioabsorbable dressings (PELNAC) were uniformly applied with antibacterial spray during the operation and during postoperative dressing. For patients in the control group, antibacterial spray was not used. A total of 68 patients took part in the study (experimental group n=36; control group n=32). Infection rate in the experimental group was significantly lower than that in the control group (2.8% versus 21.9%, respectively; p<0.05). The mean wound healing time in the experimental group was shorter by 3.2 days and the wound healing rate of the experimental group was significantly higher than that in the control group (p<0.05). Vancouver Scar Scale (VSS) scores at specific postoperative time intervals were significantly reduced in the experimental group compared with those in the control group (p<0.05). Bioabsorbable dressing combined with antibacterial spray could reduce infection rate, shorten wound healing time and reduce scar formation in repairing third-degree burns.

MP33-09 GLANSECTOMY AND NEOGLANS RECONSTRUCTION USING SPLIT-THICKNESS SKIN GRAFT / ACELLULAR DERMAL MATRIX FOR PENILE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP33-09 GLANSECTOMY AND NEOGLANS RECONSTRUCTION USING SPLIT-THICKNESS SKIN GRAFT / ACELLULAR DERMAL MATRIX FOR PENILE CANCER Haijun Yao, Dachao Zheng, Jianshu Ni, Xiang Wan, and Zhong Wang Haijun YaoHaijun Yao More articles by this author , Dachao ZhengDachao Zheng More articles by this author , Jianshu NiJianshu Ni More articles by this author , Xiang WanXiang Wan More articles by this author , and Zhong WangZhong Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penectomy as the traditional surgical treatment of penile cancer has substantial adverse functional and psychological impact. Organ-sparing surgery is recommended in selected penile cancer patients.Glansectomy and Neoglans reconstruction aims to provide curative resection while maximizing functional outcomes and minimizing psychological harm.To show the efficacy and safety of glansectomy and neoglans reconstruction using split-thickness skin graft (STSG) and Acellular Dermal Matrix (ADM). METHODS: Using our prospectively derived database, we identified 25 patients with penile squamous-cell carcinoma involving the glans, who were treated using glansectomy and neoglans reconstruction between March 2015 and December 2021. All the patients underwent total glansectomy and reconstruction of a new glans, of whom 18 (82%) with STSG and 7 with ADM. Deep spongiosal biopsies are taken to exclude invasion as a standard practice. The glans is excised and a neoglans is created using STSG/ADM. These 25 patients represent the subject of our study (mean age 57 years, range 45 to 71 years). RESULTS: 92% of patients (23/25) reported to be fully satisfied with the postoperative aesthetic appearance. The apex of corpora cavernosa was transected in 5 cases due to local invasion. Positive surgical margins were no detected in all the cases. 2 patients (8%) experienced local recurrence during the follow-up period. 4 patients had early partial loss of the graft (STSG 2 vs ADM 2). Two late complications occurred with urethral meatus stricture. CONCLUSIONS: Glansectomy and Neoglans reconstruction using STSG/ADM comprise a safe procedure in terms of oncologic control and complications for patients with penile cancer confined to the glans. Further studies are required to assess functional and sexual outcomes in these patients.The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer. Source of Funding: The Project of Biobank (No. YBKB202119) from Shanghai 9th People's Hospital,Shanghai Jiao Tong University,School of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e453 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haijun Yao More articles by this author Dachao Zheng More articles by this author Jianshu Ni More articles by this author Xiang Wan More articles by this author Zhong Wang More articles by this author Expand All Advertisement PDF downloadLoading ...

Dermal substitute: a safe and effective way in surgical management of adults post-burn dorsal foot contractures.

Neglected dorsal foοt burns may result in typical fοrefοοt defοrmities characterised by cοntractures leading tο hyperextensiοn οf the tοes and gait disturbance. These defοrmities usually cause a significant impairment in daily activities and difficulty in wearing shοes. This article presents a recοnstructiοn series οf severe fοrefοοt defοrmities by means of dermal regeneratiοn templates (also known as dermal substitutes) and split thickness skin grafts. We retrοspectively reviewed οur institutiοnal burn database from 2010 to 2020 focusing on all those dοrsal fοοt cοntractures treated with the use οf a dermal regeneratiοn template. The patients' demοgraphics, burn injury mechanisms, depth, lοcalizatiοn, surface, treatments and fοllοw-up were described. Twelve patients underwent this prοcedure and the mean affected area was 75 cm2. The mean time between the dermal regeneratiοn template applicatiοn and the split thickness skin graft was 19.6 days. Just fοr one patient, an additiοnal skin grafting prοcedure was required. The mean fοllοw-up was 4.6 years. We did not register specific cοmplicatiοns at bοth the recipient (forefoot) and dοnοr sites (scalp). All patients were able tο wear shοes and walk after the procedure. Nο recurrence οf cοntractures were οbserved. All patients were satisfied with cοsmetic results, and they did not request any additiοnal prοcedure οf cοsmetic imprοvement. The use οf the dermal regeneratiοn template can be cοnsidered as an extremely safe and efficient treatment οf severe post-burn fοrefοοt defοrmities.

MP02-03 FASCIOCUTANEOUS FLAP CLOSURE OF THE PERINEUM AS AN ALTERNATIVE TO SCROTOPLASTY FOR EXTENSIVE GENITAL TISSUE LOSS

You have accessJournal of UrologyCME1 Apr 2023MP02-03 FASCIOCUTANEOUS FLAP CLOSURE OF THE PERINEUM AS AN ALTERNATIVE TO SCROTOPLASTY FOR EXTENSIVE GENITAL TISSUE LOSS Christopher Staniorski, Robin Vasan, Michael Pintauro, Michelle Yu, and Paul Rusilko Christopher StaniorskiChristopher Staniorski More articles by this author , Robin VasanRobin Vasan More articles by this author , Michael PintauroMichael Pintauro More articles by this author , Michelle YuMichelle Yu More articles by this author , and Paul RusilkoPaul Rusilko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genital tissue loss is a surgical challenge often occurring in complex patients. Scrotoplasty with flaps and split thickness skin grafts (STSG) are two methods of closure but carry complication rates as high as 28% and may not be ideal for medically complex patients. However, closure by secondary intention is associated with wound care needs and patient discomfort. Our objective is to evaluate an alternative method of perineal closure in lieu of scrotoplasty in a complex population. METHODS: We retrospectively reviewed patient charts of adults who underwent perineal closure with fasciocutaneous flaps and thigh pouch creation. Our primary outcomes were complication rate and wound coverage. Secondary outcomes included measures of patient satisfaction and post-operative care needs. RESULTS: 20 patients were identified who underwent this closure, the majority following Fourniers gangrene. Patients had a median age of 64 (IQR 58 – 70), BMI of 34 (IQR 29 – 40) and Charlson comorbidity index of 5 (IQR 4 – 8) equating to a 21% 10-year survival. The median total wound dimension was 443 cm2 (IQR 225 – 600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation from the thigh (n=18) or abdominal wall (n=8) and resulted in 100% closure rate of the perineum. Escutcheonectomy was used to increase the size of abdominal flaps in 2 patients with over 600 cm2 of skin loss. Only three patients required abdominal STSG to complete closure. Complication rate was 15% with 1 wound infection and 2 episodes of bleeding. Patients stayed a median of 7.5 days following closure (IQR 3-12.5) and 40% were discharged home. Median follow up was 9 months (n=16, IQR 3.25 – 14.75) with only 1 patient (6%) reporting pain related to thigh pouches and none desiring elective scrotoplasty. CONCLUSIONS: Despite large defects, this method of reconstruction allowed for perineal closure in all patients with minimal use of STSG. Despite significant medical comorbidity, complication rates were comparable to those previously reported and patients were largely satisfied with their reconstruction with none desiring formal scrotoplasty. While larger sample sizes are needed, this method of closure appears to add an option for the medically and surgically complex perineal reconstruction patient. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e11 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Staniorski More articles by this author Robin Vasan More articles by this author Michael Pintauro More articles by this author Michelle Yu More articles by this author Paul Rusilko More articles by this author Expand All Advertisement PDF downloadLoading ...

V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP

You have accessJournal of UrologyCME1 Apr 2023V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP Aurélie Schirmann, Nim Christopher, David Ralph, and Wai Gin Lee Aurélie SchirmannAurélie Schirmann More articles by this author , Nim ChristopherNim Christopher More articles by this author , David RalphDavid Ralph More articles by this author , and Wai Gin LeeWai Gin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps.The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra. METHODS: A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder.Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed. RESULTS: The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device. CONCLUSIONS: Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further aesthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired. Source of Funding: None declared © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e999 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aurélie Schirmann More articles by this author Nim Christopher More articles by this author David Ralph More articles by this author Wai Gin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Myxoinflammatory Fibroblastic Sarcoma of the Hand

Myxoinflammatory fibroblastic sarcoma is an ultra-rare tumor type with a prevalence of fewer than two per 100,000 people. The tumor poses a challenge because it can be misdiagnosed as a benign lesion in clinical and radiological investigations, causing serious morbidity in patients. We present the case of a 33-year-old patient who presented with painless hand swelling that was misdiagnosed as lymphaticovenous malformation based on magnetic resonance imaging. The patient underwent surgical excision, and myxoinflammatory fibroblastic sarcoma was diagnosed postoperatively. All surgical interventions failed to achieve negative margin. A decision to start radiotherapy was made, and tissue convergence was done temporally using acellular dermal matrix and split-thickness skin graft. On patient follow-up, the graft had taken well, and the patient was undergoing radiotherapy sessions with a plan for permanent hand reconstruction after negative margins are achieved. Based on this case report, we identified that magnetic resonance imaging is not yet a reliable method to diagnose myxoinflammatory fibroblastic sarcoma. Therefore, implementing a multidisciplinary team approach, a preoperative core needle biopsy, planned surgical intervention, and early involvement of radiotherapy is recommended to minimize morbidity. We strongly urge establishing a sarcoma specialized treatment center in the region to limit patient morbidity.

The Outcome of Moderate-to-Severe Complications Related to Peripheral Intravenous Devices at Upper Limb.

Background: Intravenous access is very crucial in administration of fluids, medications and nutrition. Almost all inpatients will require it and the simplest and quickest access is peripheral with the preferred sites being either dorsum hand, radial wrist or forearm. It has its complications, of which most are avoidable. Literature has emphasised the complications and reported on preventive measures but lacks the sequelae of the complications related to peripheral intravenous devices (PIVD). We report on the sequelae of moderate-to-severe complications of these patients. Methods: Thirty-three patients had moderate-to-severe complications related to PIVD in a tertiary centre from January 2017 to December 2017. All data were obtained from electronic medical report (EMR). Results: Majority had extravasation (45.5%) and abscess (39.4%), whereas two patients had thrombophlebitis (6.1%) and three patients developed necrotising fasciitis (9.1%). All patients with abscess and necrotising fasciitis underwent surgical intervention (n = 16); four patients had multiple debridements. All infections were treated with empirical antibiotics and changed after culture results were obtained. Seven patients had sepsis/bacteraemia wherein two of them passed away. A total of 31 patients were discharged. Two patients had secondary suturing of the wound, one had split-thickness skin grafting (SSG) coverage and the others had daily dressing until the wound healed by secondary intention. Conclusions: PIVD-related complications can be debilitating and may occur despite strict preventive measures. Early clinical diagnosis and prompt treatment of these complications can decrease its morbidity. Level of Evidence: Level IV (Prognostic).

Effect of Nano Fat Graft on the Healing of Donor Site of Split Thickness Skin Graft

Effect of Nano Fat Graft on the Healing of Donor Site of Split Thickness Skin Graft

Two-Stage Penile Reconstruction after Paraffin Injection: A Case Report and a Systematic Review of the Literature

Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size. A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique. A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out. In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.

The effect of COVID-19 on surgical management of skin cancers of the head, face and neck in elderly patients.

The Corona Virus (COVID-19) has had a profound impact on healthcare systems worldwide, with interruptions to medical practices including the delivery of cancer treatment. Skin cancer is one of the leading causes of malignancy worldwide, with later stages of disease correlating to poorer prognosis. Immunocompromized and elderly patients represent populations that are at higher risk for adverse outcomes related to skin cancer, treatment delay and COVID-19 infection. Patients aged 65 and above who underwent surgical management of skin cancers from 31 January 2020 to 31 January 2021 were included in this study then compared with samples pre- and post-pandemic. Retrospective analysis was performed regarding: date of referral to date of surgery, skin cancer type, location of cancer, surgery performed, anaesthesia used, sutures used and outcomes. Data was compared to national guidelines. Five hundred and twenty skin cancers were included in this analysis, of which 340 were treated during the COVID-19 pandemic. Of the cohort treated during the pandemic, 44.2% (n=111) received excision and direct closure, 13.1% (n=33) underwent reconstruction by integra dermal substitute, 3.2% (n=8) by split thickness skin graft, 6.4% (n=16) by full thickness skin grafts and 33.1% (n=83) by local flaps. Complete excision was achieved in 88.5% of cases (n=301). The mean time from referral to surgery was 119days. There were no deaths associated with COVID-19. Safe and prompt treatment of head and neck skin cancers is achievable despite the COVID-19 pandemic. Measures to minimize infection risk include the use of teledermatology, reliable COVID-19 testing, Green Pathways and a reduction in the mean referral to surgery time.

A rare case of facial skin multicentric squamous cell carcinoma

Skin squamous cell carcinoma (SCC) is commonly seen in people with fair skin, high exposure to sunlight, and long-term smokers. A 48-year-old male patient was admitted to our clinic with the complaint of nonhealing wounds in many foci on his face. On physical examination, there were ulcerovegetative lesions of 5¥5 cm on the right zygoma, 2¥3 cm on the right lateral of the nasal dorsum, 2¥2 cm on the left zygoma, and two 1x1 cm on the medial of the left zygoma. The patient, whose histopathological examination was reported as SCC, underwent multiple SCC excision, reconstruction with a split-thickness skin graft taken from the anterior thigh region, right superficial parotidectomy, and right level 1-2 neck dissection. The lesions of our patient, who was in the 12th postoperative month, healed close to normal anatomy, and no recurrence has yet been found in the head and neck. In this article, a case of multicentric SCC in the head and neck region is presented with the diagnosis, treatment, and follow-up process, together with the current literature.

Patients over 75 years admitted to the National Burn Centre, Haukeland University Hospital, 2000-19.

The number of burn patients over the age of 75 receiving advanced treatment, including extensive surgery and intensive care, is increasing. We aimed to describe the treatment and outcomes for burn patients over the age of 75 admitted to the National Burn Centre at Haukeland University Hospital. We also wanted to investigate whether frailty scores can be a predictor of the treatment outcome. All patients ≥75 years admitted to the National Burn Centre at Haukeland University Hospital in the period 2000-19 were included in the study. Frailty scores were calculated retrospectively based on patients' medical records. Our study included 101 patients (50 women and 51 men). The number of admissions of older burn patients increased from an average of 3.3 per year in 2000-14 to 10.2 in the period 2015-19. The median total body surface area with burns was 11% (range 0.9-80%). Seventeen patients received palliative care, and 12 patients receiving active treatment died in hospital. In 68 of 84 (81%) actively treated patients, tangential excision and split-thickness skin grafting were performed. The remainder received conservative treatment (non-surgical) with wound care and application of a silver dressing. Patients who died in hospital had a significantly higher total body surface area with burns (p < 0.0001) and higher frailty scores (p = 0.003) than patients who survived. The yearly number of patients over the age of 75 treated at the National Burn Centre tripled during the period. More than two-thirds of the patients were discharged alive. Extent of burn injury and frailty score are associated with mortality and may be useful for adjusting therapy.

Single-stage transplantation combined with epidermal stem cells promotes the survival of tissue-engineered skin by inducing early angiogenesis

BackgroundThe composite transplantation of a split-thickness skin graft (STSG) combined with an acellular dermal matrix (ADM) is a promising repair method for full-thickness skin defects. Due to delayed vascularization of the ADM, no currently available engineered skin tissue is able to permanently cover full-thickness skin defects via a single-stage procedure. Epidermal stem cells (EpSCs) have been found to promote angiogenesis in the wound bed. Whether EpSCs can induce early angiogenesis of dermal substitutes and promote the survival of single-stage tissue-engineered skin transplantation needs to be further studied.MethodsIn vitro, rat vascular endothelial cells (RVECs) were treated with the supernatant of EpSCs cultured in ADM and stimulated for 48 h. RVECs were analysed by RNA sequencing and tube formation assays. For the in vivo experiment, 75 rats were randomly divided into five groups: ADM, ADM + EpSCs (AE), STSG, ADM + STSG (AS), and ADM + STSG + EpSCs (ASE) groups. The quality of wound healing was estimated by general observation and H&E and Masson staining. The blood perfusion volume was evaluated using the LDPI system, and the expression of vascular markers was determined by immunohistochemistry (IHC).ResultsThe active substances secreted by EpSCs cultured in ADM promoted angiogenesis, as shown by tube formation experiments and RNA-seq. EpSCs promoted epithelialization of the ADM and vascularization of the ADM implant. The ASE group showed significantly increased skin graft survival, reduced skin contraction, and an improved cosmetic appearance compared with the AS group and the STSG control group.ConclusionsIn summary, our findings suggest that EpSCs promote the formation of new blood vessels in dermal substitutes and support one-step transplantation of tissue-engineered skin, and thereby provide new ideas for clinical application.

Brûlures par l’usage détourné du protoxyde d’azote en bonbonne

Between November 2021 and August 2022 we treated 4 patients burned during a nitrous oxide use accident. We report the cases of three women and one man with an average age of 28. Two of them were treated in addictology. We observed an average delay before consultation of a healthcare professional of 7days. The burns were all rounded and deep, localized at the level of the thighs. For three of the patients (one having been lost to sight), a split thickness skin graft was performed within an average of 32days. The non-medical use of nitrous oxide represents a real public health problem in addition to the adverse effects of the substance itself. Prevention and health security measures seem to be becoming essential.

A Histological and Clinical Study of MatriDerm® Use in Burn Reconstruction.

Dermal substitutes are well established in the reconstructive ladder. MatriDerm® (Dr. Otto Suwelack Skin & Health Care AG, Billerbeck, Germany) is a single-layer dermal substitute composed of a bovine collagen (type I, III, and V) and elastin hydrolysate, that allows for immediate split-thickness skin grafting (SSG). The aim of this study was to histologically characterize the integration of MatriDerm® when used during burns surgery reconstruction. Eight subjects with nine burn scars and one acute burn wound underwent reconstruction with MatriDerm® and an immediate SSG. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at weeks 1, 2, 3, and 4 and months 2, 3, 6, 9, and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with a transmission electron microscope. Patient satisfaction and clinical scar outcome were assessed with the Vancouver Scar Scale and a patient questionnaire. Histological analysis showed similar stages of wound healing as shown in other dermal templates but on a different timescale. There is early evidence of vascularization and an inflammatory infiltrate in the first 2 weeks. MatriDerm® is resorbed earlier than other dermal substitutes, with evidence of resorption at week 3, to be completely replaced by a neodermis at 2 months. The use of MatriDerm® in reconstruction with immediate skin grafting is supported histologically with early evidence of vascularization to support an epidermal autograft. Future histological studies may help further characterize the ideal dermal substitute.

The versatility of biodegradable temporising matrix – A 63 paediatric case series with complex wounds

IntroTreating complex paediatric wounds is a challenge for many clinicians. Biodegradable Temporising Matrix (BTM) is a completely synthetic product that has shown promise in adults with acute burns, complex wounds, and reconstructive procedures. Currently, there is little documentation regarding the use of BTM in the paediatric population. MethodA retrospective chart review was conducted of all children who required application of BTM for wound treatment. Children were grouped into categories according to the type of injury or condition including thermal, friction, and electrical injuries, scar reconstruction, and various wound defects. Outcomes of interest included infection rates, time to application of BTM and split-thickness skin graft (SSG), dressings used, and overall functional and cosmetic outcomes. Results63 children were identified. Thermal (19/63) and friction (10/63) injuries represented the largest groups. Males accounted for 68 % of total children with lower limbs and feet most often affected. The median time for application of BTM was 7.5 days and 27 days from time of application of BTM to SSG. BTM provided satisfactory options for early wound closure and the ability to convert complex wounds, however it still does not negate the need for scar management. ConclusionFrom our review, BTM is a versatile product that has shown positive results for the treatment of complex wounds in the paediatric population. It represents the largest consecutive BTM case series in either adult or paediatric populations to date.

MANAGEMENT OF DIABETIC FOOT ULCERS AND RELATED COMPLICATIONS: A PROSPECTIVE OBSERVATIONAL STUDY

Introduction Foot ulceration and its complications are one of the major complications attributing to the hospital admission, with overall prevalence of about 4 -10% and even higher in geriatric population (5-10%).With the lifetime risk of 15%,it contributes as a major factor of morbidity and not infrequently leading to severe adverse outcomes, such as amputation and life threatening sepsis.The study was aimed at analyzing the prevalence of diabetic foot infection,its complications and outcomes of different treatment modalities available in a tertiary care center.Material and Methods A prospective observational study of 12 month duration was conducted among 100 patients having a history of diabetes and diagnosed with diabetic foot ulcer undergoing treatment in the surgery department of a tertiary care center in Jammu.The period of study was Feb 2022 to Feb 2023.Prior to the study an informed written consent and approval of the ethics committee was obtained. Results The incidence of diabetic foot ulcers peaks at the 5th decade of life with the mean age in our study being 53.17±10.2 years.A predominance in the male population (m:f ratio=2.57:1) and higher risk in the lower socio-economic strata was also noticed. The most common presenting complaint being ulcer (96%) and discharge (67%).Culture positivity was seen in 80% of the patients with Staph.Aureus being the most common causative organism. The main stray of treatment involved debridement and amputation (31%) followed by Split thickness skin grafting (30%). No adverse events were noted during the course of study. Conclusion Being a menace in developing countries,diabetes mellitus,a disease with life threatening and physically incapacitating consequences which not only increases the patient morbidity but also substantially increases the economic burden. Provision of precise counseling and a multidisciplinary line of action can lessen the complication and amputation rate, and is therefore recommended, along with the incorporation of diabetic foot management guidelines into the routine practice and teaching