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Kaiser D, Levin LS. Fasciocutaneous Free Tissue Transfer in Limb Salvage: Prior Flap as a Split-thickness Skin Graft Donor Site. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5212. [PMID: 37593694 PMCID: PMC10431587 DOI: 10.1097/gox.0000000000005212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
Free flap surgery for limb salvage has become the surgical standard for reconstruction of bone and soft tissue with success rates and flap survivals of 94%-95%. The soft tissue defect dictates the technique of coverage. In many cases, multiple techniques of soft tissue coverage are necessary, ranging from myocutaneous and fasciocutaneous free flaps to split-thickness skin grafts (STSGs). It has been shown that fasciocutaneous free flaps are not inferior to muscle flaps in treatment of lower leg limb salvage. Although a complete flap loss is rare, it is not uncommon to have partial flap necrosis, wound dehiscence, or secondary soft tissue defects, necessitating further minor reconstruction, which we call "touch up" skin grafts. In many of these secondary procedures, split thickness skin grafts are sufficient. We have been using the skin portion of the fasciocutaneous free flap as a donor site for harvesting STSGs for quite some time without disadvantages. We believe that minimizing additional donor site morbidity is of great importance. The free tissue transfer is insensate and readily available at the site of injury, making prepping and draping simple as well as cosmetically acceptable, as the transferred free tissue, unfortunately, is rarely a perfect fit. The associated pain, discomfort, and scar of an additional donor site can be avoided. In our case series, we did not experience any flap loss, infections, or complications. Thus, harvesting an STSG from a fasciocutaneous free flap seems to be a feasible option to be considered in limb salvage.
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Affiliation(s)
- Dominik Kaiser
- From the Department of Orthopaedic Surgery, Penn Medicine University City, Philadelphia, Pa
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Lawrence Scott Levin
- From the Department of Orthopaedic Surgery, Penn Medicine University City, Philadelphia, Pa
- Department of Plastic Surgery, Department of Surgery, University of Pennsylvania, Pa
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Chan S, Cherian P. Skin grafts: A survey study of Australasian Mohs surgeons. Australas J Dermatol 2022; 63:e265-e268. [DOI: 10.1111/ajd.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Su‐Lin Chan
- Oxford Dermatology Perth Western Australia Australia
| | - Paul Cherian
- Oxford Dermatology Perth Western Australia Australia
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3
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A prospective comparative study on the effectiveness of two different non-adherent polyurethane dressings on split-thickness skin graft donor sites. J Tissue Viability 2022; 31:531-536. [DOI: 10.1016/j.jtv.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
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4
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Alsaif A, Karam M, Aldubaikhi AA, Alghufaily A, Alhuwaishel K, Aldekhayel S. Polyurethane Versus Calcium Alginate Dressings for Split-Thickness Skin Graft Donor Site: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e20027. [PMID: 34987912 PMCID: PMC8717116 DOI: 10.7759/cureus.20027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Herein, we compare the outcomes of polyurethane and calcium alginate dressings for split-thickness skin graft (STSG) donor sites. A systematic review and meta-analysis were conducted with a search of electronic databases to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of polyurethane dressing versus calcium alginate for STSG donor sites. Primary outcomes were pain intensity, convenience for staff and patients, and adverse effects (namely, excessive exudate, infection rate, and hematoma). Secondary outcome measures included the assessment of healing, dressing changes, cosmetic appearance, and cost. Fixed and random-effect models were used for the analysis. Four RCTs enrolling 127 subjects were identified. There was no significant difference between polyurethane and calcium alginate in terms of pain intensity on Day 1 (mean difference (MD) 0.13, P = 0.80) and Day 5 (MD = 0.20, P = 0.38), as well as the ease of application (odds ratio (OR) = 3.08, P = 0.47). However, there was a statistically significant improvement in patient comfort, favouring the polyurethane group (OR = 44.11, P < 0.00001). In addition, no statistically significant differences were noted in terms of adverse effects between the two dressings. In terms of cost, the calcium gluconate dressing had an overall higher cost compared to polyurethane. Polyurethane is a more favourable dressing compared to calcium alginate for STSG donor sites in terms of patient comfort, healing, and cosmetic outcomes. However, comparable results were noted in terms of pain intensity, ease of application, and adverse effects profile. Cost-effectiveness analysis studies are required to justify its routine use.
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Asuku M, Yu TC, Yan Q, Böing E, Hahn H, Hovland S, Donelan MB. Split-thickness skin graft donor-site morbidity: A systematic literature review. Burns 2021; 47:1525-1546. [PMID: 33781633 DOI: 10.1016/j.burns.2021.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0-10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0-13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.
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Affiliation(s)
- Malachy Asuku
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA.
| | - Qi Yan
- Oxford PharmaGenesis Inc., 4 Caufield Place, Suite 201, Newtown, PA, 18940, USA
| | - Elaine Böing
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Helen Hahn
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Sara Hovland
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Matthias B Donelan
- Shriners Hospital for Children-Boston, 51 Blossom Street, Suite 930, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02114, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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6
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Slaninka I, Fibír A, Kaška M, Páral J. Use of autologous platelet-rich plasma in healing skin graft donor sites. J Wound Care 2020; 29:36-41. [DOI: 10.12968/jowc.2020.29.1.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To demonstrate that the use of platelet-rich plasma (PRP) enhances both the quality of healing and the time required for wound healing at a skin graft donor site. Methods: Patients who had dermo-epidermal skin grafts taken from the thigh area were included in a prospective, randomised clinical study. PRP was applied to one donor site and then covered with Vaseline-impregnated, open-weave gauze and gauze, while the contralateral donor site on the other thigh served as a control and was covered with the open-weave gauze and gauze without PRP. Results: A total of 24 patients took part in the study, of which three developed infections and were thus removed from the study. Use of PRP reduced the wound healing time of the dermo-epidermal graft donor sites by a mean 17.8% and median 18 days. On average, the treated donor sites healed in 14.9 days compared with 18.4 days for the control group. The median was 14 days compared with 18 days in the control group (p=0.026). In one patient, healing was slower on the side where PRP was applied. In 20 patients, healing of the donor site was accelerated where PRP was applied. Conclusion: The study demonstrated a beneficial effect of PRP, as healing time was shortened. Using PRP to heal wounds could be beneficial for patients for whom commonly available wound healing therapies have failed, as well as for high-risk patient groups for whom problematic wound healing may be expected.
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Affiliation(s)
- Igor Slaninka
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Aleš Fibír
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Milan Kaška
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Jiří Páral
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
- Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
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Abstract
Wound management is a notable healthcare and financial burden, accounting for >$10 billion in annual healthcare spending in the United States. A multidisciplinary approach involving orthopaedic and plastic surgeons, wound care nursing, and medical and support staff is often necessary to improve outcomes. Orthopaedic surgeons must be familiar with the fundamental principles and evidenced-based concepts for the management of acute and chronic wounds. Knowledge of surgical dressings, negative pressure wound therapy, tissue expanders, dermal apposition, biologics, and extracellular matrices can aide practitioners in optimizing wound care.
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8
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Brown JE, Holloway SL. An evidence-based review of split-thickness skin graft donor site dressings. Int Wound J 2018; 15:1000-1009. [PMID: 30117716 PMCID: PMC7949554 DOI: 10.1111/iwj.12967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022] Open
Abstract
This evidence-based review aimed to identify and evaluate current existing evidence relating to the efficacy of dressing materials for spit-thickness skin graft donor site wounds in relation to promoting rapid healing and reducing patient pain. A comprehensive systematic search of the literature between 2006 and 2016 identified 35 publications that were included in the review. Based on the results of the review, it was found that moist wound-healing products have a clear advantage over non-moist products in the reduction of pain and increased healing rates. This review concluded that moist wound-healing products are more effective than non-moist wound-healing products in reducing pain and promoting healing in split-thickness skin graft donor site wounds. A recommendation based on this review is that further research examine the role of secondary dressing usage in donor site wound management, and the consideration of using more than one primary dressing product during the donor site wound-healing process should be undertaken.
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Affiliation(s)
- Julie E Brown
- Tissue Viability ServiceOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Samantha L Holloway
- Centre for Medical Education, School of Medicine, College of Biomedical and Life SciencesCardiff UniversityWalesUK
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10
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Jansen P, Stoffels I, Klode J, Jockenhöfer F, Augustin M, Schadendorf D, Dissemond J. Postsurgical Treatment of Split Skin Graft Donor Sites in Dermatological Departments. INT J LOW EXTR WOUND 2018; 17:22-29. [PMID: 29502480 DOI: 10.1177/1534734617747685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The surgical removal of split skin grafts (SSGs) leads to superficial wounds that can be covered with different wound dressings. Currently, international guidelines that recommend a standard treatment of the donor sites are not yet established. We developed a questionnaire to evaluate the treatment of SSG donor sites and sent it to all dermatological departments in Germany. Altogether 78 of the 115 contacted departments in Germany participated in our cross-sectional trial. Our analysis reveals that multiple wound dressings with different frequencies of replacement are used. On an average, complete reepithelialization of the donor site takes 14-21 days. Foams and coated gauzes are used in 73% of all surgical procedures for postsurgical treatment of SSG donor sites. Still, neither a significant faster reepithelialization nor a lower rate of wound healing disorders can be assigned to any of the wound dressings. The results of our study indicate that a large number of wound care products and treatment strategies are currently applied on SSG donor sites in dermatological departments in Germany. The selection of the wound dressing is not based on scientific data but rather on the experience of individual experts.
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Affiliation(s)
- Philipp Jansen
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Matthias Augustin
- Center for Psychosocial Medicine, Institute of Health Care Research in Dermatology and Nursing (IVDP), University Hamburg, Hamburg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
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11
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Hosomi K, Nagai F, Yuzuriha S. Small-slice thin-thickness skin harvesting in a net pattern for patients with skin vulnerability. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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12
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Konstantinow A, Fischer TV, Ring J. Effectiveness of collagen/oxidised regenerated cellulose/silver-containing composite wound dressing for the treatment of medium-depth split-thickness skin graft donor site wounds in multi-morbid patients: a prospective, non-comparative, single-centre study. Int Wound J 2017; 14:791-800. [PMID: 27905181 PMCID: PMC7949593 DOI: 10.1111/iwj.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022] Open
Abstract
Split-thickness skin grafting (STSG) is a widely used method in reconstructive surgery, but donor site wounds (DSWs) are often slow healing and painful. This prospective study evaluated the performance of a composite wound dressing containing collagen/oxidised regenerated cellulose in the treatment of medium-depth (0·4 mm) DSWs in 25 multi-morbid patients with chronic leg ulcers requiring STSG. The range of patients' ages was 44-84 years (mean 71·6 years) with DSW sizes ranging between 12 and 162 cm2 (mean 78 cm2 ). Comorbidities included anticoagulation therapy (15 patients), anaemia (11 patients), diabetes (6 patients) and methicillin-resistant Staphylococcus aureus (MRSA) ulcer colonisation (6 patients). The first dressing change was performed after 10 days. Complete reepithelialisation was observed between the 10th and 34th day (mean 17·2, median 14 days). Postoperative medium to strong bleeding occurred in only five patients (four with anticoagulation). Wound pain levels one day after harvesting were only moderate (range 0-1·5, mean 0·5, median 0·5 on a six-item scale). No wound infection was observed during the first dressing. The composite dressing used allowed for the fast healing of medium-depth DSWs with minimal or no postoperative pain and bleeding in older multi-morbid patients under anticoagulation treatment.
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Affiliation(s)
- Alexander Konstantinow
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Tatjana V Fischer
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Johannes Ring
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
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13
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Zarrintaj P, Moghaddam AS, Manouchehri S, Atoufi Z, Amiri A, Amirkhani MA, Nilforoushzadeh MA, Saeb MR, Hamblin MR, Mozafari M. Can regenerative medicine and nanotechnology combine to heal wounds? The search for the ideal wound dressing. Nanomedicine (Lond) 2017; 12:2403-2422. [DOI: 10.2217/nnm-2017-0173] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Skin is the outermost covering of the human body and at the same time the largest organ comprising 15% of body weight and 2 m2 surface area. Skin plays a key role as a barrier against the outer environment depending on its thickness, color and structure, which differ from one site to another. The four major types of problematic wounds include ulcers (diabetic, venous, pressure) and burn wounds. Developing novel dressings helps us to improve the wound healing process in difficult patients. Recent advances in regenerative medicine and nanotechnology are revolutionizing the field of wound healing. Antimicrobial activity, exogenous cell therapy, growth factor delivery, biodegradable and biocompatible matrix construction, all play a role in hi-tech dressing design. In the present review, we discuss how the principles of regenerative medicine and nanotechnology can be combined in innovative wound dressings.
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Affiliation(s)
- Payam Zarrintaj
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | | | - Saeed Manouchehri
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Zhaleh Atoufi
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Anahita Amiri
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | | | | | - Mohammad Reza Saeb
- Department of Resin & Additives, Institute for Color Science & Technology, P.O. Box 16765–654, Tehran, Iran
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA
- Harvard-MIT Division of Health Sciences & Technology, Cambridge, MA 02139, USA
| | - Masoud Mozafari
- Nanotechnology & Advanced Materials Department, Materials & Energy Research Center (MERC), Tehran, Iran
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
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14
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Holden AM, Beech AN, Farrier JN. Diathermy of split-thickness skin graft donor site: a new technique. Br J Oral Maxillofac Surg 2017. [PMID: 28625412 DOI: 10.1016/j.bjoms.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A M Holden
- Department of Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN.
| | - A N Beech
- Department of Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN.
| | - J N Farrier
- Department of Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN.
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15
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Been RA, Bernatchez SF, Conrad-Vlasak DM, Asmus RA, Ekholm BP, Parks PJ. In vivo methods to evaluate a new skin protectant for loss of skin integrity. Wound Repair Regen 2016; 24:851-859. [PMID: 27312780 DOI: 10.1111/wrr.12455] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022]
Abstract
A new skin protectant was developed for use on conditions involving partial-thickness skin loss such as severe incontinence-associated dermatitis. This new formulation is based on a cyanoacrylate chemistry designed to polymerize in situ and create a breathable film able to protect the skin surface from external irritants. This film provides an environment favorable for healing to occur beneath the film. To evaluate the characteristics of the novel chemistry, we devised a preclinical testing strategy comprising three different animal models. The data from all three models was considered collectively to create an overall assessment of effectiveness. A guinea pig model was used to evaluate the barrier efficacy of the new product in protecting intact skin from irritation. A porcine partial-thickness wound model was used to evaluate the efficacy of the product in helping control minor bleeding and exudate. A similar model was also used to assess the process of reepithelialization in the continued presence of an irritant. In the first model, untreated sites had 8.5 times more irritation than sites covered with the new product (p < 0.001). In the second model, a single application of the new product successfully attached to intact peri-wound skin and to denuded, weepy skin. It significantly reduced the amount of fluid weeping from the wounds (p ≤ 0.001) and continued to perform throughout a 96 hours experiment. In the third model, the percent of reepithelialization was significantly greater for the wounds covered with the new product than for the control wounds (p = 0.003; on average, 18.3% greater, with a 95% confidence interval of 9.2% to 27.5%). These results suggest that the new skin protectant protects intact and denuded skin from irritants and provides an environment favorable to healing, offering promise for the management of various conditions involving loss of epidermis.
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Affiliation(s)
- Raha A Been
- 3M Critical & Chronic Care Solutions Division, St. Paul, Minnesota
| | | | | | - Robert A Asmus
- 3M Critical & Chronic Care Solutions Division, St. Paul, Minnesota
| | - Bruce P Ekholm
- 3M Critical & Chronic Care Solutions Division, St. Paul, Minnesota
| | - Patrick J Parks
- 3M Critical & Chronic Care Solutions Division, St. Paul, Minnesota
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16
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Evaluating topical opioid gel on donor site pain: A small randomised double blind controlled trial. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Optimizing the Moisture Management Tightrope with Wound Bed Preparation 2015©. Adv Skin Wound Care 2015; 28:466-76; quiz 477-8. [DOI: 10.1097/01.asw.0000470851.27030.98] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Sarheed O, Abdul Rasool BK, Abu-Gharbieh E, Aziz US. An investigation and characterization on alginate hydogel dressing loaded with metronidazole prepared by combined inotropic gelation and freeze-thawing cycles for controlled release. AAPS PharmSciTech 2015; 16:601-9. [PMID: 25425388 DOI: 10.1208/s12249-014-0237-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/09/2014] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to investigate the effect of combined Ca(2+) cross-linking and freeze-thawing cycle method on metronidazole (model drug) drug release and prepare a wound film dressing with improved swelling property. The hydrogel films were prepared with sodium alginate (SA) using the freeze-thawing method alone or in combination with ionotropic gelation with CaCl2. The gel properties such as morphology, swelling, film thickness, and content uniformity and in vitro dissolution profiles using Franz diffusion cell were investigated. The cross-linking process was confirmed by differential scanning calorimetry (DSC) and Fourier transform infrared (FTIR) spectroscopy. In vitro protein adsorption test, in vivo wound-healing test, and histopathology were also performed. The hydrogel (F2) composed of 6% sodium alginate and 1% metronidazole prepared by combined Ca(2+) cross-linking and freeze-thawing cycles showed good swelling. This will help to provide moist environment at the wound site. With the in vivo wound-healing and histological studies, F2 was found to improve the wound-healing effect compared with the hydrogel without the drug, and the conventional product.
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19
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Caliot J, Bodin F, Chiriac S, Correia N, Poli-Mérol ML, François-Fiquet C. [Split-thickness skin graft donor site: which dressing use?]. ANN CHIR PLAST ESTH 2014; 60:140-7. [PMID: 25303937 DOI: 10.1016/j.anplas.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The management of split-thickness skin graft donor sites is targeted towards promoting the healing process, reducing pain. This has been an inconclusive topic. The aim of this study was to list and to discuss the French practices in term of split-thickness skin graft (STSG) donor site dressing. MATERIALS AND METHODS Multicentric national study by questionnaire (Google Drive(®)) for the attention of the plastic and/or pediatric surgeons. The type of dressing used on skin and sclap and the rhythm of dressing changes were analyzed. RESULTS The study included 26 surgical centers on 40 contacted. The alginate is mainly used (Algostéril(®)) (17/26). It is left in position until healing (13/17). Five other types of dressings have been reported: paraffin gauze (3/26), lipidocolloides (1/26), Mepitel(®) (1/26), Mepilex(®) (1/26), indifferent use of gauze or alginate dressings (4/26). Twenty-two out of 26 centers make no difference in dressing choice between skin and scalp. Medical practices did not differ between adult or pediatric departments. CONCLUSION Cost-effectiveness has become an important issue in wound management, requiring judicious use. The lack of consensus regarding split-thickness skin graft donor site dressing and our clinical practices force us to reconsider the best therapeutic option. This study coupled with the analysis of the literature highlights the difficulties of the practitioner in choosing the best dressing. The alginate seems to get the preference of our practices by its ease of use, its absence of change (reduces pain by limiting manipulations) and its moderate cost.
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Affiliation(s)
- J Caliot
- Structure interne de chirurgie plastique et reconstructrice, pôle locomoteur, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France
| | - F Bodin
- Structure interne de chirurgie plastique reconstructrice et esthétique, chirurgie B, hôpital civil, BP 426, 67091 Strasbourg, France
| | - S Chiriac
- Structure interne de chirurgie plastique et reconstructrice, pôle locomoteur, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France
| | - N Correia
- Structure interne de chirurgie plastique et reconstructrice, pôle locomoteur, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France
| | - M-L Poli-Mérol
- Structure interne de chirurgie pédiatrique, pôle mère enfant, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims, France
| | - C François-Fiquet
- Structure interne de chirurgie plastique et reconstructrice, pôle locomoteur, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France; Structure interne de chirurgie pédiatrique, pôle mère enfant, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims, France.
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