References
Application of acellular human dermis and skin grafts for lower extremity reconstruction
Abstract
Objective:
To use both acellular human dermis and skin grafting simultaneously for improved skin grafting without contracture. The study also aims to address the lack of research on the application of an acellular human dermis in diverse clinical cases.
Method:
The study examined patients who had received acellular human dermis (CGDerm, CGBio, Seoul, Korea) and split-thickness skin grafting (STSG) simultaneously for lower limb, full-thickness skin defects between September 2012 and June 2014. The researchers performed chart reviews retrospectively and examined the patients based on the following factors: gender, age, injury mechanism, size, exposed structure, pre-coverage dressing method, coverage method, post-operational engraftment and total healing period, contracture development, elasticity, and infection development.
Results:
A sample of 27 patients with a total of 30 wounds took part in the study. Of these wounds, 29 showed successful engraftment without infection or contracture. In one case, continued seroma was observed and, following new coverage of both the acellular human dermis and STSG, engraftment was successful.
Conclusion:
Human dermis can play an important role in securing the availability of surrounding tissue and in contracture prevention, both of which are key to lower limb reconstruction. Of the types available, acellular human dermis showed lower infection rates than other human dermis types, and its engraftment rate was higher than in STSG-only cases. These findings suggest that acellular human dermis use in STSG is effective and safe in lower limb reconstruction.
Determining the best reconstruction method for lower limb skin and soft-tissue injuries has always been a challenge for plastic surgeons, mainly because of the limited amount of tissue surrounding the wound.1 Appropriate joint movement and motion range must also be considered in any reconstructive surgery, which can make it more complicated compared with operations on other body parts.2
For full-thickness injuries in lower limb skin, full-thickness transplantation or local flap coverage is often used. However, in many lower limb injury cases, there is insufficient tissue for local flap coverage and any that is available is often hard to use for treatment purposes because of the limited amount of tissue that is transferable from areas adjacent to the wound, and limited flap mobilisation.3 In the case of large, full-thickness wounds, such methods may not guarantee perfect coverage, needing further treatment, such as free flap and split-thickness skin grafting (STSG). In such cases, STSG is normally used more often than free-flap, which is a more difficult procedure to carry out successfully.2 However, since the dermal papilla tissue used in STSG rarely produces new skin without contracture, it could cause aesthetic problems, such as difference in colour and texture, scar contracture or reduced elasticity.4,5 If bone or tendon is exposed, engraftment could be disrupted as STSG cannot be grafted over bone or tendon, and even if the engraftment is successful, contracture is highly likely.6
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