Complications of Thermal Injuries
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Skin grafting has shortened recovery time and has decreased the rate of infectious complications among burn patients [19,44]. However, skin grafting is also associated with complications. Of particular importance is the contraction of skin grafts. It has been noted that full-thickness skin grafts suffer less contraction than split-thickness skin grafts. In addition, the interval of time between the initial release of contraction and subsequent releases was longer with full-thickness grafts than with split-thickness grafts [45]. Pentoxifylline has been shown to decrease cell proliferation in hypertrophic scars. In one prospective study, pentoxifylline was administered to patients with burn hypertrophic peribuccal scarring and resulted in improved mouth opening and dental distance during the 38 days of treatment [46].
Commodifying tissues and cells
Julie Kent in Regenerating Bodies, 2012
Burns treatments do not have significant commercial potential in Europe (Husing et al. 2003).34 Fetal skin cells – that is, skin taken from an aborted fetus – have also been used in clinical trials to treat children with burns, and further trials are planned (Hohlfeld et al. 2005). A patent has been filed by Hohlfeld and Applegate, but no commercialization of this technology has occurred yet.35 Chronic wounds (including pressure ulcers, venous ulcers and diabetic ulcers) are costly and require intensive nursing care and community support (Harding et al. 2002).36 Classical wound care uses traditional and advanced dressings; active management includes engineered skin. As a proportion of the total wound-management market, the use of engineered skin in 2002 remained relatively small (10 per cent; Bock et al. 2003). Skin defects can be treated using either classical methods, surgical procedures or split-skin transplantation – transplantation of engineered skin. Most are treated in the classical way, with low direct material costs, whereas engineered skin has high material costs (i.e. costs of production), which, perhaps surprisingly, it has been argued are similar for allogeneic or autologous sources.
Biotechnology products and indications II
Ronald P. Evens in Biotechnology, 2020
Cell and tissues therapy products are found in Table 9.5. Surgery, especially gastrointestinal and orthopedic (back) locations, can lead to complications where abnormal connections called adhesions can occur between tissues. They can be persistent and quite painful after surgery and often require a second surgery to eliminate them. Hyaluronic acid products in the form of gels and films are available to prevent them by placement between tissues during surgery. The products are biodegradable in situ to nontoxic substances. Also, tissue damage occurs in various diseases where the tissue is accessible for replacement, for example, skin ulcers from diabetes, or pressure. Skin grafting can be done with exogenously engineered skin products. Repair of wounds and burns can be aided with these grafts. Tissue damage is becoming a greater problem as the population ages, and tissues tend to break down more over time in older populations, for example, osteoarthritis of the knees or facial wrinkling. Knee pain can be relieved and wrinkling reduced with hyaluronic acid products administered directly into tissues, and even chondrocytes can be replaced in the knee. Bone fractures can be mended more rapidly through enhanced processes with biological products or devices that contain bone morphogenic growth proteins (BMPs). Facial lipodystrophy in HIV patients can be reduced with a biological product in a form of lactic acid.
On-target and direct modulation of alloreactive T cells by a nanoparticle carrying MHC alloantigen, regulatory molecules and CD47 in a murine model of alloskin transplantation
Published in Drug Delivery, 2018
Khawar Ali Shahzad, Xin Wan, Lei Zhang, Weiya Pei, Aifeng Zhang, Muhammad Younis, Wei Wang, Chuanlai Shen
Skin transplantation was performed by following the procedure described by Garrod (Garrod & Cahalan, 2008) and Wang (Wang et al., 2017) with minor modifications. Briefly, the dorsal tissue from the ear of male C57BL/6 J was prepared (0.5-0.5 cm), and hair of male bm1 mice was removed from the dorsal flank area under anesthesia. Then, the prepared tissue was grafted, and a BAND AID® styptic plaster containing benzalkonium chloride (Shanghai Johnson &Johnson, Ltd., Shanghai, China) was placed over the grafted area for 5 days. The mice with skin graft were housed independently. The styptic plaster was then removed, and the bm1 mice with successful graft operation were assigned randomly to 1 of 8 groups and injected intravenously through tail vein with 200-nm Killer NPs, NPaFas, NPKb, NPCD47, NPKb/aFas, NP/Kb/aFasPD-L1/TGFβ, Blank NPs or sterile PBS on days 9, 11 and 13 after transplantation with 1 mg of NPs/mouse/time point. Same was the procedure followed for 80-nm killer NPs and its three control groups (NPaFas/Kb/PD-L1/TGFβ, Blank NPs and PBS). The rejection signs for allograft were monitored on daily basis. Grafts were defined as rejected when less than 10% of the graft remained viable.
External tissue expansion to salvage failed scalp and forehead reconstruction: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Peter Y. W. Chan, Elina Patel, Ethan Paulin, Ajul Shah
After the failure of the primary reconstructive technique in the forehead and scalp, surgeons are faced with a difficult task. Skin grafting reconstruction may be considered. However, a skin graft requires a vascular bed, and scalp and forehead defects are often denuded without periosteum [9]. Although the bone can be burred to create a foundation of vascularized tissue, the healing process is lengthy and requires regular dressing changes [9]. Additionally, skin grafting in the scalp and forehead is often associated with poor cosmetic results, often leaving a white, patchy appearance [8]. A second tissue-transfer-based reconstruction may be considered; however, these secondary procedures are often even more challenging than the primary technique due to a combination of the first-choice flap already being used, a scarcity of existing vessels to create or receive a new flap, and surgical scarring in the area [5,7,10]. The complication rate of all secondary flap procedures in head and neck reconstruction after initial flap failure has been reported as high as 21–22% [7,13]. Surgeons may also be hesitant to undertake a secondary tissue-transfer-based reconstruction when there was no clear cause of failure in the first.
Usefulness of avulsed fingertip skin for reconstruction after digital amputation
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Atsuyoshi Osada, Hajime Matsumine, Wataru Kamei, Hiroyuki Sakurai
The goals of fingertip amputation treatments should include pain minimization, healing time optimization, sensibility and length preservation, painful neuroma prevention, nail deformity avoidance or limitation, minimizing time lost from work, and acceptable cosmetic appearance provision [1]. Fingertip avulsion treatment, including replantation or use of a composite graft or skin graft, reconstruction with a local flap if tissue replantation is judged difficult, and stump plasty, is conducted with these goals in mind. In cases rated as difficult for replantation, the fingertip is reconstructed often with a composite graft or skin graft or with a primary or secondary local flap procedure. Survival rate for the composite graft has been reported to be approximately 50% or less (varying depending on avulsion level or extent), and the size not exceeding 1 cm has been recommended. Thus, when treatment with the composite graft is selected, the treatment plan needs to be devised, taking into consideration prolongation of the duration of injury, possible need for additional surgery upon appearance of partial necrosis, and possible loss of avulsed finger skin [2,3]. For fingertip reconstruction with a local flap, the homodigital dorsal skin flap, reverse digital artery flap, and thenar flap are generally used. However, most operative procedures necessitate skin grafting into the donor site in both primary and secondary reconstructions. The skin graft utilizing the avulsed finger skin avoids sacrificing of the donor site, and the finger skin has very favorable texture and color match to the flap donor site.
Related Knowledge Centers
- Burn
- Necrotizing Fasciitis
- Skin Cancer
- Tissue
- Skin
- Graft
- Organ Transplantation
- Wound
- Injury
- Purpura Fulminans