A Perifascial Areolar Tissue Graft With Topical Administration of Basic Fibroblast Growth Factor for Treatment of Complex Wounds With Exposed Tendons and/or Bones

Miyanaga, Toru; Haseda, Yasuo; Daizo, Haruhisa; Yamashita, Masanobu; Yamashita, Akiko; Kishibe, Miyuki; Shimada, Kennichi

doi:10.1053/j.jfas.2017.08.026

Cited by 11 publications

(10 citation statements)

References 17 publications

(25 reference statements)

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“…Previous clinical studies have speculated that the survival of PAT grafts is facilitated by capillary anastomosis between the capillaries in the PAT and those in the recipient wound bed [ 3 , 5 , 6 ]. However, no studies have provided definitive evidence of vascular bridging.…”

Section: Discussionmentioning

confidence: 99%

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Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

Miyanaga,

Yoshitomi,

Miyanaga

2024

PLoS ONE

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Multiple studies have reported the use of perifascial areolar tissue (PAT) grafts to treat wounds involving exposed ischemic tissues, avascular structures, and defective membrane structures. Our objective was to assess the quantitative effects of PAT grafts and their suitability for wounds with ischemic tissue exposure and to qualitatively determine the factors through which PAT promotes wound healing and repair. We conducted histological, immunohistochemical, and mass spectrometric analyses of the PAT grafts. PAT grafts contain numerous CD34+ progenitor/stem cells, extracellular matrix, growth factors, and cytokines that promote wound healing and angiogenesis. Furthermore, we established a male rabbit model to compare the efficacy of PAT grafting with that of an occlusive dressing treatment (control) for wounds with cartilage exposure. PAT grafts could cover ischemic components with granulation tissue and promote angiogenesis. Macroscopic and histological observations of the PAT graft on postoperative day seven revealed capillaries bridging the ischemic tissue (vascular bridging). Additionally, the PAT graft suppressed wound contraction and alpha smooth muscle actin (αSMA) levels and promoted epithelialization. These findings suggested that PAT can serve as a platform to enhance wound healing and promote angiogenesis. This is the first study to quantify the therapeutic efficacy of PAT grafts, revealing their high value for the treatment of wounds involving exposed ischemic structures. The effectiveness of PAT grafts can be attributed to two primary factors: vascular bridging and the provision of three essential elements (progenitor/stem cells, extracellular matrix molecules, and growth factors/cytokines). Moreover, PAT grafts may be used as transplant materials to mitigate excessive wound contraction and the development of hypertrophic scarring.

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Section: Discussionmentioning

confidence: 99%

“…Thus, PAT may serve as a high-quality graft tissue for wounds involving the exposed ischemic tissue and any membrane structure. Despite the success of PAT grafts in clinical case studies, fundamental research on their molecular composition and ability to promote wound healing in ischemic structures is lacking [ 3 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

Miyanaga,

Yoshitomi,

Miyanaga

2024

PLoS ONE

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“…of perifascial areolar tissue (PAT) grafts for exposed bone wounds is an ideal option as it is minimally invasive, is technically easy, and requires less donor site sacrifice. However, PAT grafts for the treatment of complex wounds with large areas of exposed bone sometimes fail to survive because of insufficient vascularization to the grafted tissue 3,4) . Hayashi et al evaluated the results of 13 PAT grafts used to cover narrow ulcers with tendon-or bone-exposed areas and concluded that covering exposed cortical bone ulcers may be difficult with this technique, and that PAT grafting is not suitable for tendon exposure with a width > 2 cm 5) .…”

Section: Discussionmentioning

confidence: 99%

Skin Grafting on Wound with Exposed Bone

Fujioka

Fukui

Yoshino

et al. 2023

International Journal of Surgical Wound Care

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Introduction: In general, exposed bone wounds are covered with flaps. If the wound is small, skin grafting with perifascial areolar tissue can be performed for resurfacing; however, it is not suitable for large bone-exposed wounds exceeding 5 cm in length. Methods: Six patients underwent skin grafting for bone-exposed wounds at our medical center between 2014 and 2020. In all cases, a suitable local flap donor site could not be found around the wound, and a suitable donor vessel to anastomose the free flap was difficult to find. After a sequestrectomy, slit artificial dermis was applied to the wounds, and basic fibroblast growth factor was sprayed. Ointment-impregnated gauze was applied to the wounds. After confirming the creation of a suitable wound bed, skin grafting was performed. Results: In all cases, after skin grafting, the exposed bone wounds were closed. Four cases were due to extensive burns, one was due to malignant tumor resection, and one was due to exposed bone after injury. For burn injuries, suitable skin flap donors were difficult to find. Three cases of bone exposure involved the skull, and the rest involved the anterior surface of the tibia. Four cases required split-thickness skin grafts (including two mesh skin grafts), and two required full-thickness skin grafts. Covering a wound after skin grafting took 3 weeks to 3 months (median, 1 month), which is much longer than the time taken when using a skin flap. Conclusion: Even for exposed bone wounds with poor blood circulation, a good wound bed can be created by the combination of artificial dermis and bFGF, and wound closure can be achieved by skin grafting. Bone-exposed wounds should be closed early using a skin flap. However, when the patient's general condition is poor or when temporary closure is difficult due to the unavailability of a suitable donor, wound closure by skin grafting is a simple and useful treatment option, although it takes a long time.

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“…The effectiveness of this technique has been shown in several reports. 3 4 5 6 7 8 However, all of these were clinical reports, and the size and depth of the wound, the exposed tissue, the presence or absence of surrounding blood flow, the presence or absence of irradiation, the site of the wound, and so forth are diverse. The appropriate surgical indications are unknown.…”

Section: Discussionmentioning

confidence: 99%

“…It is a loose connective tissue and part of a group of structures known as the lubricant adipofascial system reported by Nakajima et al 9 Since the PAT has a layered structure of the delicate network of thin collagen fibers, it is possible to harvest supple and thin tissue. 3 In clinical cases, the PAT is often harvested from the inguinal region or the outside of the thigh in consideration of the cosmetic result and invasiveness. 4 In this model, the PAT was harvested from the back of the rat.…”

Section: Discussionmentioning

confidence: 99%

A Novel Model of Perifascial Areolar Tissue Transplant in Rats

Oshima

Sasaki

Shibuya

et al. 2022

Indian J Plast Surg

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Background Perifascial areolar tissue (PAT) transplant is a method of transplanting loose connective tissue harvested in a sheet form from above the fascia to the wound bed and is effective for wounds with exposed ischemic tissue. However, the engraftment mechanism is unknown, and no animal models of PAT transplant for wound healing exist. Methods In this study, we harvested connective tissue from the backs of Wistar rats in a sheet form to simulate a human PAT transplant. The PAT was affixed to exposed bone of the head. Results In the PAT(+) group, the wound areas gradually decreased due to epithelialization and contraction. The wound area of the PAT(+) group was significantly smaller than that of the PAT(−) group. Conclusions This clinically relevant rat model is useful for elucidating the mechanism of the PAT transplant and establishing a reliable surgical method.

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A Perifascial Areolar Tissue Graft With Topical Administration of Basic Fibroblast Growth Factor for Treatment of Complex Wounds With Exposed Tendons and/or Bones

Cited by 11 publications

References 17 publications

Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

Skin Grafting on Wound with Exposed Bone

A Novel Model of Perifascial Areolar Tissue Transplant in Rats

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