Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Abstract

Summary:Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.

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

“…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.…”

“…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 ].…”

“…This can help achieve wound closure through conservative treatment or a less invasive skin grafting technique. Several clinical studies have reported the potential use of perifascial areolar tissue (PAT) grafts in the treatment of such wounds [1][2][3][4][5][6][7]. Additionally, PAT grafts have demonstrated versatility as reconstructive membranes in tympanoplasty [8,9] as well as for skull base or spinal dural reconstruction in cases of cerebrospinal fluid leakage [8][9][10].…”

A Novel Model of Perifascial Areolar Tissue Transplant in Rats

“…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.…”

“… 6 7 There is also an opinion that the abundant stem cells contained in the PAT are involved in promotion of healing. 8 Elucidation of the mechanism of PAT engraftment and healing promotion is considered to be an issue for future studies.…”