Long-term results of split-thickness skin grafting with and without additional dermal matrix in severe traumatic soft tissue defects of the lower limb

Wallner, Britta; Öhlbauer, M.; Rüden, Christian von

doi:10.1007/s00068-022-02107-6

Cited by 1 publication

(4 citation statements)

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“…A degloving injury of the lower limb could be accompanied by extensive damage to the deep structures, and associated with severe tissue injury and a high risk of complications such as wound infection and later, phlegmon. The establishment of new treatment strategies, including hyperbaric oxygen therapy (HBO), negative pressure wound therapy (NPWT), and acellular dermal matrix (ADM), has improved the outcomes of limb reconstruction [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Five patients underwent two-stage reconstruction with an acellular dermal matrix followed by a split thickness skin graft in a subsequent surgical stage. There are several publications on the use of ADM; however, only a few large studies on its use in lower extremity defects are available [ 17 , 34 ]. The first acellular dermal matrix was engineered more than 30 years ago and has previously been widely used in the management of burn wounds.…”

Section: Discussionmentioning

confidence: 99%

“…The first acellular dermal matrix was engineered more than 30 years ago and has previously been widely used in the management of burn wounds. It has since proven to be effective in the surgical treatment of post-traumatic soft tissue defects, especially in cases where reconstruction with surgical flaps is unavailable or undesirable, in combination with a split thickness skin graft [ 17 , 35 , 36 ]. The acellular dermal matrix can also be combined with negative pressure therapy (NPWT).…”

Section: Discussionmentioning

confidence: 99%

“…However, further data are needed in favor of the combined use of HBOT with the dermal matrix to highlight the advantages of this combination. However, it must be noted that dermal matrices present important negative and limiting aspects, such as cost and longer hospital stays, that must also be considered [ 17 , 33 , 42 ]. This study was certainly limited by the small patient population and this is probably the main cause of the lack of statistical significance of certain outcome analyses.…”

Section: Discussionmentioning

confidence: 99%

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Lower Extremity Trauma: A Multidimensional Reconstructive Approach with Hyperbaric Oxygen Therapy

Marra,

Pentangelo,

Losco

et al. 2024

JCM

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Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect’s depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%