Restoring full-thickness defects with spray skin in conjunction with dermal regenerate template and split-thickness skin grafting: a pilot study

Abstract

Complex, full-thickness soft tissue defects secondary to large burns, trauma and war-related injuries continue to challenge reconstructive surgeons. To achieve positive surgical outcomes in these patient populations, novel approaches are needed to restore the functional, protective and aesthetic properties of skin. Herein, we provide the first report describing the staged use of a dermal regenerate template (DRT) with a spray-on epidermal regenerative modality (spray skin) in addition to autologous split-thickness skin grafting (STSG) in non-burn trauma and compare these results with those of patients treated with DRT and STSG alone. A pilot study was performed to evaluate whether the use of spray skin technology (ReCell, Avita Medical) as an adjunct to DRT (Integra, Integra Lifesciences) and autologous skin grafting in the treatment of patients with large full-thickness soft tissue losses impacts donor site burden as well as recipient and donor site re-epithelialization. In this retrospective study, two patients who were treated with DRT and STSG alone (control group) were compared with two patients who were treated with DRT and spray skin/STSG in combination (experimental group). The mechanisms of injury, total defect and treatment sizes, time to complete re-epithelialization, lengths of follow-up, outcomes and complications were reviewed. Our group observed that using a DRT in conjunction with spray skin/STSG can reduce donor site burden and decrease time to complete healing. It can also permit greater or larger meshing ratios, while aiding in improved re-pigmentation when compared with similar wounds treated with a DRT and autologous skin grafting alone. Copyright © 2017 John Wiley & Sons, Ltd.

Regeneration of Functional, Full-Thickness Skin With Minimal Donor Site Contribution Using Autologous Homologous Skin Construct

“…In the realm of wound care, autologous skin grafts (autografts) remain the gold standard in the treatment of skin loss. 1,4 In the case of extensive skin defects secondary to burns, trauma, or oncologic resection, healthy donor skin can be scarce; this poses a challenge to reconstructive surgeons, especially in the pediatric population where surface area is already limited. 5 In addition, split-thickness skin grafts (STSGs) often create an undesirable cosmetic result, contracture limits their use on or near joints, and the donor site often causes more discomfort than the graft itself.…”

“…These substitutes aim to restore function and provide durable barrier protection to underlying structures, all while appearing cosmetically acceptable with appropriate pigmentation. 4 The acellular skin substitutes are likely the most well-known and widely used in the treatment of soft tissue defects. Examples include Integra, which uses silicone, collagen, and shark chondroitin-6-sulphate, and Alloderm, created from decellularised cadaveric dermis.…”

“…These substitutes aim to restore function and provide durable barrier protection to underlying structures, all while appearing cosmetically acceptable with appropriate pigmentation. 4…”

“…2,5,7 Both are used as dermal substitutes that can provide coverage to decrease fluid loss and allow for revascularization and dermal cell repopulation. 2,4 These dermal substitutes prepare the wound bed to later allow autologous split-thickness skin grafting. Without cells, however, these skin substitutes provide suboptimal barrier function and inadequate longevity.…”

Advancements in Regenerative Strategies Through the Continuum of Burn Care

“…The reconstructed skin was durable with no signs of dehiscence (Matsumura et al, 2013 ). Recently, treatment of complex FT soft tissue injuries with Integra® combined with ReCell® reduced donor site skin requirements, permitted wider meshed autografts, and reduced time to complete healing (Hammer et al, 2017 ). Use of Integra® seeded with adipose tissue derived stem cells (ASCs) in porcine FT burns enhanced wound angiogenesis, blood vessel maturation, and matrix remodeling compared to Integra® without cells (Foubert et al, 2015 ).…”