Use of a Bioartificial Dermal Regeneration Template for Skin Restoration in Combat Casualty Injuries

Abstract

Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective skin barrier but also to preserve tendon and muscle excursion, provide protective padding around nerves and restore adequate joint motion. Accordingly, regenerative medicine modalities that can accomplish these goals are of great interest. The use of bioartificial dermal regeneration templates (DRT), such as Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ, USA), in the management of complex soft tissue injuries has an important role in the reconstruction of war wounds. These DRTs provide initial wound coverage and help establish a well-vascularized wound bed suitable for definitive soft tissue coverage.

A bioartificial dermal regeneration template promotes skin cell proliferation in vitro and enhances large skin wound healing in vivo

“…The acellular animal collagen sheets have been successfully used as bioartificial dermal regeneration templates (DRT) for the reconstruction of traumatic wounds [ 29 ]. The previous studies have demonstrated that using DRT to treat traumatic wounds has several potential benefits including coverage of exposed nerves, blood vessels and/or bone; decreasing or eliminating the need for more morbid procedures such as tissue transfers; promotion of a well-vascularized bed in at-risk or hypovascular wounds; lessening the need for shortening of amputated extremities by providing more stable soft tissue coverage and durability and contouring of soft tissue defects to improve cosmesis, function and/or comfort with prosthetic wear [ 30 ] [ 31 ].…”

A Case Report of the First Nonburn-related Military Trauma Victim Treated with Spray Skin Regenerative Therapy in Combination with a Dermal Regenerate Template

“…1,2,4 Skin and soft tissue losses are especially challenging in patients with multiple extremity and/or amputee injuries.…”

“…The recent introduction of regenerative medicine therapies such as the application of extracellular matrices for addressing full-thickness wounds has gained a significant role in treating combat casualties. 2 These matrices convert wounds from full-thickness injuries to partial-thickness wounds via establishment of a “neodermis,” which can accept autologous skin grafts. Spray skin is a second regenerative modality that allows for processing of a small sample of skin into a single-cell suspension containing keratinocytes, melanocytes, Langerhan cells, and fibroblasts; this has shown early promise in burn patients.…”

“…1 Regenerative modalities offer novel options for complicated reconstructions. 2–4 Herein, our case report outlines the first military nonburn-related trauma patient treated by a combination of a dermal regenerate template (DRT) followed by application of spray skin and 6:1 meshed skin grafts to address a more than 600-cm 2 abdominal skin and soft tissue deficit. Together, this approach resulted in complete healing of his otherwise debilitating full-thickness wound.…”

Use of Bioartificial Dermal Regeneration Template for Skin Restoration in Combat Casualty Injuries

“…It was with great interest that we read the article by Dr Seavey et al titled 'Use of bioartificial dermal regeneration template for skin restoration in combat casualty injuries' [1]. We congratulate the author on this important study, its outcome and conclusion where the point is made that efforts should be made to promote and develop the use of dermal substitute for complex plastic surgery reconstruction.…”