Wound Healing and Skin Grafting in Ehlers-Danlos Syndrome

Kumar, Pramod; Sethi, Nitin K.; Friji, M T; Poornima, S.

doi:10.1097/prs.0b013e3181ea935e

Cited by 11 publications

(15 citation statements)

References 4 publications

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“…While the recipient site developed suture-associated granulomas that healed after suture removal, the donor site displayed delayed wound healing, requiring a total of 6 months for complete healing to occur [4]. The most recent case of skin grafting in Ehlers-Danlos syndrome was reported by Kumar et al [11]. A 15 x 10 cm right leg wound was treated successfully in a 22-year-old male patient.…”

Section: Discussionmentioning

confidence: 99%

“…Although numerous reports have been published discussing surgical treatment of patients with Ehlers-Danlos syndrome [5,[7][8][9], only rarely has successful skin grafting been reported in patients with this condition [4,10,11]. The first case of successful skin grafting in the setting of Ehlers-Danlos syndrome was reported by Ricketson in 1957.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, similar to our case, the authors reported skin graft harvest to be challenging due to the hyperelastic properties of the skin. However, in their report, a limited access dressing (combination of intermittent negative pressure up to 30 mmHg and a moist wound dressing) was instituted both for wound bed preparation and following skin grafting [11,12]. Surgical management of patients with Ehlers-Danlos syndrome is challenging due to alterations of collagen architecture and strength.…”

Section: Discussionmentioning

confidence: 99%

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Ehlers-Danlos Syndrome and Skin Grafting

2013

J Clin Med Case Rep

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ehlers-Danlos Syndrome and Skin Grafting

2013

J Clin Med Case Rep

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“…Pinprick through the LAD plastic to evaluate the flap congestion (dark blood) is possible and site of puncture on LAD polythene can be resealed easily To protect tissue (periosteum, perichondrium, paratenon, articular cartilage and synovial membrane in exposed joint), exposed intra-abdominal structures in cases of abdominal wall defect) from desiccation and progressive necrosis following debridement in trauma cases [ Figure 5 ] To facilitate autodebridement [ Figure 6 ] To promote granulation tissue to cover implant, bone, cartilage, tendon [Figures 5 – 8 ] To replace daily conventional dressing compound fractures (avoids unnecessary movements as dressing change not required) To improve take of the split skin graft and donor area healing [Figure 5d and e ] To achieve wound isolation in immune-compromised and high-risk patients (HBsAg and HIV infection) To manage wounds with Maggots[ 18 ] Miscellaneous indications: Abdominal wall reconstruction [ Figure 9 ] and intra-LAD tissue expansion adjacent to the wound,[ 12 ] to achieve faster healing in Ehler Danlos Syndrome. [ 19 ] The LAD may be applied after abscess drainage and after 7-10 days (before skin edges retract significantly) secondary suturing over the suction drain may be done to promote faster healing and a better quality scar. Continuous intra-LAD cold saline irrigation may be useful in controlling hyperpyrexia.…”

Section: Indications Of Ladmentioning

confidence: 99%

“…Miscellaneous indications: Abdominal wall reconstruction [ Figure 9 ] and intra-LAD tissue expansion adjacent to the wound,[ 12 ] to achieve faster healing in Ehler Danlos Syndrome. [ 19 ] The LAD may be applied after abscess drainage and after 7-10 days (before skin edges retract significantly) secondary suturing over the suction drain may be done to promote faster healing and a better quality scar. Continuous intra-LAD cold saline irrigation may be useful in controlling hyperpyrexia.…”

Section: Indications Of Ladmentioning

confidence: 99%

Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing

Kumar

2012

Indian J Plast Surg

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Role of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3½ hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.

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Characteristics, Diagnosis, and Management of Ehlers-Danlos Syndromes

Joseph

Francomano

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Ehlers-Danlos syndromes (EDSs) are a group of heritable connective tissue disorders. Patients with EDSs can develop excessive facial rhytids, nasal deformities, and facial scarring, for which they may seek consultation with a facial plastic surgeon. Ehlers-Danlos syndromes can be associated with serious surgical complications and should be identified preoperatively to facilitate optimal treatment. To our knowledge, no management guidelines for patients with EDSs exist in the facial plastic surgery literature. We present a review of the literature and management recommendations for the facial plastic surgeon.OBSERVATIONS We performed a PubMed/MEDLINE search for all publications in the English language related to surgical experience in patients with EDSs. A total of 37 publications (including reviews and case series) were included. Ehlers-Danlos syndromes are more common than appreciated, with an overall point prevalence between 1 in 2500 and 1 in 5000 according to existing literature. There are 6 main subtypes of EDSs that have significant phenotypic heterogeneity. Patients with classic type and hypermobile EDS (the 2 most common subtypes) can typically undergo elective facial plastic surgery without major complications. However, specific preoperative, intraoperative, and postoperative issues, as outlined in this review, must be taken into consideration. Vascular EDS should serve as a contraindication to elective surgery given its potential for life-threatening complications.CONCLUSIONS AND RELEVANCE Because of their skin laxity, patients with EDSs may present more frequently to facial plastic surgeons' offices. Simple screening questions can help the surgeon identify potential patients with EDSs. Treatment should be individualized and performed with extreme care to ensure optimal outcomes.

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Wound Healing and Skin Grafting in Ehlers-Danlos Syndrome

Cited by 11 publications

References 4 publications

Ehlers-Danlos Syndrome and Skin Grafting

Ehlers-Danlos Syndrome and Skin Grafting

Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing

Characteristics, Diagnosis, and Management of Ehlers-Danlos Syndromes

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