Acellular allograft dermal matrix: immediate or delayed epidermal coverage?
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Keywords:
Acellular Dermis
Skin grafting
Matrix (chemical analysis)
A full thickness skin graft includes the complete dermis, whereas a split thickness skin graft comprises a varying amount of dermis. The thicker is the dermal component, the closer to normal are the characteristics of the graft. During healing over the first day, the graft receives nutrition and oxygen from the interstitial fluid of the wound base. During the following week, new blood vessels joining with the capillaries of the graft start growing from the wound base. The skin graft donor site will heal by epithelization from the edges of the site and at the center by accessory organs.
Skin grafting
Blood supply
Skin transplantation
Epidermis (zoology)
Acellular Dermis
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Abstract To evaluate the efficacy of one‐step acellular dermis combined with autologous split thickness skin grafting in the treatment of burn or trauma wounds by a multicenter controlled study. In patients with extensive burns, it is even difficult to repair the wounds due to the shortage of autologous skin. The traditional skin grafting method has the disadvantages of large damage to the donor site, insufficient skin source and unsatisfactory appearance, wear resistance and elasticity of the wound tissue after skin grafting. One‐step acellular dermis combined with autologous ultra‐thin split thickness skin graft can achieve better healing effect in the treatment of burn and trauma wounds. A total of 1208 patients who underwent single‐layer skin grafting and one‐step composite skin grafting in the First Affiliated Hospital of Wannan Medical College, Wuhan Third People's Hospital and Lu ‘an People's Hospital from 2019 to 2022 were retrospectively analysed. The total hospitalization cost, total operation cost, hospitalization days after surgery, wound healing rate after 1 week of skin grafting and scar follow‐up at 6 months after discharge were compared and studied. The total cost of hospitalization and operation in the composite skin grafting group was significantly higher than those in the single‐layer autologous skin grafting group. The wound healing rate after 1 week of skin grafting and the VSS score of scar in the follow‐up of 6 months after discharge were better than those in the single‐layer skin grafting group. One‐step acellular dermis combined with autologous ultra‐thin split thickness skin graft has high wound healing rate, less scar, smooth appearance and good elasticity in repairing burn and trauma wounds, which can provide an ideal repair method for wounds.
Skin grafting
Acellular Dermis
Economic shortage
Artificial skin
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Skin reconstruction of full-thickness skin defect wounds using artificial dermis is performed using secondary split-thickness skin grafting. For the selection of artificial dermis to shorten the treatment period, the waiting time until secondary skin grafting was investigated when the dermis-like tissue was constructed with Pelnac or Integra.We evaluated 26 patients who underwent secondary skin grafting after dermis reconstruction with Pelnac (18 patients) or Integra (8 patients) for full-thickness skin defects between 2006 and 2017. The waiting period from artificial dermis application to closure of the full-thickness skin defect with a secondary skin graft was investigated retrospectively.Skin grafts survived well in all cases, and no complications of grafts or donors were observed. The mean waiting period was 17.5 ± 4.2 and 22.0 ± 4.6 days for the Pelnac and Integra groups, respectively (significantly shorter in the Pelnac group).The difference in waiting period is presumed to be due to the structural differences between the collagen sponge layer, which is the dermal replacement layer of Pelnac and Integra grafts. In cases where shortening the treatment period is important, Pelnac should be the first choice. In addition, in pediatric cases and widespread burns where it is difficult to control the infection during the waiting period, Pelnac is considered to be the first choice because the risk can be reduced by shortening the waiting period.
Skin grafting
Acellular Dermis
Artificial skin
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MicroRNA-200b (miR-200b) down-regulation has been found in wound-healing tissues. Fibroblasts are the predominant cells that orchestrate the production of collagen in wound healing. However, it is still unclear whether miR-200b can affect the wound healing by regulating the fibroblasts' function. The current rodent wound-healing models are not ideal due to their marked difference in structure compared with the human skin. In this study, we demonstrated that the murine plantar skin had similar anatomical features to the human skin. Using this model, the gain/loss-of-function studies showed that miR-200b caused a significantly delayed wound healing in vivo. Furthermore, using cell proliferation, migration and collagen synthesis assays, we found that miR-200b attenuated cell proliferation, migration and collagen synthesis of fibroblasts, which are critical aspects of wound healing. miR-200b also decreased the expression of Zeb1. Collectively, we established a new murine plantar skin model for the investigation of wound healing, and based on it we found that miR-200b affected the wound healing by regulating the biological function of fibroblasts, which provided a new insight for wound healing.
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Wound healing is an important physiological process to maintain the integrity of skin after trauma, either by accident or by intent procedure. The normal wound healing involves three successive but overlapping phases, including hemostasis/inflammatory phase, proliferative phase, and remodeling phase. Aberration of wound healing, such as excessive wound healing (hypertrophic scar and keloid) or chronic wound (ulcer) impairs the normal physical function. A large number of sophisticated experimental studies have provided insights into wound healing. This article highlights the information after 2010, and the main text includes (i) wound healing; (ii) wound healing in fetus and adult; (iii) prostaglandins and wound healing; (iv) the pathogenesis of excessive wound healing; (v) the epidemiology of excessive wound healing; (vi) in vitro and in vivo studies for excessive wound healing; (vii) stem cell therapy for excessive wound healing; and (viii) the prevention strategy for excessive wound healing.
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Background & Objectives: Skin substitutes are a diverse set of biologics, synthetics, and biosynthetic materials that can replace open skin wounds temporarily or permanently. Skin substitutes are designed to mimic the qualities of natural skin. One must select an option that accomplishes an excellent wound healing and closure. This study aimed to assess the reliability and effectiveness of ?acellular dermal matrix for potentially more pliable coverage of the wound and for better ?functional and aesthetic appearance of the skin defects. Methods: A prospective cohort study performed on 20 patients with full-thickness skin defects who underwent surgery using acellular dermal substitute and skin grafting in Erbil Governorate from January 2017 to December 2019. Functional and aesthetic outcome has been evaluated in this study. Results: The study included 20 patients with mean age of 18.8 ± 6.2 years, female to male ratio was 1.5:1, and the majority of the cases presented with burn (90%). The Vancouver Scar Scale score was significantly reduced after 1 month of follow-up in which it reduced by 4.12 mm (57.6% reduce from baseline), Mean healing score was 93.5%, and Re-epithelialization after 1 month Was 95.55%, Overall the complication rate is low with 5% had hematoma, 5% had infection and 5% had loss of graft. Conclusion: The use of acellular dermal matrix in conjunction with split thickness skin graft result in substantial improvement in the quality of wound healing and tissue reconstruction.
Skin grafting
Acellular Dermis
Wound Closure
Artificial skin
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【Objective】 To discuss the surgical management of extensive skin avulsed wound of limbs.【Methods】A total of 60 cases of extensive skin avulsed wound of limbs were chosen from 1998,4 to 2006,3.Among them 19 cases were treated with pedicle skin grafting,31 cases with free skin grafting from injuried skin and 10 cases with free skin grafting from injuried skin and flap.【Results】Skin survival rate was 89.5%(17/19)in pedicle skin grafting,83.9%(26/31)in free skin grafting from injuried skin and 80%(8/10)in free skin grafting from injuried skin and flap.【Conclusion】 The repair method of extensive skin avulsed wound of limbs should be chosen according to the status of wound,avulsed skin etc,by pedicle skin grafting,free skin grafting from injuried skin and free skin grafting from injuried skin and flap,the effect is good.
Skin grafting
Skin flap
Artificial skin
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Wound healing is a complex process that involves a significant number of chemical and physiological events acting on the cellular and molecular level. Wound healing passes through four stages, which are not distinctly separated one from another. There are many factors that can affect the wound healing process and their activities slow down, or completely interrupt the healing process. Wound around tissue ischemia, which is due to spasm of the arteries or atherosclerotic changes in them, can easily lead to slowing down or even stops the wound healing process. Wound infections and use of corticosteroids are significant barriers to healing. Other factors that can influence the course of wound healing are inadequate nutrition with consequent lack of energy or protein and some vitamins, wound abidance, wound bed status, localization of wound, etc. Only with the knowledge of the wound healing pathophysiology and understanding all the factors that may affect delayed wound healing, we can adequately prevent and treat chronic wounds.
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To use both acellular human dermis and skin grafting simultaneously for improved skin grafting without contracture. The study also aims to address the lack of research on the application of an acellular human dermis in diverse clinical cases.The study examined patients who had received acellular human dermis (CGDerm, CGBio, Seoul, Korea) and split-thickness skin grafting (STSG) simultaneously for lower limb, full-thickness skin defects between September 2012 and June 2014. The researchers performed chart reviews retrospectively and examined the patients based on the following factors: gender, age, injury mechanism, size, exposed structure, pre-coverage dressing method, coverage method, post-operational engraftment and total healing period, contracture development, elasticity, and infection development.A sample of 27 patients with a total of 30 wounds took part in the study. Of these wounds, 29 showed successful engraftment without infection or contracture. In one case, continued seroma was observed and, following new coverage of both the acellular human dermis and STSG, engraftment was successful.Human dermis can play an important role in securing the availability of surrounding tissue and in contracture prevention, both of which are key to lower limb reconstruction. Of the types available, acellular human dermis showed lower infection rates than other human dermis types, and its engraftment rate was higher than in STSG-only cases. These findings suggest that acellular human dermis use in STSG is effective and safe in lower limb reconstruction.
Skin grafting
Seroma
Acellular Dermis
Human skin
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Skin grafting
Subcutaneous fat
Subcutaneous tissue
Acellular Dermis
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