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A Novel Concept for Treating Large Necrotizing Fasciitis Wounds With Bilayer Dermal Matrix, Split-thickness Skin Grafts, and Negative Pressure Wound Therapy
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
2009 (engelsk)Inngår i: Wounds (King of Prussia, Pa.), ISSN 1044-7946, E-ISSN 1943-2704, Vol. 21, nr 8, s. 215-220Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Treatment of necrotizing fasciitis (NF) includes radical surgical debridement often resulting in large wounds that need to be closed with methods including split-thickness skin grafts (STSG), local flaps, or guided tissue regeneration procedures. In this case report, a 45 year-old Caucasian male was surgically treated for a benign left groin hernia, developed NF, and was transferred to the authors burn unit. The wound was treated initially with wide debridement and with a brief delay before finally closing the wound. A collagen matrix such as Integra (R) Dermal Regeneration Template (Integra LifeSciences, Plainsboro, NJ) in combination with STSG and negative pressure wound treatment, can provide fast recovery resulting in pliable, functional skin.

sted, utgiver, år, opplag, sider
2009. Vol. 21, nr 8, s. 215-220
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-20581ISI: 000269472900006OAI: oai:DiVA.org:liu-20581DiVA, id: diva2:235290
Merknad

Funding text: "We express our sincere gratitude to Mrs. Kristina Briheim and Mrs. Anita Lonn, Senior Laboratory Technicians at the Laboratory for Experimental Plastic Surgery, Institute of Biomedicine and Surgery, Faculty Of Health Sciences, Linkoping Universitet, Linkoping, Sweden."

Tilgjengelig fra: 2009-09-15 Laget: 2009-09-15 Sist oppdatert: 2017-12-13bibliografisk kontrollert
Inngår i avhandling
1. Keratinocytes in tissue engineering of human skin: invitro and in vivo studies
Åpne denne publikasjonen i ny fane eller vindu >>Keratinocytes in tissue engineering of human skin: invitro and in vivo studies
2008 (engelsk)Licentiatavhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Full thickness wounds, such as deep burns, need restoration of both the dermal and epidermal layers of the skin. In normal wound healing, re-epithelialization occurs by migration and proliferation of keratinocytes from the wound edges and by differentiation of stem cells from remaining hair follicles. Restoration of dermis occurs by influx of growth factors secreted by macrophages, platelets, and fibroblasts; by fibroblast proliferation and subsequent synthesis and remodeling of collagenous dermal matrix. In the case of full-thickness acute burn injuries and chronic wounds (e.g. pressure ulcers, venous ulcers and diabetic foot ulcers), these processes are defective. With the principles of tissue engineering in mind (to correct, improve and maintain tissues and their functions), researchers have developed promising materials and methods to make it possible to restore either the dermal (Integra® DRT, Alloderm®) or the epidermal layer (split thickness skin grafts (STSG), cultured epithelial autografts (CEA), autologous keratinocytes in single cell suspension). It is now well established that superior results are obtained if both dermal and epidermal components are combined, for example in a bilayered skin equivalent. Apligraf® is recommended for use on venous ulcers and is the only bilayered living skin equivalent currently approved by the FDA. Studies on different factors affecting the wound healing capacity as well as techniques in use provide valuable information for further development.

In this licentiate thesis, we evaluated different transplantation techniques for delivering cultured human keratinocytes in single cell suspension, a measure becoming more frequently used in addition to STSG and CEA for restoring the epidermal layer of the skin. We found that the pressure device, commonly used to spray cell suspension onto the wound with pressures as high as 200 kPa, killed around 0% of the cells. In comparison, an ordinary syringe with the attachment of a spray nozzle showed almost 90% viable cells post transplantation and provided an equally good distribution of the cell suspension.

We also studied different silver containing dressings regarding silver accumulation in human skin. In addition, we graded the re-epithelialization to evaluate whether the dressings caused any delay in the wound healing process. We found that the silver dressings tested, with few exceptions, caused dermal accumulation of silver, primarily aggregated around blood vessels. We could also show that most of the dressings had negative effect on the re-epithelialization.

For the restoration of the dermal layer of the skin, Integra® DRT functions as a scaffold for guided tissue regeneration of the dermis. We had the possibility to study a case of necrotizing fasciitis were the treatment consisted of the use of Integra® DTR together with sub-atmospheric pressure (after initial surgical debridement) and later transplantation of split thickness skin grafts. This measure proved to be safe as well as giving satisfactory pliable and aesthetically acceptable result.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2008. s. 49
Serie
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 87
Emneord
Keratinocytes tissue engineering
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-21283 (URN)978-91-7393-779-5 (ISBN)
Presentation
2008-11-21, Hagdahlssalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2009-10-06 Laget: 2009-09-30 Sist oppdatert: 2009-10-06bibliografisk kontrollert

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Danielsson, PärFredriksson, CamillaHuss, Fredrik
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