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Erschienen in: European Surgery 5/2013

01.10.2013 | Original Scientific Paper

First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

verfasst von: M. Keck, MD, H. F . Selig, MD, J. Kober, MSc, D. B . Lumenta, MD, H. Schachner, A. Gugerell, PhD, L-P. Kamolz, MD, PhD, MSc

Erschienen in: European Surgery | Ausgabe 5/2013

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Summary

Background

Deep excision down to the muscle fascia and split-thickness skin grafting is a necessary part in modern surgical care of adult burn patients presenting with full-thickness wounds. We evaluated a new surgical approach combining a dermal matrix, autologous fat-transfer, and split-thickness skin grafting.

Methods

Full thickness burn wounds of five consecutive patients were excised down to the muscle fascia. Parts of the excised adipose tissues were harvested for in vitro analysis of preadipocyte viability and its potential for proliferation and differentiation. The excised fatty tissue was manually harvested by use of a Coleman Liposuction needle mounted on 10 ml syringes, and spread onto a bovine collagen-elastin scaffold (Matriderm®). The sheet was put upside down onto the wound and covered with split-thickness grafts during the same operation. Skin biopsies for histological evaluation were taken on days 30 and 90 postoperatively.

Results

Preadipocytes from excised burn wounds showed cell behavior comparable to healthy fat tissue. FACS Analysis showed 75 % viable cells in the samples which is comparable to healthy fat tissue. Three patients showed more than 90 % vital split thickness skin grafts 10 days after surgery. All skin biopsies confirmed the presence of adipose tissue.

Conclusions

Autologous fat-transfer in combination with a dermal substitute and split-thickness skin grafts seems to be a possible reconstructive procedure for covering defects after deep excision down to the fascia in a single step approach.
Literatur
1.
Zurück zum Zitat de Vries HJ, Middelkoop E, van Heemstra-Hoen M, Wildevuur CH, Westerhof W. Stromal cells from subcutaneous adipose tissue seeded in a native collagen/elastin dermal substitute reduce wound contraction in full thickness skin defects. Lab Invest. 1995 Oct;73(4):532–40. (Research Support, Non-U.S. Gov’t)PubMed de Vries HJ, Middelkoop E, van Heemstra-Hoen M, Wildevuur CH, Westerhof W. Stromal cells from subcutaneous adipose tissue seeded in a native collagen/elastin dermal substitute reduce wound contraction in full thickness skin defects. Lab Invest. 1995 Oct;73(4):532–40. (Research Support, Non-U.S. Gov’t)PubMed
2.
Zurück zum Zitat Keck M, Haluza D, Lumenta DB, Burjak S, Eisenbock B, Kamolz LP, et al. Construction of a multilayer skin substitute: simultaneous cultivation of keratinocytes and preadipocytes on a dermal template. Burns. 2011 Jun;37(4):626–30.PubMedCrossRef Keck M, Haluza D, Lumenta DB, Burjak S, Eisenbock B, Kamolz LP, et al. Construction of a multilayer skin substitute: simultaneous cultivation of keratinocytes and preadipocytes on a dermal template. Burns. 2011 Jun;37(4):626–30.PubMedCrossRef
3.
Zurück zum Zitat Haslik W, Kamolz LP, Nathschlager G, Andel H, Meissl G, Frey M. First experiences with the collagen-elastin matrix Matriderm as a dermal substitute in severe burn injuries of the hand. Burns. 2007 May;33(3):364–8.PubMedCrossRef Haslik W, Kamolz LP, Nathschlager G, Andel H, Meissl G, Frey M. First experiences with the collagen-elastin matrix Matriderm as a dermal substitute in severe burn injuries of the hand. Burns. 2007 May;33(3):364–8.PubMedCrossRef
4.
Zurück zum Zitat Schneider J, Biedermann T, Widmer D, Montano I, Meuli M, Reichmann E, et al. Matriderm versus Integra: a comparative experimental study. Burns. 2009 Feb;35(1):51–7. (Comparative Study)PubMedCrossRef Schneider J, Biedermann T, Widmer D, Montano I, Meuli M, Reichmann E, et al. Matriderm versus Integra: a comparative experimental study. Burns. 2009 Feb;35(1):51–7. (Comparative Study)PubMedCrossRef
5.
Zurück zum Zitat Keck M, Ueberreiter K. Successful correction of an adherent scar on the dorsal hand with Matriderm. Handchir Mikrochir Plast Chir. . 2008 Jun;40(3):197–200. (Case Reports) Keck M, Ueberreiter K. Successful correction of an adherent scar on the dorsal hand with Matriderm. Handchir Mikrochir Plast Chir. . 2008 Jun;40(3):197–200. (Case Reports)
6.
Zurück zum Zitat van Zuijlen PP, van Trier AJ, Vloemans JF, Groenevelt F, Kreis RW, Middelkoop E. Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model. Plast Reconstr Surg. 2000 Sep;106(3):615–23. (Clinical Trial Comparative Study Research Support, Non-U.S. Gov’t)PubMed van Zuijlen PP, van Trier AJ, Vloemans JF, Groenevelt F, Kreis RW, Middelkoop E. Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model. Plast Reconstr Surg. 2000 Sep;106(3):615–23. (Clinical Trial Comparative Study Research Support, Non-U.S. Gov’t)PubMed
7.
Zurück zum Zitat Natesan S, Wrice NL, Baer DG, Christy RJ. Debrided skin as a source of autologous stem cells for wound repair. Stem Cells. 2011 Aug;29(8):1219–30. (Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, Non-P.H.S.)PubMedCrossRef Natesan S, Wrice NL, Baer DG, Christy RJ. Debrided skin as a source of autologous stem cells for wound repair. Stem Cells. 2011 Aug;29(8):1219–30. (Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, Non-P.H.S.)PubMedCrossRef
8.
Zurück zum Zitat Hold A, Kamolz L, Frey M. The need for flaps in burn surgery. Handchi Mikrochir Plast Chir. 2009 Dec;41(6):343–7. Hold A, Kamolz L, Frey M. The need for flaps in burn surgery. Handchi Mikrochir Plast Chir. 2009 Dec;41(6):343–7.
9.
Zurück zum Zitat Gregoire FM, Smas CM, Sul HS. Understanding adipocyte differentiation. Physiol Rev. 1998 Jul;78(3):783–809. (Research Support, U.S. Gov’t, P.H.S. Review)PubMed Gregoire FM, Smas CM, Sul HS. Understanding adipocyte differentiation. Physiol Rev. 1998 Jul;78(3):783–809. (Research Support, U.S. Gov’t, P.H.S. Review)PubMed
10.
Zurück zum Zitat Ryssel H, Radu CA, Germann G, Otte M, Gazyakan E. Single-stage Matriderm(R) and skin grafting as an alternative reconstruction in high-voltage injuries. Int Wound J. 2010 Oct;7(5):385–92.PubMedCrossRef Ryssel H, Radu CA, Germann G, Otte M, Gazyakan E. Single-stage Matriderm(R) and skin grafting as an alternative reconstruction in high-voltage injuries. Int Wound J. 2010 Oct;7(5):385–92.PubMedCrossRef
11.
Zurück zum Zitat Kolokythas P, Aust MC, Vogt PM, Paulsen F. Dermal subsitute with the collagen-elastin matrix Matriderm in burn injuries: a comprehensive review. Handchi Mikrochir Plast Chir. 2008 Dec;40(6):367–71. (Comparative Study Review) Kolokythas P, Aust MC, Vogt PM, Paulsen F. Dermal subsitute with the collagen-elastin matrix Matriderm in burn injuries: a comprehensive review. Handchi Mikrochir Plast Chir. 2008 Dec;40(6):367–71. (Comparative Study Review)
12.
Zurück zum Zitat Haslik W, Kamolz LP, Manna F, Hladik M, Rath T, Frey M. Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm. J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):360–4.PubMedCrossRef Haslik W, Kamolz LP, Manna F, Hladik M, Rath T, Frey M. Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm. J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):360–4.PubMedCrossRef
13.
Zurück zum Zitat Kamolz L-PH W, Frey M. Die Kollagen-Elastin-Matrix Matriderm als Dermisersatz bei schweren Handverbrennungen. Plastische Chirurgie. 2007;4:135–9. Kamolz L-PH W, Frey M. Die Kollagen-Elastin-Matrix Matriderm als Dermisersatz bei schweren Handverbrennungen. Plastische Chirurgie. 2007;4:135–9.
14.
Zurück zum Zitat Kamolz L-PL DB, Kitzinger, HB, Frey, M. Tissue engineering for cutaneous wounds: an overview of current standards and possibilities. Eur Surg. 2008;40(1):19–26.CrossRef Kamolz L-PL DB, Kitzinger, HB, Frey, M. Tissue engineering for cutaneous wounds: an overview of current standards and possibilities. Eur Surg. 2008;40(1):19–26.CrossRef
15.
Zurück zum Zitat van Zuijlen PP, Lamme EN, van Galen MJ, van Marle J, Kreis RW, Middelkoop E. Long-term results of a clinical trial on dermal substitution. A light microscopy and Fourier analysis based evaluation. Burns. 2002 Mar;28(2):151–60. (Clinical Trial Comparative Study Controlled Clinical Trial Research Support, Non-U.S. Gov’t)PubMedCrossRef van Zuijlen PP, Lamme EN, van Galen MJ, van Marle J, Kreis RW, Middelkoop E. Long-term results of a clinical trial on dermal substitution. A light microscopy and Fourier analysis based evaluation. Burns. 2002 Mar;28(2):151–60. (Clinical Trial Comparative Study Controlled Clinical Trial Research Support, Non-U.S. Gov’t)PubMedCrossRef
16.
Zurück zum Zitat van Zuijlen PP, Vloemans JF, van Trier AJ, Suijker MH, van Unen E, Groenevelt F, et al. Dermal substitution in acute burns and reconstructive surgery: a subjective and objective long-term follow-up. Plast Reconstr Surg. 2001 Dec;108(7):1938–46. (Clinical Trial Controlled Clinical Trial Research Support, Non-U.S. Gov’t)PubMedCrossRef van Zuijlen PP, Vloemans JF, van Trier AJ, Suijker MH, van Unen E, Groenevelt F, et al. Dermal substitution in acute burns and reconstructive surgery: a subjective and objective long-term follow-up. Plast Reconstr Surg. 2001 Dec;108(7):1938–46. (Clinical Trial Controlled Clinical Trial Research Support, Non-U.S. Gov’t)PubMedCrossRef
17.
Zurück zum Zitat Kim JH, Park SH, Park SG, Choi JS, Xia Y, Sung JH. The pivotal role of reactive oxygen species generation in the hypoxia-induced stimulation of adipose-derived stem cells. Stem Cells Dev. 2011 Oct;20(10):1753–61. (Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t)PubMedCrossRef Kim JH, Park SH, Park SG, Choi JS, Xia Y, Sung JH. The pivotal role of reactive oxygen species generation in the hypoxia-induced stimulation of adipose-derived stem cells. Stem Cells Dev. 2011 Oct;20(10):1753–61. (Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t)PubMedCrossRef
18.
Zurück zum Zitat Barillo DJ, Goode R. Fire fatality study: demographics of fire victims. Burns. 1996 Mar;22(2):85–8.PubMedCrossRef Barillo DJ, Goode R. Fire fatality study: demographics of fire victims. Burns. 1996 Mar;22(2):85–8.PubMedCrossRef
Metadaten
Titel
First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer
verfasst von
M. Keck, MD
H. F . Selig, MD
J. Kober, MSc
D. B . Lumenta, MD
H. Schachner
A. Gugerell, PhD
L-P. Kamolz, MD, PhD, MSc
Publikationsdatum
01.10.2013
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-013-0211-2

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