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The provision of skin coverage for the upper extremity presents surgeons with several challenges. The special functional and physiologic requirements of the integument such as mobility and sensibility need special consideration when performing soft issue reconstructions of the upper limb.
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Adhering to the concept of the reconstructive ladder, soft tissue reconstruction of the upper extremity has treatment options that range from the application of skin grafts to reconstruction with microsurgical
Dermal Skin Substitutes for Upper Limb Reconstruction: Current Status, Indications, and Contraindications
Section snippets
Key points
Histologic properties of dermal skin substitutes
Dermal skin substitutes are a heterogeneous group of wound coverage materials that aids in wound closure and replaces some of the functions of the skin, either temporarily or permanently, depending on the product characteristics.7 They provide several biologic and physiologic properties of human dermis that allow and/or promote new tissue growth and optimize the conditions for healing.
These biodegradable materials are composed of a bilayer of collagen and glycosaminoglycan covered by a
Application of dermal substitutes
The mainstay of management of upper extremity wounds is centered on the adequate surgical debridement of wounds followed by early soft tissue coverage and mobilization. Following debridement, dermal skin substitutes can be used to cover the resultant defect. Although the composition of different dermal regeneration templates is slightly different, their method of application and uses is principally similar. Nevertheless, one must always follow the manufacturer’s instructions for each type of
Clinical indications and outcomes of dermal skin substitutes
Dermal skin substitutes have been commonly used in acute and chronic reconstructive burn surgery. The US Food and Drug Administration more recently extended the indications of dermal skin substitutes to include non-burn-related, traumatic, and chronic extremity wounds.17 Furthermore, these medical devices have been proposed as part of the surgeon’s reconstructive ladder (Fig. 2).5 However, the role of dermal substitutes in upper limb reconstruction is still evolving. Apart from burn surgery,
Soft Tissue Reconstruction After Tumor Resection
Tumor resection and wide local excision may leave patients with defects requiring complex reconstructive surgery. The reconstructive approach following tumor resection differs greatly from the traditional approach of soft tissue reconstruction resulting from other mentioned causes, for several reasons. First, the treatment of suspected benign tumors (eg, pyogenic granuloma or a soft tissue lipoma) is usually achieved by a direct excision of the lesion and skin closure. However, in suspected
Summary
Tissue repair with dermal skin substitutes seems to be a useful tool in reconstructive surgery. The immediate skin coverage achieved using dermal substitutes consists of a reconstructive option for managing injuries of the upper extremity that minimizes donor-site morbidity and provides final acceptable functional and aesthetic outcomes. However, one must always be conscious of publication bias in which favorable results tend to be reported and published more often. Furthermore, as hand
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2021, Annals of Medicine and SurgeryCitation Excerpt :This is true in developing countries, while more economically advanced countries are likely to buy dermal substitutes. In our knowledge, there is only one study on the cost analysis that compares the total costs derived from the use of dermal substitutes vs. total skin graft costs for small burns treatment: the costs of dermal substitutes were higher, but not statistically significant; indirect costs such as the duration of hospitalization and overheads have been the most important factors in influencing the total cost of treatment [32]. The potential use of dermal substitutes in difficult wounds with deep structures exposure leaves an open chapter that could avoid more complex procedures and cause less morbidity to patients [36].
Aesthetic functional reconstruction of the mutilated hand: Indications and selection of reconstructive techniques
2020, Annales de Chirurgie Plastique Esthetique
Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute on Aging (R01 AR062066), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2R01 AR047328-06), and a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) (Dr K.C. Chung). Dr M. Singhal has received a fellowship grant from Indian Council of Medical Research, New Delhi, India to study various applications of skin substitutes.