A novel skin grafting modality: prefabricated large sheet of postage-stamp autografts and allografts to repair extensive burn wounds; a prospective matched-control study.
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
received:
01
06
2023
accepted:
21
08
2023
medline:
23
1
2024
pubmed:
23
1
2024
entrez:
23
1
2024
Statut:
epublish
Résumé
The excessively long operative time has been the greatest barrier to the success of transplanting postage-stamp auto- and allografts directly and piece-by-piece onto extensive burn wounds. To solve this challenge, the authors present a novel grafting modality, that is, the prefabricated-large-sheet grafting that moves the labor-intensive and time-consuming process of grafts-positioning before grafting and thereby markedly shortens the operative time. Twenty-one operations using the novel modality were performed on 11 patients with extensive deep burns. The grafting time using the novel modality was recorded and compared with that of the conventional piece-by-piece grafting. Eventually, the take rates of the two modalities were compared. All patients were healed and discharged. The average grafting time per unit area (100 cm2) of prefabricated-large-sheet grafting and piece-by-piece grafting were (0.41±0.09) min and (7.46±1.07) min, respectively, and the difference is statistically significant(P<0.001). The average take rate of the prefabricated sheets was (85.43±6.14)% and that of the piece-by-piece transplanted grafts was (87.29±5.23)% and there is no significant difference(P>0.05). The prefabricated-large-sheet grafting significantly reduces the intraoperative grafting time while ensures uniformity of the skin grafts and secures good outcomes, thereby making the intermingled transplantation of postage-stamp auto- and allografts, which has been an excellent modality per se but limited to repair small residual wounds, now feasible to repair extensive deep burn wounds. It is worth wider understanding and application in the treatment of extensive deep burns.
Sections du résumé
BACKGROUND
BACKGROUND
The excessively long operative time has been the greatest barrier to the success of transplanting postage-stamp auto- and allografts directly and piece-by-piece onto extensive burn wounds. To solve this challenge, the authors present a novel grafting modality, that is, the prefabricated-large-sheet grafting that moves the labor-intensive and time-consuming process of grafts-positioning before grafting and thereby markedly shortens the operative time.
METHODS
METHODS
Twenty-one operations using the novel modality were performed on 11 patients with extensive deep burns. The grafting time using the novel modality was recorded and compared with that of the conventional piece-by-piece grafting. Eventually, the take rates of the two modalities were compared.
RESULTS
RESULTS
All patients were healed and discharged. The average grafting time per unit area (100 cm2) of prefabricated-large-sheet grafting and piece-by-piece grafting were (0.41±0.09) min and (7.46±1.07) min, respectively, and the difference is statistically significant(P<0.001). The average take rate of the prefabricated sheets was (85.43±6.14)% and that of the piece-by-piece transplanted grafts was (87.29±5.23)% and there is no significant difference(P>0.05).
CONCLUSIONS
CONCLUSIONS
The prefabricated-large-sheet grafting significantly reduces the intraoperative grafting time while ensures uniformity of the skin grafts and secures good outcomes, thereby making the intermingled transplantation of postage-stamp auto- and allografts, which has been an excellent modality per se but limited to repair small residual wounds, now feasible to repair extensive deep burn wounds. It is worth wider understanding and application in the treatment of extensive deep burns.
Identifiants
pubmed: 38258998
doi: 10.1097/JS9.0000000000000724
pii: 01279778-202312000-00026
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3967-3973Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Liu HF, Zhang F, Lineaweaver WC. History and advancement of burn treatments. Ann Plast Surg 2017;78(2 Suppl 1):S2–S8.
Jackson D. A clinical study of the use of skin homografts for burns. Br J Plast Surg 1954;7:26–43.
Chih-Chun Y, Tsi-Siang S, Te-An C, et al. The intermingled transplantation of auto- and homografts in severe burns. Burns 1980;6:141–145.
Luo B, Chan WF, Shapiro AM, et al. Non-myeloablative mixed chimerism approaches and tolerance, a split decision. Eur J Immunol 2007;37:1233–1242.
Turk E, Karagulle E, Turan H, et al. Successful skin homografting from an identical twin in a severely burned patient. J Burn Care Res 2014;35:e177–e179.
Hufnagel B, Ninnemann JL, Hettich R. Immunology of intermingled skin grafts in rats: preliminary results. Burns Incl Therm Inj 1989;15:31–35.
Qaryoute S, Mirdad I, Hamail AA. Usage of autograft and allograft skin in treatment of burns in children. Burns 2001;27:599–602.
Shizhao J, Yongjun Z, Lisen Z, et al. Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds. Burns 2017;43:206–214.
Mathew G, Agha R; for the STROCSS Group. STROCSS 2021: strengthening the Reporting of cohort, cross-sectional and case–control studies in surgery. Int J Surg 2021;96:106165.
Zuo KJ, Medina A, Tredget EE. Important developments in burn care. Plast Reconstr Surg 2017;139:120e–138ee.
Gacto-Sanchez P. Surgical treatment and management of the severely burn patient: review and update. Med Intensiva 2017;41:356–64.
Gang RK, Arturson G, Hakelius L. The effect of split skin allografts on wound epithelialization from autologous patch grafts. An experimental study in rabbits. Scand J Plast Reconstr Surg 1981;15:1–4.
Lee SS, Chen YH, Sun IF, et al. ʻShift to right flypaper techniqueʼ a refined method for postage stamp autografting preparation. Burns 2007;33:764–769.
Quintero EC, Machado JFE, Robles RAD. Meek micrografting history, indications, technique, physiology and experience: a review article. J Wound Care 2018;27(Sup2):S12–S18.
Akita S, Hayashida K, Yoshimoto H, et al. Novel application of cultured epithelial autografts (cea) with expanded mesh skin grafting over an artificial dermis or dermal wound bed preparation. Int J Mol Sci 2017;19:57.