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Comparison of healing parameters of full thickness wounds transplanted with micrografts, spit thickness skin grafts or cultured keratinocytes
Vol. 213, No. 3S, September 2011
Comparison of healing parameters of full thickness wounds transplanted with micrografts, spit thickness skin grafts or cultured keratinocytes Elizabeth Kiwanuka MD, Florian Hackl MD, Justin Philip B Eng, Edward J Caterson MD, PhD, Johan P E Junker PhD, Elof Eriksson MD, PhD, FACS Brigham and Women’s Hospital, Boston, MA INTRODUCTION: Transplantation of split-thickness skin grafts, cultured autologous keratinocytes and skin micrografts result in healing of full-thickness wounds. This study compares these methods in a porcine wound model, investigating the utility of micrograft transplantation in skin restoration. METHODS: Full-thickness wounds were created on Yorkshire pigs and assigned to one of the following treatment groups: meshed splitthickness skin graft (STSG), cultured autologous keratinocytes (CK), skin micrografts (MG), wet environment (W) and dry environment (D). Dry wounds were covered with gauze and the other groups were enclosed in a polyurethane chamber containing 2 mL of saline. Samples were taken 6, 12 and 18 days post wounding. Macroscopic wound healing was quantified using the Vancouver Scar Scale (VSS). Wound healing parameters such as contraction, reepithelialization, epidermal characteristics and scar formation was determined by quantitative morphometric or morphologic analysis. RESULTS: Grafted wounds had a lower VSS score compared to non-grafted wounds (STSG:4, CK:6, MG:3, W:8.5, D:10, unwounded skin:0). Wounds grafted with STSG and MG showed significantly reduced contraction compared to non-grafted wounds (STSG:25%, CK:35%, MG:28%, W:43%, D:44%). All grafted wounds showed increased epidermal healing compared to nongrafted wounds. Furthermore, transplantation with STSG or MG led to less scar tissue formation compared to the non-grafted wounds and no significant impact on scar formation was observed after transplantation of CK. CONCLUSIONS: Transplantation with micrografts decreases healing time and improves the functional restoration of skin, similar to STSG and cultured autologous keratinocytes.
Tissue expander breast reconstruction using different techniques for implant coverage: A comparative analysis Akhil K Seth MD, Elliot M Hirsch MD, Neil A Fine MD, FACS, Gregory A Dumanian MD, Thomas A Mustoe MD, FACS, John Y Kim MD Northwestern University, Chicago, IL INTRODUCTION: Historically, multiple techniques have been used to obtain implant coverage during immediate tissue expander breast reconstruction (TE). We evaluate outcomes following reconstruction with complete submuscular (including serratus) coverage, elevation of serratus fascia, or incorporation of acellular dermis (ADM). METHODS: Retrospective review of 944 consecutive patients from 4/1998-8/2008 at one institution yielded 689 (942 breasts) that underwent mastectomy with TE using one-of-four procedures: elevation of serratus muscle (SM) or serratus fascia (SF), or human
Surgical Forum Abstracts
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ADM implantation (cryopreserved [CHADM] or prehydrated [PHADM]). Demographic, operative, and postoperative factors, and follow-up were recorded. Statistics were calculated using one-way analysis of variance. RESULTS: Demographics were comparable among SM (n⫽370), SF (n⫽171), CHADM (n⫽85), and PHADM (n⫽63) patients. Mean follow-up was 29.5 months. There were no differences in total complications per breast (14.8-17.7%), particularly seromas requiring aspiration (1.1-5.5%), infection (4.5-5.6%), mastectomy flap necrosis (5.5-7.8%), unscheduled reoperation (5.4-7.8%), or explantation (8.5-9.4%) among any groups, including CHADM versus PHADM. SM patients had smaller intraoperative fill-volumes (p⬍0.001) and more postoperative expansions (p⬍0.01), but no increased time to expander-to-implant exchange, compared to all other groups. CONCLUSIONS: Our comparative analysis, the largest study-todate to stratify by type of submuscular (fascia vs. muscle) and ADM (CHADM vs. PHADM) coverage, demonstrates no increased complication rates secondary to ADM-assisted reconstruction, regardless of ADM-type used. However, ADM did not significantly decrease time to second-stage reconstruction despite reducing postoperative expansion requirements. Current autologous and non-autologous tissue coverage techniques are safe, comparable, and effective, allowing for versatility and adaptability when tailoring the optimal reconstruction for an individual patient.
Does type of immediate breast reconstruction affect surgical site infection? Melinda A Costa MD, T JoAnna Nguyen MD, Ahva Shahabi MPH, Evan N Vidar MA, Gabrielle B Davis MD, Linda S Chan PhD, Alex K Wong MD University of Southern California/Keck School of Medicine, Los Angeles, CA INTRODUCTION: To date, there are few data regarding whether type of immediate breast reconstruction affects the incidence of surgical site infection (SSI) in women undergoing mastectomy. Here, we examine how the risk of SSI may be affected by type of immediate reconstruction, which was further classified into implant, autologous, or latissimus based reconstruction. METHODS: All female patients undergoing mastectomy, with or without immediate reconstruction, from 2005 - 2009 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database. Only “clean” procedures were analyzed. The primary outcome is SSI within 30 days of operation. The incidence rate ratio (IRR) and 95% CI were calculated as well. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with SSI in each type of reconstruction. RESULTS: A total of 48,393 mastectomies were performed during the study period; 9,315 had immediate breast reconstruction, and 39,078 did not. The incidence of SSI was 2.7% in all mastectomy patients, 2.5% in patients that did not have immediate reconstruction, and 3.5% in immediate reconstruction patients. Of those with
Comparison of healing parameters of full thickness wounds transplanted with micrografts, spit thickness skin grafts or cultured keratinocytes Elizabeth Kiwanuka MD, Florian Hackl MD, Justin Philip B Eng, Edward J Caterson MD, PhD, Johan P E Junker PhD, Elof Eriksson MD, PhD, FACS Brigham and Women’s Hospital, Boston, MA INTRODUCTION: Transplantation of split-thickness skin grafts, cultured autologous keratinocytes and skin micrografts result in healing of full-thickness wounds. This study compares these methods in a porcine wound model, investigating the utility of micrograft transplantation in skin restoration. METHODS: Full-thickness wounds were created on Yorkshire pigs and assigned to one of the following treatment groups: meshed splitthickness skin graft (STSG), cultured autologous keratinocytes (CK), skin micrografts (MG), wet environment (W) and dry environment (D). Dry wounds were covered with gauze and the other groups were enclosed in a polyurethane chamber containing 2 mL of saline. Samples were taken 6, 12 and 18 days post wounding. Macroscopic wound healing was quantified using the Vancouver Scar Scale (VSS). Wound healing parameters such as contraction, reepithelialization, epidermal characteristics and scar formation was determined by quantitative morphometric or morphologic analysis. RESULTS: Grafted wounds had a lower VSS score compared to non-grafted wounds (STSG:4, CK:6, MG:3, W:8.5, D:10, unwounded skin:0). Wounds grafted with STSG and MG showed significantly reduced contraction compared to non-grafted wounds (STSG:25%, CK:35%, MG:28%, W:43%, D:44%). All grafted wounds showed increased epidermal healing compared to nongrafted wounds. Furthermore, transplantation with STSG or MG led to less scar tissue formation compared to the non-grafted wounds and no significant impact on scar formation was observed after transplantation of CK. CONCLUSIONS: Transplantation with micrografts decreases healing time and improves the functional restoration of skin, similar to STSG and cultured autologous keratinocytes.
Tissue expander breast reconstruction using different techniques for implant coverage: A comparative analysis Akhil K Seth MD, Elliot M Hirsch MD, Neil A Fine MD, FACS, Gregory A Dumanian MD, Thomas A Mustoe MD, FACS, John Y Kim MD Northwestern University, Chicago, IL INTRODUCTION: Historically, multiple techniques have been used to obtain implant coverage during immediate tissue expander breast reconstruction (TE). We evaluate outcomes following reconstruction with complete submuscular (including serratus) coverage, elevation of serratus fascia, or incorporation of acellular dermis (ADM). METHODS: Retrospective review of 944 consecutive patients from 4/1998-8/2008 at one institution yielded 689 (942 breasts) that underwent mastectomy with TE using one-of-four procedures: elevation of serratus muscle (SM) or serratus fascia (SF), or human
Surgical Forum Abstracts
S93
ADM implantation (cryopreserved [CHADM] or prehydrated [PHADM]). Demographic, operative, and postoperative factors, and follow-up were recorded. Statistics were calculated using one-way analysis of variance. RESULTS: Demographics were comparable among SM (n⫽370), SF (n⫽171), CHADM (n⫽85), and PHADM (n⫽63) patients. Mean follow-up was 29.5 months. There were no differences in total complications per breast (14.8-17.7%), particularly seromas requiring aspiration (1.1-5.5%), infection (4.5-5.6%), mastectomy flap necrosis (5.5-7.8%), unscheduled reoperation (5.4-7.8%), or explantation (8.5-9.4%) among any groups, including CHADM versus PHADM. SM patients had smaller intraoperative fill-volumes (p⬍0.001) and more postoperative expansions (p⬍0.01), but no increased time to expander-to-implant exchange, compared to all other groups. CONCLUSIONS: Our comparative analysis, the largest study-todate to stratify by type of submuscular (fascia vs. muscle) and ADM (CHADM vs. PHADM) coverage, demonstrates no increased complication rates secondary to ADM-assisted reconstruction, regardless of ADM-type used. However, ADM did not significantly decrease time to second-stage reconstruction despite reducing postoperative expansion requirements. Current autologous and non-autologous tissue coverage techniques are safe, comparable, and effective, allowing for versatility and adaptability when tailoring the optimal reconstruction for an individual patient.
Does type of immediate breast reconstruction affect surgical site infection? Melinda A Costa MD, T JoAnna Nguyen MD, Ahva Shahabi MPH, Evan N Vidar MA, Gabrielle B Davis MD, Linda S Chan PhD, Alex K Wong MD University of Southern California/Keck School of Medicine, Los Angeles, CA INTRODUCTION: To date, there are few data regarding whether type of immediate breast reconstruction affects the incidence of surgical site infection (SSI) in women undergoing mastectomy. Here, we examine how the risk of SSI may be affected by type of immediate reconstruction, which was further classified into implant, autologous, or latissimus based reconstruction. METHODS: All female patients undergoing mastectomy, with or without immediate reconstruction, from 2005 - 2009 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database. Only “clean” procedures were analyzed. The primary outcome is SSI within 30 days of operation. The incidence rate ratio (IRR) and 95% CI were calculated as well. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with SSI in each type of reconstruction. RESULTS: A total of 48,393 mastectomies were performed during the study period; 9,315 had immediate breast reconstruction, and 39,078 did not. The incidence of SSI was 2.7% in all mastectomy patients, 2.5% in patients that did not have immediate reconstruction, and 3.5% in immediate reconstruction patients. Of those with