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• W4377013455 abstract "PURPOSE: Thermal burns to the face or extremities are highly morbid injuries risking severe disfigurement, functional and psychosocial impairment. These injuries commonly require debridement and prolonged or staged reconstruction often with multiple grafts, flaps, and need for delayed-touch ups. This standard-of-care is costly, time-consuming, deeply frustrating, and puts patients at risk of extensive donor-site and surgical complications. Currently there are no simple, scalable, and single-stage procedures available for extensive or multifocal burns able to address full-thickness trilaminar defects. Our team has previously demonstrated the viability of an adipose-first reconstruction to address hypodermal defects and provide a well-vascularized base reconstruction of complex burns. In this study, we demonstrate the efficacy of a combined fat plus finely minced skin (pixel-grafted) to achieve a single-stage trilaminar skin reconstruction with minimal donor site morbidity. METHODS: Female Yorkshire swine sustained 16 full-thickness circular burns with a custom burn device of 7 cm2 in surface area for 16 seconds at 100oC. After 48-hours, escharectomies were performed to the level of the fascia. Adipose from female Yorkshire swine was used on the wound as the initial layer of the reconstruction upon removal of the eschars. In one group, autologous split-thickness skin grafts were cut into pixel size (0.3x0.3 mm) grafts and applied on top of the adipose grafts. Pigs were maintained for 4-weeks with weekly photography, ultrasound, and biopsies, followed by sacrificed for histology and tension measurements. RESULTS: At the end of the 4-week period, adipose combined with pixel graft demonstrated improved epithelialization and less contracture (p<0.01). Thickness and mobility measurements were consistent in both groups and were similar to our previous approaches using adipose following surgical debridement. Tissue pliability in the pixel grafting group was maintained to a high degree. On histologic analyses the presence of distinct, viable epidermal, dermal, and hypodermal elements was noted on cross-sections, suggesting the reconstitution of full-thickness trilaminar cutaneous architecture. CONCLUSION: We found that a basal layer of particulate fat provided enough nutrient exchange to support immediate pixel-grafted skin. This particulate skin-plus-fat approach allowed us to generate a single-stage trilaminar reconstruction in complex burn defects in a highly translatable swine model. Immediate, single-stage trilaminar reconstruction of full-thickness complex burns reduces contracture, mitigates adhesion, and restores normal soft-tissue thickness, therefore, presenting a paradigm changing approach in the current practice of burn injuries to the mobile surfaces." @default.
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• W4377013455 date "2023-05-01" @default.
• W4377013455 modified "2023-09-26" @default.
• W4377013455 title "96. Trilaminar Skin Reconstruction Following Full-thickness Burn Injury: A Single-staged Novel Approach" @default.
• W4377013455 doi "https://doi.org/10.1097/01.gox.0000937972.00388.5f" @default.
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