Reconstruction of Soft Tissue Defect on Scleroderma Using STSG & Artificial Dermis (Terudermis(R))

Scleroderma is a rare disease characterized by hard and thick skin, due to fibrosis of tissue with excessive deposition of collagen and extracellular matrix. It is well known that sclerodermatous skin does not heal well after trauma and also difficult to select proper reconstruction method. This article presents a treatment of skin and soft tissue defect with tendon exposure in a scleroderma patient using artificial dermis and STSG. A 67-year old woman, diagnosed as localized scleroderma in 2001, had contact thermal burn on her right hand 2 months ago. She was referred due to 9x5 cm sized skin and soft tissue defect with inflammation and necrosis on the dorsum of her right hand. Necrotic and inflammated tissues were excised under local anesthesia and, on postoperative day 13, debridement & artificial dermis (Terudermis(R)) was applied under general anesthesia. Her cutaneous lesion was spread so widely that we couldn't find appropriate donor site. After 16 days, wound was covered with STSG donated from sclerodermatous skin on right thigh. Artificial dermis was taken without inflammation or other specific complications, and she had uneventful post-operative course after STSG.

Application of artificial dermis(terudermis.) and split thickness skin graft on the donor site of radial forearm flap

Histological and clinical study of artificial dermis implantation for restoration of soft tissue defects

The present study was aimed to compare the resorption rate and the histological change of the autogenous dermis and the artificial dermis (Terudermis(R).) after the transplantation, and to report the clinical results of the use of Terudermis(R). in order to restore the soft tissue defect. Twenty mature rabbits, weighing about 2 kg, were used for the experimental study. The autogenous dermis and the Terudermis(R). size 1 x 1 cm were transplanted to the space between the external abdominal oblique muscle and the external abdominal oblique fascia of the each rabbits. They were divided into 4 groups (n=5 each) and gathered at 1, 2, 4, and 8 weeks after the transplantation. The resorption rate was calculated, and H-E stain was preformed to observe the histological changes. The chart review of the 17 patients who received Terudermis(R). graft to the facial soft tissue defects was conducted for the clinical study. The resorption rate at 8 weeks after the transplantation was 21.5% for the autogenous dermis, and 36.4% Terudermis(R). In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. The neovascularization and the progressive growth of the new fibroblast were shown in the Terudermis(R). graft. In clinical data of 17 patients, the size of the grafted Terudermis(R). was from 1.5 cm2 to 7.5 cm2 (average 3.5 cm2). Follow-up ranged from 5 to 25 months. Fourteen patients with cleft palate demonstrated stability of the graft and unremarkable complications. But unstability of the graft and the partial relapse were observed in three patients received the vestibuloplasty. These results indicate that Terudermis(R). can be available substitute of autogenous dermis because of the stability about resorption, the histocompatibility, and the unremarkable clinical complications.

Experimental Assessment of the Histologic Changes of Collagen Matrix(Terudermis(R)) in Subcutaneous Implantation: Comparison with Autologous Dermal Graft

PURPOSE: Numerous materials, both autologous and nonautologous, have been used for augmentation of sunken areas, but they have their own limitations. The purpose of this study is to determine the histologic response and volume change of the xenogenic collagen-based scaffold(Terudermis(R)) to the transfer into a subcutaneous soft tissue location in vivo rabbit model. METHODS: Eighteen New Zealand white rabbits were used. Three 1.2x1.2cm sized subcutaneous pockets were created on the dorsal surface of each ear. 1x1 cm sized collagen matrix(Terudermis(R)) and autologous dermal graft were implanted into each pocket. Full thickness of ear was harvested in 3 days, 1, 2, 4 weeks, 3, 6 months after implantation. RESULTS: Histological analysis of implants demonstrated progressive neovascularization, fibroblast infilteration, neocollagen bundle synthesis and organization, and few foreign body reaction. The thickness of the collagen matrix in 3 days after the operation was 87.69% of the thickness of the collagen matrix in wet state. Then it decreased to 30.17% in 6 months after the operation. The rate of decrease was similar at all points at the same time compared with autologous dermal graft. CONCLUSION: Our experimental study suggests that Terudermis(R) could be a safe material as an implant for permanent augmentation in subcutaneous tissue. However the choice of graft for augmentation should be remained to the clinical situations.

Reconstruction of Wide Soft Tissue Defect of Frontal Area with Terudermis(R) and Hydrogel(R)

There have been many difficult cases in direct closure of soft tissue defect of frontal area because of its tension, so that for reconstruction of this area skin graft, local flap and free flap has been used traditionally. Although local flap represent best result in concern of its color, touchness and compatability of function, it is not always available in case that the defect size is wide. we must consider skin graft in such case but it also can not be used if there is exposure of bone with loss of periosteum. Recently there are many reports about the use of collagen dermal substitude (Terudermis(R)) and the use of Hydrogel(R) which provide moist wound environment to facilitate epithelization is increased. The authors report the experience of combination treatment with Terudermis(R) and Hydrogel(R) to take rapid soft tissue regeneration in case of wide soft tissue defect in frontal area with bone exposure.

Coverage of Donor Site Defect of Radial Forearm Free Flap by using Terudermis(R)

Split-thickness skin grafting is commonly used to cover donor site defect of radial forearm free flap. One of disadvantages in this method is contour reflection of underlying structures (tendons and muscles) with irregularity which was caused by incomplete soft tissue replacement, and we called it 'silhouette phenomenon'. To promote soft tissue replacement, we have used Terudermis(R) (atelocollagen). In 10 cases of radial forearm free flap surgery of 10 patients, Terudermis(R) was applied on flap donor site just after flap surgery, followed by split-thickness skin grafting for resurfacing after 2 weeks. In all cases, Terudermis(R) and skin graft were taken well with no complications such as skin necrosis and loss. We successfully overcame silhouette phenomenon in all cases in the follow-up period of mean 8 months. Terudermis(R) , as a tissue-restoring biomaterial, is expected to be easily used for coverage of donor site defect of radial forearm free flap.

The Effect of an Artificial Dermis on Chondrogenesis from Perichondrium

The purpose of this study is to investigate the effect of artificial dermis(Terudermis(R)) on cartilage induction from perichondrium. A total of 24 rabbits were used and divided into control(n = 12) and experimental groups(n = 12). Each group was divided into 2 weeks(n = 6) and 4 weeks subgroups(n = 6). The dorsal skin of the rabbit ear was incised in reverse L-shape and the perichondrium was exposed. The silicone membrane from the Terudermis(R) , 1 x 1 cm sized,was removed. The Terudermis(R) was grafted on the exposed perichondrium in the experimental group. However, Terudermis(R) was not grafted in the control group. At 2 and 4 weeks after the surgery, the specimen was obtained and studied by histologic study. The results are as follows: 1. In control group at 2 weeks after surgery, the appearance of perichondrocytes and chondrocytes were not different from those of normal tissue. 2. In control group at 4 weeks after surgery, the extent of chondroblast differentiation and cartilage regeneration was insignificant compared to experimental group. 3. In experimental group at 2 weeks after surgery, we examined the active differentiation process of chondroblast beneath the perichondrium. The mean thickness of the neocartilage layer was 0.11+/-0.04 mm. 4. In experimental group at 4 weeks after surgery, there was an active regenerated new cartilage layer eneath the perichondrium, but the neocartilage layer was immature. The mean thickness of neocartilage layer was 0.33+/-0.10 mm. In conclusion, this study suggested that the grafted Terudermis(R) has an effect on chondrogenetic induction by activating the perichondrium.