Clinical application of cultured epithelial autografts on acellular dermal matrices in the treatment of extended burn injuries.

Achieving permanent replacement of skin in extensive full-thickness and deep partial-thickness burn injuries and chronic wounds remains one of the fundamental surgical problems. Presently, split-thickness skin grafts are still considered the best material for surgical repair of an excised burn wound. However, in burns that affect greater than 50% of total body surface area, the patient has insufficient areas of unaffected skin from which split-thickness skin grafts can be harvested. The use of cultured epithelial (or epidermal) autografts (CEAs) has achieved satisfactory results. But the take rate of CEAs is poor in full-thickness bed or in chronically infected area. Providing temporary cover with allograft skin, or a more permanent allodermis, may increase clinical take. This review aims to (1) describe the use of CEAs in the regeneration of the epidermis, (2) introduce the application of the acellular dermal matrices (ADMs) in the clinics, and (3) enhance understanding of the CEAs applied with ADM as an appropriate strategy to treat the extended burn injuries. The current evidence regarding the cultured epithelial cell or keratinocyte autograft and dermal grafts applied in the treatment of burn injuries was investigated with an extensive electronic and manual search (MEDLINE and EMBASE). The included literature (N=136 publications) was critically evaluated focusing on the efficacy and safety of this technique in improving the healing of the deep dermal and full-thickness burn injuries. This review concluded that the use of ADM with CEAs is becoming increasingly routine, particularly as a life-saving tool after acute thermal trauma.

Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis.

BACKGROUND: Vascularized fibular grafting (VFG) has been initiated to treat avascular necrosis of the femoral head (ANFH) since the late 1970s. There are a number of review articles updating the use of VFG to treat the ANFH. None of them applied statistical analysis for combining results from different studies to obtain a quantitative estimate of the overall effect and potential harm of VFG in comparison to other treatment. METHODS: Several electronic databases were searched to find studies using VFG to treat ANFH. The outcomes sought included Harris Score, failure rate (conversion to total hip arthroplasty (THA) and/or femoral head collapse), and complications rate. Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. RESULTS: The clinical results of 69.0 % of VFG-treated patients and 25.0 % of non-VFG-treated patients were good to excellent (OR 0.13; p < 0.01). The conversion rate to THA of VFG-treated and that of other methods treated hips was 16.5 % and 42.6 % (OR 0.19; p < 0.001). Collapse rate of VFG-treated and that of non-VFG-treated hips was 16.7 % and 63.6 % (OR 0.09; p < 0.05). The complication rate of VFG-treated and that of other methods treated patients was 23.8 % and 8.9 % (OR 3.44; p = 0.09). For Steinberg stage I, II ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 9.8 % and 40.2 % (OR 0.17; p < 0.001). For Steinberg stage II, III ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 16.5 % and 42.8 %, respectively (OR 0.17; p < 0.001). CONCLUSIONS: VFG is a justified method that can prevent the ANFH from progressing to collapse, and that can retard or avoid hip replacement, especially in the hips of Steinberg stage I, II, and III.

Role of anti-TNF-α therapy in fat graft preservation.

BACKGROUND/OBJECTIVE: In this study, we evaluated the role of antitumor necrosis factor-alpha (TNF-α) therapy in the decrease of adipocyte apoptosis and weight preservation of fat grafts in the rat model. METHODS: A total of 64 rats were randomly divided into 2 groups, with 32 rats in each group. Autologous fat tissue was grafted subcutaneously on the back of each rat. For the experimental group, antirat TNF-α monoclonal antibody was injected into the fat grafts during operation. No treatment was given to the tissue in the control group. Eight rats in each group were killed respectively, at days 7, 14, 30, and 60 postoperatively and sampled for assessments of weight preservation, gene expression of TNF-α, histology, and adipocyte apoptosis. RESULTS: There were no significant differences in the weight of fat tissues between the control group and the experimental group at days 7, 14, and 30 postoperatively (P > 0.05). However, the preservation ratio of the tissue was 65.36% ± 14.98% in the antirat TNF-α antibody-treated group when compared with the weight at transplantation, which was significantly higher than the control group (44.63% ± 10.39%) 60 days after the operation (P < 0.05). The numbers of apoptotic cells in the control group were 15.6 ± 3.17, 24.6 ± 4.34, 22.8 ± 2.42, and 27 ± 3.83 per field at different postoperative intervals. However, the numbers of apoptotic cells in the tissues treated with TNF-α antibody were significantly lower than that in the control group, which was 1 ± 0.63, 4 ± 1.41, 6 ± 2.08, and 7.2 ± 2.82 per field (P < 0.05). Gene expression showed that the expression of TNF-α was lower in the experimental group than the control group at days 7 and 14 postoperatively (P < 0.05). CONCLUSION: The results indicate that antirat TNF-α monoclonal antibody can preserve the quality of the transplanted fat tissue.

Synthetic and biological mesh in component separation: a 10-year single institution review.

Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Despite the great morbidity associated with incisional hernia, no consensus exists on the best means for treatment (Korenkov et al, Langenbecks Arch Surg. 2001;386:65-73). Ramirez et al (Plast Reconstr Surg. 1990;83:519-526) describes the "component separation" technique to mobilize the rectus-abdominus internal oblique and external oblique flap to correct the defect. This retrospective institutional study reviewed 10 years of myofascial flap reconstruction from 1996 to 2006 at Thomas Jefferson University Hospital and revealed an 18.3% recurrence rate in 545 component separations. We identified obesity (body mass index >30 kg/m2), age >65 years old, male gender, postoperative seroma, and preoperative infection as risk factors for hernia recurrence.