Adipose-derived stromal vascular fraction aids epithelialisation and angiogenesis in an animal model.

OBJECTIVE: Limited data exist regarding the correlation between adipose-derived stromal vascular fraction (SVF) and wound healing. The aim of this study was to investigate the direct effect of intradermally injected SVF on full-thickness cutaneous wounds in a murine model. METHOD: Wistar rats were divided into three groups (A, B and C) according to their day of euthanasia (day 7, 16 and 21). Inguinal fat pad was excised and SVF enzymatically extracted. Full-thickness cutaneous wounds were created on each side of the dorsum; SVF injected intradermally at one side while the contralateral wound served as control receiving normal saline. Postoperatively, evaluation of wound healing was performed by planimetry (percentages of wound contraction, epithelialisation and total wound healing) on days 0, 3, 5, 7, 10, 13, 16 and 21, and histology and immunochemistry (cellular infiltration score, collagen production score, neoangiogenesis and epithelial thickness) on days 7, 16 and 21. RESULTS: Despite the high rate of wound contraction, it was significantly lower in the SVF-treated wounds on day 21 (p=0.037). On days 13, 16 and 21, the percentages of epithelialisation were higher in the SVF-treated wounds compared with control wounds (p=0.026, p=0.048 and p=0.05, respectively). Histologically, the number of new vessels was significantly higher in the SVF-treated wounds compared with controls on days seven (p=0.028) and 16 (p=0.027). This was also confirmed by immunohistochemistry. No significant differences were found between treated and control wounds regarding cellular infiltration score, collagen production score and epithelial thickness. CONCLUSION: Data indicate that intradermally injected SVF increases angiogenesis and enhances epithelialisation in full-thickness cutaneous wounds in rats.

Reconstruction of skin avulsion injuries of the upper extremity with integra(®) dermal regeneration template and skin grafts in a single-stage procedure.

INTRODUCTION: Management of skin avulsion injuries of the upper extremity may require coverage with large flaps or skin autografts. Cutaneous grafting is frequently combined with artificial skin to optimize the final functional and cosmetic result. The conventional use of bilaminated dermal substitutes consists of a two-stage procedure and requires long immobilization of the operated area. The purpose of this retrospective study is to evaluate the impact of a dermal regeneration template immediately covered by skin grafts in a one-step procedure for reconstructing skin avulsion injuries of the hand and forearm. MATERIALS AND METHODS: We performed this technique in eight patients who presented with extended skin defects of the hand and forearm following skin avulsion injuries. Dimensions of the defects ranged from 160 to 1,250 cm(2). After debridement, Integra(®) Single Layer was applied and covered with unmeshed thin skin autografts; compressive dressings were used for 1 week and mobilization started by the second postoperative week. Histological examination of the grafted areas was performed 2 weeks after surgery. Functional and cosmetic outcome was assessed 12 months postoperatively. RESULTS: The overall take rate of the dermal substitute and skin graft was 95-98 %. Histological results showed complete incorporation and vascular proliferation of the template, which allowed the neo-vascularization of the overlying autograft. The mean grip strength of the operated hands was at the 83 % of the normal contralateral hands. Pliability and overall appearance of the reconstructed areas was satisfactory (mean Vancouver Scar Scale Score 1.875). CONCLUSIONS: The use of Integra(®) Single Layer dermal substitute and immediate skin overgrafting consists an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.

Reconstruction of perineoscrotal and vaginal defects with pedicled anterolateral thigh flap.

OBJECTIVE: To present a series of perineoscrotal and vaginal defects reconstruction with the use of anterolateral thigh flap. METHODS: We present a series of 11 patients in whom we used pedicled thigh flaps (10 anterolateral thigh flaps and 1 anteromedial thigh flap) to cover defects of perineum, scrotum, and vagina. Ten patients had perineoscrotal defects and 1 patient had vaginal agenesis. RESULTS: Age group ranged from 26 to 79 years. The size of the flaps ranged from 105 cm² to 220 cm². The vascular pedicle length ranged from 10 cm to 12 cm. Stable closure was achieved in every patient. There were no complications from the donor site. In 1 patient, we found only 1 perforator at the superomedial edge of the flap that originated from the medial circumflex femoral artery; hence, in this patient, we used an anteromedial thigh flap as a salvage procedure. CONCLUSION: With versatility in their design and low donor site morbidity, these flaps present an option in the armamentarium of the reconstructive surgeon for the coverage of defects at the perineoscrotal and vaginal area.