Is artificial dermis an effective tool in the treatment of tendon-exposed wounds?

As flap surgery remains the main technique to close wounds with tendon exposure, the application of artificial dermis in these complex soft tissue wounds is seldom reported. The purpose of this article is to review our experiences in the treatment of tendon-exposed wounds with artificial dermis. This retrospective study included 23 patients with 33 tendon-exposed wounds treated with artificial dermis from 2004 to 2009. Data including patient demographics, wound type, duration from artificial dermis implantation to split thickness skin grafting, surgical complications, and clinical outcome were obtained by chart review. Successful treatment was defined as the formation of golden-yellow neodermis followed by successful split thickness skin grafting. Among the 33 tendon-exposed wounds, 11 were secondary to chronic ulcers, 16 to acute wounds, and 6 to surgical wounds after hypertrophic scar excision. The mean patient age was 49 years. The overall success rate with the artificial dermis technique was 82%, including 63% in the chronic ulcer group, 88% in the acute wounds, and 100% in the surgical wounds. In the success group, 11% of the wounds required repeated artificial dermis implantations. Within the failure group, two wounds were closed by below knee amputation, two by local flap surgery, and two were allowed spontaneous healing as a result of graft failure. We have demonstrated an overall success rate of 82% for tendon-exposed wound closure by using artificial dermis. The outcome was better in surgical and acute wounds than in chronic wounds.

Risk factors of tissue-expansion failure in burn-scar reconstruction.

BACKGROUND: Tissue expansion has become invaluable for burn-scar reconstruction. However, its use is hindered by the complications that often result in expansion failure. This study attempts to identify the risk factors of expansion failure in burn patients, as such factors have not been clearly defined. METHODS: This study included 62 tissue expansions in 37 burn patients from January 2001 to June 2009. Factors including patient's age, sex, co-morbidities, expander size, implantation site, volume injected at implantation, preinflation volume ratio (PVR=volume injected at implantation/expander size), final inflation volume ratio (FIVR=cumulative volume injected at completion of expansion/expander size) and expansion duration were analysed. Cases were allocated into success (n=53) and failure (n=9) groups. Logistic regression was used in multivariate analysis for identifying predictors of expansion failure. RESULTS: The mean age of the patients was 29.6 years. The male to female ratio was 1:1.4. Expansion complication and failure rates were 53% (n=33) and 14.5% (n=9), respectively. The risk factors statistically correlated to expansion failure (p<0.05) were age, expander size, PVR and implantation at lower limb. Expansion of lower limbs carried a risk of failure 43 times greater than other sites. CONCLUSION: We conclude that tissue expansion should be avoided in older patients and in lower limbs. The largest possible expander size and inflation at time of implantation should be used to lower the risk of expansion failure.