Combination of meshed dermis graft and cultured epithelial autograft for massive burns: Three case reports.

RATIONALE: This study reviewed the use of a combination of meshed dermis graft and cultured epithelial autografts (CEA) made in Japan "JACE" (JACE; Japan Tissue Engineering Co., Ltd. Japan) for the treatment of massively burns. JACE is a Green-type CEA. We recently described a method in which we prepare the wound bed for burned patients by using artificial dermis and graft with JACE on a meshed 6:1 split-thickness autograft. In this report, we used a meshed 3:1 split-thickness dermis graft without epithelial cells. There are several reports of combination of using CEA on meshed split-thickness autograft, however this is the first report of using CEA on meshed split-thickness dermis graft. PATIENT CONCERNS AND DIAGNOSIS: Between March 2015 and August 2017, 3 burn patients were enrolled in this study. The patients ranged in age from 51 to 66 years. All 3 patients suffered severe burn injury that caused by flame. % Total Body Surface Area (TBSA) burned were ranged from 37.5% to 69%. INTERVENTIONS: All patients received surgical treatment with tangential excision within a week from admission. We implanted artificial dermis immediately after debridement. Basically, we applied meshed 6:1 split-thickness autografts to the wound bed and covered with JACE. However, in the absence of split-thickness autografts, we used a meshed 3:1 split-thickness dermis graft instead of a meshed 6:1 split-thickness autograft. OUTCOMES: At 3 weeks after the transplantation of JACE, the take rate for JACE sheets was >60% on the meshed 3:1 split-thickness dermis graft. Furthermore, almost all of the burn wounds had healed at 6 weeks after surgery. LESSONS: We observed good results by grafting JACE on meshed 3:1 dermis graft. With this new method, it is possible to cover a large burn wound by harvesting tissue from only a small site.

Changes in the Dermal Structure during Cultured Epidermal Autograft Engraftment Process.

The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE). METHODS: We undertook a skin biopsy at 2, 4, and 6 weeks after transplantation with JACE. By using electron microscopy we observed the engraftment process. RESULTS: In transmission electron microscope findings, we recognized the engraftment process of JACE. Keratinocytes matured gradually. Collagen fibers formed thick bundles in the dermis layer. In scanning electron microscope findings, we observed papillary dermis development on the artificial dermis. CONCLUSIONS: After managing wound bed preparation by using artificial dermis, we were able to recognize the good result of grafting JACE on meshed 6:1 split thickness autografts. This is because the auto dermis from autograft extended under the JACE, binding between JACE, and the dermis became strong.

Hemi aplasia of the nose with complete cleft lip and palate of the contralateral side.

Nasal aplasia, including hemi aplasia of the nose, is a rare congenital anomaly of the nose. Since the ipsilateral side tends to be affected more frequently than the contralateral side of the face in half nose anomalies, only reports concerning the ipsilateral defect are numerous. This report presents an unusual case of hemi aplasia of the nose with complete cleft lip and palate of the contralateral side. A local flap on the nasal dorsum was used for nasal reconstruction, where correction of the elongation of the inner canthal distance and the shape of the inner canthus was performed.

Left displacement of the mediastinum determines the imbalance in the pulmonary vascular bed and lung volume in children with pectus excavatum.

The purpose of this study was to determine the influence of morphologic alteration on lung function in children with pectus excavatum (PE) and to establish the usefulness of chest radiography to predict the imbalance of pulmonary perfusion and lung volume. Chest radiography, pulmonary perfusion scintigraphy, and computed tomography (CT) for calculation of each lung volume were performed in 38 children with PE. To assess the relationship between position change of the mediastinum and lung, the following indices were calculated: (1) vertebral index (VI); the severity of sternal depression on the lateral chest radiograph, (2) left displacement index (LDI); the ratio between the left border of the mediastinum and the left border of the thorax to the transverse thoracic dimension on posterioanterior chest radiography; (3) left-to-right count ratio for the lung scintigraphy (Ls/Rs), and (4) the left-to-right thorax volume ratio from the CT scan (Lv/Rv). Compared to children without PE, VI was significantly higher, and LDI was lower in patients with PE. Pulmonary perfusion scintigraphy and CT showed that left pulmonary perfusion and lung volume were significantly lower than in the right lung in PE. LDI showed a close correlation with Ls/Rs (R = 0.443, P = 0.005) and Lv/Rv (R = 0.703, P < 0.001). Left displacement of the mediastinum within the closed thoracic cavity directly imposes constraints on the left lung, resulting in reductions of perfusion and lung volume that likely determine the physiologic severity of lung function in PE. Posterioanterior chest radiography might be useful in predicting the severity of PE.

Visceral coverage with absorbable mesh followed by split-thickness skin graft in the treatment of ruptured giant omphalocele.

We report a case of ruptured giant omphalocele in whom herniated organs were successfully covered by an absorbable mesh and a subsequent skin graft. A 2,200 g male baby was born at 35 weeks of gestation. An abdominal wall abnormality was detected by prenatal ultrasound at 21 weeks of gestation. At birth, the entire liver, stomach, and small and large bowel had herniated from the defect of the abdominal wall. The thorax and abdomen were highly underdeveloped, and attempts to reduce the organs into the abdomen were unsuccessful due to the extremely small abdominal cavity and associated pulmonary hypoplasia. To protect the herniated organs and prevent abdominal infections, the organs were covered by a polyglycan mesh and subsequently a meshed split-thickness skin graft. Ten weeks later, it was confirmed that the organs were completely covered by epithelialized tissue. However, the patient suffered from frequent respiratory infections and finally died of respiratory insufficiency. Based on the experience of the patient, we conclude that coverage of the herniated organs with an absorbable mesh and a skin graft is a recommendable treatment in ruptured giant omphalocele.

Umbilicoplasty for large protruding umbilicus accompanying umbilical hernia: a simple and effective technique.

A large umbilical protrusion with redundant skin accompanying an umbilical hernia sometimes needs umbilicoplasty. Although several different techniques for making umbilical depression have been used, the results of the plastic surgery are sometimes unsatisfactory due to postoperative flattening or disappearance of the umbilical depression. To make a permanent umbilical depression that is cosmetically acceptable, we have modified the techniques. Umbilicoplasty was performed in 14 children whose ages ranged from 6 months-6 years and 3 months (median, 1 year and 10 months) and who had umbilical hernia with a large umbilical protrusion. After the fascial defect was closed, the diameter of the umbilicus was reduced to half that before surgery by removing fan-shaped skin flaps and approximating skin edges, and then inverting the umbilicus and fixing it caudally to the fascia and skin. There were no postoperative complications, and no flattening or disappearance of umbilical depression was observed during the follow-up of 10-19 months. The authors' technique of umbilicoplasty for a large protruding umbilicus accompanying umbilical hernia is a simple method that produces acceptable cosmetic results.