Autologous Homologous Skin Constructs Allow Safe Closure of Wounds: A Retrospective, Noncontrolled, Multicentered Case Series.

An autologous homologous skin construct (AHSC) has been developed for the repair and replacement of skin. It is created from a small, full-thickness harvest of healthy skin, which contains endogenous regenerative populations involved in native skin repair. A multicenter retrospective review of 15 wounds in 15 patients treated with AHSC was performed to evaluate the hypothesis that a single application could result in wound closure in a variety of wound types and that the resulting tissue would resemble native skin. Patients and wounds were selected and managed per provider's discretion with no predefined inclusion, exclusion, or follow-up criteria. Dressings were changed weekly. Graft take and wound closure were documented during follow-up visits and imaged with a digital camera. Wound etiologies included 5 acute and chronic burn, 4 acute traumatic, and 6 chronic wounds. All wounds were closed with a single application of AHSC manufactured from a single tissue harvest. Median wound, harvest, and defect-to-harvest size ratio were 120 cm2 (range, 27-4800 cm2), 14 cm2 (range, 3-20 cm2), and 11:1 (range, 2:1-343:1), respectively. No adverse reactions with the full-thickness harvest site or the AHSC treatment site were reported. Average follow-up was 4 ± 3 months. An AHSC-treated area was biopsied, and a micrograph of the area was developed using immunofluorescent confocal microscopy, which demonstrated mature, full-thickness skin with nascent hair follicles and glands. This early clinical experience with ASHC suggests that it can close different wound types; however, additional studies are needed to verify this statement.

Salvage of end-stage erectile dysfunction using vascularized fibula as autologous implant.

INTRODUCTION: Patients in whom medical and surgical options for the treatment of erectile dysfunction have failed pose a unique challenge to reconstructive genitourinary surgeons. We report a novel reconstructive option for the treatment of end-stage erectile dysfunction using a microsurgically transferred vascularized fibula as an autologous implant in a patient in whom multiple inflatable prostheses had failed. TECHNICAL CONSIDERATIONS: A reconstructive team, consisting of urologic and plastic reconstructive surgeons, transferred a vascularized fibula into the corporeal body in 1 patient to restore sexual function. Using this technique, successful intercourse was achieved by 6 months of follow-up. We describe the surgical technique of autologous implant of a vascularized fibula in the salvage treatment of end-stage erectile dysfunction. CONCLUSIONS: Patients with multiple failed inflatable penile implants can present a formidable challenge to reconstructive surgeons with regard to restoring adequate sexual function. The standard approach to the patient after repeated episodes of unsuccessful salvage of penile prosthesis due to infection and/or extrusion is to remove the prosthesis, leaving the patient impotent. Vascularized autologous tissue transfer provides an option to salvage end-stage erectile dysfunction.