From skin allograft coverage to allograft–micrograft sandwich method: A retrospective review of severe burn patients who received conjunctive application of cultured epithelial autografts

A 12-year retrospective review of severe burn patients who received cultured epithelial autografts (CEA) at the Singapore General Hospital Burns Centre from January 2005 to December 2016 was carried out. During this period, two different surgical modalities were employed to manage these burn injuries. In the earlier period, following early excision of the burn wounds, exposed surfaces were covered with a combination of split thickness skin autografts (STSG) and allografts. Surfaces covered with skin allografts were subsequently debrided of the allo-epidermis in about 3 weeks later, exposing the allodermis with granulating tissues for grafting of CEA; a technique known as the Cuono’s method. In the later period, allograft–autologous micrograft sandwich technique was used to graft on the early excised burns with subsequent CEA grafting. The former and latter groups represented by STSG/C (n = 10) and M/CEA (n = 14) respectively, were compared in terms of clinical profiles, outcomes, allograft/CEA usage and total graft cost. No significant differences were found based on mean age and presence of inhalation burns between the two treatment methods However, percentage total body surface area (TBSA) and Revised Baux Score were significantly higher (p < 0.05) in the M/CEA group compared to the STSG/C group. Differences in clinical outcomes of mortality and length of hospital stay between the 2 groups were statistically insignificant. The average area amount of skin allografts used per patient in the M/CEA group was significantly lower compared to the STSG/C method group which contributed to lower total average cost of grafts used per % TBSA in the M/CEA method group. This might be attributed to the presence of micrografts which seemed to improve stabilization of the wound bed resulting in less operating procedures and improving CEA take. To conclude, the M/CEA method introduced was able to treat more severe burn patients at lower graft costs without compromising critical clinical outcomes significantly.     

自体与新鲜同种异体骨软骨移植的实验研究

目的:评价自体与新鲜异体骨软骨镶嵌移植两种方法修复全层关节软骨缺损的生物学特性和修复效果。方法:采用完全随机设计,将16只新西兰大白兔的左右后肢制成全层软骨缺损模型,分别进行自体骨软骨镶嵌移植、同种异体骨软骨镶嵌移植修复。术后第12周处死动物取材,分别进行膝关节活动度测定、大体观察、光镜观察及Wakitani组织学评分法,数据行统计学分析。结果:膝关节伸屈活动度、大体观察、组织学光镜及组织修复评分显示自体骨软骨移植在第12周时能以类透明软骨组织修复缺损,而新鲜同种异体骨软骨移植为纤维肉芽组织。结论:自体骨软骨镶嵌移植可以修复兔关节软骨的缺损。新鲜无处理的同种异体骨软骨镶嵌移植修复关节软骨缺损不可行,其排斥反应及吸收破坏严重。     

Double papilla repositioned flap for the treatment of isolated recession – A case report

Root coverage is achieved by many procedures like free gingival autografts, connective tissue grafts and pedicle grafts. Several studies state that root coverage using connective tissue grafts have high success rates but have disadvantages like creation of second surgical site and post-operative color harmony is less. Although Cohen and Ross reported more than 85% success in covering denuded roots, the degree of success varies among other clinicians. The double papilla pedicle graft has limited usefulness. The double papillae pedicle graft is most appropriate in those cases where esthetics demand a close tissue color match and where the papillae are large and have shallow gingival grooves.     

Outcomes of sprayed cultured epithelial autografts for full-thickness wounds: a single-centre experience

Introduction

The lack of autograft donor sites with major burns provides the impetus to develop innovative solutions due to the difficulty of wound closure. Autograft donor sites are particularly limited in patients with burns involving over 50% total body surface area (TBSA). The introduction of cultured epithelial cell autografts offers a potential solution to assist in wound closure. The objective of this study was the assessment of clinical results after sprayed application of the cultured epithelial autograft (CEA, Keraheal™, Seoul, Korea, MCTT) suspension onto the wounds of extensively burned patients.

Materials and methods

This retrospective clinical audit of major burn patients (n = 16) describes the use of CEA which was combined with 6:1 meshed expansion grafts in those with the burn over 40% TBSA in our hospital between the period of August 2007 and January 2010. The burn patients included 12 males and 4 females with a mean age 41.5 and a burn area of 51.3 ± 3.1% TBSA (30–70%; median: 50.5%) and a mean third burn area of 32.5 ± 3.0% TBSA (median 34.0%).

Results

The take rates were 37.6%, 68.0% and 90.0% on average at 2, 4 and 8 weeks after treatment with the suspension, respectively, and the transplantation of the cultured cells was applied to full-thickness burns, with the coverage of a skin area of 497.5 cm² per 1 ml of the cultured cells. For clinical follow-up, 12 patients were observed for 21.5 months on average, with a maximum follow-up period of 39 months. Six patients were excluded from the surveillance because two died during hospitalisation and the other four were impossible to trace.

Conclusion

The use of a sprayed cultured epithelial cell autograft (Keraheal™) in treating a full-thickness skin wound in severely burned patients results in favourable quality of scars and also good potential to save lives by providing epidermal cover.     

Fate of cartilage autografts for ossiculoplasty: an electron microscopic study

Two cartilage autografts used for ossiculoplasty for 3 and 8 years were examined under the transmission electron microscope. The most significant change was progressive deposition of calcium salts in the matrix of the cartilage. Chondrocytes showed degenerative changes in the nuclei, cytoplasm, and cell walls. Contrary to common belief, autograft cartilage did not seem to resorb in time.     

Cultured epithelial autografts in massive burns: a single-center retrospective study with 63 patients

Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availability and difficulty of permanent skin coverage in massive burns, but this approach still has limited documentation.

Methods

In this retrospective, single-center study, medical records of patients treated with CEAs in our burn center from 1991 until 2008 were analyzed in search of factors associated with outcome.

Results

Out of 68 patients, 63 records were analyzable. Patients were aged 29 [17-41.5] years (seven children). Total body surface area (TBSA) burned was 81 ± 10%, of which 69 ± 14% TBSA full thickness. CEAs were first applied after 45 ± 34 days, on a surface of 32 ± 14% TBSA. Success rate at take down was 65 ± 19%, correlating only with young age (r² = 0.18; p = 0.0006). At discharge, CEAs covered 26 ± 15% TBSA. Infections (4.3 ± 2 per patient), most frequently of skin, often complicated the clinical course. Mortality was 16% (10 patients). In multivariate analysis, the number of infections was the only factor associated with mortality (OR = 2.05 per single infection, 95%CI 1.03-4.07, p = 0.04).

Conclusion

Although complex and costly, CEAs can be used with reasonable success and satisfying survival results for the treatment of massive burns. In this study, favorable outcome was principally associated with young age and low number of infectious complications.     

酪氨酸酶在自体中厚移植皮片中的表达

目的:检测酪氨酸酶在人体自体中厚移植皮片中的表达,并与自身正常皮肤作对照,初步认识酪氨酸酶在自体移植皮片色素过度沉着中的作用。方法:利用免疫组化法检测人体自体中厚移植皮片与原供区及受区周围自体正常对照皮肤中酪氨酸酶的蛋白表达,并行统计学分析。结果:酪氨酸酶的表达定位于表皮基底部黑素细胞的细胞质,在大部分自体中厚移植皮片中呈强阳性表达,表达率为65.2%,与自体正常对照皮肤比较,差异有显著性意义(P<0.01);酪氨酸酶在受区与原供区周围正常对照皮肤中的表达差异无显著性意义(P>0.05)。结论:α黑素细胞刺激激素(αMSH)在自体中厚移植皮片中较自体正常对照皮肤中的表达显著增高,在自体移植皮片色素过度沉着中起重要的调控作用。     

翼状胬肉切除联合自体结膜瓣移植术对泪膜泪液状态的影响

目的 分析研究翼状胬肉切除联合自体结膜瓣移植术对翼状胬肉患者泪膜泪液状态的影响。 方法 对65例翼状胬肉患者分别在术前3 d及术后7 d、术后1个月、3个月作泪膜泪液相关检查,包括泪膜破裂时间(BUT)、基础泪液分泌Ⅰ试验(SⅠ)及角膜荧光素染色(FL),并做对比分析。 结果 BUT及FL术前与术后不同时间对比,差异有统计学意义(P<0.05);SⅠ试验结果手术前后对比差异无统计学意义(P>0.05)。 结论 翼状胬肉切除联合带有角膜缘上皮的游离结膜瓣移植术可以有效改善翼状胬肉术后的泪膜泪液的功能。     

Ultrastructure of parathyroid autografts in chronic renal failure including the occurrence of concentric membranous bodies and intermediate filaments

The ultrastructure of long-term parathyroid autografts and their donor glands has been studied in nine patients with chronic renal failure. Autografts showed ultrastructural features of functional activity. Unusual findings included the presence of 'spironolactone-like' concentric membranous bodies derived from the endoplasmic reticulum in one hyperplastic autograft and prominent intracellular intermediate filaments (tonofilaments) in the donor parathyroid gland and recurrent autograft growths in another patient.     

Reconstruction of Acetabular Defects With Impaction Grafting in Primary Cemented Total Hip Arthroplasty Produces Favorable Results: Clinical and Radiographic Outcomes Over 6.4 Years on Average

BackgroundCemented primary total hip arthroplasty (THA) associated with acetabular reconstruction (AR) involving impacted bone grafting has been employed successfully in the revision of cavitary defects but the results are reportedly less predictable for segmental defects. The objective of the study is to evaluate the clinical and radiographic results of patients who had presented cavitary, segmental, and combined acetabular defects and received THA/AR involving impacted morselized cancellous bone autografts followed by rigorous postoperative management.MethodsClinical outcomes were assessed retrospectively of 154 patients who had been submitted to 169 THA/AR procedures performed by a single surgeon over a 15-year period. The Harris Hip Score system was applied to 103 patients, and the degree of acetabular migration was determined from radiograph images of 91 AR procedures, of which 40 were segmental/combined and 51 were cavitary reconstructions.ResultsThe frequency of aseptic acetabular loosening was 3% while that of thromboembolic events was 4.1%. According to Harris Hip Score, 87.4% of outcomes were classified as excellent/good after an average follow-up period of 6.4 years irrespective of the type of acetabular defect. Horizontal and/or vertical acetabular migrations and changes in angular tilt were observed in all ARs, although the minor movements detected did not undermine the structural stability of the reconstructions or the functional capacity of patients.ConclusionThe described THA/AR technique can be used effectively in the reconstruction of segmental/combined and cavitary acetabular defects. The success of the technique as applied to segmental/combined defects was attributed in part to the rigorous rehabilitation protocol with temporary postoperative weight-bearing restriction.