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Background Full-thickness skin grafts (FTSGs) have been widely used after facial skin cancer resection, for correcting defects that are too wide to be reconstructed using a local flap or if structural deformation is expected. The preauricular, posterior auricular, supraclavicular, conchal bowl, nasolabial fold, and upper eyelid skin areas are known as the main donor sites for facial FTSG. Herein, we aimed to describe the effectiveness of using infraclavicular skin as the donor site for specific cases. Methods We performed FTSG using the infraclavicular skin as the donor site in older Asian adults following skin cancer resection. Outcomes were observed for > 6 months postoperatively. The Manchester Scar Scale was used for an objective evaluation of satisfaction following surgery and scarring. Results We analyzed the data of 17 patients. During follow-up, the donor and recipient sites of all patients healed without complications. Upon evaluation, the average Manchester Scar Scale scores for the recipient and donor sites were 7.4 points and 5.7 points, respectively. Conclusion In general, conventional donor sites, such as the preauricular, posterior auricular, and supraclavicular sites, are widely used for facial FTSG because they achieve good cosmetic results. However, the infraclavicular skin may be a useful donor for facial FTSG in cases where the duration of time spent under anesthesia must be minimized due to a patient's advanced age or underlying health conditions, or when the recipient site is relatively thick area, such as the nose, forehead, or cheek.

New autologous skin regeneration technology yielded full‐thickness skin as evidenced by clinical observation and skin biopsy 5 months after surgery, providing relief for debilitating split‐thickness skin graft contracture in a pediatric burn case., New autologous skin regeneration technology yielded full‐thickness skin as evidenced by clinical observation and skin biopsy 5 months after surgery, providing relief for debilitating split‐thickness skin graft contracture in pediatric burn case.

During a full-thickness skin graft procedure, the thickness of the harvested donor skin is adjusted based on the location of the recipient site and the judgment of the surgeon. Conventionally, the thickness of the harvested skin is roughly adjusted using surgical instruments such as scalpels and scissors. However, this method is not only time-consuming, but also requires effort to obtain both the desired thickness of the harvested skin and a smooth surface of that skin. Moreover, there is a possibility of skin perforation. Hence, the authors devised a method of adjusting harvested skin thickness using the Versajet Hydrosurgery System. The Versajet device is a handheld hydrosurgical tool that delivers a high-speed jet stream of saline solution, which enables the precise debridement of tissue. This method makes it easier and faster for the surgeon to obtain the desired thickness of harvested skin. In addition, by obtaining a smooth surface and an even thickness of harvested donor skin, this technique may lead to improved graft viability.

Background Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss. However, for patients with extensive burns, split-thickness skin grafting is limited by donor skin availability. Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality. Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds, but their application currently requires two surgeries. The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model. Methods A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old. The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac, respectively, were overlaid on minced split-thickness skin grafts to repair the defects. Wound healing rate and quality were compared between the two groups. For better illustration of the quality of wound healing, some results were compared with those obtained for normal skin of rats. Results We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis. In addition, this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation. Conclusions Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of full-thickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia. METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system. RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups. CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

Objective. This study aimed to examine the effectiveness of ozonated Aloe vera oil on the wound healing response of full-thickness defect tissue in Sprague-Dawley rats, assessed by collagen thickness and the number of fibroblasts. Methods. This was an experimental research method using control groups and treatment groups with a posttest only control group design. The results showed that collagen thickness in wounds tended to increase, assessed on day 3 and day 7 using Masson’s trichrome staining and microscopic evaluation. Results. There was a significant difference in the number of fibroblasts between the two control and treatment groups on days 3 and 7 tested using one-way Kruskal–Wallis test, with a value of p = 0.001 p < 0.05 , resulting in a significant difference in wound size reduction between the groups. Further post hoc analysis using the Mann–Whitney test indicated a significant difference between the control groups and the treatment groups (P0, P1 versus P3, P4, P5, P8, P9, and P10) with a value of p = 0.009 p < 0.05 . Conclusions. Ozonated Aloe vera oil is effective in increasing the healing response of full-thickness defects, leading to the increase in the number of fibroblasts and collagen thickening that in turn accelerates wound healing in Sprague-Dawley rats.

Summary:. Split-thickness skin graft has been the standard in the coverage of large full-thickness skin defects. However, donor sites can be associated with significant pain and scarring. Further, the recipient sites frequently lack some basic skin functions, such as temperature regulation, uniform texture, appropriate color, normal pliability, elasticity, and lubrication. Full-thickness skin grafts, while able to more adequately recapitulate skin function, have even greater donor site requirements. Implantation of full-thickness skin micro-columns is a relatively novel concept in which the skin is harvested orthogonally rather than tangentially. These micro-columns contain elements of full-thickness skin grafts, including reticular dermal fibroblasts, hair follicles, skin adnexa, and adipose tissue—all elements that contribute to skin function. Notably, it has been shown that the diameter of the skin micro-columns determine donor site morbidity; however, in most cases, full-thickness skin micro-column harvest results in a trivial donor site far less invasive or morbid than a traditional full-thickness skin graft or split-thickness skin graft harvest. Here, we present 2 cases in which full-thickness skin micro-columns were harvested and implanted into a bilayer dermal regeneration matrix (Integra) to achieve durable single-stage skin replacement with practically no donor site morbidity.

ObjectiveThis study investigated the synergistic repair effects of Prontosan hydrogel and carbon photon therapy in a rat full-thickness wound model.MethodsThe wavelength distribution of the photon source was determined. Dehydration of the Prontosan hydrogel and fibroblast viability were analyzed following exposure to different durations of light exposure at different distances from the source. Indexes of wound healing in a full-thickness rat wound model were then determined in groups ( n = 8 each) subjected to either no treatment, Prontosan treatment only, carbon photon therapy only, or a combination of the two treatments (synergistic group).ResultsCarbon photon exposure for 15 minutes at a distance of 20 cm from the wound was found to be optimal. Wound healing occurred faster in the synergistic group compared with the control and single-treatment groups. Growth factor secretion, granulation tissue formation, inflammation regulation, collagen deposition, and neovascularization were all higher in the synergistic group.ConclusionsProntosan hydrogel combined with carbon photon therapy may provide an optimal environment for wound healing and serve as a novel physical approach to the treatment of wounds. However, the number of animals included in this study was relatively small and a larger study is required to confirm these findings.

Basal cell carcinoma in medial canthal is a surgical challenge to oculoplastic surgeon. We report a case an 80 –year-old woman who presented with a vegetative tumor in the right inferior medial canthus that increased slowly in size over the past two years. An excisional biopsy from the tumor was suggestive of a basal cell carcinoma. A full-thickness excision of the tumor within the oncologic safety limits, was performed. A wide range of reconstruction techniques should be customized to the individual patient. In this case, the use of a preauricular full. Thickness skin graft was a favorable option, without complications, and with acceptable functional and cosmetic results. The aim of the treatment is to restore anatomy, functional and cosmetic of the patients.

Two cases are presented where large (25 mm and 45 mm diameter) skin cancers were removed followed by the application of full thickness skin grafts over the defect where the margins of these defects had been de-epithelialized in order to enhance the take of the full thickness skin grafts.FTSGs have a greater risk of failure as compared to split skin grafts (SSG). This relates to the thickness of the graft (split vs full thickness) and the time to vascularization of the defect bed (48 hours). It is proposed that de-epithelialization of the wound (recipient) margin provides an immediate partial wound vascular bed, reducing the need for adequate vascularization of the recipient wound bed.These cases suggest that with marginal de-epithelialization of the recipient wound margin, survival of a large skin graft can be enhanced. Keywords: Skin neoplasms, Transplantation, Scalp, Hand

BACKGROUND: The management of deep partial-thickness and full-thickness skin defects remains a significant challenge. Particularly with massive defects, the current standard treatment, split-thickness skin grafting, is fraught with donor-site limitations and unsatisfactory long-term outcomes. A novel, autologous, bioengineered skin substitute was developed to address this problem. METHODS: To determine whether this skin substitute could safely provide permanent defect coverage, a phase I clinical trial was performed at the University Children's Hospital Zurich. Ten pediatric patients with acute or elective deep partial- or full-thickness skin defects were included. Skin grafts of 49 cm were bioengineered using autologous keratinocytes and fibroblasts isolated from a patient's small skin biopsy specimen (4 cm), incorporated in a collagen hydrogel. RESULTS: Graft take, epithelialization, infection, adverse events, skin quality, and histology were analyzed. Median graft take at 21 days postoperatively was 78 percent (range, 0 to 100 percent). Healed skin substitutes were stable and skin quality was nearly normal. There were four cases of hematoma leading to partial graft loss. Histology at 3 months revealed a well-stratified epidermis and a dermal compartment comparable to native skin. Mean follow-up duration was 15 months. CONCLUSIONS: In the first clinical application of this novel skin substitute, safe coverage of skin defects was achieved. Safety and efficacy phase II trials comparing the novel skin substitute to split-thickness skin grafts are ongoing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Malaria, a disease caused by Plasmodium parasites, is widespread throughout tropical and sub-tropical regions worldwide; it mostly affects children and pregnant woman. Eradication has stalled despite effective prevention measures and medication being available for this disease; this has mainly been due to the parasite's resistance to medical treatment and the mosquito vector's resistance to insecticides. Tackling such resistance involves using renewed approaches and techniques for accruing a deep understanding of the parasite's biology, and developing new drugs and vaccines. Studying the parasite's invasion of erythrocytes should shed light on its ability to switch between invasion phenotypes related to the expression of gene sets encoding proteins acting as ligands during target cell invasion, thereby conferring mechanisms for evading a particular host's immune response and adapting to changes in target cell surface receptors. This review considers some factors influencing the expression of such phenotypes, such as Plasmodium's genetic, transcriptional and epigenetic characteristics, and explores some host-related aspects which could affect parasite phenotypes, aiming at integrating knowledge regarding this topic and the possible relationship between the parasite's biology and host factors playing a role in erythrocyte invasion. © 2019 Ararat-Sarria, Patarroyo and Curtidor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

The human skin is involved in protecting the inner body from constant exposure to outer environmental stimuli. There is an evident need to screen for toxicity and the efficacy of drugs and cosmetics applied to the skin. To date, animal studies are still the standard method for substance testing, although they are currently controversially discussed Therefore, the multi-organ chip is an attractive alternative to replace animal testing. The two-organ chip is designed to hold 96-well cell culture inserts (CCIs). Small-sized skin equivalents are needed for this. In this study, full-thickness skin equivalents (ftSEs) were generated successfully inside 96-well CCIs. These skin equivalents developed with in vivo-like histological architecture, with normal differentiation marker expressions and proliferation rates. The 96-well CCI-based ftSEs were successfully integrated into the two-organ chip. The permeation of fluorescein sodium salt through the ftSEs was monitored during the culture. The results show a decreasing value for the permeation over time, which seems a promising method to track the development of the ftSEs. Additionally, the permeation was implemented in a computational fluid dynamics simulation, as a tool to predict results in long-term experiments. The advantage of these ftSEs is the reduced need for cells and substances, which makes them more suitable for high throughput assays. The human skin is involved in protecting the inner body from constant exposure to outer environmental stimuli. There is an evident need to screen for toxicity and the efficacy of drugs and cosmetics applied to the skin. To date, animal studies are still the standard method for substance testing, although they are currently controversially discussed Therefore, the multi-organ chip is an attractive alternative to replace animal testing. The two-organ chip is designed to hold 96-well cell culture inserts (CCIs). Small-sized skin equivalents are needed for this. In this study, full-thickness skin equivalents (ftSEs) were generated successfully inside 96-well CCIs. These skin equivalents developed with in vivo-like histological architecture, with normal differentiation marker expressions and proliferation rates. The 96-well CCI-based ftSEs were successfully integrated into the two-organ chip. The permeation of fluorescein sodium salt through the ftSEs was monitored during the culture. The results show a decreasing value for the permeation over time, which seems a promising method to track the development of the ftSEs. Additionally, the permeation was implemented in a computational fluid dynamics simulation, as a tool to predict results in long-term experiments. The advantage of these ftSEs is the reduced need for cells and substances, which makes them more suitable for high throughput assays.

Background/Aim. Surgeons often face with the problem when selecting a reconstructive method for nasal skin defects. The aim of this study was to determine functional and aesthetic character-istics of different reconstructive methods used for skin defects in different regions of the nose. Methods. The study involved 44 patients with basocellular carcinoma in nasal area. The nasal skin was divided into four subunits: the tip, the alar lobules, the side-walls and the dorsum. The average skin defect size was 10 mm in diameter. Local flaps and full thickness skin grafts were used in the study. We analyzed the functional and esthetic results of dif-ferent reconstructive methods used for nasal defects in different regions of the nose 12 months after the surgery. Results. The study shows that different reconstructive methods produce dif-ferent functional and esthetic results in the same nasal subunits and that the same reconstructive method produces different re-sults in different nasal subunits. Conclusions. Estimation the postoperative functional and esthetic characteristics of different reconstructive methods is one of the basic preconditions of suc-cessful reconstruction.

We describe a new technique of temporary stabilisation of a divergent Lisfranc fracture dislocation of foot with severe crush injury using an Ilizarov frame. A 69-year-old man presented with severe crush injury and complete disruption of the midfoot. Examination revealed full thickness skin necrosis, haemorrhagic blisters and extensive swelling. A staged technique was used with temporary application of an Ilizarov frame followed by delayed limited internal fixation. Excellent result was achieved with restoration of medial arch, complete pain relief and good functional outcome. A staged treatment initially using an Ilizarov frame prior to limited internal fixation allows soft tissue to settle in severe crush injury. Keywords: Lisfranc, Ilizarov frame, Crush injury

The suppression of elements associated with wound contracture and unfavorable scarring is a potentially important strategy in clinical wound management. In this study, the presence of α smooth muscle actin (αSMA), a protein involved in wound contraction, was analyzed in a series of wounds in which bovine fetal collagen (BFC) acellular dermal matrix (PriMatrix) was used in staged split thickness skin graft procedures. The results obtained through histological and quantitative image analyses of incidental biopsies from these wounds demonstrated a suppression of αSMA in the wound regions occupied by assimilated BFC relative to increased levels of αSMA found in other areas of the wound. The αSMA levels found in assimilated BFC were similar to αSMA levels in uninjured human dermis. These findings suggest a mechanism by which application of BFC could decrease contraction of full thickness skin wounds.

Full-thickness skin grafts (FTSGs) are frequently used to treat patients with burn injuries and to repair defects rendered by excisional (including Mohs) surgery. The evidence for corrective laser surgery after scar formation is well established. With regard to laser treatment of FTSG, the evidence is sparse. Laser treatment after FTSG is a novel concept, with minimal literature. We present a case series, one of the first to our knowledge, of the treatment of FTSG with fractional CO2 laser in five patients after Mohs surgery.

BACKGROUND: Importance: Hernia surgery requires reinforcement material with few side effects when used in the intraperitoneal position. Autologous skin grafting may meet this requirement, but animal experiments are obligatory before being applied in humans. OBJECTIVE: To compare survival and effects of isogeneic full-thickness skin grafts in the intraperitoneal onlay mesh (IPOM) position in mice, with a control group using the onlay position. Primary end point was graft survival and secondary end point adhesion formation and inflammation through NF-κB activity. METHODS: Design: Intervention study with 8-week follow-up in accordance with ARRIVE criteria, performed between 2015 and 2016. SETTING: Animal laboratory. PARTICIPANTS: Transgenic C57BL/6 mice with isogeneic background were used. Recipients were female wild-type phenotype mice >3 mo (n = 24). Donors were male or female mice >7 mo, with phenotype-positive for the luciferase gene (n = 20) or positive for NF-κB-luciferase gene (n = 4). INTERVENTION: Full-thickness skin was grafted in the IPOM position and compared with grafts in the onlay position as controls. Survival was evaluated by regular longitudinal postoperative luminescence imaging over 8 wk. Adherence formation was evaluated macroscopically after sacrifice. Inflammation of full-thickness skin grafts in IPOM position of NF-κB mice was evaluated in four additional mice. Main outcome and measure: Survival of grafts, evaluated by luminescence. RESULTS: Ten animals received grafts in the IPOM position, and 10 in the onlay position as controls. Graft survival after 8 wk was 100% (20/20). Average luminescence at the end of the 8-week period was 999,597 flux (min 162,800, max 2,521,530) in the IPOM group (n = 10) and 769,708 flux (min 76,590, max 2,164,080) in the onlay control group (n = 10). No adhesions requiring sharp dissection (Jenkins' scale >2) were seen. Four animals with grafts in the IPOM position showed peak inflammation (NF-κB activity) 5 d after surgery subsiding toward the end of follow-up. CONCLUSIONS: Full-thickness skin survives as well in the IPOM position as in the onlay control position, and few adherences develop. Further studies are required to fully characterize the tissue remodeling and repair processes associated with IPOM skin grafting. The result is relevant in the search for alternative reinforcement materials to be used in complex hernia surgery in humans.

The skin is the largest organ in the body and plays multiple essential roles ranging from regulating temperature, preventing infection and ultimately defining who we are physically. It is a highly dynamic organ that constantly replaces the outermost cells throughout life. However, when faced with a major injury, human skin cannot restore a significant lesion to its original functionality, instead a reparative scar is formed. In contrast to this, many other species have the unique ability to regenerate full thickness skin without formation of scar tissue. Here we review recent advances in the field that shed light on how the skin cells in regenerative species react to injury to prevent scar formation versus scar forming humans.

Tissue engineered skin substitutes for wound healing have evolved tremendously over the last couple of years. New advances have been made toward developing skin substitutes made up of artificial and natural materials. Engineered skin substitutes are developed from acellular materials or can be synthesized from autologous, allograft, xenogenic, or synthetic sources. Each of these engineered skin substitutes has their advantages and disadvantages. However, to this date, a complete functional skin substitute is not available, and research is continuing to develop a competent full thickness skin substitute product that can vascularize rapidly. There is also a need to redesign the currently available substitutes to make them user friendly, commercially affordable, and viable with longer shelf life. The present review focuses on providing an overview of advances in the field of tissue engineered skin substitute development, the availability of various types, and their application.

Background For patients with full thickness skin defects, autologous Split-thickness skin grafts (STSG) are generally regarded as the mainstay of treatment. However, skin grafts have some limitations, including undesirable outcomes resulting from scars, poor elasticity, and limitations in joint movement due to contractures. In this study, we present outcomes of Matriderm grafts used for various skin tissue defects whether it improves on these drawbacks. Methods From January 2010 to March 2012, a retrospective review of patients who had undergone autologous STSG with Matriderm was performed. We assessed graft survival to evaluate the effectiveness of Matriderm. We also evaluated skin quality using a Cutometer, Corneometer, Tewameter, or Mexameter, approximately 12 months after surgery. Results A total of 31 patients underwent STSG with Matriderm during the study period. The success rate of skin grafting was 96.7%. The elasticity value of the portion on which Matriderm was applied was 0.765 (range, 0.635-0.800), the value of the trans-epidermal water loss (TEWL) was 10.0 (range, 8.15-11.00) g/hr/m2, and the humidification value was 24.0 (range, 15.5-30.0). The levels of erythema and melanin were 352.0 arbitrary unit (AU) (range, 299.25-402.75 AU) and 211.0 AU (range, 158.25-297.00 AU), respectively. When comparing the values of elasticity and TEWL of the skin treated with Matriderm to the values of the surrounding skin, there was no statistically significant difference between the groups. Conclusions The results of this study demonstrate that a dermal substitute (Matriderm) with STSG was adopted stably and with minimal complications. Furthermore, comparing Matriderm grafted skin to normal skin using Cutometer, Matriderm proved valuable in restoring skin elasticity and the skin barrier.

Background To minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type. Methods The AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3×3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively. Results More rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group. Conclusions These observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.

Background: Elephantiasis nostras verrucosa is a rare cutaneous complication of chronic lymphatic obstruction. It is most commonly caused by bacterial infection, trauma, neoplasia, obesity, and venous stasis. Main observations: In this report, we describe a case of elephantiasis nostras verrucosa involving the scrotum and perineal area in a 32-year-old. The lesions were excised, and full-thickness skin grafting of the penis, scrotum, and perineal skin was performed. Conclusion: This case demonstrates the efficacy of excision with full-thickness skin grafting of the penis, scrotum, and perineal area in a patient with elephantiasis nostras verrucosa confined to the scrotum and perineal region. ( J Dermatol Case Rep . 2016; 10(2): 32-34)

There is a clinical need for skin substitutes to replace full-thickness skin loss. Our group has developed a bilayered skin substitute produced from the patient's own fibroblasts and keratinocytes referred to as Self-Assembled Skin Substitute (SASS). After cell isolation and expansion, the current time required to produce SASS is 45 days. We aimed to optimize the manufacturing process to standardize the production of SASS and to reduce production time. The new approach consisted in seeding keratinocytes on a fibroblast-derived tissue sheet before its detachment from the culture plate. Four days following keratinocyte seeding, the resulting tissue was stacked on two fibroblast-derived tissue sheets and cultured at the air–liquid interface for 10 days. The resulting total production time was 31 days. An alternative method adapted to more contractile fibroblasts was also developed. It consisted in adding a peripheral frame before seeding fibroblasts in the culture plate. SASSs produced by both new methods shared similar histology, contractile behavior in vitro and in vivo evolution after grafting onto mice when compared with SASSs produced by the 45-day standard method. In conclusion, the new approach for the production of high-quality human skin substitutes should allow an earlier autologous grafting for the treatment of severely burned patients.

The authors have written a prognosis of full-thickness skin defects in premature infants. The authors begin by dressing 14 cases of full-thickness skin defects due to extravasation of total parenteral nutrition. The authors described the dressing method, wound healing, and final scar. The timing of extravasation was 14 to 50 days after birth, and the gestational ages at birth ranged from 28 weeks and 4 days to 35 weeks and 6 days. This is the earliest clinical study of a premature infant wound healing process. Fetal wound healing is characterized by minimal inflammation and scarless repair. Premature infants are not completely the same fetuses, but premature infants in the early period after birth undoubtedly have characteristics in common with fetuses and, most relevantly to the present discussion, can heal without scarring. Despite some important differences, the authors stress that intensive wound management for moisturization and reduction of an inflammatory response could help in the successful treatment of skin defects and lead to scarless repair. The biological phenomenon of scarless wound healing in the fetal period is not the same during the whole gestational period, but it would be the same in the postfetal wound healing process [1]. There is a developmentally regulated threshold for scarless healing based on both gestational age and the extent of injury [2]. The late-gestation fetus has been proven to heal with fibrosis and scarring [3]. Wound size also affects the degree of scarless repair [4]. This transition phenomenon has also been demonstrated in fetal sheep [5], rodents [6], and monkeys [7]. No one has been able to determine which factors have more influence on a final scar, and further studies are needed. It seems as we understand more about scarless repair, we understand how much more we need to learn about the process. In the future, however, advances in technology might help us elucidate the mechanisms behind the wound healing process. More extensive research must be conducted to further define the integral process and the unknown aspects of fetal and scarless wound healing. It can be argued that well-intentioned clinicians, researchers, biologists, technicians, and industry personnel need to come together to better identify other mechanisms and principles in this rapidly developing subfield. It is well known that human fetal wound healing research is practically impossible to conduct due to the bioethical issues. A premature infant is in a transitional stage between the fetus and adult stage, and thus has characteristics of both of them. From the prospective view, the wound healing process of premature infants could serve as a good surrogate for a scarless adult wound healing model.

Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

金沢大学医薬保健研究域保健学系, We prepared full thickness skin defects in rats fed on a protein-free diet as a hypoproteinaemia model, then switched the animals to a diet containing a normal protein level 1, 6 or 12 days after wounding (inflammatory, granulation and rearrangement phases of the wound healing process) to examine whether improvement in the low-protein state promotes subsequent wound healing. The interval until wound healing in rats fed on a normal protein diet was significantly shorter, whereas that in rats continuously fed on a protein-free diet was significantly longer than those of other groups. Early correction tended to accelerate wound healing. Although wound contraction in groups receiving a protein-corrected or protein-free diet remained similar until 15 days after wounding, thereafter the duration of the rearrangement phase was significantly longer in the protein-free group than in the other groups. The collagen level per unit of granulation tissue area during wound healing was significantly lower in the protein-free group than in the other groups. These findings indicate that protein correction at any time after wounding accelerates wound healing, although early correction is more effective, and reduces the duration of the rearrangement phase more than those of the inflammatory and granulation phases because of the deposit of collagen.

An acellular cholecyst derived extracellular matrix (b-CEM) of bubaline origin was prepared using anionic biological detergent. Healing potential of b-CEM was compared with commercially available collagen sheet (b-CS) and open wound (C) in full thickness skin wounds in rats. Thirty-six clinically healthy adult Sprague Dawley rats of either sex were randomly divided into three equal groups. Under general anesthesia, a full thickness skin wound (20 × 20 mm2) was created on the dorsum of each rat. The defect in group I was kept as open wound and was taken as control. In group II, the defect was repaired with commercially available collagen sheet (b-CS). In group III, the defect was repaired with cholecyst derived extracellular matrix of bovine origin (b-CEM). Planimetry, wound contracture, and immunological and histological observations were carried out to evaluate healing process. Significantly (P<0.05) increased wound contraction was observed in b-CEM (III) as compared to control (I) and b-CS (II) on day 21. Histologically, improved epithelization, neovascularization, fibroplasia, and best arranged collagen fibers were observed in b-CEM (III) as early as on postimplantation day 21. These findings indicate that b-CEM have potential for biomedical applications for full thickness skin wound repair in rats.

Sir, Full Thickness Skin Graft (FTSG) holds an irreplaceable position in a reconstructive and aesthetic surgeon’s armamentarium. Particularly for coverage of defects over face and hands, FTSG provides superior aesthetic and functional result as compared to the split thickness graft. FTSG is harvested free hand with a scalpel and invariably tends to include some of the underlying fat with it. Defattening of the graft is an important step to avoid fat necrosis [1] and to facilitate approximation of the dermis to wound bed which is essential for the revascularisation of the graft and eventually affects the ‘take’ [2]. Placing the skin graft under tension over a convex surface is a prerequisite for optimal defattening. As originally described in text [3] and as per the conventional teaching, the FTSG has always been defattened by stretching it upside down over the tip of surgeon’s index finger of non dominant hand while cutting with a sharp scissors [Table/Fig-1] [3]. This may at times lead to inadequate or irregular defattening, may also cause buttonholing and may be quite time consuming for large area grafts. [Table/Fig-1]: Conventional technique of defattening of FTSG We have tried a novel way of defattening of a large FTSG by placing it over the dorsum of the non dominant hand of the assistant with dermal side facing upwards and defattening by using sharp scissors [Table/Fig-2a,b]. This technique has been particularly found useful for the large FTSG required for resurfacing of extensive facial post burn scars as the sheer size of the graft renders it unmanageable to defattening by conventional technique. Other advantages are that it is easier and faster and provides better outcome in terms of more uniform defattening of the FTSG and also prevents any inadvertent buttonholing of the precious graft. It is worth noting that this technique keeps both hands of the surgeon free to work. [Table/Fig-2a,b]: Our technique for defattening of large grafts placing the graft on back of the assistant’s hand: a) relative position of surgeon and assistant; b) the way graft is held over back of the hand of assistant while fat is trimmed off In our practice we cover large post burn scars over face and neck with large FTSGs harvested from lower abdomen with or without the use of tissue expansion. These grafts may sometimes be of dimensions upto 25 x 10 cm. As the surgery is being done for aesthetic effect, buttonholing and graft necrosis due to inadequate defattening is not acceptable. Defattening of such large grafts proves to be a challenge. The authors have been using this technique routinely for the cases requiring large size full thickness grafts (in more than 100 patients till now) with excellent outcomes and never had complications associated with the conventional technique as discussed above [Table/Fig-3]. [Table/Fig-3]: Cases of post burn scar over face resurfaced with large FTSG from lower abdomen Thus we see that with this modified technique, one can defatten FTSG with precision in just few minutes and it makes the surgeon’s life easier while also giving a superior aesthetic result as compared to the conventional technique.

Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

Free flap reconstruction often results in a composite defect at the donor site. Many of these defects can be closed primarily (scapular free flaps, rectus abdominis free flap, and antero‐ lateral thigh free flaps). However, some donor sites, such as fibular free flaps and radial forearm free flap, are particularly difficult to close primarily and require the use of skin grafts for coverage of the underlying muscle and tendon. There are several options available for obtaining material to cover the donor site defect. 1. Split thickness skin grafts harvested from a different anatomical site than free flap do‐ nor site 2. Split thickness skin graft harvested from the free flap donor site 3. Full thickness skin grafts harvested from a site adjacent to free flap donor site Coverage with a skin graft compared to primary closure has not been shown to have in‐ creased complication rates [1] and decreases wound tension leading to less wound contrac‐ ture, or worst yet, compartment syndrome [2]. We will discuss the different options for closure of free flap donor sites with skin grafts and the techniques to employ these options in the clinical practice.

Background Large full thickness skin defects caused by trauma or surgery require skin grafting, often in conjunction with dermal scaffolds such as INTEGRA ® . Due to the size and severity of these procedures, complications such as infection may occur. This can lead to poor healing outcomes. Objective To identify early biomarkers of complications during INTEGRA ® healing. Methods Levels of EGF, TGF-β1, FGF-2, VEGF, IFN-α, GM-CSF, IL-4 and IL-8 were measured pre-surgery and at days 1, 7 and 25 post-surgery in peripheral blood of 15 pediatric patients treated with INTEGRA ® for reconstructive procedures. The levels of these molecules were analysed with respect to the occurrence of complications. Results Complications (local infection) occurred in a group of 4 patients. This resulted in a reduced INTEGRA ® take rate comparing to the group without complications (71.5 ± 5.4% vs. 98.1 ± 0.7%). In cases with complications there were significantly higher plasma concentrations of IL-4 and FGF-2 on day 7 ( p = 0.037 and p = 0.008 respectively). Other markers were not significantly different between groups or at very low level at all time-points. WCC and CRP remained within normal ranges at all time-points. Conclusions This data suggests that elevated levels of IL-4 and FGF-2 at early time-points after surgery may predict the development of complications in patients with INTEGRA ® . This may enable early interventions to prevent complications in procedures involving the use of INTEGRA ® .

Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery.

When contemplating the repair of defects involving the ear, second intention healing and full or split thickness skin grafts are often considered for reconstructive choices. Closing the combined full thickness helical rim and posterior ear defects, however, represents a reconstructive challenge because of the lack of available freely mobile skin anteriorly, superiorly, and inferiorly to the defect. The choice of the bilobed flap circumvents this challenge by rotating the skin and recruiting the tissue from the post-auricular sulcus, the lower pole of the posterior ear, and, if necessary, from the superior area of the neck adjacent to the posterior ear. This bilobed flap also enables an inconspicuous closure of the donor site and provides sufficient blood supply to ensure flap viability in a simple one-stage repair. Herein, we describe two cases in which we used the bilobed flap to rotate skin from the post-auricular surface to reconstruct full thickness skin defects involving the helical rim and posterior ear, with excellent cosmetic results.

Bone cement reaches significant temperatures and is known to cause thermal and chemical damage to various tissues. All the reports of such damage occurred following a direct contact of the tissue or structure with cement. We report the case of a patient with a giant cell tumour of the proximal tibia who underwent curettage and bone cement application through a posterior approach and subsequently developed full thickness pretibial skin damage despite showing no evidence of any direct contact of the involved skin with bone cement. This is the first report of its kind and though anecdotal is a serious complication that surgeons should be aware of.

WOS: A1994PV27100017 PubMed: 7880424 Flexion contracture of the neck after burns can produce severe functional deformity. Excision and split or full thickness skin grafts, local or distant flaps, and free flaps have been used for reconstruction. Recently, tissue expansion has been introduced as an additional reconstructive procedure. We have used tissue expansion for reconstruction of postburn neck contractures. Twelve patients with ages that ranged from 9 to 34 years were treated with expanded fasciocutaneous supraclavicular and shoulder flaps. No flap necrosis has been seen. In two patients, recontracture occurred between the expanded flap and uninvolved skin. To date we have not seen any problems with nerve neuropraxia and impression on blood vessels.

WOS: A1992HR71500013 PubMed ID: 1596667 The purpose of this study was to determine the effect of expansion on the survival of full thickness skin grafts. In eight pigs 300 ml rectangular tissue expanders were placed into subcutaneous pockets. In four pigs (group I), the expanders were inflated rapidly with a mean 200 ml saline. In the other four pigs (group II), a mean total of 300 ml saline was injected in weekly increments over eight weeks. At the completion of expansion, full thickness skin grafts were taken from the expanded area and sutured back to the donor defects. In both groups surviving graft areas were similar to controls (p > 0.06). This study showed that acute and traditional expansion does not lead to increased loss of full thickness skin grafts of the expanded skin.

Graphical abstract Images of PC hollow MN arrays using a variety of microscopy techniques (a) Digital microscope images of single MN and a section of the MN array (b) SEM images of a single MN, the bore of the MN and a section of the MN array (c) X-ray microtomography images of single MNs, the bore of the MN and the Mn array (d) He-ion images of a single MN, illustrating the bore of the needle and a radial view of the MN., Interest in bacteriophages as therapeutic agents has recently been reawakened. Parenteral delivery is the most routinely-employed method of administration. However, injection of phages has numerous disadvantages, such as the requirement of a health professional for administration and the possibility of cross-contamination. Transdermal delivery offers one potential means of overcoming many of these problems. The present study utilized a novel poly (carbonate) (PC) hollow microneedle (MN) device for the transdermal delivery of Escherichia coli-specific T4 bacteriophages both in vitro and in vivo. MN successfully achieved bacteriophage delivery in vitro across dermatomed and full thickness skin. A concentration of 2.67 × 106 PFU/ml (plaque forming units per ml) was detected in the receiver compartment when delivered across dermatomed skin and 4.0 × 103 PFU/ml was detected in the receiver compartment when delivered across full thickness skin. An in vivo study resulted in 4.13 × 103 PFU/ml being detected in blood 30 min following initial MN-mediated phage administration. Clearance occurred rapidly, with phages being completely cleared from the systemic circulation within 24 h, which was expected in the absence of infection. We have shown here that MN-mediated delivery allows successful systemic phage absorption. Accordingly, bacteriophage-based therapeutics may now have an alternative route for systemic delivery. Once fully-investigated, this could lead to more widespread investigation of these interesting therapeutic viruses.

Defatting is usually required when patients undergo fullthickness skin grafting. However, this procedure is often burdensome, because it requires both stable fixation and appropriate tensioning of the skin piece. Furthermore, a skin piece may drop on the floor by accident during the defatting process To solve these problems, we present a unique method of full-thickness skin harvesting, which is easy and convenient, and does not require any special devices. The distal end of elliptical skin is not cut off but remains attached to the body like a pedicled flap. The surgeon pulls the end of the skin and puts his finger on the skin surface during the defatting procedure. This looks similar to a barber sharpening a razor using a strop belt. Our “razor strop” defatting method facilitates full-thickness skin harvesting without any need to purchase specialized equipment. We believe that this technique is an effective option for defatting in full-thickness skin grafting

The effect of MCCH on wound healing was studied in animals and patients. A full thickness dorsal skin defect was made in mice and standard amounts of MCCH applied immediately to the wound in half the mice. There were no significant differences in wound closure rates between control and MCCH treated mice. A standard dorsal skin incision was made in rats. In half the rats, MCCH was put into the incision just before suturing with fine stainless steel sutures. There were no statistically significant differences in breaking strengths between control and MCCH treated rats when tested on the 8th, 20th and 40th days postoperatively. Histologic examination of the wounds showed mild inflammatory reaction surrounding the MCCH-fiber fragments, but no giant cells. Small amounts of MCCH were demonstrable at 40 days. Full thickness skin burns in pigs were excised one day after burning. MCCH was applied immediately in some pigs; excess MCCH was removed by saline irrigation. Split thickness skin autografts were applied. MCCH was applied to donor sites. The "takes" of the grafts were excellent and not affected by the use of MCCH and the donor sites healed uneventfully. MCCH was used in four patients with burns, three of whom underwent early excision of full thickness skin burns and immediate autografting. The fourth underwent skin grafting to the granulating areas 3 months after injury. The MCCH was applied to some donor sites and to some areas of excision. In one patient with severe burns, wound sepsis developed equally in areas with and without MCCH and the grafts were lost. In the other three patients, there were excellent takes of the grafts at all sites. All donor sites, treated and untreated, healed normally in all patients.

Background Tests for drug development require an almost perfect fit with the human (patho-) physiological microenvironment. The majority of skin equivalents currently commercially available are based on static culture systems emulating only human epidermis, or combining epidermis and dermis in so-called full thickness skin equivalents. None of the existing systems contain important elements, such as vasculature, skin appendices or an immune system. Therefore, current in vitro and animal tests are failing to accurately predict drug toxicity. Our Multi-Organ-Chip (MOC) platform is a micro scale bioreactor providing pulsatile dynamic perfusion for microscale organoids. Here, we combine skin equivalents with vasculature in our two-organ variant (2OC). This would be needed for physiological-like interactions, regulation and, eventually, homeostasis within the chip.