J Reconstr Microsurg 2009; 25(7): 405-410
DOI: 10.1055/s-0029-1223848
© Thieme Medical Publishers

Evaluation of Artificial Dermis Neovascularization in an Avascular Wound

Richard C. Baynosa1 , Leslie K. Browder1 , Seth R. Jones1 , Jill A. Oliver1 , Carol A. Van Der Harten2 , Linda L. Stephenson1 , Wei Z. Wang1 , Kayvan T. Khiabani1 , William A. Zamboni1
  • 1Division of Plastic Surgery, Microsurgery and Hyperbaric Laboratory, University of Nevada School of Medicine, Las Vegas, Nevada
  • 2Quest Diagnostics, Las Vegas, Nevada
Further Information

Publication History

Publication Date:
19 May 2009 (online)

ABSTRACT

Soft tissue coverage for avascular wounds is necessary in reconstructive surgery. Several authors have demonstrated successful treatment of problem wounds using artificial dermis. This study evaluates in an animal model the potential for neovascularization of artificial dermis in devascularized and avascular wound beds. Forty rats were assigned to four groups: (1) control, full-thickness skin graft was replaced on the vascular wound bed; (2) Integra, Integra placed over the full-thickness wound; (3) fascia, the spinotrapezius fascia exposed and Integra placed over the wound; and (4) fascia/Parafilm, a Parafilm layer placed under the raised fascia with Integra over the fascia. Laser Doppler readings were taken at baseline over the intact skin and then over the created wound beds. Biopsies of the full-thickness skin graft and the neodermis were obtained on postoperative day 14 and histologically evaluated for neovascularization. The laser Doppler readings confirmed the nature of the surgically created, poorly vascularized and avascular wound beds. Subsequent biopsies of the artificial dermis in these wound beds, however, demonstrated active neovascularization. This study demonstrates that Integra artificial dermis can serve as an effective dermal substitute in avascular wounds. Lateral ingrowth of capillaries into the dermal substitute may explain the successful integration of this artificial dermis.

REFERENCES

  • 1 Buncke H J, Chang D W. History of microsurgery.  Semin Plast Surg. 2003;  17 5-15
  • 2 Losken A, Carlson G W, Culbertson J H et al.. Omental free flap reconstruction in complex head and neck deformities.  Head Neck. 2002;  24 326-331
  • 3 Jones N F. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction.  Microsurgery. 1988;  9 159-164
  • 4 Mahoney J. Complications of free flap donor sites.  Microsurgery. 1995;  16 437-444
  • 5 Helgeson M D, Potter B K, Evans K N, Shawen S B. Bioartificial dermal substitute: a preliminary report on its use for the management of complex combat-related soft tissue wounds.  J Orthop Trauma. 2007;  21 394-399
  • 6 Jeng J C, Fidler P E, Sokolich J C et al.. Seven years' experience with Integra as a reconstructive tool.  J Burn Care Res. 2007;  28 120-126
  • 7 Muangman P, Engrav L H, Heimbach D M et al.. Complex wound management utilizing an artificial dermal matrix.  Ann Plast Surg. 2006;  57 199-202
  • 8 Yeong E K, Huang H F, Chen Y B, Chen M T. The use of artificial dermis for reconstruction of full thickness scalp burn involving the calvaria.  Burns. 2006;  32 375-379
  • 9 Violas P, Abid A, Darodes P, Galinier P, de Gauzy J S, Cahuzac J P. Integra artificial skin in the management of severe tissue defects, including bone exposure, in injured children.  J Pediatr Orthop B. 2005;  14 381-384
  • 10 Komorowska-Timek E, Gabriel A, Bennett D C et al.. Artificial dermis as an alternative for coverage of complex scalp defects following excision of malignant tumors.  Plast Reconstr Surg. 2005;  115 1010-1017
  • 11 Stern R S, McPherson M, Longaker M T. Histologic study of artificial skin used in the treatment of full-thickness thermal injury.  J Burn Care Rehabil. 1990;  11 7-13
  • 12 Heimbach D M, Luterman A, Burke J et al.. Artificial dermis for major burns. A multi-center randomized clinical trial.  Ann Surg. 1988;  208 313-320
  • 13 Heimbach D M, Warden G D, Luterman A et al.. Multicenter postapproval clinical trial of Integra dermal regeneration template for burn treatment.  J Burn Care Rehabil. 2003;  24 42-48
  • 14 Fitton A R, Drew P, Dickson W A. The use of a bilaminate artificial skin substitute (Integra) in acute resurfacing of burns: an early experience.  Br J Plast Surg. 2001;  54 208-212
  • 15 Dantzer E, Queruel P, Salinier L, Palmier B, Quinot J F. Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery.  Br J Plast Surg. 2003;  56 764-774
  • 16 Ryan C M, Schoenfeld D A, Malloy M, Schulz III J T, Sheridan R L, Tompkins R G. Use of Integra artificial skin is associated with decreased length of stay for severely injured adult burn survivors.  J Burn Care Rehabil. 2002;  23 311-317
  • 17 Lorenz C, Petracic A, Hohl H P, Wessel L, Waag K L. Early wound closure and early reconstruction. Experience with a dermal substitute in a child with 60 per cent surface area burn.  Burns. 1997;  23 505-508
  • 18 King P. Artificial skin reduces nutritional requirements in a severely burned child.  Burns. 2000;  26 501-503
  • 19 Wisser D, Steffes J. Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma.  Burns. 2003;  29 375-380
  • 20 Loss M, Wedler V, Künzi W, Meuli-Simmen C, Meyer V E. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA.  Burns. 2000;  26 644-652
  • 21 Pandya A N, Woodward B, Parkhouse N. The use of cultured autologous keratinocytes with Integra in the resurfacing of acute burns.  Plast Reconstr Surg. 1998;  102 825-828 discussion 829-830
  • 22 Boyce S T, Kagan R J, Meyer N A, Yakuboff K P, Warden G D. The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns.  J Burn Care Rehabil. 1999;  20 453-461
  • 23 Chou T D, Chen S L, Lee T W et al.. Reconstruction of burn scar of the upper extremities with artificial skin.  Plast Reconstr Surg. 2001;  108 378-384 discussion 385
  • 24 Hunt J A, Moisidis E, Haertsch P. Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture.  Br J Plast Surg. 2000;  53 652-658
  • 25 Palao R, Gómez P, Huguet P. Burned breast reconstructive surgery with Integra dermal regeneration template.  Br J Plast Surg. 2003;  56 252-259
  • 26 Moore C, Lee S, Hart A, Watson S. Use of Integra to resurface a latissimus dorsi free flap.  Br J Plast Surg. 2003;  56 66-69
  • 27 Giovannini U M, Teot L. Aesthetic complex reconstruction of the lower leg: application of a dermal substitute (Integra) to an adipofascial flap.  Br J Plast Surg. 2002;  55 171-172
  • 28 Blanco N M, Edwards J, Zamboni W A. Dermal substitute (Integra) for open nasal wounds.  Plast Reconstr Surg. 2004;  113 2224-2225
  • 29 Gonyon Jr D L, Zenn M R. Simple approach to the radiated scalp wound using INTEGRA skin substitute.  Ann Plast Surg. 2003;  50 315-320
  • 30 Shermak M A, Wong L, Inoue N, Nicol T. Reconstruction of complex cranial wounds with demineralized bone matrix and bilayer artificial skin.  J Craniofac Surg. 2000;  11 224-231
  • 31 Moiemen N S, Staiano J J, Ojeh N O, Thway Y, Frame J D. Reconstructive surgery with a dermal regeneration template: clinical and histologic study.  Plast Reconstr Surg. 2001;  108 93-103
  • 32 Moiemen N S, Vlachou E, Staiano J J, Thawy Y, Frame J D. Reconstructive surgery with Integra dermal regeneration template: histologic study, clinical evaluation, and current practice.  Plast Reconstr Surg. 2006;  117(7, Suppl) 160S-174S
  • 33 Koga Y, Komuro Y, Yamato M et al.. Recovery course of full-thickness skin defects with exposed bone: an evaluation by a quantitative examination of new blood vessels.  J Surg Res. 2007;  137 30-37

William A ZamboniM.D. 

Professor and Chairman, Department of Surgery, University of Nevada School of Medicine

2040 W. Charleston Blvd., Suite 301, Las Vegas, NV 89102-2227

Email: wzamboni@medicine.nevada.edu

    >