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The Staged Use of Dermal Regenerate and Spray Skin Technology in the Restoration of Full Thickness Soft Tissue Defects
Juan L. Rendon, MD, PhD1, Daniel Hammer, DDS2, Jennifer Sabino, MD2, Barry Martin, MD2, Kerry Latham, MD2, Mark E. Fleming, MD2, Ian L. Valerio, MD1.
1The Ohio State University Wexner Medical Center, Columbus, OH, USA, 2Walter Reed National Military Medical Center, Baltimore, MD, USA.

Purpose: Full thickness soft tissue defects secondary to large burns, traumatic and war-related injuries continue to challenge reconstructive surgeons. Novel approaches are needed to restore the functional, protective barrier and aesthetic properties of skin. We report the staged use of a dermal regenerate template (DRT) (Integra, Integra Lifesciences) with a spray skin epidermal regenerative (ReCell, Avita Medical LLC) in addition to STSG and compare these results with those from patients treated with DRT and STSG alone.
Methods: First stage, wound debridement and DRT application to wound beds. Second stage, 3-5 weeks following DRT placement, patients in the control group were treated with STSG, patients in the experimental group were treated with intraoperative application of spray skin and 6:1 meshed STSG. Mechanisms of injury, total defect and treatment sizes, time to complete healing, donor site morbidity/burden, outcomes and complications were reviewed.
Results: Table 1.
Table 1. Patient Characteristics and Results
DRT + STSGDRT + STSG + Spray Skin
PatientABCD
Age (years)24212936
Mechanism of InjuryBlastBlastBlastMotorcycle
Wound Size (cm2)76022006001190
STSG Donor Size (cm2)7602200140462
STSG Mesh Ratio1.5:13:16:16:1
Complete Healing (weeks)7944
Pigmentation MatchMismatchMismatchMatchMatch

Conclusion: We show that staged use of DRT and spray skin provides a safe and effective method for restoring large soft tissue defects, limits donor site morbidity, decreases donor site burden and time to complete healing. It also allows for a greater mesh ratio, and results in matching pigmentation when compared to treatment with DRT and STSG alone. The use of this technology remains promising in patients with significant traumatic, war-related or large burn injuries who have limited amounts of donor tissue.


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