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Free Flap Donor Site Reconstruction: A Prospective Case Series Using an Optimized Polyurethane Biodegradable Temporizing Matrix.

Wagstaff MJ, Schmitt BJ, Caplash Y, Greenwood JE - Eplasty (2015)

Bottom Line: Long-term scar outcomes improved compared with the pilot group.This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration.No infection was observed, and split-skin overgrafting was successful and uncomplicated.

View Article: PubMed Central - PubMed

Affiliation: Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia ; Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

ABSTRACT

Introduction: We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal.

Objective: This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material.

Methods: The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft.

Results: Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis.

Conclusion: This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated.

No MeSH data available.


Related in: MedlinePlus

Higher magnification histological appearance of scar at day 362 (patient 9) demonstrating the mature but loose edematous whorls of collagen laid down inside the BTM and persisting after degradation. BTM indicates biodegradable temporizing matrix.
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Figure 14: Higher magnification histological appearance of scar at day 362 (patient 9) demonstrating the mature but loose edematous whorls of collagen laid down inside the BTM and persisting after degradation. BTM indicates biodegradable temporizing matrix.

Mentions: The histology slides (Figs 11–14) were produced from punch biopsy specimens taken from the center of each scar of the patients surviving to 1 year (n = 6). In the pilot study, microscopic remnants of polymer, surrounded by giant cells, were detectable at 12 months.1 The inference was that hydrolysis had been completed and residual, nonhydrolyzable fragments were phagocytosed. Biopsy specimens were taken at approximately 1 year in the current cohort. Each biopsy specimen was sectioned vertically, yielding between 3 and 5 vertical sections. Microfragments were observed, surrounded by giant cells, in 7 of 21 sections. Their histological appearance is illustrated in Figure 12a (from patient 3), where the largest microscopic remnant of any of the 6 subjects can be seen, and has been boxed on the figure. This series reflects the desired properties of the BTM, i.e. that the structure would be maintained until tissue integration, and that the product would largely degrade over 12 months. Figure 13 shows a punch biopsy specimen stratified and Figure 14, a high magnification of the whorling collagen characteristic of the intrafoam deposition, which persists after the polymer has degraded. An important feature of all of the punch biopsy specimens is the lack of fibroblast infiltration in the BTM collagen, indicating that, at 12 months, this collagen is mature.


Free Flap Donor Site Reconstruction: A Prospective Case Series Using an Optimized Polyurethane Biodegradable Temporizing Matrix.

Wagstaff MJ, Schmitt BJ, Caplash Y, Greenwood JE - Eplasty (2015)

Higher magnification histological appearance of scar at day 362 (patient 9) demonstrating the mature but loose edematous whorls of collagen laid down inside the BTM and persisting after degradation. BTM indicates biodegradable temporizing matrix.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492216&req=5

Figure 14: Higher magnification histological appearance of scar at day 362 (patient 9) demonstrating the mature but loose edematous whorls of collagen laid down inside the BTM and persisting after degradation. BTM indicates biodegradable temporizing matrix.
Mentions: The histology slides (Figs 11–14) were produced from punch biopsy specimens taken from the center of each scar of the patients surviving to 1 year (n = 6). In the pilot study, microscopic remnants of polymer, surrounded by giant cells, were detectable at 12 months.1 The inference was that hydrolysis had been completed and residual, nonhydrolyzable fragments were phagocytosed. Biopsy specimens were taken at approximately 1 year in the current cohort. Each biopsy specimen was sectioned vertically, yielding between 3 and 5 vertical sections. Microfragments were observed, surrounded by giant cells, in 7 of 21 sections. Their histological appearance is illustrated in Figure 12a (from patient 3), where the largest microscopic remnant of any of the 6 subjects can be seen, and has been boxed on the figure. This series reflects the desired properties of the BTM, i.e. that the structure would be maintained until tissue integration, and that the product would largely degrade over 12 months. Figure 13 shows a punch biopsy specimen stratified and Figure 14, a high magnification of the whorling collagen characteristic of the intrafoam deposition, which persists after the polymer has degraded. An important feature of all of the punch biopsy specimens is the lack of fibroblast infiltration in the BTM collagen, indicating that, at 12 months, this collagen is mature.

Bottom Line: Long-term scar outcomes improved compared with the pilot group.This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration.No infection was observed, and split-skin overgrafting was successful and uncomplicated.

View Article: PubMed Central - PubMed

Affiliation: Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia ; Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

ABSTRACT

Introduction: We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal.

Objective: This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material.

Methods: The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft.

Results: Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis.

Conclusion: This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated.

No MeSH data available.


Related in: MedlinePlus