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Augmentation of Adipose-First Burn Reconstruction with Dexamethasone Loaded-Microspheres Mitigates Soft-Tissue Contracture
Shawn Jeffrey Loder, MD, Phoebe Lee, BS, Wayne Vincent Nerone, BS, Fuat Baris Bengur, MD, Caroline Fedor, BS, Rachel Ricketts, Lauren Kokai, PhD, Kacey Marra, PhD, J Peter Rubin, MD.
University of Pittsburgh Department of Plastic Surgery
2022-01-15
Presenter: Shawn Jeffrey Loder
Affidavit:
Certified
Director Name: Vu T. Nguyen, MD
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background/Purpose: Soft-tissue deficits, adhesion, and contracture after complex burns are devastating to quality of life, ability to work, and psychosocial well-being. We previously demonstrated that immediate lipografting to the wound base at time of excision mitigates adhesions and long-term soft tissue deficits. However, a fat-first approach currently precludes immediate skin grafting and consequently is limited by contracture in the delay-period between fat- and skin-graft placement. Our team has previously demonstrated the efficacy of dexamethasone as a lipo-protective agent supporting fat graft survival and here we demonstrate it value in mitigating contracture in adipose-based burn reconstruction.
Methods: Yorkshire swine received 16, 4x4 cm full-thickness burns. After 48 hours, eschar was removed to fascia. Wounds were stratified across untreated pigs to receive A) No Reconstruction, B) Skin-Only, C) Fat-Only, D) Immediate-Skin, Delayed-Fat, or E) Immediate-Fat, Delayed-Skin. Treatment pigs with Group E wounds then received either Empty Microspheres or Dexamethasone as follows 2) Continuous/Sustained, 3) Immediate-Pulsed, 4) Delayed-Pulsed, or 5) Bimodal-Pulsed. At 8 weeks post-engraftment animals were sacrificed and all wounds were collected for photography, ultrasound, histology and serum studies.
Results: Early dexamethasone blocks contracture, however, sustained dosing limited skin graft take. Pulsed-dosing was permissive of skin grafts in the drug elution nadir. Combination fat first with pulsed-dexamethasone resulted in significant reduction in adhesion, soft-tissue deficit, and contracture vs. skin-first approaches.
Discussion/Conclusion: Timed-release dexamethasone safely and effectively mitigate contracture, adhesion, and soft-tissue deficits in an adipose-based reconstruction of complex burn wounds.
