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An Innovative Single-Staged Approach To Improve Re-Epithelization and Volume Loss After Burn Injury
Yadira Villalvazo, MD, MS1
Pooja Humar, BS1
Fuat Baris Bengur, MD1
Shawn J. Loder, MD1
Wayne V. Nerone, BS1
Alexandra Vagonis, BS1
Bahaa Shaaban, MD, MS, MA1
Yusuf Surucu, MD1
Lauren E. Kokai, PhD1
Kacey G. Marra, PhD1
Elof Eriksson, MD2
J. Peter Rubin, MD, MBA1
1University of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA, USA
2Harvard Medical School, Boston, MA, USA
University of Pittsburgh Department of Plastic Surgery
2023-02-09
Presenter: Yadira Villalvazo, MD, MS
Affidavit:
The work presented represents the fellows original work.
Director Name: J. Peter Rubin
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
INTRODUCTION: Thermal burns are highly morbid injuries that present a unique challenge. We have previously demonstrated the viability of an adipose-derived reconstruction to address hypodermal defects. Here, we aim to provide a comprehensive approach using a single-staged minced skin graft plus autologous adipose graft in a closed microenvironment with a platform wound device (PWD) to achieve rapid reconstruction after burns.
METHODS: Sixteen full-thickness burns were created on Female Yorkshire swine with delayed escharectomies. One group received standard-of-care skin graft versus split-thickness skin cut into pixel size (0.3x0.3mm), combined with or without adipose, and either bolster or PWD. Pigs were followed for 8-weeks with photography, tension measurements, ultrasound, cutometer and histology.
RESULTS: Pixel-plus-fat grafts in PWD group had enhanced wound closure and scar formation. At one week, epithelization started in all PWD groups, with notable acceleration with pixel grafting. Scars had distinct differences in topography between dressings. Cutometer illustrated an enhanced trend to return to baseline elasticity in the PWD group. The reconstruction of full-thickness trilaminar cutaneous architecture was depicted on histology and immunofluorescent staining. This included pan-cytokeratin, CD31 and perilipin which represented the viability of grafted adipose.
CONCLUSION: The skin-plus-fat with PWD approach allowed us to generate a single-stage trilaminar reconstruction in complex burn defects in a highly translatable swine model. This study introduces a wholistic approach that could challenge the need for the status quo. Further research in clinical translation could demonstrate the feasibility of this approach and reduce overall burden of multiple procedures in complex burn reconstruction.
