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Testing Adherence Strategies in Multilaminar Point-of-Care Composite Reconstruction in Burns
Shayan Sarrami, MD, Shawn J. Loder, MD, Jose Arellano, MD, Vanessa Mrouh, BS, Samantha Bosco, BS, Francesco Egro, MD, Kacey Marra, PHD, J. Peter Rubin, MD.
UPMC
2025-01-15
Presenter: Shawn Loder, MD
Affidavit:
I agree.
Director Name: Vu T Nguyen, MD
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Purpose
Managing complex coverage after burn trauma remains challenging, with morbidity arising from both the injury and reconstruction techniques. Previously, we demonstrated a single-stage technique using a split-thickness skin graft (STSG) over morselized autologous fat. While thin (5 mm) adipose layers resisted adhesion, residual defects occurred in deep trauma. The viable upper limit for adipose layer thickness to support skin grafts remains unknown. Furthermore, the effects of mechanical forces during STSG and bolster placement on particulate adipose displacement are unclear. This study tests fibrin sealant integration to stabilize adipose tissue, minimize displacement, and enhance graft stability.
Methods
We obtained human adipose from panniculectomy samples for pre-animal testing to evaluate layering and cementing strategies under bolster placement. Compression testing assessed adipose stability. Subsequently, 2 female Yorkshire swine sustained 18 full-thickness burns (16 cm² each; total n=36) treated 48 hours post-injury. Controls received STSG over fascia. Experimental groups included: (A) thin (0-5 mm) adipose, (B) thick (5-10 mm) adipose, (C) thin + sealant, and (D) thick + sealant. Reconstruction thickness was measured via ultrasound.
Results
Pre-animal testing showed sealant reduced adipose displacement. In swine, thick adipose with sealant compromised graft survival, whereas thin adipose ± sealant or thick adipose alone supported reproducible graft viability and healing.
Conclusion
Thick (10 mm) adipose and fibrin sealant (5 mm) are viable for single-stage multilaminar reconstruction. However, combining thick fat and sealant impairs nutrient exchange, reducing STSG survival worsening wound contracture.
