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Yong Shen - One of the best experts on this subject based on the ideXlab platform.
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the use of Dermal Regeneration Template for treatment of complex wound with bone tendon exposed at the forearm and hand a prospective cohort study
Medicine, 2019Co-Authors: Qiusheng Wang, Rui Jia, Wenyuan Ding, Yong ShenAbstract:The purpose of this study was to assess the efficacy and safety of Pelnac and split-thickness skin graft for management of complex wound with underlying bone/tendon exposure at forearm and hand.This is a prospective study, beginning from March 2013 up to May 2017. There were 13 patients, with age of 31.2 years. All of them underwent the staged Pelnac and split-thickness skin graft to manage the complex wound with bone/tendon. Postoperatively, scheduled follow-up was conducted.The average follow-up was 15 months. There were no infections, wound necrosis, hematoma, or seroma during the phase when Pelnac was applied. There was 100% "take" of the Pelnac in 12/13 patients. In 11 patients, there was complete skin graft "take". Patients' satisfaction for the esthetic appearance of the grafted area was 75.0 ± 8.5/100. The VSS value was 2.9 ± 2.5. Regarding the sensory recovery, the response of "normal or near normal" could be obtained in 7/13 patients, "slight loss" in 5 patients and "significant loss" in 1 case. The average DASH score was 27.2 ± 18.5, and most patients (12/13) could obtain an acceptable ability to perform the daily activities.Pelnac Dermal Template is a favorable alternative to flap reconstruction in the treatment of complex wound with underlying tissues exposure.
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Dermal Regeneration Template and vacuum sealing drainage for treatment of traumatic degloving injuries of upper extremity in a single stage procedure
Anz Journal of Surgery, 2019Co-Authors: Qiusheng Wang, Rui Jia, Wenyuan Ding, Yong ShenAbstract:Background This study aimed to assess the efficacy and safety of a single-stage procedure using single-layer Pelnac and defatted avulsed skin for the management of degloving injuries of the forearm and hand. Methods This is a prospective study conducted from March 2013 to May 2017. A total of 15 consecutive patients with degloving injuries of the forearm and hand were treated with a single-stage procedure using single-layer Pelnac and defatted avulsed skin as a split-thickness skin graft. Post-operatively, scheduled follow-up was conducted. Results The overall 'take' rate of the Pelnac Dermal Template and the skin graft was 85-100%. No infections, haematoma or seroma were observed during hospitalization and after discharge. At the final follow-up, patients' subjective satisfaction with the aesthetic appearance of the grafted areas was, on average, 71.0 (SD 8.0, range 55-92). The Vancouver Scar Scale value was 2.1 (SD 1.8, range 1.0-5.5), representing a good result. The response of 'normal or near normal' to the sensory recovery was obtained for 13 patients and 'slight loss' for two patients. The average Disabilities of the Arm, Shoulder and Hand score was 21.2 (SD 13.5, range 0-53), and most patients (14/15) regained the ability to perform the daily activities without pain or restriction by tissue adhesion. Conclusion This single-stage procedure represents an effective technique for the management of degloving injuries of the forearm and hand and should be considered an alternative to other reconstructive procedures.
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revision surgery with Dermal Regeneration Template and vacuum sealing drainage for reconstruction of complex wounds following necrosis of reattached avulsed skins in a degloving injury a case report
Medicine, 2019Co-Authors: Qiusheng Wang, Rui Jia, Wenyuan Ding, Yong ShenAbstract:RATIONALE Degloving injury of the upper limb often extends to underlying tendons and bone, which is at high risk of treatment failure if only simple reattachment of defatted avulsed skins was performed. Pelnac Dermal Regeneration Template could be used as a treatment choice for necrosis of the reattached avulsed skins in a degloving injury. PATIENT CONCERNS A 48-year-old woman with a degloving injury of the right forearm, wrist, and hand received initial treatment by reattachment of the defatted avulsed skins over the wound bed. However, 17 days postoperatively, the reattached skins developed complete necrosis, leaving large size of tissue defects and tendon/bone exposure. DIAGNOSIS Failure to reconstruct the skin and soft-tissue envelop by reattachment of the defatted avulsed skins in a severe degloving injury of the upper limb. INTERVENTIONS We decided to use a 2-stage procedure of Pelnac Dermal Regeneration Template and secondary skin graft to solve this issue, in consideration of these conditions and the patient' demanding of limb function and aesthetic appearance. OUTCOMES At the final follow-up, this patient obtained an excellent result, in term of scar quality, aesthetic appearance, and the ability to perform the daily activities. LESSONS We believe this could become an interesting option in patients who needed revision procedure for management of complex wounds with tendon/bone exposure following the necrosis of reattached skins in degloving injuries.
Jorg Faulhaber - One of the best experts on this subject based on the ideXlab platform.
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Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases.
Dermatologic Surgery, 2020Co-Authors: Johannes Benecke, Wolfgang Koenen, Moritz Felcht, Clausdetlev Klemke, Lisa Mager, Kasia Weina, Jorg FaulhaberAbstract:BACKGROUND Artificial skin substitute Templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data. OBJECTIVE The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases. MATERIALS AND METHODS In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months. RESULTS The mean size of the defects was 63 (±54) cm. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including Template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer. CONCLUSION The use of a Dermal Regeneration Template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.
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long term results after reconstruction of full thickness scalp defects with a Dermal Regeneration Template
Journal of The European Academy of Dermatology and Venereology, 2010Co-Authors: Jorg Faulhaber, Sergij Goerdt, Moritz Felcht, G Teerling, Clausdetlev Klemke, C Wagner, Wolfgang KoenenAbstract:Objective Large scalp defects in which the pericranium has to be resected can be reliably reconstructed using Integra®. In the present study, we retrospectively analysed the long-term outcome of our patients. Methods Nineteen patients were included who had received Integra® Dermal Regeneration Template for treatment of full thickness scalp defects after resection of various malignant tumours. All patients were followed up with a mean follow-up time of 31 months (14–72). Results All transplants were on almost equal levels with the surrounding skin. Cosmetic results were acceptable and scars were stable. Nodal ultrasound status was negative in all patients. During the follow-up period of up to 72 months, no local recurrences were observed. One patient with a leiomyosarcoma received radiotherapy after transplantation. In the irradiated area, multiple small regular-shaped round ulcerations and later on partial necrosis of the transplant occurred when the patient developed renal failure 29 months after the initial operation. Five patients died of disease not related to the primary skin tumour. All other patients are alive and free of disease without any complications. Conclusion After reconstruction of full thickness scalp defects with Integra®, the cosmetic results are appealing and we observed no local recurrences during the follow-up period.
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removal of the outer table of the skull for reconstruction of full thickness scalp defects with a Dermal Regeneration Template
Dermatologic Surgery, 2008Co-Authors: Wolfgang Koenen, Sergij Goerdt, Jorg FaulhaberAbstract:BACKGROUND: The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches. OBJECTIVE: The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects. METHODS: Full-thickness scalp defects of up to 126 cm(2) in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a Dermal Regeneration Template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the Template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis. RESULTS: Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (+/- 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed. CONCLUSION: This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.
Wolfgang Koenen - One of the best experts on this subject based on the ideXlab platform.
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Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases.
Dermatologic Surgery, 2020Co-Authors: Johannes Benecke, Wolfgang Koenen, Moritz Felcht, Clausdetlev Klemke, Lisa Mager, Kasia Weina, Jorg FaulhaberAbstract:BACKGROUND Artificial skin substitute Templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data. OBJECTIVE The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases. MATERIALS AND METHODS In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months. RESULTS The mean size of the defects was 63 (±54) cm. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including Template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer. CONCLUSION The use of a Dermal Regeneration Template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.
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long term results after reconstruction of full thickness scalp defects with a Dermal Regeneration Template
Journal of The European Academy of Dermatology and Venereology, 2010Co-Authors: Jorg Faulhaber, Sergij Goerdt, Moritz Felcht, G Teerling, Clausdetlev Klemke, C Wagner, Wolfgang KoenenAbstract:Objective Large scalp defects in which the pericranium has to be resected can be reliably reconstructed using Integra®. In the present study, we retrospectively analysed the long-term outcome of our patients. Methods Nineteen patients were included who had received Integra® Dermal Regeneration Template for treatment of full thickness scalp defects after resection of various malignant tumours. All patients were followed up with a mean follow-up time of 31 months (14–72). Results All transplants were on almost equal levels with the surrounding skin. Cosmetic results were acceptable and scars were stable. Nodal ultrasound status was negative in all patients. During the follow-up period of up to 72 months, no local recurrences were observed. One patient with a leiomyosarcoma received radiotherapy after transplantation. In the irradiated area, multiple small regular-shaped round ulcerations and later on partial necrosis of the transplant occurred when the patient developed renal failure 29 months after the initial operation. Five patients died of disease not related to the primary skin tumour. All other patients are alive and free of disease without any complications. Conclusion After reconstruction of full thickness scalp defects with Integra®, the cosmetic results are appealing and we observed no local recurrences during the follow-up period.
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removal of the outer table of the skull for reconstruction of full thickness scalp defects with a Dermal Regeneration Template
Dermatologic Surgery, 2008Co-Authors: Wolfgang Koenen, Sergij Goerdt, Jorg FaulhaberAbstract:BACKGROUND: The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches. OBJECTIVE: The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects. METHODS: Full-thickness scalp defects of up to 126 cm(2) in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a Dermal Regeneration Template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the Template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis. RESULTS: Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (+/- 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed. CONCLUSION: This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.
Naiem Moiemen - One of the best experts on this subject based on the ideXlab platform.
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long term clinical and histological analysis of integra Dermal Regeneration Template
Plastic and Reconstructive Surgery, 2011Co-Authors: Naiem Moiemen, Jeremy Yarrow, Elaine L B Hodgson, Jiannis Constantinides, Elizabeth Chipp, H Oakley, Elizabeth Shale, Martin FreethAbstract:Background: This study looked at clinical and histological outcomes of patients treated with Integra more than 2 years earlier. Although previous studies have investigated the short-term clinical and histological results, there have been no studies to investigate longer-term changes. Methods: Fourteen patients (23 sites) were assessed. Patients used a visual analogue scale to score characteristics of their scars. Objective evaluation of the reconstructions was carried out using the Cutometer MPA580. Punch biopsy specimens of the sites were stained and labeled immunohistochemically with S100, CD31, and CD34 antisera. Results: The highest scoring category by patients was softness (median, +45 percent). The lowest score was sweating, which all patients scored 0. The median Cutometer readings ranged from 39 to 52 percent of the control values. Histological examination showed three patterns of collagen arrangement; parallel arrangement was found in over 60 percent of specimens. Elastic fibers were identified in all specimens; however, all were of abnormal morphology. The majority of specimens showed evidence of nerve fiber Regeneration although confined to the mid- or lower reticular dermis. There was no Regeneration of skin adnexa. Conclusions: This study showed significant improvements in patient-assessed mobility, softness, and appearance. Collagen and elastic fibrin were present in all specimens, nerve fiber Regeneration was limited to the mid- or lower reticular dermis, and adnexal structures were absent. The typical wrinkled appearance of mature Integra reconstruction cannot be said to be entirely due to a lack of elastic fibers.
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topical negative pressure therapy does it accelerate neovascularisation within the Dermal Regeneration Template integra a prospective histological in vivo study
Burns, 2010Co-Authors: Naiem Moiemen, Jeremy Yarrow, Dia Kamel, Daniel Kearns, Derek MendoncaAbstract:Abstract Background The use of topical negative pressure (TNP) dressings with Dermal Regeneration Template (DRT), Integra, has improved outcomes and simplified aftercare. Previous clinical studies have suggested accelerated vascularisation; with a reduction in the duration of the 1st stage after the application of Integra, from 2 to 4 weeks to as little as 4 days, but with no histological evidence. However, histological studies, without TNP, have shown that vascularisation occurs between the second and the fourth week. This study set out to examine histologically the rate of DRT neovascularisation when combined with TNP. Methods Eight patients with nine reconstruction sites were enlisted. Unmeshed Integra and fibrin sealant to promote adherence were used. TNP was applied for the duration between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 post-application. The biopsies were stained with H&E and endothelial markers CD31 and CD34. Template vascularisation was assessed as a percentage of the Template depth in which patent, canalised vascular channels could be demonstrated. Results The median percentage of the Template depth which demonstrated canalised channels was 0%, 20%, 61% and 80% for days, 7, 14, 21 and 28, respectively. Conclusion The application of TNP dressings to Dermal Templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance. However, this study could not demonstrate that TNP accelerates neovascularisation as verified by the presence of histologically patent vascular channels.
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reconstructive surgery with integra Dermal Regeneration Template histologic study clinical evaluation and current practice
Plastic and Reconstructive Surgery, 2006Co-Authors: Naiem Moiemen, Jonathan J Staiano, E Vlachou, Yi Thawy, J D FrameAbstract:Background:Yannas and Burke developed the concept of the Dermal Regeneration Template in the 1970s. It is now a widely accepted tool in the treatment of burns as well as in reconstructive surgery.Methods:The authors present a previously published study of Integra used in 20 consecutive patients to r
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reconstructive surgery with a Dermal Regeneration Template clinical and histologic study
Annual Meeting of the American Burn Association, 2001Co-Authors: Naiem Moiemen, Jonathan J Staiano, Nkemcho Ojeh, Yi Thway, J D FrameAbstract:Integra artificial skin was introduced in 1981 and its use in acute surgical management of burns is well established, but Integra has also been used in patients undergoing reconstructive surgery. Over a period of 25 months, the authors used Integra to cover 30 anatomic sites in 20 consecutive patients requiring reconstructive surgery and then analyzed the clinical and histologic outcomes. The most common reason for surgery was release of contracture followed by resurfacing of tight or painful scars. The authors assessed patients' satisfaction using a visual analog scale and scar appearance using a modified Vancouver Burn Index Scale. They evaluated the progress of wound healing by examining weekly punch-biopsy specimens with standard and immunohistochemical stains. Patients reported a 72 percent increase in range of movement, a 62 percent improvement in softness, and a 59 percent improvement in appearance compared with their preoperative states. Pruritus and dryness were the main complaints, and neither was improved much. Four distinct phases of Dermal Regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. The color of the wound reflected the state of neoDermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal Dermal collagen. The authors conclude that Integra is a useful tool in reconstructive surgery. The additional cost of its use can be justified by its distinct benefits compared with current methodology.
Ezio Faglia - One of the best experts on this subject based on the ideXlab platform.
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the use of a Dermal substitute to preserve maximal foot length in diabetic foot wounds with tendon and bone exposure following urgent surgical debridement for acute infection
International Wound Journal, 2010Co-Authors: Giacomo Clerici, Maurizio Caminiti, Vincenzo Curci, Antonella Quarantiello, Ezio FagliaAbstract:In this study, we evaluated the utility of a Dermal substitute for preserving maximal foot length after urgent surgical debridement. Patients referred to our Diabetic Foot Center with foot lesions were assessed for sensory-motor neuropathy, infection and critical limb ischaemia. The presence of acute foot infection indicated the need for immediate surgical debridement. The degree of amputation, if necessary, was based on the amount of apparently non infected vital tissue. When vital tendon/bone tissue remained exposed, the lesion was covered with a Dermal substitute. From January to December 2008, 393 patients underwent surgical treatment for diabetic foot syndrome; 30 patients underwent immediate surgical debridement resulting in exposed tendon and/or bone tissues. An average of 4.4 +/- 2.1 days following surgical debridement, all 30 patients underwent Dermal Regeneration Template grafting to cover-exposed healthy tendon and bone tissues, instead of achieving primary wound closure with a proximal amputation. After 21 days, a skin graft was performed. Complete wound healing occurred in 26 patients (86.7%). In these patients, the amputation level was significantly more distal (P < 0.003) with respect to that potentially required for immediate wound closure. The average healing time was 74.1 +/- 28.9 days. Four patients underwent a more proximal amputation. No patients underwent major amputation. The use of the Dermal substitute for treating exposed tendon and bone tissues allowed timely wound healing and preserved maximal foot length. Continued follow-up will allow assessment of long-term relapse and complication rates. Such treatment could constitute part of the comprehensive management of diabetic wounds.
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the use of a Dermal substitute integra to preserve maximal foot length in a diabetic foot wound with bone and tendon exposure following urgent surgical debridement for an acute infection
The International Journal of Lower Extremity Wounds, 2009Co-Authors: Giacomo Clerici, Maurizio Caminiti, Vincenzo Curci, Antonella Quarantiello, Ezio FagliaAbstract:In this report, the authors present the case of a 62-year-old female patient who was admitted to our hospital with an acute deep foot infection. The patient was taken immediately to the operating room where she underwent surgical debridement to completely remove all infected tissues; at the end of this first surgical step, all 5 metatarsal bones remained exposed dorsally. Once eradication of infection was completed, we had to decide whether to perform a transmetatarsal amputation at proximal levels, which would have allowed healing by first intention but would have left the patient with a smaller foot stump, or amputation at more distal levels followed by coverage of healthy tendon and bone tissues with a Dermal Regeneration Template (Integra, Integra Life Sciences Corporation, Plainsboro, NJ), which would have preserved the foot stump length and allowed better walking. We opted for the second choice, and the use of a Dermal Template actually enabled our patient to maintain a considerable foot stump length, much longer than would have resulted from an amputation with immediate primary closure.