Background: Restoration of breast sensation has become an important goal in autologous and implant-based breast reconstruction after cancer-related mastectomy. Although gender-affirming mastectomy with free nipple grafting (FNG) results... more
Background: Restoration of breast sensation has become an important goal in autologous and implant-based breast reconstruction after cancer-related mastectomy. Although gender-affirming mastectomy with free nipple grafting (FNG) results in similar sensory deficits, chest reinnervation concepts have not been applied to this procedure. Methods: This article describes a novel technique to reinnervate the FNG in patients undergoing double incision gender mastectomy. Results: Our technique differs from previously described reinnervation techniques in several aspects: (1) the donor axon count is maximized by preserving the third to fifth lateral cutaneous nerves for coaptation to the nipple areola complex, (2) the reinnervation approach varies and is based on patient anatomy, (3) the distal graft or donor nerve is split into fascicles to increase the reinnervation zone, and (4) the split fascicles are coapted to the dermatosensory peripheral nerve elements of the dermis. Conclusion: Chest...
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Objectives/Interrogation: Sarcomas are rare tumors that make up roughly 1% of all malignancies, and complete resection remains a mainstay of current treatment guidelines for localized disease. Post-extirpative defects following sarcoma... more
Objectives/Interrogation: Sarcomas are rare tumors that make up roughly 1% of all malignancies, and complete resection remains a mainstay of current treatment guidelines for localized disease. Post-extirpative defects following sarcoma resection often pose a difficult challenge to the reconstructive[for full text, please go to the a.m. URL]
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This article cites 12 articles, 10 of which can be accessed free
Amputation of an extremity is a common procedure performed for a variety of indications. For lower extremity amputations, certain co-morbid states (peripheral vascular disease, diabetes, etc.), trauma, oncology, and congenital deformities... more
Amputation of an extremity is a common procedure performed for a variety of indications. For lower extremity amputations, certain co-morbid states (peripheral vascular disease, diabetes, etc.), trauma, oncology, and congenital deformities all contribute patients who may require amputation for medical or functional needs. Amputation can be performed at varying levels based on the patient’s need, including partial foot amputation, below-knee or above-knee amputation, or hip disarticulation. Regardless of the reason and site of amputation, there are a set of common principles of amputation that can aid in achieving the best functional outcome for the residual limb [1]. Figure 16.1 summarizes the most common levels of amputation and the most common associated motor nerve targets at each level.
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CONCLUSION: In both groups, fat grafting for pedal atrophy positively impacted pain and function. These measures demonstrated a persistent improvement, though fat volume returned to baseline. This finding may be attributed to the observed... more
CONCLUSION: In both groups, fat grafting for pedal atrophy positively impacted pain and function. These measures demonstrated a persistent improvement, though fat volume returned to baseline. This finding may be attributed to the observed increase in dermal thickness. Together, these results suggest that fat grafting may thicken or stabilize the dermis, contributing to improved clinical outcomes despite loss of grafted fat.
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PURPOSE: The medial sural artery perforator (MSAP) flap offers thin, pliable tissue with a relatively long pedicle. Compared to other thin fasciocutaneous flaps, its relatively low donor site morbidity makes the MSAP flap a valuable... more
PURPOSE: The medial sural artery perforator (MSAP) flap offers thin, pliable tissue with a relatively long pedicle. Compared to other thin fasciocutaneous flaps, its relatively low donor site morbidity makes the MSAP flap a valuable option for the reconstructive microsurgeon. The purpose of this study is to systematically evaluate the literature on use of MSAP flaps with regards to flap characteristics, indications, recipient site defects, and postoperative outcomes.
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To ascertain if immunization with pneumococcal polysaccharide vaccine is associated with rises in the levels of proinflammatory cytokines in the plasma of human immunodeficiency virus type 1 (HIV-1)-infected patients, the levels of tumor... more
To ascertain if immunization with pneumococcal polysaccharide vaccine is associated with rises in the levels of proinflammatory cytokines in the plasma of human immunodeficiency virus type 1 (HIV-1)-infected patients, the levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were measured serially after immunization. IL-6 levels rose an average of 2.2- and 2.1-fold 6 and 8 h after immunization, respectively, but TNF-α levels remained unchanged. The levels of these cytokines were stable in unimmunized controls. Immunization with pneumococcal polysaccharide vaccine induces increases in the levels of IL-6 in the plasma of persons with HIV-1 infection.
Research Interests: Immunology, Biology, Cytokines, Medicine, Streptococcus pneumoniae, and 13 moreHIV, Antiretroviral Therapy, Humans, Infection Control, Gram Positive, Immunization, Medical Care, Human immunodeficiency virus, Tumor necrosis factor-alpha, Pneumococcal Vaccines, Interleukin, opportunistic infection, and HIV infections
In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to unprecedented survival rates in blast-injured soldiers, resulting in... more
In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to unprecedented survival rates in blast-injured soldiers, resulting in large numbers of wounded warriors with complex limb trauma. Bone and soft tissue defects have resulted in increased use of complex reconstructive algorithms to restore limbs and function. In addition, in failed salvage attempts, advances in amputation options are being developed. In this review, we summarize state-of-the-art limb-salvage methods for both soft tissue and bone. In addition, we discuss advances in diagnostic methods with development of personalized clinical decision support tools designed to optimize outcomes after severe blast injuries. Finally, we present new advances in osteointegrated prostheses for above-knee amputations.
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Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective... more
Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective skin barrier but also to preserve tendon and muscle excursion, provide protective padding around nerves and restore adequate joint motion. Accordingly, regenerative medicine modalities that can accomplish these goals are of great interest. The use of bioartificial dermal regeneration templates (DRT), such as Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ, USA), in the management of complex soft tissue injuries has an important role in the reconstruction of war wounds. These DRTs provide initial wound coverage and help establish a well-vascularized wound bed suitable for definitive soft tissue coverage.
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of the lower limb almost 30 years ago, there has been continued interest in determining which of the two options, muscle flaps or fasciocutaneous flaps, are more suitable for treatment of traumatic limb defects. The debate has raged on... more
of the lower limb almost 30 years ago, there has been continued interest in determining which of the two options, muscle flaps or fasciocutaneous flaps, are more suitable for treatment of traumatic limb defects. The debate has raged on over the past three decades, with numerous laboratory-based and clinical studies designed to answer this question. Currently, it would be safe to say that it is far from resolved. Laboratorybased studies have indicated that muscle flaps are better at reducing infectious colonization and promoting enhanced healing of fractures despite their seemingly less superior vascular density compared with fasciocutaneous flaps.3 Clinical studies, in contrast, favor the use of fasciocutaneous flaps in these traumatic defects, highlighting the fact that they provide a more suitable reconstructive substrate while equaling outcomes of muscle flaps in terms of complications.4,5 All of the laboratory work has been carried out on animal models, which are usually oversimplifications of the clinical context, and at the same time incorporate a number of other flaws in the fundamental design of the experiments. The same can be said of the clinical studies, with more or less all of them being retrospective case reviews. Thus, if we are to move forward in this sphere, it is essential that we design experiments with a higher therapeutic index with the capability of answering these questions more accurately. Furthermore, a greater focus on functional and patientreported outcomes following limb salvage in this cohort of patients will help us to better appreciate the impact of these procedures on patients. Finally, muscle and fasciocutaneous flaps have distinct differences that make each of them suitable in different circumstances. It is probably more important that future research focuses more on delineating the circumstances within which each option should be used rather than pitting muscle flaps against fasciocutaneous flaps. DOI: 10.1097/PRS.0000000000001610
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War trauma patients who have sustained extremity trauma often exhibit extensive zones of injury with multiple concomitant injuries that can contribute to limited coverage options. Thus, flap availability and choice can become critical in... more
War trauma patients who have sustained extremity trauma often exhibit extensive zones of injury with multiple concomitant injuries that can contribute to limited coverage options. Thus, flap availability and choice can become critical in the reconstruction algorithm of these severely traumatized patients. The authors' purpose was to analyze the outcomes of muscle and fasciocutaneous flaps during their extremity reconstructive experience to determine which option had better flap and limb salvage outcomes. A retrospective review of servicemembers treated with flap-based limb salvage from 2003 through 2012 at the National Capital Consortium was completed. Patients were divided into cohorts of patients who underwent muscle or fasciocutaneous flaps. Three hundred fifty-nine flap procedures were performed. Of these procedures, 197 were muscle (55 percent) and 152 were fasciocutaneous flaps (42 percent). There was no difference in overall flap complications between groups (30 percent v...
Research Interests: Treatment Outcome, Adolescent, Medicine, Humans, Iraq War, and 15 moreFemale, Male, Young Adult, Clinical Sciences, Middle Aged, Adult, Time Factors, Retrospective Studies, Soft Tissue Injuries, Limb Salvage, Extremities, Injury Severity Score, Multiple trauma, Surgical Flaps, and Reconstructive Surgical Procedures
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Research Interests: Surgery, Medicine, Heart Failure, Plastic and Reconstructive Surgery, Humans, and 12 moreLeft Ventricular Assist Device, Male, Plastic, Transposition, Clinical Sciences, Middle Aged, And, Heart Transplantation, Continuous Flow Heart Assist Devices, Omentum, Surgical wound infection, and Surgical Flaps
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Evolution in extremity injury treatment often occurs during major conflicts, with lessons learned applied and translated among military and civilian settings. In recent periods of war, improvements in protective equipment, in-theater... more
Evolution in extremity injury treatment often occurs during major conflicts, with lessons learned applied and translated among military and civilian settings. In recent periods of war, improvements in protective equipment, in-theater damage control resuscitation/surgery, delivery of antibiotics locally/systemically, and rapid evacuation to higher levels of medical care capabilities have greatly improved combat casualty survivability rates. Additionally, widespread application of lower extremity tourniquets also has prevented casualties from exsanguination, thus reducing hemorrhagic-related deaths. Secondary to these, a high number of combat casualties suffering lower extremity traumatic injuries have presented for functional limb reconstruction and restoration as well as residual limb care.
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The increasing use of explosive devices in recent military operations has introduced complex patterns of injury requiring new reconstructive considerations. Proper initial management, staging, traditional and advanced reconstruction... more
The increasing use of explosive devices in recent military operations has introduced complex patterns of injury requiring new reconstructive considerations. Proper initial management, staging, traditional and advanced reconstruction methods, and the use of regenerative medicine can have a drastic effect on outcomes. Even when limb salvage is not achieved, an understanding of residual limb length preservation and peripheral nerve techniques can improve functionality within the amputee patient. Surgery utilizing regenerative modalities and peripheral nerve techniques has shown promising results in military injuries with extensive soft tissue, orthopedic, and neurovascular damage. Improved understanding of the hybrid reconstructive ladder, the increased use of innovative surgical strategies, and further study into the benefits of regenerative medicine may lead to improvements in care for both military and nonmilitary trauma patients suffering from blast injuries.
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The increasing use of explosive devices in recent military operations has introduced complex patterns of injury requiring new reconstructive considerations. Proper initial management, staging, traditional and advanced reconstruction... more
The increasing use of explosive devices in recent military operations has introduced complex patterns of injury requiring new reconstructive considerations. Proper initial management, staging, traditional and advanced reconstruction methods, and the use of regenerative medicine can have a drastic effect on outcomes. Even when limb salvage is not achieved, an understanding of residual limb length preservation and peripheral nerve techniques can improve functionality within the amputee patient. Surgery utilizing regenerative modalities and peripheral nerve techniques has shown promising results in military injuries with extensive soft tissue, orthopedic, and neurovascular damage. Improved understanding of the hybrid reconstructive ladder, the increased use of innovative surgical strategies, and further study into the benefits of regenerative medicine may lead to improvements in care for both military and nonmilitary trauma patients suffering from blast injuries.
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This paper reports a new type of augmented reality (AR) system that integrates a Microsoft HoloLens device with a three-dimensional (3D) point tracking module for medical training and telementored surgery. In this system, a stereo camera... more
This paper reports a new type of augmented reality (AR) system that integrates a Microsoft HoloLens device with a three-dimensional (3D) point tracking module for medical training and telementored surgery. In this system, a stereo camera is used to track the 3D position of a scalpel and transfer its coordinates wirelessly to a HoloLens device. In the scenario of surgical training, a virtual surgical scene with pre-recorded surgical annotations is superimposed with the actual surgical scene so that the surgical trainee is able to operate following virtual instructions. In the scenario of telementored surgery, the virtual surgical scene is co-registered with the actual surgical scene so that the virtual scalpel remotely mentored by an experienced surgeon provides the AR guidance for the inexperienced on-site operator. The performance characteristics of the proposed AR telementoring system are verified by benchtop experiments. The clinical applicability of the proposed system in telementored skin grafting surgery and fasciotomy is validated in a New Zealand rabbit model. Our benchtop and in vivo experiments demonstrate the potential to improve surgical performance and reduce healthcare disparities in remote areas with limited resources.
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OBJECTIVEThe consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the... more
OBJECTIVEThe consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the effectiveness of a protocol-based multidisciplinary approach in optimizing wound outcome in complex oncological spine care patients.METHODSA retrospective consecutive case series was performed from 2015 to 2019 of all patients who underwent oncological spine surgery. A protocol was established to identify oncological patients at high risk for potential wound complications. Preoperative and postoperative treatment plans were developed by the multidisciplinary tumor board team members. Wound healing risk factors such as diabetes, obesity, prior spine surgery, pre- or postoperative chemotherapy or radiation exposure, perioperative steroid use, and poor nutritional status were recorded. Operative details, including the regions of spinal involvement, presence of ...
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We report our experience with next-generation incisional negative pressure wound therapy (iNPWT) applied after major limb amputation or amputation revision. In this high-risk patient population, the need for reliable post-operative soft... more
We report our experience with next-generation incisional negative pressure wound therapy (iNPWT) applied after major limb amputation or amputation revision. In this high-risk patient population, the need for reliable post-operative soft tissue management is imperative. In both cases reported, healing was uncomplicated. Using the next generation iNPWT in this unique way optimizes the post-operative residual limb by improved incision healing, residual limb edema reduction, and reduced risk of surgical site infection (SSI). This is the first case report of its kind reporting a novel use of next-generation iNPWT, and it demonstrates a need to examine this particular use further.
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Coronavirus disease 2019 (COVID-19) resulted in a worldwide pandemic that at the time of this writing has caused over 400,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical... more
Coronavirus disease 2019 (COVID-19) resulted in a worldwide pandemic that at the time of this writing has caused over 400,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical Corps (MC) and Nurse Corps (NC) providers were mobilized in direct support of critical care capabilities through expansion intensive care units. In the course of the deployment, high rates of neurological-related manifestations associated with COVID-19 infection were directly observed by our military provider teams which will be described and supporting literature highlighted. This is organic information absorbed in real time during the early stages of the pandemic in New York City. The neurological manifestations of COVID-19 varied in presentation and severity. Cerebral vascular injuries documented included strokes, iatrogenic intraparenchymal hemorrhage, hypoxia-related changes and sequelae, as well as acquired diseases secondary to delayed treatment of other primary neurologic disease states. Hypercoagulable and inflammatory markers (d-dimer, C-reactive protein, etc) were commonly elevated, and anticoagulation became a key factor in disease treatment and to help mitigate the downstream neurologic sequelae associated with this disease. Here we present these initial findings to lay the groundwork for more robust clinical studies moving forward.
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BackgroundCOVID-19 resulted in a worldwide pandemic that at the time of this writing resulted in over 200,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical Corps (MC) and... more
BackgroundCOVID-19 resulted in a worldwide pandemic that at the time of this writing resulted in over 200,000 deaths within the United States. During the pandemic surge in New York City, NY, a number of military Medical Corps (MC) and Nurse Corps (NC) providers were mobilized in direct support of critical care capabilities through expansion intensive care units. In the course of the deployment, high rates of neurological-related manifestations associated with COVID-19 infection were directly observed by our military provider teams which will be described and supporting literature highlighted.Case ReportExperiences of a group of mobilized providers including anesthesiologists, neurosurgeons, and other physician specialists were integrated as attending intensive care unit providers as part of the Navy Medicine Support Team (NMST) during the Federal Emergency Management Agency (FEMA) and Department of Defense (DoD) collective response – i.e. Operation Gotham. Various neurological manif...
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Background: Orthopaedic trauma etiologies are a common cause for amputation. Targeted muscle reinnervation (TMR) is a technique aimed at reducing or preventing pain and improving function. The purpose of this study was to examine... more
Background: Orthopaedic trauma etiologies are a common cause for amputation. Targeted muscle reinnervation (TMR) is a technique aimed at reducing or preventing pain and improving function. The purpose of this study was to examine postoperative phantom limb pain and residual limb pain following TMR in orthopaedic trauma amputees. In addition, postoperative rates of opioid and neuromodulator medication use were evaluated. Methods: Twenty-five patients (60% male) prospectively enrolled in a single-institution study and underwent TMR at the time of major limb amputation (48% nonmilitary trauma, 32% infection secondary to previous nonmilitary trauma, and 20% other, also secondary to trauma). Phantom limb pain and residual limb pain scores, pain temporality, prosthetic use, and unemployment status were assessed at the time of follow-up. The use of opioid and neuromodulator medications both preoperatively and postoperatively was also examined. Results: At a mean follow-up of 14.1 months, phantom limb pain and residual limb pain scores were low, with 92% of the patients reporting no pain or brief intermittent pain only. Pain scores were higher overall for male patients compared with female patients (p < 0.05) except for 1 subscore, and higher in patients who underwent amputation for infection (odds ratio, 9.75; p = 0.01). Sixteen percent of the patients reported opioid medication use at the time of the latest documented follow-up. Fifty percent of the patients who were taking opioids preoperatively discontinued use postoperatively, while 100% of the patients who were not taking opioids preoperatively discontinued postoperative use. None of the patients who were taking neuromodulator medication preoperatively discontinued use postoperatively (0 of 5). The median time to neuromodulator medication discontinuation was 14.6 months, with female patients taking longer than male patients (23 compared with 7 months; p = 0.02). At the time of the latest follow-up, the rate of reported prosthetic use was 85% for lower-extremity and 40% for upper-extremity amputees, with a rate of unemployment due to disability of 36%. Conclusions: The use of TMR in orthopaedic trauma amputees was associated with low overall pain scores at 2-year follow-up, decreased overall opioid and neuromodulator medication use, and an overall high rate of daily prosthetic use. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Wound infection involving hardware can be notoriously difficult to treat, often requiring the removal of the infected implant. The goal of this study was to determine the utility of instillation negative pressure wound therapy to help... more
Wound infection involving hardware can be notoriously difficult to treat, often requiring the removal of the infected implant. The goal of this study was to determine the utility of instillation negative pressure wound therapy to help eradicate infection and allow for definitive wound closure in patients without removing the infected hardware. A retrospective review was performed on the outcomes of 28 patients who presented with open wounds with exposed or infected hardware and who were treated with a combination of surgical debridement and negative pressure wound therapy with instillation (NPWTi). Eleven patients were treated for infected spinal hardware, 12 for extremity, and 5 for sternal hardware. Twenty‐five of 28 (89%) patients had successful retention or replacement of hardware, with clearance of infection and healed wounds. Original hardware was maintained in 17 of 28 (61%) patients. In 11 patients, original hardware was removed, with subsequent replacement in eight of those patients after a clean wound was achieved. Average time to definitive closure was 12.6 days. Average follow‐up was 135 days. This series supports NPWTi as an effective adjunct therapy to help expeditiously eradicate hardware infection, allowing for hardware retention.
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We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation.
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Summary: Approximately 25 percent of major limb amputees will develop chronic localized symptomatic neuromas and phantom limb pain in the residual limb. A method to treat and possibly prevent these pain symptoms is targeted reinnervation.... more
Summary: Approximately 25 percent of major limb amputees will develop chronic localized symptomatic neuromas and phantom limb pain in the residual limb. A method to treat and possibly prevent these pain symptoms is targeted reinnervation. Previous studies prove that targeted reinnervation successfully treats and, in some cases, resolves peripheral neuropathy and phantom limb pain in patients who have undergone previous amputation (i.e., secondary targeted reinnervation). This article seeks to share the authors’ clinical indications and surgical technique for targeted muscle reinnervation in below-knee amputation, a surgical description currently absent from our literature. Targeted reinnervation for the below-knee amputee has been performed on 22 patients at the authors’ institution. Each patient has been followed on an outpatient basis for 1 year to evaluate symptoms of neuroma or phantom limb pain, patient satisfaction, and functionality. All subjects have denied neuroma pain following amputation. The majority of subjects reported phantom pain at 1 month. However, at 3 months, all patients reported resolution of this pain. Dumanian et al. first noted the improvement of symptomatic neuroma and phantom limb pain in patients undergoing targeted reinnervation to provide intuitive control of upper limb prostheses. These findings have been substantiated by multiple previous studies at various amputation levels. This study extends the success of targeted muscle reinnervation to below-knee amputations and provides a description for this technique.
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In the United States, 54 million people live in a designated health service area with either no plastic surgeon or less than 1 plastic surgeon per 100,000 population. Previous studies demonstrate that patients in rural communities often... more
In the United States, 54 million people live in a designated health service area with either no plastic surgeon or less than 1 plastic surgeon per 100,000 population. Previous studies demonstrate that patients in rural communities often have limitations with access to basic primary care services and subspecialty care services. Such limitations can have significant adverse impacts on health care and quality of life. Plastic and reconstructive surgeons offer unique advantages especially within rural settings given their broad scope of surgical skillsets. The purposes of this study are to illustrate the shortage of plastic and reconstructive surgeons within rural America catchment regions, identify and outline certain care offerings provided by these surgical specialists, and highlight the potential impact having such specialists directly involved in provision of care to patients within rural community settings. Our group will present data demonstrating misperceptions and an unawarenes...
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full-thickness skin defects remain a reconstructive challenge. Novel regenerative modalities can aid in addressing these defects. A literature review of currently available dermal and epidermal regenerates was performed. The mechanism and... more
full-thickness skin defects remain a reconstructive challenge. Novel regenerative modalities can aid in addressing these defects. A literature review of currently available dermal and epidermal regenerates was performed. The mechanism and application for each skin substitute was analyzed to provide a guide for these modalities. Available epidermal substitutes include autografts and allografts and may be cultured or noncultured. Dermal regenerate templates exist in biologic and synthetic varieties that differ in the source animal and processing. Epidermal and dermal skin substitutes are promising adjunctive tools for addressing certain soft tissue defects and have improved outcomes in reconstructive procedures. The following article provides a comprehensive review of the biologic materials available and the types of complex wounds amenable to their use.
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Massive soft tissue and skin loss secondary to war-related traumas are among the most frequently encountered challenges in the care of wounded warriors. This case report outlines the first military nonburn-related trauma patient treated... more
Massive soft tissue and skin loss secondary to war-related traumas are among the most frequently encountered challenges in the care of wounded warriors. This case report outlines the first military nonburn-related trauma patient treated by a combination of regenerative modalities. Our case employs spray skin technology to an established dermal regenerate matrix. Our patient, a 29-year-old active duty male, suffered a combat blast trauma in 2010 while deployed. The patient's treatment course was complicated by a severe necrotizing fasciitis infection requiring over 100 surgical procedures for disease control and reconstruction. In secondary delayed reconstruction procedures, this triple-limb amputee underwent successful staged ventral hernia repair via a component separation technique with biologic mesh underlay although this resulted in a skin deficit of more than 600 cm(2). A dermal regenerate template was applied to the abdominal wound to aid in establishing a "neodermis....
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Complex, full-thickness soft tissue defects secondary to large burns, trauma and war-related injuries continue to challenge reconstructive surgeons. To achieve positive surgical outcomes in these patient populations, novel approaches are... more
Complex, full-thickness soft tissue defects secondary to large burns, trauma and war-related injuries continue to challenge reconstructive surgeons. To achieve positive surgical outcomes in these patient populations, novel approaches are needed to restore the functional, protective and aesthetic properties of skin. Herein, we provide the first report describing the staged use of a dermal regenerate template (DRT) with a spray-on epidermal regenerative modality (spray skin) in addition to autologous split-thickness skin grafting (STSG) in non-burn trauma and compare these results with those of patients treated with DRT and STSG alone. A pilot study was performed to evaluate whether the use of spray skin technology (ReCell, Avita Medical) as an adjunct to DRT (Integra, Integra Lifesciences) and autologous skin grafting in the treatment of patients with large full-thickness soft tissue losses impacts donor site burden as well as recipient and donor site re-epithelialization. In this re...
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Response to: Leclère FM & Casoli V. Use of bioartificial dermal regeneration template for skin restoration in combat casualty injuries. Regen. Med. 11(4), 359–360 (2016).
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Bone tissue engineering (BTE) intends to restore structural support for movement and mineral homeostasis, and assist in hematopoiesis and the protective functions of bone in traumatic, degenerative, cancer, or congenital malformation.... more
Bone tissue engineering (BTE) intends to restore structural support for movement and mineral homeostasis, and assist in hematopoiesis and the protective functions of bone in traumatic, degenerative, cancer, or congenital malformation. While much effort has been put into BTE, very little of this research has been translated to the clinic. In this review, we discuss current regenerative medicine and restorative strategies that utilize tissue engineering approaches to address bone defects within a clinical setting. These approaches involve the primary components of tissue engineering: cells, growth factors and biomaterials discussed briefly in light of their clinical relevance. This review also presents upcoming advanced approaches for BTE applications and suggests a probable workpath for translation from the laboratory to the clinic.
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ABSTRACT
ABSTRACT
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To assess the outcomes of treatment with a dermal regeneration template (DRT) in a cohort of combat casualties with severe upper extremity injuries. Records of all active duty military patients treated with DRT at our institution between... more
To assess the outcomes of treatment with a dermal regeneration template (DRT) in a cohort of combat casualties with severe upper extremity injuries. Records of all active duty military patients treated with DRT at our institution between November 2009 and July 2013 were screened. Inclusion criteria were upper extremity open wounds sustained during combat, requiring split-thickness or full-thickness skin grafting for closure. The primary outcome measure was wound healing after the first attempt at definitive treatment (defined as the first application of split-thickness or full-thickness skin graft). Independent variables collected included time from injury to arrival at our facility, mechanism of injury, wound infection, tobacco use, location of wound, number of operative debridements, and patient demographics. A total of 60 patients with 69 wounds met the inclusion criteria. Most wounds were to the wrist or forearm (54%) or fingers (19%). All wounds were heavily contaminated, requiring a mean of 2.5 operative debridements before DRT placement. All wounds treated with full-thickness skin grafting after DRT healed completely without further complication. Split-thickness skin grafting was successful in 96% of patients. DRT wound dressings are a helpful adjunct in the treatment of contaminated war wounds to the upper extremity. Therapeutic IV.