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A Novel Concept for Treating Large Necrotizing Fasciitis Wounds With Bilayer Dermal Matrix, Split-thickness Skin Grafts, and Negative Pressure Wound Therapy
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
2009 (English)In: Wounds (King of Prussia, Pa.), ISSN 1044-7946, Vol. 21, no 8, 215-220 p.Article in journal (Refereed) Published
Abstract [en]

Treatment of necrotizing fasciitis (NF) includes radical surgical debridement often resulting in large wounds that need to be closed with methods including split-thickness skin grafts (STSG), local flaps, or guided tissue regeneration procedures. In this case report, a 45 year-old Caucasian male was surgically treated for a benign left groin hernia, developed NF, and was transferred to the authors burn unit. The wound was treated initially with wide debridement and with a brief delay before finally closing the wound. A collagen matrix such as Integra (R) Dermal Regeneration Template (Integra LifeSciences, Plainsboro, NJ) in combination with STSG and negative pressure wound treatment, can provide fast recovery resulting in pliable, functional skin.

Place, publisher, year, edition, pages
2009. Vol. 21, no 8, 215-220 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-20581ISI: 000269472900006OAI: diva2:235290

Funding text: "We express our sincere gratitude to Mrs. Kristina Briheim and Mrs. Anita Lonn, Senior Laboratory Technicians at the Laboratory for Experimental Plastic Surgery, Institute of Biomedicine and Surgery, Faculty Of Health Sciences, Linkoping Universitet, Linkoping, Sweden."

Available from: 2009-09-15 Created: 2009-09-15 Last updated: 2014-09-11Bibliographically approved
In thesis
1. Keratinocytes in tissue engineering of human skin: invitro and in vivo studies
Open this publication in new window or tab >>Keratinocytes in tissue engineering of human skin: invitro and in vivo studies
2008 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Full thickness wounds, such as deep burns, need restoration of both the dermal and epidermal layers of the skin. In normal wound healing, re-epithelialization occurs by migration and proliferation of keratinocytes from the wound edges and by differentiation of stem cells from remaining hair follicles. Restoration of dermis occurs by influx of growth factors secreted by macrophages, platelets, and fibroblasts; by fibroblast proliferation and subsequent synthesis and remodeling of collagenous dermal matrix. In the case of full-thickness acute burn injuries and chronic wounds (e.g. pressure ulcers, venous ulcers and diabetic foot ulcers), these processes are defective. With the principles of tissue engineering in mind (to correct, improve and maintain tissues and their functions), researchers have developed promising materials and methods to make it possible to restore either the dermal (Integra® DRT, Alloderm®) or the epidermal layer (split thickness skin grafts (STSG), cultured epithelial autografts (CEA), autologous keratinocytes in single cell suspension). It is now well established that superior results are obtained if both dermal and epidermal components are combined, for example in a bilayered skin equivalent. Apligraf® is recommended for use on venous ulcers and is the only bilayered living skin equivalent currently approved by the FDA. Studies on different factors affecting the wound healing capacity as well as techniques in use provide valuable information for further development.

In this licentiate thesis, we evaluated different transplantation techniques for delivering cultured human keratinocytes in single cell suspension, a measure becoming more frequently used in addition to STSG and CEA for restoring the epidermal layer of the skin. We found that the pressure device, commonly used to spray cell suspension onto the wound with pressures as high as 200 kPa, killed around 0% of the cells. In comparison, an ordinary syringe with the attachment of a spray nozzle showed almost 90% viable cells post transplantation and provided an equally good distribution of the cell suspension.

We also studied different silver containing dressings regarding silver accumulation in human skin. In addition, we graded the re-epithelialization to evaluate whether the dressings caused any delay in the wound healing process. We found that the silver dressings tested, with few exceptions, caused dermal accumulation of silver, primarily aggregated around blood vessels. We could also show that most of the dressings had negative effect on the re-epithelialization.

For the restoration of the dermal layer of the skin, Integra® DRT functions as a scaffold for guided tissue regeneration of the dermis. We had the possibility to study a case of necrotizing fasciitis were the treatment consisted of the use of Integra® DTR together with sub-atmospheric pressure (after initial surgical debridement) and later transplantation of split thickness skin grafts. This measure proved to be safe as well as giving satisfactory pliable and aesthetically acceptable result.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 49 p.
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 87
Keratinocytes tissue engineering
National Category
urn:nbn:se:liu:diva-21283 (URN)978-91-7393-779-5 (ISBN)
2008-11-21, Hagdahlssalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Available from: 2009-10-06 Created: 2009-09-30 Last updated: 2009-10-06Bibliographically approved

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Danielsson, PärFredriksson, CamillaHuss, Fredrik
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SurgeryFaculty of Health SciencesDepartment of Plastic Surgery, Hand surgery UHLPlastic Surgery, Hand Surgery and BurnsBurn Center
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