Tissue Engineering-based Limb Salvage (teLS): A Promising Alternative to Free Tissue Transfer in the Pediatric Patient
Fouad Saeg, BS1, Elvira N. Chiccarelli, MD2, Frank H. Lau, MD2.
1Tulane University School of Medicine, New Orleans, LA, USA, 2Louisiana State University Health Sciences Center, New Orleans, LA, USA.
PURPOSE: Children with complex extremity wounds often require microvascular free tissue transfer. However, free flap-based limb salvage (fLS) is associated with high costs of care and limited specialist availability. We present a case series which assesses the safety and efficacy of a novel tissue engineering-based limb salvage (teLS) technique compared with the traditional free flap approach to complex pediatric extremity wounds. The teLS technique uses dehydrated human amnion/chorion membrane (dHACM) in combination with split-thickness skin graft (STSG) for limb salvage.
METHODS: We performed a retrospective chart review of all pediatric extremity reconstructions at Childrenís Hospital New Orleans in a 24-month period (2014-2016). Patients were subdivided into teLS (n=5) and fLS (n=4) groups. Patient demographic, perioperative management, and outcome data were collected and analyzed using studentís t-test. Mean postoperative follow-up was 7 months.
RESULTS: All five teLS patients had successful limb salvage and were able to resume ambulation at follow-up. Patients in the teLS group required fewer ICU stays (0 vs 2 days, p=0.033), had fewer wound complications (0 vs 3, p=0.028), required significantly less operative time (58.6 vs 225.5 minutes, p<0.001), and achieved definitive wound closure faster (15.2 vs 94.5 days, p=0.044). Patient age, initial wound size, and operative times for debridement, skin grafting, and dressing changes were similar between the two groups.
CONCLUSION: This data supports teLS as a safe and effective alternative to the traditional free flap approach in pediatric extremity reconstruction.
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