American Association of Plastic Surgeons

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Single Stage Composite Regeneration Of Skin And Subcutaneous Layer For Burn Reconstruction: Preclinical Study In A Swine Model
Yadira Villalvazo, MD, MS1, Yusuf Surucu, MD1, Jose Antonio Arellano, MD1, Pooja Humar, BS1, Fuat Baris Bengur, MD1, Shawn Loder, MD1, Hamid Malekzadeh, MD1, Amr Elmeanawy, MD1, Alexandra Vagonis, BS1, Wayne Nerone, BS1, Francesco Egro, MD1, Lauren Kokai, PhD1, Kacey Marra, PhD1, Elof Eriksson, MD2, J. Peter Rubin, MD, MBA1..
1University of Pittsburgh, Pittsburgh, PA, USA, 2Harvard Medical School, Boston, MA, USA.

A major problem in burn reconstruction is disfigurement, pain, and functional impairment due to stiffness and immobility of skin grafts. This work aims to demonstrate efficacy of a single stage technique to regenerate skin and underlying adipose tissue for burn reconstruction. We hypothesized that a composite graft of a STSG placed over a layer of morselized fat graft would yield a closed wound with improved mobility and flexibility in a single stage procedure.
Three female Yorkshire swine each sustained four 64cm2 surface area full thickness burns (n=12). Surgical debridement to fascia and reconstruction was performed 48 hours post-injury. Control animals received STSG over fascia. Experimental wounds received; 1) base layer of morselized autologous fat graft under a STSG, or; 2) base fat graft layer under a skin pixels. Biomechanical and histologic analysis were performed at 6 weeks.
STSG over fat graft, when compared with STSG alone, showed presence of a regenerated subcutaneous layer on ultrasound approaching uninjured tissue (ANOVA; p<0.05). In-vivo biomechanical testing by multiple methods showed improved mobility and flexibility of the epidermis (ANOVA; p<0.05). Furthermore, adipose groups showed increased hypodermal thickness on ultrasound (ANOVA; p<0.05). Histology and immunofluorescent staining confirmed regeneration of epidermis, dermis, and a viable adipose layer beneath. Pixel grafts did not perform as well.
CONCLUSION:Immediate, single-stage adipose graft and STSG reconstruction of full thickness burns restores normal soft tissue thickness, and improves skin graft mobility and flexibility in a swine model. This work provides preclinical data for translation to burn patients.
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