American Association of Plastic Surgeons

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Single-stage, Multilaminar Skin And Subcutaneous Composite Reconstruction In Burns: Optimization And Clinical Translation
Shayan Sarrami, MD, Shawn J. Loder, MD, Jose Arellano, MD, Vanessa Mrouh, BS, Samantha Bosco, BS, Francesco Egro, MD, Kacey Marra, PHD, J. Peter Rubin, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

Purpose We have developed a single-stage technique for grafting skin and subcutaneous adipose tissue to restore soft, mobile, pliable skin after burns and trauma. We validated this concept in a Yorkshire swine model demonstrating multilaminar viability and significantly improved mobility of the grafted skin (p<0.05). We then successfully applied these principles to an index clinical case which we will present for the first time. We further studied this technique to determine the limits of thickness for the grafted fat layer related to viability of the reconstruction, and whether the adipose-layer can be secured fibrin sealant.
Methods Stability of fat/fibrin constructs were assessed via ex vivo compression. We used a Yorkshire swine model of full-thickness burns (16 cm², total n=36), escharectomy, and immediate reconstruction. Control wounds were treated with STSG over fascia, while experimental groups were treated with: (A) thin adipose grafts 5mm, (B) thick adipose grafts 10mm, (C) thin adipose w/fibrin, or (D) thick adipose w/fibrin. We performed gross assessment, of graft viability followed by serial photography, ultrasound, and tensiometry at harvest.
Results All adipose with fibrin sealant formulations reduced displacement forces. In pigs, thicker adipose or fibrin sealant with thin fat are viable. Combining thick fat with sealant decreases STSG survival.
Conclusions We have validated in animals that single stage layered-composite grafting improves mobility and pliability of the grafted skin, and have demonstrated initial clinical success in an ankle wound. We demonstrate here that an adipose layer 5-mm or less secured with fibrin sealant is optimal for this technique.
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