Chronic cavities of the dorsum of the foot often have bare bone and are unsuitable for free skin grafting. Local Flaps are often impossible because of surrounding scar tissue and dead space. A simple method is presented; it consists of the excision of the lesion, filling the cavity by a two staged random-pattern de-epithelialised turn over flap, and skin graft.
Cicatrix ; Foot ; Methods ; Skin ; Skin Transplantation ; Transplants

Since microskin grafting was used in 1985, 23 years have passed. Many patients with extensive third degree burns were cured by the technique. Some progresses and further improvements are discussed. (1) Several kinds of apparatus were devised to cut skin into micrografts with good results. (2) The orientation of each skin granule and even dispersion of micrografts are very important. Some methods to spread micrografts on wound were compared with one another, the technique of flotation in saline and transferring them on silk texture is still the best way. (3) Many outside materials other than silk can be selected, among them the homograft is commonly used, but it has some shortcomings. (4) The technique should be further improved. Stem cell transplantation may be expected as a new way to help heal extensive wounds.
Burns ; surgery ; Humans ; Skin Transplantation ; methods ; trends

Papineau's technique represents an excellent method of dealing with serious bone infections with significant bone and soft tissue loss. The procedure is carried out in three stages: the 1st stage is the excision of infected bone and soft tissue, stabilization of the fracture site, the 2nd stage is the cancellous bone grafting, and the 3rd stage is the skin coverage. During the period from June 1980 to September 1982, our limited experience with 14 cases has been extremely satisfactory; 1. This method is applicable to traumatic osteomyelitis and some cases in which the infection has been blood borne. 2. Successful bone grafting in the presence of infection depends upon; a. complete sequestrectomy and removal of all infected tissue b. an adequate vascular bed for the graft c. no dead space d. sufficient immobilization.
Bone Transplantation ; Immobilization ; Methods ; Osteomyelitis ; Skin ; Transplants

OBJECTIVETo prepare a porcine acellular dermal matrix (PADM), and to optimize the interpore distance between PADM and co-grafted split-thickness autologous skin.

METHODSPorcine skin was treated with trypsin/Triton X-100 to prepare an acellular dermal matrix. Micropores were produced on the PADM with a laser punch. The distance between micropores varied as 0.8 mm, 1.0 mm, 1.2 mm and 1.5 mm. Full-thickness defect wounds were created on the back of 144 SD rats. The rats were randomly divided into 6 groups as follows, with 24 rats in each group. Micropore groups I -IV: the wounds were grafted with PADM with micropores in four different intervals respectively, and covered with split-thickness autologous skin graft. Mesh group: the wounds were grafted with meshed PADM and split-thickness autograft.

CONTROL GROUPwith simple split-thickness autografting. The gross observation of wound healing and histological observation were performed at 2, 4, 6 weeks after surgery. The wound healing rate and contraction rate were calculated.

RESULTSTwo and four weeks after surgery, the wound healing rate in micropore groups I and II was lower than that in control group (P < 0.05), but no obvious difference was between micropore groups I , II and mesh group (P > 0.05) until 6 weeks after grafting( P <0.05). The wound contraction rate in micropore groups I and II ([(16.0 +/- 2.6)%, (15.1 +/- 2.4)%] was remarkably lower than that in control group 4 and 6 weeks after grafting (P < 0.05), and it was significantly lower than that in mesh group [(19.3 +/- 2.4)%] 6 weeks after surgery (P <0.05). Histological examination showed good epithelization, regularly arranged collagenous fibers, and integral structure of basement membrane.

CONCLUSIONLaser micropore PADM (0.8 mm or 1.0 mm in distance) grafting in combination with split-thickness autografting can improve the quality of wound healing. PADM with laser micropores in 1.0 mm distance is the best choice among them.

Animals ; Dermis ; transplantation ; Lasers ; Rats ; Rats, Sprague-Dawley ; Skin Transplantation ; methods ; Skin, Artificial ; Swine ; Transplantation, Heterologous

Artificial dermis is a kind of tissue engineering dermal substitute and is used to repair dermal defects caused by a variety of reasons. This article describes the characteristics and the mechanism of repair and reconstruction of bilayer artificial dermis. Based on domestic experience of clinical applications and relative literature of bilayer artificial dermis, more than 50 domestic experts in related field reached a consensus on indications, contraindications, operation procedures in clinical application, cautions, and treatment and prevention of complications of bilayer artificial dermis, providing reference for clinical application.
Consensus ; Dermis ; pathology ; Skin Transplantation ; methods ; Skin, Artificial ; Tissue Engineering

OBJECTIVETo compare the composite grafts of acellular dermal matrix (ADM) from different sources with autoskin.

METHODSSix local white mini pigs were employed for the experiment. The pigs were randomly divided into four groups according to different skin grafts, i.e. A (human ADM with razor thin autoskin), B (porcine ADM with razor thin autoskin), C (razor thin autoskin only), and D (split thickness autoskin) as control. The survival rate, the contraction degree of the grafts, and the histological changes in grafting area were observed at 2, 4, 8, 12 and 24 hours after the operation.

RESULTSThe grafted area in both A and B groups appeared smooth and elastic with satisfactory graft survival. The in growth of the host reparative cells such as fibroblast and vascular endothelium could be induced by composite grafts of different ADMs with skin grafting. The contraction areas in A and B groups seemed bigger than those in C and D groups. The tissue structure of grafting areas was similar to that of split thickness skin grafting area at 24 post-operation weeks.

CONCLUSIONCombination of the homogenous and heterogeneous ADMs with autografts exhibited similar biological function during the observation period (24 weeks after operation). Xenogenous ADMs might have broader clinical applications.

Animals ; Dermis ; transplantation ; Graft Survival ; Humans ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Homologous

OBJECTIVETo summarize and present the experiences and results of the expanded distant skin flaps used in plastic and reconstructive operations.

METHODS102 patients who had undergone expanded distant skin flap transfer were reviewed and followed up.

RESULTSGood results were obtained. Especially when there was no sufficient normal skin close to the lesion or defect, the distant skin flaps were employed. The expanded distant skin flap can be directly transferred as a pedicle skin flap or an island skin flap. It can be indirectly transferred with an intermediary carrier or as a free skin flap.

CONCLUSIONThe expanded distant skin flaps have many advantages, indications, worthy of recommendation.

Humans ; Skin Transplantation ; methods ; Surgery, Plastic ; methods ; Surgical Flaps

OBJECTIVETo construct composite skin containing living cells and to observe its significance in the repair of full skin loss in mice.

METHODSThe dermal substitute was formed by culturing heterogeneous fibroblasts on the acellular chondrocyte collagen scaffold for 3 days, and then cultured on the epithelial membrane for another 10 days, to form the composite skin containing living cells. The composite skin was grafted onto full layer skin defect. The growth condition was observed and biopsies were harvested for histologic examination.

RESULTSBoth fibroblasts and stratified epithelium grew well in the collagen scaffold. The composite skin adhered tightly to wounds of the mice, with obvious vascularization one week after grafting. The grafts began to merge with the wound margin at 6 post operation weeks without obvious signs of rejection.

CONCLUSIONFull skin loss could be repaired by composite skin formed by acellular chondrocyte collagen scaffold as a skin substitute.

Animals ; Collagen ; Humans ; Mice ; Skin ; pathology ; Skin Transplantation ; methods ; Skin, Artificial ; Tissue Engineering

OBJECTIVE: To identify the pathological character of denatured dermis,and its turnover after autologous skin transplant. METHODS: Deep partial thickness burn wounds whose diameter was 2.5 cm were produced on the back of Sprague-Dawley (SD) rats. After simple debriding,xenogenic skin was transplanted. Superficial tangential excision was performed on the burn wounds on 48 hours postburn with the preservation of denatured dermis. Split thickness autologous skin was grafted on the wounds immediately. Tissue samples of whole layer of the skin were harvested from the grafted sites at different time points after the skin grafting. Pathological observation on the denatured skin and the transplanted skin was carried out with HE and Massonos trichrome blue. RESULTS: The superficial cells of the denatured dermis necrotized largely with few cells alive,collagen denatured,and many inflammatory cells infiltrating. Necrosis tissue and inflammatory cells could be found in the denatured skin in the early period after the skin transplant. There were infiltrated inflammatory cells in the transplanted skin 3 days after the skin transplant. On the 10th day,the necrotized tissue diminished markedly,and red cells were found in its upper stratum. On the 21st day, the morphology and structure of the transplanted skin were similar to those of the normal skin. CONCLUSION The retained denatured dermis has little effect on the survival of the transplanted skin. The necrosis components can be absorbed and replaced by the tissue alive after the autologous skin is transplanted.
Animals ; Burns ; pathology ; surgery ; Dermis ; transplantation ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Skin ; pathology ; Skin Transplantation ; methods ; Transplantation, Autologous

The first skin-flap procedures were performed in Mongolia by a team of Chinese doctors (Chenod, Chen) who treated children with burn injuries in the 1950s. The field of plastic surgery was further developed through assistance from the former Soviet Union and is now widely practiced by a number of surgeons around the country. In recent years, the fast evolving field of plastic surgery in Mongolia has created a need for clear and consistent system for the classification of various plastic materials. A team of Mongolian surgeons at the National Hospital for Traumatology, Orthopedics, Rehabilitation and Teaching Research have completed a research programme aimed at adopting a leading classification system that can facilitate effective communication between plastic surgeons. This requires the chosen system to be in line with modern trends in plastic surgery and the established international norms. As a result of extensive research and analysis, they have developed a customized version of Vasiliev's classification that focuses on formulating general principles of the description of plastic materials based on their functional characteristics. The main reason for this selection is its similarity with existing Mongolian standards as well as its principles that contain important implications for surgery.
Humans ; Mongolia ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps