Dermal Allograft Plus Autologus Epidermal Graft: Evaluation of
Dermal Allograft Plus Autologus Epidermal Graft: Evaluation of
The authors describe three years of clinical experience in chronic wound management. The authors treated 315 patients (age 65-75 years) with chronic recurrent leg ulcers by allograft of cryopreserved dermis. Patients were divided into two groups (A and B) on the basis of patient preference and underwent two different reepithelization techniques. Patients in group A received autologous thin mesh grafts. Patients in group B received cultured autologous epidermal grafts. Proportions were compared by univariate analysis (X test with the Yates correction; EpiInfo version 5). P values <0.05 were considered significant. The cultured autologous epidermal graft (group B) was significantly more effective at one-month follow up (p = 0.023, odd ratio=1.85), but no differences were seen at 6 and 12 months. Dermal allografts were obtained from Siena skin bank (Tuscan Region Tissue Bank). Autologous keratinocytes were obtained by skin biopsy from the buttocks of patients. Patients were treated as outpatients. At one-year follow up, complete wound closure was observed in 75 percent of the patients; recurrences occurred in six percent of patients.
Chronic ulcers of the lower limbs are a major cause of morbidity in European countries, affecting 0.5 to 1.5 percent of the population. Lower-extremity chronic ulcers affect 3 to 5 percent of persons over 60 years of age, with a male:female ratio of 1:2. The most frequent causes are venous failure (70-90% of cases), arterial failure, and metabolic diseases, especially diabetes.
Treatment is usually problematical, requiring a multidisciplinary approach to obtain healing and reduce morbidity. Even with a correct diagnostic-therapeutic approach, about 30 percent of leg ulcers suffer relapse.
Besides treating the underlying pathology and vascular failure, medication of the ulcer to prepare the wound bed for grafting is necessary. Autologous skin grafts are the elective surgical therapy for skin repair; however, frequent recurrences and problems connected with repair of donor areas make it necessary to consider other surgical methods for permanent wound coverage. Reconstruction of both the epidermal and dermal compartments is another essential condition for stable functional repair of full-thickness ulcers. The utility of homologous dermis for this purpose has long been known. The low immunogenicity of the fibrous dermal component ensures good taking and rapid colonization by host cells, at the same time preventing contraction of the graft and scarring. Unlike bioengineered skin replacements, which are absorbed into the wound bed, homologous dermis has delayed absorption (more than 4 weeks), and its collagen and elastic fibers remain integral forming scaffolding, which acts as a permanent template for infiltrating host cells. Compared to bioenginereed skin equivalents, which are costly and suitable only for small wounds/grafts, sandwich techniques based on use of homologous de-epidermized dermis (~1/cm) and autologous epithelial components are valid and less expensive alternatives for recalcitrant leg ulcers.
The authors describe three years of clinical experience in chronic wound management. The authors treated 315 patients (age 65-75 years) with chronic recurrent leg ulcers by allograft of cryopreserved dermis. Patients were divided into two groups (A and B) on the basis of patient preference and underwent two different reepithelization techniques. Patients in group A received autologous thin mesh grafts. Patients in group B received cultured autologous epidermal grafts. Proportions were compared by univariate analysis (X test with the Yates correction; EpiInfo version 5). P values <0.05 were considered significant. The cultured autologous epidermal graft (group B) was significantly more effective at one-month follow up (p = 0.023, odd ratio=1.85), but no differences were seen at 6 and 12 months. Dermal allografts were obtained from Siena skin bank (Tuscan Region Tissue Bank). Autologous keratinocytes were obtained by skin biopsy from the buttocks of patients. Patients were treated as outpatients. At one-year follow up, complete wound closure was observed in 75 percent of the patients; recurrences occurred in six percent of patients.
Chronic ulcers of the lower limbs are a major cause of morbidity in European countries, affecting 0.5 to 1.5 percent of the population. Lower-extremity chronic ulcers affect 3 to 5 percent of persons over 60 years of age, with a male:female ratio of 1:2. The most frequent causes are venous failure (70-90% of cases), arterial failure, and metabolic diseases, especially diabetes.
Treatment is usually problematical, requiring a multidisciplinary approach to obtain healing and reduce morbidity. Even with a correct diagnostic-therapeutic approach, about 30 percent of leg ulcers suffer relapse.
Besides treating the underlying pathology and vascular failure, medication of the ulcer to prepare the wound bed for grafting is necessary. Autologous skin grafts are the elective surgical therapy for skin repair; however, frequent recurrences and problems connected with repair of donor areas make it necessary to consider other surgical methods for permanent wound coverage. Reconstruction of both the epidermal and dermal compartments is another essential condition for stable functional repair of full-thickness ulcers. The utility of homologous dermis for this purpose has long been known. The low immunogenicity of the fibrous dermal component ensures good taking and rapid colonization by host cells, at the same time preventing contraction of the graft and scarring. Unlike bioengineered skin replacements, which are absorbed into the wound bed, homologous dermis has delayed absorption (more than 4 weeks), and its collagen and elastic fibers remain integral forming scaffolding, which acts as a permanent template for infiltrating host cells. Compared to bioenginereed skin equivalents, which are costly and suitable only for small wounds/grafts, sandwich techniques based on use of homologous de-epidermized dermis (~1/cm) and autologous epithelial components are valid and less expensive alternatives for recalcitrant leg ulcers.
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