Verbelen J, Hoeksema H, Pirayesh A, Van Landuyt K, Monstrey S, et al.
Burns : journal of the International Society for Burn Injuries. Date of publication 2016 Mar 1;volume 42(2):e31-7.
1. Burns. 2016 Mar;42(2):e31-7. doi: 10.1016/j.burns.2015.08.013. Epub 2015 Sep
12.
Exposed tibial bone after burns: Flap reconstruction versus dermal substitute.
Verbelen J(1), Hoeksema H(1), Pirayesh A(2), Van Landuyt K(1), Monstrey S(3).
Author information:
(1)Department of Plastic and Reconstructive Surgery - Burn Center Gent
University Hospital, Gent, Belgium.
(2)Plastic Surgery, Amsterdam, The Netherlands.
(3)Department of Plastic and Reconstructive Surgery - Burn Center Gent
University Hospital, Gent, Belgium. Electronic address: Stan.Monstrey@UGent.be.
A 44 years old male patient had suffered extensive 3rd degree burns on both
legs, undergoing thorough surgical debridement, resulting in both tibias being
exposed. Approximately 5 months after the incident he was referred to the
Department of Plastic and Reconstructive Surgery of the University Hospital
Gent, Belgium, to undergo flap reconstruction. Free flap surgery was performed
twice on both lower legs but failed on all four occasions. In between flap
surgery, a dermal substitute (Integra(®)) was applied, attempting to cover the
exposed tibias with a layer of soft tissue, but also without success. In order
to promote the development of granulation tissue over the exposed bone, small
holes were drilled in both tibias with removal of the outer layer of the
anterior cortex causing the bone to bleed and subsequently negative pressure
wound therapy (NPWT) was applied. The limited granulation tissue resulting from
this procedure was then covered with a dermal substitute (Glyaderm(®)),
consisting of acellular human dermis with an average thickness of 0.25mm. This
dermal substitute was combined with a NPWT-dressing, and then served as an
extracellular matrix (ECM), guiding the distribution of granulation tissue over
the remaining areas of exposed tibial bone. Four days after initial application
of Glyaderm(®) combined with NPWT both tibias were almost completely covered
with a thin coating of soft tissue. In order to increase the thickness of this
soft tissue cover two additional layers of Glyaderm(®) were applied at intervals
of approximately 1 week. One week after the last Glyaderm(®) application both
wounds were autografted. The combination of an acellular dermal substitute
(Glyaderm(®)) with negative pressure wound therapy and skin grafting proved to
be an efficient technique to cover a wider area of exposed tibial bone in a
patient who was not a candidate for free flap surgery. An overview is also
provided of newer and simpler techniques for coverage of exposed bone that could
question the universal plastic surgery paradigm that flap surgery is the only
way to cover these defects.
Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
DOI: 10.1016/j.burns.2015.08.013
PMID: 26376411 [Indexed for MEDLINE]
