An Acute Wound of the Lower Limb
A 85-year-old woman presented at the emergency department after having a fall in her apartment and during the fall she hit a furniture with a resulting wound measuring 6 × 8 cm (width × height) on her right anterior-lateral lower leg displaying exposed muscle, subcutaneous fat, and dermal tissue (Fig 2a). The wound was cleansed, subcutaneous tissues were adapted with sutures to cover the muscle, and the wound was grafted with skin harvested and processed with Xpansion (Figs 2b and 2c). The expansion rate was 1:12 (donor site 2 × 2 cm), and the procedure lasted approximately 15 minutes including local anesthesia and bandaging. The patient was admitted to the hospital for 12 days to allow for daily inspections, leg elevation, and the planning for home care. Eight days posttransplantation, graft take was evident (Fig 2c). The wound healed completely at day 25. A follow-up at 6 weeks showed a wound that remained healed and that exhibited a spotty pattern of incorporated micrografts (Fig 2d). The donor site also healed displaying redness but no hypertrophic scarring, typically what is seen in split-thickness skin donor sites at this time point (Fig 2e).
An acute wound measuring approximately 6 × 8 cm (width × length) with exposed muscle fascia, subcutaneous fat, and dermal tissue (a). (b) After suturing and transplantation. (c) Silicone dressing in place on the top of grafts. (d) Eight days posttransplantation with evidence of graft take seen as lighter colored epithelial islands. (e) Follow-up 6 weeks postgrafting showing a spotty pattern of the skin grafts separated by red scar tissue without any hypotrophy. (f) The donor site (approximately 2 × 2 cm) at 6 weeks also showing typical redness but no hypertrophic scarring. This redness usually disappears within a year.
A Chronic Venous Leg Ulcer
An otherwise healthy 54-year-old woman was referred to the Dermatology department with a pretibial ulcer on the right leg since 18 months (Fig 3a). Despite conservative therapy with compression bandages for 3 months, the ulcer failed to heal. The ankle brachial index was 0.8, blood pressure was 160/90 mm Hg, and the body mass index was 28.7. A marked insufficiency of the vena saphena magna was confirmed by Duplex investigation. There were no signs of deep venous insufficiency. Routine laboratory finding was normal (hemoglobin, erythrocyte sedimentation rate, albumin, blood glucose). The wound was clinically clean and exhibited granulation tissue; a routine wound swab showed only sparse growth of Staphylococcus aureus. Transplantation was performed with an expansion rate of 1:1.25 (donor site 2 × 6 cm, wound 3 × 5 cm) and the procedure lasted approximately 20 minutes including local anesthesia and bandaging. Routine visit 3 days postoperatively showed grafts in place (Fig 3b). Ten days postoperatively, there were signs of partial graft take (Fig 3c), but the wound also exhibited some pus and a scattered signs of folliculitis was seen in the surrounding skin. Treatment was initiated with isoxazolyl penicillin 500 mg 3 times daily for 10 days. On days 17 (Fig 3d) and 24 (Fig 3e), the wound showed healing and free of infection. On day 31, the surrounding skin once again presented with folliculitis as well as eczema. The wound, however, continued to heal as demonstrated by expanding epithelial islands and diminishing open wound area (Fig 3f). Treatment with isoxazolyl penicillin (in accordance with resistance pattern of cultured S aureus) and topical corticosteroids was started. On day 38, the wound almost healed (Fig 3g), and 45 days postoperatively, the wound healed completely (Fig 3h). At follow-up (5 months postoperatively), the wound had remained healed (Fig 3i), compression stockings class 2 were continuously used, and the donor site was hardly visible (Fig 3l) as compared with day 0 (Fig 3j) and day 24 (Fig 3k). The patient underwent foam sclerosing treatment of the insufficient vena saphena magna 7 months postoperatively. At 19 months, the patient continues with compressing stocking and her wound remains healed.
A venous ulcer transplanted with skin grafts. (a) The ulcer displaying complete granulation. (b) Three days postgrafting displaying grafts in place. (c) Ten days postgrafting and complicated by a mild infection (Staphylococcus aureus) with some pus. On day 17 (d) and day 24 (e), the wound appeared to be healing and small epithelial islands were sparsely distributed over the wound surface. (f) On day 31, healing has progressed significantly, and on day 38 (g), the wound was almost healed. (h) A completely healed wound on day 45. (i) Follow-up visit at 5 months and still healed. The redness has become less pronounced. (j) Donor site (approximately 2 × 6 cm) immediately after harvest, (k) at 24 days, and (l) at 5 months barely visible.
ePlasty. 2016;16 © 2016 Open Science Company