Reconstruction of massive skin avulsion of the scrota and penis by combined application of dermal regeneration template(Pelnac) and split-thickness skin graft with vacuum-assisted closure: A case report

BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

A single-stage bilayered skin reconstruction using Glyaderm■as an acellular dermal regeneration template results in improved scar quality:an intra-individual randomized controlled trial

Background:Absence of almost the entire reticular dermal layer is inherent to the use of autologous split-thickness skin grafting(STSG)to close full-thickness wounds,often resulting in hypertrophic scars and contractures.Many dermal substitutes have been developed,but unfortunately most have varying results in terms of cosmetic and/or functional improvement as well as patient satisfac-tion,in addition to high costs.Bilayered skin reconstruction using the human-derived glycerolized acellular dermis(Glyaderm■)has been reported to result in significantly improved scar quality using a two-step procedure.Unlike the necessary two-step procedure for most commercially available dermal substitutes,in this study we aimed to investigate the use of Glyaderm■in a more cost-effective single-stage engrafting.This is a method which,if autografts are available,is preferred by the majority of surgeons given the reduction in costs,hospitalization time and infection rate.Methods:A prospective,randomized,controlled,intra-individual,single-blinded study was per-formed,investigating the simultaneous application of Glyaderm■and STSG vs.STSG alone in full-thickness burns or comparable deep skin defects.During the acute phase,bacterial load,graft take and time to wound closure were assessed and were the primary outcomes.Aesthetic and functional results(secondary outcomes)were evaluated at 3,6,9 and 12 months follow-up using subjective and objective scar measurement tools.Biopsies for histological analysis were taken at 3 and 12 months.Results:A total of 66 patients representing 82 wound comparisons were included.Graft take(>95%),pain management and healing time were comparable in both groups.At 1 year follow-up,the overall Patient and Observer Scar Assessment Scale assessed by the patient was significantly in favour of sites where Glyaderm■was used.Not infrequently,patients attributed this difference to improved skin sensation.Histological analysis showed the presence of a well-formed neodermis,with donor elastin present for up to 12 months.Conclusions:A single-stage bilayered reconstruction with Glyaderm■and STSG results in optimal graft take without loss of Glyaderm■nor the overlaying autografts due to infection.The presence of elastin in the neodermis was demonstrated during long-term follow-up in all but one patient,which is a crucial factor contributing to the significantly improved overall scar quality as evaluated by the blinded patients.

Polydopamine-modified collagen sponge scaffold as a novel dermal regeneration template with sustained release of platelet-rich plasma to accelerate skin repair:A one-step strategy

Although employed to release growth factors(GFs)for regenerative medicine,platelet-rich plasma(PRP)has been hindered by issues like burst effect.Based on collagen sponge scaffolds(CSSs)modified with polydopamine(pDA),a novel dermal regeneration template(DRT)was designed.However,whether it could efficiently deliver PRP and even foster wound healing remained unclear.In this work,after PRP was prepared and pDA-modified CSSs(pDA-CSSs)were fabricated,microscopic observation,GFs release assay and in-vitro biological evaluations of pDA-CSSs with PRP(pDA-CSS@PRP)were performed,followed by BALA-C/nu mice full-thickness skin defects implanted with pDA-CSS@PRP covered by grafted skins(termed as a One-step strategy).As a result,scanning electron microscope demonstrated more immobilized platelets on pDA-CSS′surface with GFs’controlled release via enzyme-linked immunosorbent assay,compared with CSSs.In line with enhanced in-vitro proliferation,adhesion and migration of keratinocytes&endothelial cells,pDA-CSS@PRP were histologically revealed to accelerate wound healing with less scar via rapid angiogenesis,arrangement of more mature collagen,guiding cells to spread,etc.In conclusion,pDA-CSSs have potential to serve as a novel DRT capable of delivering PRP,which may foster full-thickness skin defect healing by means of a One-step strategy.