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Comparative Skin Evaluation After Split-Thickness Skin Grafts Using 2 Different Acellular Dermal Matrices to Cover Composite Forearm Defects

 Myung Chul Lee  ;  Yong Jun Jang  ;  In Sik Yun  ;  Dae Hyun Lew  ;  Won Jai Lee 
 JOURNAL OF HAND SURGERY-AMERICAN VOLUME, Vol.42(4) : 297.e1-297.e10, 2017 
Journal Title
Issue Date
Acellular Dermis* ; Adult ; Aged ; Animals ; Cadaver ; Cattle ; Dermatologic Surgical Procedures ; Female ; Forearm/surgery* ; Forearm Injuries/etiology ; Forearm Injuries/surgery* ; Head and Neck Neoplasms/surgery* ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Skin ; Skin Transplantation/methods* ; Skin, Artificial ; Surgical Flaps ; Transplantation, Autologous ; Wound Healing ; Wounds and Injuries/etiology ; Wounds and Injuries/surgery*
Acellular dermal matrix ; functional skin value ; radial forearm flap donor site
PURPOSE: The combination of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) has been widely adopted to overcome functional and cosmetic limitations of conventional STSG. In this study, we evaluated the efficacy of this combination using 2 types of ADM: cadaveric acellular dermal matrix (CDM) and bovine acellular dermal matrix (BDM). METHODS: We recruited 72 patients undergoing autologous STSG to cover radial forearm free flap donor sites. They were included in 1 of 3 therapeutic groups: group 1, STSG using CDM (n = 29); group 2, STSG using BDM (n = 20); and group 3, STSG only (n = 23). Functional skin values for skin elasticity, humidification, transepidermal water loss, and color were determined. Values were compared between graft sites and adjacent normal (control) skin, and between grafted areas of each group. RESULTS: All skin defects were successfully reconstructed without graft loss. Groups 1 and 2 demonstrated better elasticity than did group 3, based on the analysis using the ratio of grafted area to control. Grafted areas in all 3 groups exhibited less moisture than did control normal skin. There was less transepidermal water loss in group 1 than in group 3, which implied that CDM application had better barrier capacity against water evaporation. Graft sites of groups 1 and 3 exhibited darker and redder color compared with control areas. CONCLUSIONS: Composite forearm defects were successfully restored and exhibited acceptable quality after treatment with an ADM plus STSG. Applying either CDM or BDM under a STSG was a suitable procedure, as verified by objective measurements. Elasticity was well preserved in CDM and BDM groups. However, both ADMs revealed functional impairment of humidification. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Lew, Dae Hyun(유대현)
Yun, In Sik(윤인식) ORCID logo https://orcid.org/0000-0003-1103-7047
Lee, Won Jai(이원재) ORCID logo https://orcid.org/0000-0003-3056-0503
Jang, Yong Jun(장용준)
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