A new technique to resurface wounds with composite biocompatible epidermal graft and artificial skin.
BACKGROUND
The incorporation of cultured epidermal autograft on the neodermis of artificial skin (Integra, Integra LifeSciences, Plainsboro, NJ) has been met with some difficulties. A new engraftment technique to resurface the wounds with Integra and composite biocompatible epidermal graft (CBEG) has been successfully applied on three patients for elective reconstructive procedures.


METHODS
A small skin biopsy was taken from the normal edge of the lesion for keratinocytes and dermal fibroblast cultures 2 weeks before surgery. When sufficient cells were grown, the patient was admitted for the excision of the lesions or scars. The wounds of the patients, ranging from 125 to 250 cm2, were covered with Integra. When the neodermis of the Integra was fully vascularized, the silicone membrane of the Integra was removed and replaced with the CBEG, which consisted of autologous keratinocytes cultivated on a hyaluronate-derived membrane (Laserskin; Fidia Advanced Biopolymers, Abano Terme, Italy)) using human dermal fibroblasts as a feeder layer.


RESULTS
Clinically, there was good initial "take" of the CBEGs in these three patients, ranging from 50% to 100%. Biopsy specimens of the grafted wounds were taken 1 to 3 weeks after the application of the CBEGs. Epithelialization was noted in all patients.


CONCLUSIONS
This engraftment technique has several advantages. The CBEG is much easier to handle than the conventional cultured epidermal autograft. It eliminates the invasive second procedure for skin harvesting, with resulting pain and scarring. The application of the CBEG can be easily performed at the bedside.
Chan
E S
ES
Department of Surgery, Hong Kong Skin Bank, Division of Head and Neck/Plastic and Burns Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Lam
P K
PK
Liew
C T
CT
Lau
H C
HC
Yen
R S
RS
King
W W
WW
D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials; D002478:Cells, Cultured; D003286:Contracture / Q000601:surgery*; D005260:Female; D006801:Humans; D015603:Keratinocytes; D008297:Male; D009506:Nevus / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation; D017768:Skin, Artificial
D001672:Biocompatible Materials