title: Lower extremity reconstruction after necrotising fasciitis and necrotic skin lesions using a porcine-derived skin substitute.
abstract: Seven consecutive clinical cases of necrotising fasciitis or necrotic skin lesions (42-78 years old; average 65.0 years of age, three females and four males) due to group A Streptococcus, group B Streptococcus, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in the lower extremities, who demonstrated rapid systemic symptoms, were investigated for the usefulness of a bilayer artificial dermis, derived from porcine tendons, over 4 +/- 2.4 years (1-7 years). All surgical debridement was confirmed as sufficiently deep and wide for clinically infected lesions and artificial dermis was applied to all wounds. The average interval to secondary split-thickness skin grafting was about 17.5 days (17.5 +/- 2.44 days, 21 days max., 14 days min.) and the average thickness was 0.009 +/- 0.0022 in. (range: 0.006 - 0.012 in.). No clinical problems were noted during the application of the artificial dermis and the subsequent skin grafting. Since, the donated skin graft was thin, the morbidity was minimised. The use of artificial dermis after extensive surgical debridement in necrotising fasciitis was easy and effective. Local or systemic infection was negligible.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Developmental and Reconstructive Medicine, Graduate School of Biomedical and Sciences, Nagasaki University, 1-7-1 Sakamoto Machi, Nagasaki 8528501, Japan. akitas@hf.rim.or.jp
authors.forename: Sadanori
authors.initials: S
authors.lastname: Akita
authors.forename: Katsumi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D062109:Dermatologic Surgical Procedures; D020405:Dermis / Q000637:transplantation; D019115:Fasciitis, Necrotizing / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012867:Skin / Q000382:microbiology / Q000473:pathology; D012874:Skin Diseases, Infectious / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D013203:Staphylococcal Infections / Q000601:surgery; D013290:Streptococcal Infections / Q000601:surgery; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013552:Swine; D014183:Transplantation, Heterologous; D016896:Treatment Outcome