title: The use of a dermal substitute and thin skin grafts in the cure of "complex" leg ulcers.
abstract: BACKGROUND
  In some chronic leg ulcers, a reconstructive operation using skin grafts may be extremely difficult or is quite likely to fail as a result of the position, the width, and the depth of the lesions.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a dermal substitute and thin skin grafts in the treatment of patients suffering from deep and wide chronic leg ulcers.
  
  
  METHODS
  Twenty-six consecutive patients with leg ulcers at least 1 year old were admitted to the study. The ulcers were large (>100 cm2) and deep (>3 mm) over at least 50% of the surface area. After surgical debridement of the wounds, the dermal matrix was modeled and applied. After 21 days, the attachment of the artificial dermis was tested, and in positive cases, the patient was re-admitted for "thin" skin grafting.
  
  
  RESULTS
  In all patients, at the first follow-up, a notable reduction in pain, exudate, and perilesional edema was ascertained. After 2 weeks, the progressive substitution of granulation tissue with new yellow or gold derma became evident in all patients. After 21 days, the dermal matrix was completely integrated with the guest tissue. In 23 patients (88.5%), attachment of the skin graft was complete, and in three patients (11.5%), it was partial but nevertheless larger than 70% of the surface. Even in these cases, complete healing of the lesions was achieved within 4 weeks at most. All patients were checked for a minimum of 3 months, and none suffered an ulcerous recurrence.
  
  
  CONCLUSIONS
  In our series, the use of this dermal matrix allowed for the complete refilling of the loss of tissue, the rapid disappearance of pain, and the rapid regeneration of a permanent dermis.
authors.affiliation: Department of Gerontology and Geriatrics, Section of Surgery, Second University of Naples, Naples, Italy. silvestro.canonico@unina2.it
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Campitiello
authors.forename: Angela
authors.initials: A
authors.lastname: Della Corte
authors.forename: Andrea
authors.initials: A
authors.lastname: Fattopace
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012008:Recurrence; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents