title: A case of lower-extremity deep burn wounds with periosteal necrosis successfully treated by use of allogenic cultured dermal substitute.
abstract: In patients with burns, bone exposure accompanies serious problems which occasionally lead to amputation. We present a case of an 82-year-old woman who sustained 22% of total body surface area flame burns on her bilateral lower extremities with bone exposure. Despite fascial excision and mesh skin graft, muscles, bones, and tendons were widely exposed on her right leg. The wound was infected by methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. To promote wound healing, we applied an allogeneic cultured dermal substitute (CDS) to the wound surface once weekly, resulting in healthy granulation except for the exposed bone area of the right anterior tibia. We then shaved the cortex of the exposed bone surface until bone marrow bleeding, and grafted mesh skin in combination with CDS. Finally, all wounds healed without osteomyelitis. The use of CDS to treat deep burns exposing bone surface may expand reconstructive options for extremities that otherwise might have been amputated.
authors.affiliation: Programs for Biomedical Research, Division of Molecular Medical Science, Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. n-ohara@shobara.jrc.or.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohara
authors.forename: Shoji
authors.initials: S
authors.lastname: Mihara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nihara
authors.forename: Narihiro
authors.initials: N
authors.lastname: Akimoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Madokoro
authors.forename: Mikio
authors.initials: M
authors.lastname: Kawai
authors.forename: Hideki
authors.initials: H
authors.lastname: Noda
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hide
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Kuroyanagi
mesh_terms: D000369:Aged, 80 and over; D002056:Burns / Q000473:pathology / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D009336:Necrosis / Q000473:pathology / Q000601:surgery; D010521:Periosteum / Q000473:pathology / Q000601:surgery; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D014945:Wound Healing