title: Use of acellular dermal regeneration template combined with NPWT to treat complicated extremity wounds in children.
abstract: OBJECTIVE
  The treatment of open wounds with exposed bone, tendon, or nerve is a challenging reconstructive problem, especially in children. The purpose of this study is to evaluate the safety and effectiveness of using acellular dermal templates combined with negative pressure wound dressings in the treatment of complicated paediatric soft tissue extremity wounds.
  
  
  METHODS
  A retrospective review of eight patients treated with acellular dermal templates for closure of complicated extremity wounds was performed. After debridement, all patients were treated with a template and a negative pressure wound treatment (NPWT) system.
  
  
  RESULTS
  The average age was 8.8 years with 4 females and 4 males. Four wounds were at the foot/ankle, with tendon exposed in all 4, nerve in 2, and bone in 3. There were 3 lower leg wounds, all with exposed bone. One patient had arm/hand wounds with exposed tendon. The size of the wounds and dermal graft averaged 86cm² and 57cm². The average time to wound closure was 65 days. The majority of the treatment was received as an outpatient, including NPWT. For inpatient and outpatient care, the average number of sponge system changes was 2.6 compared to 4.6, and time between changes was 3.5 compared to 6.8 days. Each patient had only one procedure each for application of the dermal substitute and later one skin grafting procedure. Complications were minimal, and all patients healed their wounds without the need of flaps. One patient required wound revision.
  
  
  CONCLUSIONS
  Our study demonstrates that a dermal template combined with NPWT can safely and effectively be used to treat complicated wounds in children. Closure was obtained without flaps, the majority of the treatment time was spent in the outpatient setting, and the complication rate was low.
  
  
  BACKGROUND
  There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
authors: MD, Hand and Plastic Surgeon, Assistant Professor, Division of Orthopaedic Surgery, Childrens Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
authors: R L
authors: RL
authors: Hutchison
authors: MD, Chief Resident, Department of Orthopaedic Surgery, University of Missouri  Kansas City School of Medicine; Kansas City, Missouri, USA.
authors: J R
authors: JR
authors: Craw
mesh_terms: D062088:Acellular Dermis; D001134:Arm Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing