title: Repair of refractory wounds through grafting of artificial dermis and autologous epidermis aided by vacuum-assisted closure.
abstract: BACKGROUND
  This study aimed to investigate the clinical efficacy of vacuum-assisted closure (VAC) combined with grafting of artificial dermis and autologous epidermis in the repair of refractory wounds.
  
  
  METHODS
  Patients with refractory wounds underwent debridement. Then the VAC device was used to culture wound granulation tissue. After the wound granulation tissue began to grow, artificial dermis was grafted on the wounds with VAC treatment. Then autologous epidermis was grafted on the artificial dermis to repair the wounds after survival of the artificial epidermis. The study mainly observed length of the hospital stay, survival of the artificial dermis, time required for culture of the granulation tissue using VAC before grafting of the artificial dermis, survival time of the artificial dermis, survival conditions of the autologous epidermis, influence on functions of a healed wound at a functional part, healing conditions of donor sites, and recurrence conditions of the wounds.
  
  
  RESULTS
  Healing was successful for 22 patients (95.7%), but treatment failed for 1 child. The 22 patients were followed up for 6 to 24 months. According to follow-up findings, the skin grafts had good color and a soft texture. They were wear resistant and posed no influence on function. The appearance of the final results was the same as that of the full-thickness skin graft. Mild or no pigmentation and no scar formation occurred at the donor sites, and the wounds did not recur.
  
  
  CONCLUSIONS
  Vacuum-assisted closure combined with grafting of artificial dermis and autologous epidermis is an effective means for repairing refractory wounds and is worth clinical popularizing and application.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
authors.forename: Chenwei
authors.initials: C
authors.lastname: Zhang
authors.forename: Dalie
authors.initials: D
authors.lastname: Liu
authors.forename: Zhi
authors.initials: Z
authors.lastname: Liang
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
authors.forename: Haibo
authors.initials: H
authors.lastname: Lin
authors.forename: Zhengdong
authors.initials: Z
authors.lastname: Guo
mesh_terms: D000328:Adult; D064592:Autografts; D002648:Child; D004817:Epidermis / Q000637:transplantation*; D005260:Female; D006097:Granulation Tissue / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D054843:Negative-Pressure Wound Therapy; D016038:Skin Transplantation; D017768:Skin, Artificial; D017695:Soft Tissue Injuries / Q000601:surgery; D014945:Wound Healing; D055815:Young Adult