title: Combined use of fenestrated-type artificial dermis and topical negative pressure wound therapy for the venous leg ulcer of a rheumatoid arthritis patient.
abstract: We report a case of circumferential venous leg ulcer in a rheumatoid arthritis patient. Mesh skin grafting was performed in another hospital, but the graft failed and the patient was referred to our hospital. This ulcer was treated by the combination therapy of a fenestrated-type artificial dermis with negative pressure wound therapy (NPWT) and secondary mesh grafting using our 'grip tape technique'. NPWT was started at -100 mmHg and continued until the formation of dermis-like tissue. A section stained using haematoxylin and eosin and an anti-αSMA (α smooth muscle actin) immunohistological section of the biopsy from dermis-like tissue showed an abundant infiltration of fibroblasts and capillary formation beneath the fenestration of the silicone sheet. Threefold mesh skin grafting was subsequently performed and it was taken up completely. The fenestrated-type artificial dermis in combination with NPWT produced good results without infection in the treatment of complex wounds. In addition, our 'grip tape technique' was useful to apply polyurethane foam to the entire surface of the lower leg.
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Naoki
authors: N
authors: Morimoto
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Atsuyuki
authors: A
authors: Kuro
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Takashi
authors: T
authors: Yamauchi
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Ai
authors: A
authors: Horiuchi
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Natsuko
authors: N
authors: Kakudo
authors: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Michiharu
authors: M
authors: Sakamoto
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University Takii Hospital, Moriguchi, Japan.
authors: Kenji
authors: K
authors: Suzuki
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
authors: Kenji
authors: K
authors: Kusumoto
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications; D003646:Debridement; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D018919:Neovascularization, Physiologic; D017768:Skin, Artificial; D014647:Varicose Ulcer / Q000473:pathology / Q000628:therapy*
keywords: Fenestrated-type artificial dermis; Grip tape technique; Negative pressure wound therapy; Venous leg ulcer
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