title: A Case Report of the First Nonburn-related Military Trauma Victim Treated with Spray Skin Regenerative Therapy in Combination with a Dermal Regenerate Template.
abstract: Massive soft tissue and skin loss secondary to war-related traumas are among the most frequently encountered challenges in the care of wounded warriors. This case report outlines the first military nonburn-related trauma patient treated by a combination of regenerative modalities. Our case employs spray skin technology to an established dermal regenerate matrix. Our patient, a 29-year-old active duty male, suffered a combat blast trauma in 2010 while deployed. The patient's treatment course was complicated by a severe necrotizing fasciitis infection requiring over 100 surgical procedures for disease control and reconstruction. In secondary delayed reconstruction procedures, this triple-limb amputee underwent successful staged ventral hernia repair via a component separation technique with biologic mesh underlay although this resulted in a skin deficit of more than 600 cm2. A dermal regenerate template was applied to the abdominal wound to aid in establishing a "neodermis." Three weeks after dermal regenerate application, spray skin was applied to the defect in conjunction with a 6:1 meshed split thickness skin graft. The dermal regenerate template allowed for optimization of the wound bed for skin grafting. The use of spray skin allowed for a 6:1 mesh ratio, thus minimizing the donor-site size and morbidity. Together, this approach resulted in complete healing of a large full-thickness wound. The patient is now able to perform activities of daily living, walk without a cane, and engage in various physical activities. Overall, our case highlights the potential that combining regenerative therapies can achieve in treating severe war-related and civilian traumatic injuries.
authors.affiliation: Department of Plastic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.; and Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, and Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Ian L
authors.initials: IL
authors.lastname: Valerio
authors.affiliation: Department of Plastic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.; and Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, and Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hammer
authors.affiliation: Department of Plastic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.; and Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, and Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rendon
authors.affiliation: Department of Plastic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.; and Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, and Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Kerry P
authors.initials: KP
authors.lastname: Latham
authors.affiliation: Department of Plastic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.; and Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, and Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Fleming