Lucilla Lucarini

The use of MatriDerm® and skin grafting in post-traumatic wounds

The aim of this study was to prove the effectiveness of MatriDerm® combined with skin grafting versus skin grafting alone in post‐traumatic wounds treatment. At the Department of Plastic and Reconstructive Surgery of the University of Rome Tor Vergata, we treated 60 patients: 30 patients with dermal substitutes (MatriDerm®) combined with autologous skin graft and 30 with skin graft alone. Two weeks after the first treatment, 95% of wounds treated with MatriDerm® and skin graft showed a re‐epithelisation, whereas it was 75–80% in the control group. We used the Manchester Scar Scale (MSS) and patients self‐estimation scale to assess the outcomes. Mann–Whitney U test was performed for the five items of the MSS and the results were combined to those of patients self‐estimation scale and the re‐epithelialisation percentage to test the significance between the two groups. These data confirm the evidence of the clinical use of MatriDerm® technology in the healing of soft tissue wounds and prove the effectiveness of combining MatriDerm® and skin grafting for the first time. Furthermore, we observed a percentage reduction of wound contraction and in the same time an improvement of elasticity, quality of scars tissue and dermal architecture.

The use of Matriderm and autologous skin grafting in the treatment of diabetic ulcers: a case report.

The aim of our case report was to analyse the results obtained with the Matriderm® system and autologous skin grafting for the surgical treatment of diabetic ulcers. We recruited one patient with diabetic ulcers admitted at the Department of Plastic and Reconstructive Surgery, University of Rome ‘Tor Vergata’. The patient underwent Matriderm® system and autologous skin grafting for diabetic ulcer treatment. After just a single treatment, we obtained reduction in ulcer after 15 days from the surgical treatment. We achieved a reduction in pain and exudate secretion of the ulcer. We noticed an almost complete restoration of the missing volume and good quality of skin. Matriderm® system and autologous skin grafting is a simple, safe and feasible technique. This method, when compared with other methods of treatment, is simple, cheap, less time consuming and does not require sophisticated laboratory facilities.

Use of platelet-rich plasma and hyaluronic acid in the loss of substance with bone exposure

OBJECTIVE:In lower-extremity surgery, the complex wound with bone exposure remains a challenging problem for the plastic surgeon. The purpose of this study was to describe a new therapeutic approach to stimulate the regeneration of the lower-extremity complex wounds based on a combined treatment composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) dressing. DESIGN:Wounds with posttraumatic bone exposure have been treated with HA dressing alone or in combination with PRP. PATIENT:Fifteen patients affected by lower-extremity wound with posttraumatic bone exposure have been treated at the Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy. RESULTS:After a single treatment, the authors observed that the mean re-epithelialization time was 8.1 weeks in 73.3% patients treated with PRP and HA dressing versus the 30% patients treated with HA dressing only. CONCLUSION:These data confirm the evidence of using PRP technology in the healing of both soft- and hard-tissue wounds. Moreover, the satisfaction of the patient confirms the quality of this studys results.

Use of a novel autologous cell-harvesting device to promote epithelialization and enhance appropriate pigmentation in scar reconstruction

Background.  Epidermal replacement is an important step in the management of patients with post‐traumatic and iatrogenic scars. Skin‐colour variation from disease or trauma causes significant changes in self‐image and appearance.

The use of a non cultured autologous cell suspension to repair chronic ulcers

The purpose of this uncontrolled study was to evaluate the clinical effectiveness of ReCell® system in the treatment of chronic ulcers. From October 2011 to July 2012, 20 patients, 8 men and 12 women with a mean age of 70 years, with chronic ulcers of different aetiology that were unresponsive to conventional therapies were recruited and treated using the ReCell® system. Patient pain rate, scar aesthetics and patient satisfaction were assessed using a Visual Analogue Scale, Manchester Scar Scale and the Rosenberg Self‐Esteem Scale, respectively. Complete ulcer healing, defined as 100% reepithelialisation was observed between 40 and 60 days in 14 patients (70%) depending on the type of ulcer and comorbidity. At day 60 postprocedure, 80% reepithelialisation was present in five patients (25%), while one patient with concomitant psoriasis had 50% reepithelialisation. Pain scores improved by day 7 postprocedure. The function and aesthetics of the ReCell‐treated patients were good. It is concluded that the ReCell technique may have provided the regenerative tissue stimulation necessary for the rapid healing of chronic ulcers, including those not responsive to more traditional methods.

Regenerative surgery of the complications with Morton's neuroma surgery: use of platelet rich plasma and hyaluronic acid

Mortons neuroma is an entrapment neuropathy of the plantar digital nerve. We treated five patients with wound dehiscence and tendon exposure, after Mortons neuroma surgery excision using a dorsal approach. In this article we describe our technique. From July 2010 to August 2011, at the Department of Plastic and Reconstructive Surgery, University of Rome ‘Tor Vergata’, five patients (four females and one male), with ages ranging between 35 and 52 years, were treated with a combination of PRP (platelet rich plasma) and HA (hyaluronic acid). Thirty days following surgery, all patients showed a complete healing of the wound. The use of this technique for the treatment of postoperative wound dehiscence and tendon exposure has proven as satisfactory.

Combined use of super-oxidised solution with negative pressure for the treatment of pressure ulcers: case report.

A 61‐year‐old patient was affected by flaccid paraplegia for 20 years because of post‐traumatic medullar injury caused by an accidental fall, with stage IV sacral pressure ulcer for 3 years. The patient later developed stage IV sacral pressure ulcer. After 6 months, a new granulation tissue formation appeared in the wound and a reduction of its diameter was observed (length 20 cm, width 15 cm, depth 5 cm). We therefore treated the wound with PRP (platelet rich plasma) intra‐lesion and peri‐lesional injections. The wounds were covered with three‐dimensional polymerised hyaluronic acid medicated biologic dressing. After the surgery, a moderate reduction in diameter and the depth was observed. Super‐oxidised solution (SOS‐Dermacyn) was applied to control infection locally together with negative pressure to control the exudate and the local bacteremia, to avoid infectious complications without application of systematic antibiotic therapy.

Skin necrosis of scrotum due to endovascular embolisation: a case report

The aim of our case report was to analyse the results obtained with the Matriderm® system and autologous skin grafting for the surgical treatment of skin necrosis of scrotum as a result of endovascular embolisation. We recruited one patient with scrotum skin necrosis as a result of endovascular embolisation admitted at the department of Plastic and Reconstructive Surgery, University of Rome ‘Tor Vergata’. The patient underwent Matriderm® system and autologous skin grafting for skin necrosis treatment. After a single treatment, reduction of the skin necrosis was obtained, after 30 days from the surgical treatment. Patient experienced a reduction in pain and a complete restoration of the loss in volume and quality of skin was noticed. Matriderm® system and autologous skin grafting is a simple, safe and feasible technique. When comparing this treatment with others, Matriderm® is a simpler, more economic and less time‐consuming method, and does not require sophisticated laboratory facilities.

Reconstruction of the Skin in Posttraumatic Wounds

A wound is a breach of the skin that can lead to infection and sepsis. Fast wound closure and minimal scar contracture must be taken into account as primary end points. Wound healing is an evolutionarily conserved complex multicellular process that aims to restore a skin barrier and consists of four stages: