Treatment of chronic wounds by combination of autodermatoplasty and lipotransfer
Abstract
Background. A compelling reason for unsatisfactory results of surgical closure of lower limbs soft tissues extensive defects is its specific anatomical organization: small number of subcutaneous soft tissues, the proximity of osseous structures and joints to the skin surface.
The aim is to develop the method of closing chronic wounds on lower limbs which allows enhancing the efficacy of autodermatoplasty by reducing the risk of complications caused by a local lack of soft tissues due to its combination with lipotransfer.
Material and methods. The authors carried out the prospective controlled clinical study (evidence level II) of surgical treatment of 34 patients who underwent surgical treatment of chronic wounds on lower limbs soft tissues. 20 patients (a control group) were operated by using the traditional methods of dermothensy and transplantation of a free skin graft while 14 patients (an experimental group) were operated by using the newly developed methods that included the combination of autodermatoplasty and lipotransfer. In the process of dermothensy on a thigh and a knee the local mobilization was carried out by using the liposuction method and the obtained lipoaspirate was replaced into the wound defect.
Results. In the control group the typical complications in cases of free skin grafting were suppuration (2 cases) and total (1 case) or partial (1 case) transplant necrosis. In cases of dermothensy the local complications like partial necrosis of the stretching skin graft (2 cases) and inflammation in the area of pins passage (2 cases) were observed. To sum up, in the control group the complications in the course of wound process were registered in 8 of 20 cases. In the experimental group the complication in the form of eruption of the sutures after the decubitus of ulcer dermothensy was registered in 1 case out of 14 (p=0.05).
Conclusion. The proposed combination of autodermatoplasty and lipotransfer is effective and safe and it allows improving the results of surgical treatment of patients with lower limbs soft tissues defects.
Keywords:chronic wound, trophic ulcer, dermoplasty, lipofilling, lipoaspirate
Clin Experiment Surg. Petrovsky J. 2018; 6 (4): 17–23.
doi: 10.24411/2308-1198-2018-14002. Received: 26.11.2017. Accepted: 24.10.2018.
References
1. Gluhov A.A., Aralova M.V. Pathophysiology of persistent chronic and current methods of stimulation of wound process. Novosti khirurgii [News of Surgery]. 2015; 23 (6): 673–9. (in Russian)
2. Shibaev E.Y., Ivanov P.A., Vlasov A.P., Kisel D.A., et al. Soft tissue reconstruction in patients with severe open tibia fractures. Zhurnal imeni N.V. Sklifosovskogo «Neotlozhnaya meditsinskaya pomoshch’» [Journal named after N.V. Sklifosovsky. «Emergency Medical Care». 2014; (1): 30–6. (in Russian)
3. Bhatia A. Epidermal skin grafting in patients with complex wounds: a case series. J Wound Care. 2016; 25 (3): 148, 150–3.
4. Khrupkin V.I., Lipatov K.V., Komarova E.A., Asatryan A.G., et al. Plastic surgery in patients with soft-tissue infection. Vestnik experimental’noy i klinicheskoy khirurgii [Bulletin of Experimental and Clinical Surgery]. 2013; (19): 131–8. (in Russian)
5. Tikhilov R.M., Kochish A.Yu., Rodomanova L.A., Kutyanov D.I., et al. Possibilities of modern techniques of plastic and reconstructive surgery in the treatment of patients with major posttraumatic defects of extremities. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2011; 2 (60): 164–9. (in Russian)
6. Beschastnov V.V., Orlinskaya N.Yu., Kudykin M.N. Experimental-clinical justification of dosed dermotension application in the first phase of wound process. Novosti khirurgii [News of Surgery]. 2012; 20 (2): 55–9. (in Russian)
7. Martel’ I.I., Grebeniuk L.A., Dolganova T.I. Elimination of an extensive femoral soft-tissue defect using dermotension according to the Ilizarov technology. Zhurnal klinicheskoy i eksperimental’noy ortopedii imeni G.A. Ilizarova [Journal of Clinical and Experimental Orthopedics named after G.A. Ilizarov]. 2016; (4): 109–13. (in Rus- sian)
8. Vinnik Yu.S., Salmina A.B., Drobushevskaya A.I., Teplyakova O.V., et al. The cell technologies and the tissue engineering are for healing chronic wounds. Vestnik experimental’noy i klinicheskoy khirurgii [Bulletin of Experimental and Clinical Surgery]. 2011; (2): 392–7. (in Russian)
9. Julianto I., Rinastati Y. Topical delivery of mesenchymal stem cells «secretomes» in wound repair. Acta Med Indones. 2016; 48 (3): 217–20.
10. Piccolo N.S., Piccolo M.S., Piccolo M.T. Fat grafting for treatment of burns, burn scars, and other difficult wounds. Clin Plast Surg. 2015; 42 (2): 263–83.