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PLASTIC SURGERY 2014, Abstract Supplement
Garvey PB. Bailey CM, Baumann DP, Liu J, Butler CE.
Violation of the rectus complex is not a contraindication to
component separation for abdominal wall reconstruction.
J Am Coll Surg. 2012;214:131-139.
Booth JH, Garvey PB, Baumann DP, et al. Primary fascial
closure with mesh reinforcement is superior to bridged
mesh repair for abdominal wall reconstruction. J Am Coll
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis
WR. Guideline for prevention of surgical site infection,
1999. Hospital Infection Control Practices Advisory
Committee. Infect Control Hosp Epidemiol. 1999;20:250278.
Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen
MJ. Outcomes of synthetic mesh in contaminated ventral
hernia repairs. J Am Coll Surg. 2013;217:991-998.
Dr. Garvey is a consultant for LifeCell Corporation (Branchburg,
NJ). None of the other authors have disclosures related to this
manuscript. No products were specifically mentioned by brand
Innovative 3D Collagen Microsphere
Scaffold (MSS) Promotes Robust Cellular
Ope Asanbe, MD; Rachel Hooper, MD;
Tarek Elshazly, PrM; Hector Osoria, BS;
Adam Jacoby, BA; Jeremiah Joyce, BA;
Ross Weinreb; Abraham Stroock, PhD;
Jason Spector, MD; Ryan Walters, BS;
Jaime Bernstein, BS; Bella Vishnevsky, BS;
John Morgan, BS
INTRODUCTION: Contemporary dermal substitutes are
avascular and prone to high failure rates when used in complex
settings, such as irradiated wounds or those with exposed
hardware or bone. In order to overcome these shortcomings,
we designed a scaffold to guide and hasten cellular invasion and
neovascularization, via the use of regularly spaced interfaces of
differing collagen densities.
METHODS: Utilizing Kepler’s conjecture of sphere packing,
which states that the arrangement of spheres in a 3D space has
a density of 74%, we fabricated 7 mm microsphere scaffolds
(MSS) with a regular arrangement of density gradients. Type
I collagen microspheres (1%, 0.6% or 0.4%), ranging 50 to
150 μm in diameter, were manufactured via an oil emulsion
technique. MSS were fabricated by encasing microspheres of
varying collagen density into collagen bulk of varying density
(0.3%, 0.2% or 0.6%), so that 74% of the scaffold’s volume
was comprised of microspheres and 26% of bulk collagen.
MSS underwent thermal gelation at 37°C for 1 hour. Nonmicrosphere-containing 1% or 0.3% collagen scaffolds were
fabricated as controls. Scaffolds were implanted subcutaneously
in the dorsa of 8 week old wild-type mice and harvested for
histological analysis after 7 or 14 days.
RESULTS: After 7 and 14 days, fluorescent microscopy
revealed MSS with robust cellular invasion spanning the
scaffold depth. The optimal collagen density gradient was
observed in MSS with 0.6% microspheres embedded in 0.3%
bulk. Comparatively, cells sporadically invaded 0.3% collagen
scaffolds and failed to invade 1% collagen scaffolds, remaining
confined to the periphery. Immunohistochemical analysis
identified CD31 expression in all MSS after 7 and 14 days of
implantation, indicative of invading endothelial precursors.
CONCLUSIONS: By enhancing mechanical and spatial cues
of MSS through the regular arrangement of collagen density
gradients, we significantly accelerated cellular invasion and
neovascularization. In addition to optimizing structural cues
sensed by cells, collagen microspheres may be impregnated with
growth factors and medications to further hasten wound healing.
Our innovative MSS hold tremendous promise for creating the
next generation dermal replacement product.
Treatment of the Radial Forearm Flap
Donor Site with Single-Stage IntegraTM
Artificial Dermal Matrix and Autograft
Catharine B. Garland, MD; Scott L. Hansen,
MD; William Y. Hoffman, MD; Hani Sbitany,
INTRODUCTION: Optimal treatment of the radial forearm
flap donor site remains a difficult clinical problem, with
complications including unsightly scarring, tendon exposure,
and impaired range of motion and strength. IntegraTM artificial
dermal matrix has been described as an alternative to autograft
alone for the reconstruction of these donor site defects using a
two-stage process.1,2 This study is a retrospective review of a
consecutive series of radial forearm flap donor sites that have
been treated with monolayer IntegraTM artificial dermal matrix
and autograft in a single stage.
METHODS: Fourteen consecutive cases of radial forearm
free flaps performed between June 2011 and June 2013 were
reviewed. In each case, the donor site was reconstructed using
monolayer IntegraTM artificial dermal matrix and autograft in a
single stage. After routine harvest of the flap, monolayer Integra
artificial dermal matrix was meshed and applied to the wound.
A split-thickness skin graft was then harvested and either
meshed or pie-crusted prior to application over the IntegraTM.
A negative pressure wound dressing was applied over the grafts
for 5-7 days. The donor site was evaluated with regards to
skin graft take, scar appearance, strength and range of motion,
paresthesias, infection, and the need for secondary interventions.
RESULTS: The fourteen patients had a mean age of 53 years
old (range 20-68) and radial forearm donor site defect area of
65 cm2 (range 30-110 cm2). Follow up time ranged from four to
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