Deep hypothermic preservation of autologous skin in the treatment of large-area circumferential multi-plane degloving trauma: a pilot study of 2 cases

Abstract

To evaluate the clinical outcome of deep hypothermic preservation of autologous skin in the treatment of large-area skin avulsion. Medium or full thickness-skin slices were harvested from large avulsion flaps between July and November 2017. They were stored in liquid nitrogen by vitrification. After the patient's condition became stable and the growth of the wound granulation tissue was satisfactory, the frozen skin slices were reheated quickly and replanted to the wound. Autologous skin that had been kept by deep cryopreservation had a high survival rate when grafted. It did not create new trauma or bring additional pain to patients. Yet it could shorten the course of treatment and reduce the medical cost for patients. It is an effective and economical way to treat large-area skin avulsion.

Keywords: Autologous skin; Deep hypothermic preservation; Large-area degloving trauma.

Fig. 1

Case 1. The avulsion of the skin was from the lower left abdomen to the knee joint, and covers an area of about 2200 cm². Circumferential multi-plane injury was observed, accompanied by large amount of muscle and fatty fascia damage

Fig. 2

Case 1. Granulation tissue grew fresh and well, 13 days after the injury and the application of VSD

Fig. 3

Case 1. Nine days after the autologous skin graft, most grafted skin survived, with necrosis happening only on a very small scale (yellow parts). (Color figure online)

Fig. 4

Case 1. 40 days after skin grafting, the wound was healed, and the skin survived well without infection and vesicles

Fig. 5

Case 1. One year later, the skin color changed from flushing to normal color

Fig. 6

Case 1. One year later, the hip was slightly restricted

Fig. 7

Case 2. The skin was avulsed from below the left knee to the middle part of the foot including the medial and lateral malleolus. Circumferential multiplane degloving took place, with a large amount of muscle and fat fascia damage

Fig. 8

Case 2. Sixteen days after the injury, and after twice debridement and application of VSD (the first time, during the emergency operation on the day of the injury; the second time, 10 days after the injury) the granulation tissue grew well, with a small amount of tendon was exposed

Fig. 9

Case 2. Ten days after autologous skin grafting, the VSD was removed. Most of the skin survived, with necrosis on a small scale (the yellow area). (Color figure online)

Fig. 10

Case 2. After 1 years of follow-up, the skin texture and the function was acceptable

Fig. 11

Case 2. Pathology (HE staining, 400 ×) performed on skin previously preserved for graft and ultimately left unused. The structure of the tissue and cells was integrated and the nucleuses were slightly enlarged