Novel application of absorbable gelatine sponge combined with polyurethane film for dermal reconstruction of wounds with bone or tendon exposure

Abstract

Trauma, burns, and diabetes result in nonhealing wounds that can cause bone or tendon exposure, a significant health threat. The use of an artificial regeneration template combined with skin grafting as an alternative method to highly invasive flap surgery has been shown to be an effective way to cover full-thickness skin defects with bone or tendon exposure for both functional and aesthetic recovery. However, artificial regeneration templates, such as Pelnac, are overwhelmingly expensive, limiting their clinical use. Here, we demonstrate for the first time that polyurethane film combined with absorbable gelatine sponge, affordable materials widely used for haemostasis, are effective for dermal reconstruction in wounds with bone or tendon exposure. The absorbable gelatine sponge combined with polyurethane film was applied to eight patients, all resulting in adequate granulation that fully covered the exposed bone or tendon. The outcome of absorbable gelatine sponge combined with polyurethane film application indicates that this approach is a potential novel and cost-effective dermal reconstruction strategy for the treatment of severe wounds with bone or tendon exposure.

Keywords: absorbable gelatine sponge; artificial dermis; full-thickness skin defect; polyurethane film; wound healing.

FIGURE 1

Macro and scanning electron microscope images of the absorbable gelatine sponge (AGS) template used in this study: (A) polyurethane film dressing (3M Tegaderm) and the absorbable gelatine sponge (Jinling Pharmaceutical Company, Ltd, Nanjing, China), (B) the polyurethane film and AGS were bonded together and trimmed according to the size of the wound, and (C) scanning electron microscopy images show the internal structure of the AGS template (scale bar: 300 μm)

FIGURE 2

Histological examination of the absorbable gelatine sponge template graft covering the right shin bone of patient 2 on POD 17: (A,B) Haematoxylin and Eosin staining with scale bars of 50 μm (×100) and 20 μm (×400), respectively, and (C,D) Masson's trichrome staining with scale bars of 50 μm (×100) and 20 μm (×400), respectively

FIGURE 3

Case 1 (Table 1) (A) A 58‐year‐old man with a left diabetic foot lesion, (B) debridement leading to partial exposure of the metatarsal bone, cuboid bone, and partial flexor digitorum longus tendon, (C) the absorbable gelatine sponge template was applied to the wound, (D) adequate granulation was achieved when the 3 M film and sutures were removed, (E) medium‐thickness skin grafting was performed, and (F) one month after skin grafting surgery, the wound showed good resurfacing

FIGURE 4

Case 2 (Table 1) (A) A 52‐year‐old man with a large‐area full‐thickness burn, (B) resection of necrotic tissue leads to an 80 × 30 mm skin defect in the right tibia region with partially exposed shin bone, (C) the absorbable gelatine sponge (AGS) template was applied to the surface of the exposed shin bone, (D) adequate granulation covered the whole wound area when the top layer of the AGS template was removed 17 days after surgery, and (E) 18 days after split‐thickness skin grafting

FIGURE 5

Case 3 (Table 1) (A) A 60‐year‐old man with a deep hydrofluoric acid burn on his left middle finger, (B) extensive debridement leading to the exposure of the phalangeal bone, (C) the absorbable gelatine sponge template was applied and secured with silk thread, (D) when the polyurethane sheet was removed on POD 12, the distal phalanx was covered with firm granulation tissue and partially epithelialized, and (E) full epithelialization and nail regeneration were observed 5 months after surgery