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. 2022 Aug 14;9(8):389.
doi: 10.3390/bioengineering9080389.

Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft-A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa

Marcin Gierek  1 , Wojciech Łabuś  1 , Anna Słaboń  1 , Karolina Ziółkowska  1 , Gabriela Ochała-Gierek  2 , Diana Kitala  1 , Karol Szyluk  3   4 , Paweł Niemiec  5
Affiliations

Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft-A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa

Marcin Gierek et al. Bioengineering (Basel). .

Abstract

Hidradenitis suppurativa is a chronic disease that significantly reduces patients' quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research.

Keywords: acellular dermal matrix; hidradenitis suppurativa; split thickness skin graft; surgical treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Presentation of Case 1 patient—(A)—HS of buttocks before the operation, excision was marked, (B)—immediately after excision, (C)—local flaps moved to partially close the wound, (D)—VAC therapy applied. Legend: HS—Hidradenitis Suppurativa, VAC—Vacuum-Assisted Closure.
Figure 2
Figure 2
Presentation of second patient—extensive HS of right armpit, before operation. Legend: HS—Hidradenitis Suppurativa.
Figure 3
Figure 3
Stages of surgical procedure (case 1); (A)—Frozen ADM (defrosting procedure) before the operation, (B)—ADM meshing (ratio 1:1.5), (C)—application of ADM, (D)—STSG grafted onto ADM. Legend: ADM—Acellular Dermal Matrix, STSG—Split thickness skin graft.
Figure 4
Figure 4
Stages of surgical procedure (case 2); (A)—wound after excision, (B)—Application of ADM directly to the wound (meshing in ration 1:2.0), (C)—total wound closure (co-graft ADM + STSG). Legend: ADM—Acellular Dermal Matrix, STSG—Split thickness skin graft.
Figure 5
Figure 5
Case 1—Laser speckle analysis and wound image, (A1,A2)—Patient before admission, (B1,B2)—Patient before surgical intervention, (C1,C2)—Patient just after first surgical intervention, (D1,D2)—Patient after 5 days of VAC-therapy, (E1,E2)—Patient just before ADM and STSG application, (F1,F2)—Patient after application of ADM and STSG, (G1,G2)—Patient on third day after surgery, (H1,H2)—Patient on 5th day after surgery, (I1,I2)—Patient on 7th day after surgery, (J1,J2)—Patient on 12th day after surgery, (K1,K2)—Patient on 14th day after surgery, L(1,L2)—Patient on 16th day after surgery patient, (M1,M2)—Patient on 20th day after surgery, (N1,N2)—patient 1 month after surgery, (O1,O2)—patient 2 months after surgery, (P1,P2)—patient 2.5 months after surgery. Legend: ADM—Acellular Dermal Matrix, STSG—Split Thickness Skin Graft, VAC—Vacuum-Assisted Closure.
Figure 6
Figure 6
Measurements of microperfusion in blood vessels in selected areas—Case 1. Legend: ROI—Region of interest.
Figure 7
Figure 7
Case 2—Laser speckle analysis and wound image, (A1–B2)—Patient before admission, (C1,C2)—Patient before surgical excision, (D1,D2)—Patient after ADM and STSG grafting (E1,E2)—Patient on third day after surgery, (F1,F2)—Patient on 5th day after surgery, (G1,G2)—Patient on 7th day after surgery, (H1,H2)—Patient on 12th day after surgery, (I1,I2)—Patient on 14th day after surgery, (J1,J2)—patient 1 month after surgery, (K1,K2)—patient after 2 months after surgery, (L1,L2)—patient 2.5 months after surgery.
Figure 8
Figure 8
Measurements of microperfusion in blood vessels in selected areas—Case 2. Legend: ROI—Region of Interest.
Figure 9
Figure 9
Final results 2.5 month after procedure co-graft of ADM and STSG. (A)—Final result of reconstructed bottocks, (B)—Elastic scar in the “pinch” test, (C)—Final result of reconstructed right axilla, (D)—“Pinch” test in right axilla (elastic scar). Legend: ADM—Acellular Dermal Matrix, STSG—Split thickness skin graft.
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