Basic fibroblast growth factor-impregnated collagen gelatin sponge completes formation of dermis-like tissue within 2 weeks: A prospective cohort study

Abstract

Introduction: This study included patients who underwent full-thickness skin reconstruction using a two-stage procedure comprising basic fibroblast growth factor-impregnated collagen gelatin sponge (bFGF-CGS) implantation and autologous skin grafting, and the take rate of skin grafts was compared between groups of patients who underwent autologous skin grafting after a waiting period of <2 weeks or ≥2 weeks.

Methods: An acute, full-thickness skin defect was treated with thorough debridement of contaminated/necrotic tissue, followed by washing with saline and hemostasis with electrocautery. Then, an FGF-CGS was fixed to the skin defect wound using non-absorbable sutures, and after confirming regeneration of sufficient dermis-like tissue, the second-stage autologous skin grafting was performed for wound closure. Patients were divided into two groups according to the waiting period before the second operation, namely, <2 weeks (early group) and ≥2 weeks (late group), and the take rate of skin grafts was compared.

Results: We enrolled and treated 25 cases (18 men, 7 women; mean age: 49 [range 2-86] years). The mean take rate of skin grafts was 93% (range 80%-100%) in the early group and 92% (range 65%-100%) in the late group, with no significant difference between the two groups. There was a significant difference between the groups in mean time to complete healing: 25.2 ± 9.7 days in the early group vs 44.7 ± 27 days in the late group (p < 0.05).

Conclusion: Our data suggest that bFGF-CGF can form dermis-like granulation tissue with sufficient quality as a graft bed for skin transplantation within 2 weeks.

Keywords: Artificial dermis; Basic fibroblast growth factor; Drug delivery system; bFGF, basic fibroblast growth factor; bFGF-CGS, basic fibroblast growth factor-impregnated collagen gelatin sponge.

Fig. 1

Findings during the course of treatment in Case 1. (A) A 3-year-old boy sustained a deep burn injury to the right upper extremity (B) On the second day of injury, debridement of necrotic tissue was performed (C) A bFGF-CGS was applied to the resulting skin defect wound (D) On postoperative day 13, the skin defect wound was completely covered with firm dermis-like tissue (E) A second operation was performed for split-thickness skin grafting using the scalp and buttocks as donor sites (F) On postoperative day 7, the take rate of the skin graft was 95%.

Fig. 2

Findings during the course of treatment in Case 2. (A) A 29-year-old woman sustained a deep burn injury to the dorsum of the left foot (B) On day 19 of injury, under general anesthesia, debridement of necrotic tissue was performed down to the layer where good bleeding points were obtained (C) A bFGF-CGS was applied to the resulting skin defect wound with exposure of the extensor digitorum longus (D) On postoperative day 10, the skin defect wound was completely covered with firm dermis-like tissue (E) A second operation was performed for split-thickness skin grafting using the left thigh as the donor site (F) On postoperative day 7, the take rate of the skin graft was 100%.

Fig. 3

Findings during the course of treatment in Case 3. (A) An 80-year-old woman sustained a skin defect on the right elbow (B) On the day of injury, debridement of the contaminated tissue down to the muscle layer was performed, followed by application of a bFGF-CGS to the resulting skin defect wound (C) On postoperative day 7, the skin defect wound was completely covered with firm dermis-like tissue (D) A second operation was performed for split-thickness skin grafting using the thigh as the donor site (E) On postoperative day 7, there was an area where the skin graft did not take (white dotted line), resulting in a skin graft take rate of 80% (F) Subsequently, ulceration was observed in the area where the skin graft did not take (white dotted line).