Persistent Subepidermal Blistering in Split-Thickness Skin Graft Sites

Epstein, Anne; Hendrick, Sophia J.; Sánchez, Ramón L.; Solomon, Alvin R.; Fine, Jo David

doi:10.1001/archderm.1988.01670020062019

Cited by 17 publications

(4 citation statements)

References 24 publications

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“…BSSs are commercially available, easy to apply, and eliminate the need for donor‐site harvesting. Although skin substitutes have been used to facilitate healing of chronic wounds in EB patients, 5,7,24–26 their role in postsurgical defects in this population needs to be further investigated. In an open‐label, uncontrolled study of 15 EB patients, Falabella and colleagues reported faster and less painful healing without adverse effects in 69 wounds treated with the Apligraf (Organogenesis Inc, Canton, Mass) 26 .…”

Section: Discussionmentioning

confidence: 99%

Mohs Micrographic Surgery for Squamous Cell Carcinoma Associated with Epidermolysis Bullosa

Saxena

Lee

Humphreys

2008

Dermatologic Surgery

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Section: Discussionmentioning

confidence: 99%

Mohs Micrographic Surgery for Squamous Cell Carcinoma Associated with Epidermolysis Bullosa

Saxena

Lee

Humphreys

2008

Dermatologic Surgery

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“…Bullae have been noted to occur at the recipient sites of split-thickness skin grafts.I2 The etiology of these bullae is not known although they may share ultrastructural and antigenic similarities with epidermolysis bullosa acquisita. 13 We have not had any patients develop this complication.…”

Section: Complicationsmentioning

confidence: 90%

Techniques of Split‐Thickness Skin Grafting for Lower Extremity Ulcerations

Kirsner

Falanga

1993

The Journal of Dermatologic Surgery and Oncology

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“…44 Thus, the appearance of blisters and associated ultrastructural abnormalities following thermal burns, split-thickness skin grafting, and cultured autografting is a well-recognized phenomenon that is not peculiar to cultured autografting alone. The recipient sites were all resected down to fascia before grafting to ensure that the cultured epithelium was not contributed to by the epithelial cells from hair follicles or skin appendages.…”

Section: Histology Of Culture-grafted Epidermismentioning

confidence: 99%

Cultured Skin Grafts

Phillips¹

1988

Arch Dermatol

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ages. The use of autologous skin grafts has been the "gold standard" for wound closure, but in patients with wounds of large surface area, such as extensive burns, this strategy cannot be realized because of the lack of adequate donor sites for grafting. Because the ultimate outcome of many burn patients is determined by wound coverage, temporary coverage of wounds with materials other than the patient's own skin has been performed in these situations using fresh or cadaver skin allografts from related or unrelated donors. However, such allografts are rejected, usually after two weeks, and regrafting is necessary.1,2 See also JAMA 1988;259:2566-2571. DEVELOPMENT OF KERATINOCYTE CULTURE TECHNIQUESAs techniques for organ culture and tissue culture were developing in the 1970s, attempts were made to cover skin wounds with epidermal sheets derived from in vitro cultivation of skin. In explant cultures, a skin sample was placed with the dermal surface in contact with the culture dish to allow attachment and then incubated in culture medium. The epider¬ mis grew down the side of the expiant, attached to the dish, then migrated outward to produce epitheli¬ al layers that could be used as allografts in animal models.35 However, proliferation of epidermal cells using this method was insufficient to produce the large amounts of epidermis required for grafting, and fibroblast overgrowth in the cultures was a significant problem. By six to eight weeks, the grafted epithelium began to deteriorate, leaving only a small residue of grafted epithelium on the con¬ tracted wound. The development of techniques of in vitro cultivation and serial subculture of epidermal cells to produce viable epithelial sheets changed the situation.6 In 1975, Rheinwald and Green6 described a method allowing the successful serial subcultivation of human keratinocytes. Whole skin was trypsinized to disaggregate epidermal cells, which were then cultivated on a monolayer of lethally irradiated 3T3 mouse fibroblasts. Since that time, there have been many reported modifications in the technique, and it is now possible, beginning with a skin sample as small as 1 cm2, to expand the amount of cultured epithelium to an area comparable to body surface. Using the enzyme Dispase (a neutral protease from Bacillus polymyxa; Boehringer-Mannheim GmbH, Mannheim, West Germany), a confluent layer of epithelial cells can be detached as an intact sheet and transferred to the graft bed.7 In addition, new culture systems have been developed,8" but their relevance to large-scale grafting needs to be further docu¬ mented. CLINICAL APPLICATIONS: CULTURED AUTOGRAFTS AND CULTURED ALLOGRAFTSThe first successful clinical application of this technique was reported by O'Connor et al12 in 1981, when small skin biopsy specimens from burned patients were cultured in vitro. These cultured autografts were placed on full-thickness wounds on the arms of two adult burn patients and successfully grew to cover the wounds in six weeks. The epitheli¬ um on these wounds appeared stable for the f...

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Persistent Subepidermal Blistering in Split-Thickness Skin Graft Sites

Cited by 17 publications

References 24 publications

Mohs Micrographic Surgery for Squamous Cell Carcinoma Associated with Epidermolysis Bullosa

Mohs Micrographic Surgery for Squamous Cell Carcinoma Associated with Epidermolysis Bullosa

Techniques of Split‐Thickness Skin Grafting for Lower Extremity Ulcerations

Cultured Skin Grafts

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