Bioengineered dermal substitutes for the management of traumatic periocular tissue loss

Tiffany A. Chen, Juan Ayala Haedo, Nathan W. Blessing, Katie Topping, Chrisfouad Raif Alabiad, Benjamin P. Erickson

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Traumatic periocular injuries occasionally result in significant soft tissue loss, for which there are limited management options that provide satisfactory cosmetic and functional outcomes. The authors describe the use of a bioengineered dermal substitute (Integra® Dermal Regeneration Template [DRT], Integra LifeSciences, Plainsboro, NJ) as an alternative to immediate flap reconstruction or skin grafting. Methods: Retrospective interventional case series of patients who underwent DRT placement for periocular tissue loss at the time of trauma. In each case, primary closure or immediate flap reconstruction was deemed impractical or undesirable due to the size and location of the primary and associated secondary defects. One to four weeks later, the outer silicone layer was removed and healing assessed. Additional reconstructive techniques were performed as needed. Results: Three patients were treated at Bascom Palmer Eye Institute and one at Byers Eye Institute at Stanford. The defects healed completely in two patients, and by 79.2% in a third, with no need for additional reconstructive surgery. In the remaining patient, the defect was significantly downsized by 56.1%, allowing for a simpler flap reconstruction. Conclusions: Bioengineered dermal substitutes should be considered as a viable alternative to traditional reconstructive techniques for large periocular defects resulting from trauma. The outer silicone layer prevents desiccation and serves as a protective barrier, while the inner collagen matrix organizes the growth of neo-dermis and minimizes wound contraction. The dimensions of cutaneous defects can therefore be reduced dramatically, potentially eliminating the need for skin grafting and/or reducing the ultimate complexity of flap reconstruction.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalOrbit
DOIs
StateAccepted/In press - Sep 13 2017

Fingerprint

Artificial Skin
Skin Transplantation
Wounds and Injuries
Silicones
Skin
Regeneration
Reconstructive Surgical Procedures
Desiccation
Dermis
Cosmetics
Collagen
Growth

Keywords

  • Dermal regeneration template
  • eyelid defect
  • flap reconstruction
  • periocular trauma
  • tissue loss

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Chen, T. A., Ayala Haedo, J., Blessing, N. W., Topping, K., Alabiad, C. R., & Erickson, B. P. (Accepted/In press). Bioengineered dermal substitutes for the management of traumatic periocular tissue loss. Orbit, 1-6. https://doi.org/10.1080/01676830.2017.1367014

Bioengineered dermal substitutes for the management of traumatic periocular tissue loss. / Chen, Tiffany A.; Ayala Haedo, Juan; Blessing, Nathan W.; Topping, Katie; Alabiad, Chrisfouad Raif; Erickson, Benjamin P.

In: Orbit, 13.09.2017, p. 1-6.

Research output: Contribution to journalArticle

Chen, Tiffany A. ; Ayala Haedo, Juan ; Blessing, Nathan W. ; Topping, Katie ; Alabiad, Chrisfouad Raif ; Erickson, Benjamin P. / Bioengineered dermal substitutes for the management of traumatic periocular tissue loss. In: Orbit. 2017 ; pp. 1-6.
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AB - Purpose: Traumatic periocular injuries occasionally result in significant soft tissue loss, for which there are limited management options that provide satisfactory cosmetic and functional outcomes. The authors describe the use of a bioengineered dermal substitute (Integra® Dermal Regeneration Template [DRT], Integra LifeSciences, Plainsboro, NJ) as an alternative to immediate flap reconstruction or skin grafting. Methods: Retrospective interventional case series of patients who underwent DRT placement for periocular tissue loss at the time of trauma. In each case, primary closure or immediate flap reconstruction was deemed impractical or undesirable due to the size and location of the primary and associated secondary defects. One to four weeks later, the outer silicone layer was removed and healing assessed. Additional reconstructive techniques were performed as needed. Results: Three patients were treated at Bascom Palmer Eye Institute and one at Byers Eye Institute at Stanford. The defects healed completely in two patients, and by 79.2% in a third, with no need for additional reconstructive surgery. In the remaining patient, the defect was significantly downsized by 56.1%, allowing for a simpler flap reconstruction. Conclusions: Bioengineered dermal substitutes should be considered as a viable alternative to traditional reconstructive techniques for large periocular defects resulting from trauma. The outer silicone layer prevents desiccation and serves as a protective barrier, while the inner collagen matrix organizes the growth of neo-dermis and minimizes wound contraction. The dimensions of cutaneous defects can therefore be reduced dramatically, potentially eliminating the need for skin grafting and/or reducing the ultimate complexity of flap reconstruction.

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