Saved by De-epithelialization. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Singh, Mansher; Carty, Matthew; Nuutila, Kristo; Ricci, Joseph A.; Caterson, Edward J.; Caterson, Stephanie A.
• Is Part Of: Plastic and reconstructive surgery. Volume 3:Issue 9(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Surgery, Plastic -- Periodicals; Surgery, Plastic -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; 617.95205
• DOI: 10.1097/GOX.0000000000000466
• Languages: English
• ISSNs: 2169-7574

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Wound re-epithelialization has been traditionally described to occur from the dermal appendages of the wound edges. As such, the role of the dermal wound bed in re-epithelialization has been questioned. In a patient undergoing breast reconstruction with free tissue transfer, the buried portions of the free flap skin paddle could be either de-epithelialized or deskinned. In case of mastectomy skin flap loss, the role of de-epithelialized skin in wound healing has not been described before.</p> </sec> <sec> <title>Methods:</title> <p>We report a patient with bilateral mastectomies and bilateral deep inferior epigastric perforator flaps whose postoperative course was complicated by bilateral full-thickness mastectomy skin flap loss. Multiple debridements of nonviable skin resulted in exposure of previously buried de-epithelialized skin paddle of the deep inferior epigastric perforator flap.</p> </sec> <sec> <title>Results:</title> <p>Our study demonstrates self re-epithelialization of the dermal wound bed from the dermal appendages. We noticed multiple noncontiguous neoepidermal islands in the dermal wound bed, which did not communicate with the wound edges.</p> </sec> <sec> <title>Conclusions:</title> <p>In case of full-thickness mastectomy skin flap loss, deep vascular plexus present in the dermal bed of the underlying de-epithelialized skin paddle of the free flap converts an otherwise full-thickness wound to a partial-thickness wound. Our study demonstrates the self-epithelialization potential of the de-epithelialized dermal wound bed from the dermal appendages when exposed to air and in the presence of wound healing elements.</p> </sec> </abstract>