Principal Investigator: Francesco Egro, MBChB, MSc, MRCS
Performing Organization: University of Pittsburgh
Rational: Major complex trauma and burns are common debilitating and disfiguring causes of amputation, loss of function, reduced quality of life, and inability to return to work or duty.
These injuries are compounded by large areas of soft-tissue loss and are complicated by injury to deeper structures, thick scars which prevent movement and make it hard to use the injured limb.
We seek to improve the treatment for these disfiguring and debilitating treatments in a way that is 1) autologous or taken from the patient’s own body, 2) immediately available with limited risk to any donor sites, 3) doesn’t require costly skin substitutes, 4) doesn’t require complex dressings beyond standard of care, 5) is single-staged without dependence on complex and specialized microsurgical care, and 6) improves upon the softness, contour, mobility, and overall form and function of current reconstructive options. In this proposal we describe a repurposing of commonly utilized fat and skin grafting protocols to provide a fat-first composite reconstruction (which we term Autologous Layered Composite Grafting) for these injuries.
Objectives: Our goal is to demonstrate that combining autologous micronized fat with split thickness skin grafts improves early healing and the final outcome of complex soft-tissue injuries in the setting of trauma and burn reconstruction.
Specific Aims
- Aim 1: Demonstrate efficacy of immediate autologous adipose and Autologous Layered Composite Grafting in acute functional soft-tissue reconstruction.
- Aim 2: Demonstrate non-inferiority of Autologous Layered Composite Grafting to full- thickness skin for delayed reconstruction of post-burn/trauma scar contracture.
Study Design: We propose a clinical study examining fat-first and composite fat and skin-based (Autologous Layered Composite Grafting) reconstruction of different types of complex injuries. In the first aim of this trial, we will compare this technique with current standard of care (split- thickness skin graft) to reconstruct acute injuries affecting soft-tissue. In the second aim of this trial, we will evaluate these techniques compared to current standard of care (full-thickness skin graft) for the revision and reconstruction of tethered and contracted scars. We will look at how well the reconstructed fat and skin survives as well as the surrounding tissues and functional metrics of the affected extremity including skin strength, pliability, and mobility.
Impact and Military Benefit: This work will lead to better ways of treating serious skin and soft-tissue injuries affecting the extremities or any mobile surface with implications for complex trauma and burn injuries. These injuries are far more frequent among our wounded warfighters; however, these findings have the potential to help both military and civilian populations. The new treatments we’re proposing are meant to prevent complications and reduce the need for multiple surgeries. This strategy is technically simple, uses the person’s own tissues, can be done in one surgery, and has several advantages versus current standard of care. It doesn’t require highly specialized skills and can work even in situations with limited medical resources. Using this technique could mean a quicker recovery, less time spent in recovery, better movement of the limbs, and less need for long therapy sessions.