Cosmetic results of wound treatment using the living skin equivalent in open tibial fractures

BACKGROUND: Soft tissue wound treatment in open tibial fractures requires complex clinical approach. New cellular methods of wound treatment must be compared with the gold standard split-thickness skin grafting.

AIM: To compare the esthetic results of wound management with the living skin equivalent and skin grafting.

MATERIAL AND METHODS: A comparative study included 108 patients with open tibial fractures and soft tissue defects who underwent staged surgical treatment. In group 1 (n=51), the living skin equivalent was used, which is a bioengineered three-layer construction containing keratinocytes, fibroblasts, and collagen matrix. In group 2 (n=57), standard split-thickness skin grafting was used for wound repair. The surgery duration, complete epithelialization period, hospital stay, Vancouver Scar Scale (VSS) after 3, 6, and 12 months, and self-reported esthetic results 1 year after surgery were compared.

RESULTS: Living skin equivalent procedures were performed significantly faster than skin grafting (18.2±4.8 min vs. 35.5±14.8 min, р <0.001), and wound healing took longer (25.5±6.3 days vs. 19.6±4.7 days, р=0.035). The overall VSS score was significantly lower at all follow-up visits in group 1 than in group 2 (6.23±0.81 points vs. 8.12±0.98 points after 3 months, р <0.001; 5.17±1.18 points vs. 6.76±1.31 points after 6 months, р <0.001; 4.54±1.07 points vs. 5.09±0.65 points after 12 months, р=0.038). Moreover, 74.5 and 68.4% of the patients were satisfied with the appearance of the limb after treatment with living skin equivalent and skin grafting, respectively (р=0.023).

CONCLUSION: The cosmetic results of wound treatment in open tibial fractures with living skin equivalents are significantly better than those of split-thickness skin grafting.