Using Cadaver Skin As a Graft

SavageGlow · #1 ● 06-10-2024, 03:54 PM

A 50 years old female with a history of type 2 diabetes mellitus presented to the emergency department. The patient presented with chief complaints of pain and discoloration of the skin of the left buttock and thigh region for 4 days which was gradually increasing. There was a history of intramuscular injection of left gluteal region 7 days back for her old sciatica pain. Multiple fasciotomy incisions were done over the left gluteal region at another hospital. At the time of presentation, the patient was conscious, oriented. Her heart rate was 110/m, blood pressure was 100/70 mmHg and respiratory rate was 22/m. She was afebrile at that time but had a history of few spikes of fever 2 days back. After a detailed history and clinical examination, oozing pus was sent for gram stain and culture. Broad-spectrum antibiotics were started. Then the patient was admitted to the plastic surgery department.

On local examination large area of skin discoloration and blister formation was seen over the left gluteal region extending distally over the left thigh, proximally over the lower back and anteriorly over the pubic and perineal regions. Multiple fasciotomy incisions were present in the dead skin (Figure 1 and 2). There was a foul smell from the wound discharge present. Dead skin was insensate but surrounding erythematic skin was hyper-aesthetic. Distal left leg neurovascular examination was normal. The Doppler study was normal for the left lower limb. The LRINEC score (laboratory risk indicator for necrotizing fasciitis score) was sent. The patient was prepared for emergent debridement for all unhealthy tissue.

Debridement of all unhealthy tissue over the left gluteal region and left thigh was done within 24 hours of admission (Figure 3 and 4). A chunk of tissue was obtained for histopathology. On exploration, findings were suggestive of NSTI. The LRINEC score was 10 within 48 hours of admission and her HbA1C was 8.2. The culture report showed Staphylococcus aureus which was methicillin sensitive and antibiotics were changed accordingly. On day 4, discoloration of the skin of wound margins was noted and the patient was again taken for debridement of all unhealthy tissue.

After a few days, again discoloration of the skin of wound margins and blister formation was noted over the pubic region. On day 8, the patient was taken for debridement of all unhealthy tissue. Finally, she had lost 15% of her total body surface area. The wound was covered temporarily by cadaveric human skin allograft on day 14 (Figure 5). The allograft was tailored to fit the wound. The patient was responding well for the allograft treatment. Meanwhile, authors used the time to build up the patients’ nutritional status and control of infections. After the 2 weeks rejection of allograft was started . Finally, patient underwent debridement and autologous skin grafting for all the raw areas on day 32 . The donor site healed adequately with no major infection and wound complications. The patient was discharged in satisfactory condition from the hospital on day 38 of admission.