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Published on: March 4, 2016
Minced Skin Grafting: A Minimally Invasive and Low-Cost Procedure to Treat Pyoderma Gangrenosum
Edoardo Cammarata1, Roberto Giorgione, Elia Esposto
1Edoardo Cammarata, MD, is a resident in dermatology and venereology, Department of Health Science, University of Eastern Piedmont, Novara, Italy. Roberto Giorgione, MD, is a specialist in dermatology and venereology, AOU Maggiore della Carità, Novara. Elia Esposto, MD, is a resident in dermatology and venereology, Department of Health Science, University of Eastern Piedmont. Vanessa Mazzoletti, MD, is a resident in dermatology and venereology, Department of Health Science, University of Eastern Piedmont. Paolo Boggio, MD, is Head of Dermosurgery, AOU Maggiore della Carità, Novara. Paola Savoia, MD, is Associate Professor of Dermatology, Department of Health Science, University of Eastern Piedmont. The authors have disclosed no financial relationships related to this article. Submitted February 7, 2020; accepted in revised form March 31, 2020.
Abstract:
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that usually presents as a painful ulcer with erythematous and undermined borders and is often characterized by pathergy. Although this condition precludes a surgical approach, in cases resistant to treatment with immunosuppressive agents, skin grafts and amputation are considered last resorts. Both expose the patient to the risk of developing new lesions. A minimally invasive autologous graft, "minced micrografts," is a possible alternative to speed up the healing process, reducing the risk of pathergy.This procedure was implemented in a 28-year-old man with PG who was prescribed prednisone and dapsone and who had a large ulcer on the arm and armpit that had persisted for 4 months and was undergoing slow re-epithelialization. A sample of finely minced skin previously taken from the clavicular region suspended in a hydrogel was spread on the wound bed in a proportion of less than 1:6 with respect to the receiving site. Seven days later, initial signs of re-epithelialization appeared, and the wound healed in 3 months.In patients with PG, the minced micrograft method could facilitate ulcer healing by releasing cytokines, chemokines, and growth factors, thus promoting granulation tissue formation, neoangiogenesis. Because this method does not require special equipment or complex surgical techniques and is very low cost, it should be an integral part of the arsenal of procedures aimed at improving the quality of life of patients with PG.
Insights
Minced micrografts offer a minimally invasive, low-cost treatment for pyoderma gangrenosum (PG) ulcers. This technique promotes faster healing and reduces the risk of new lesions, improving patient quality of life.
Area of Science:
- Dermatology
- Regenerative Medicine
Background:
- Pyoderma gangrenosum (PG) is a rare, painful neutrophilic dermatosis characterized by ulcers and pathergy.
- Standard treatments include immunosuppressants, but advanced cases may require risky surgical options like skin grafts or amputation.
Observation:
- A novel approach using minced micrografts was applied to a patient with a persistent PG ulcer.
- The procedure involved applying finely minced autologous skin suspended in hydrogel to the wound bed.
Findings:
- Initial signs of re-epithelialization were observed within seven days post-procedure.
- Complete wound healing was achieved in three months, demonstrating the efficacy of the minced micrograft technique.
Implications:
- Minced micrografts may accelerate PG ulcer healing by stimulating granulation tissue formation and neoangiogenesis via cytokine and growth factor release.
- This cost-effective, minimally invasive method, requiring no specialized equipment, presents a valuable therapeutic option for managing pyoderma gangrenosum.
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