One-stage transplantation of artificial dermis and autologous split-thickness skin graft for the repair of severe foot trauma: a case report.

Abstract

For the repair of complex wounds involving bone and joint infections resulting from severe trauma, the conventional approach typically involves a two-stage procedure: initial implantation of an artificial dermis (AD), followed by autologous split-thickness skin grafting (STSG) after 2-3 weeks. This report presents an innovative one-stage technique in which AD and autologous STSG were transplanted simultaneously onto a wound bed prepared with antibiotic-loaded bone cement (ALBC). The patient had sustained multiple open fractures, dislocations, bone defects, and bone and joint infections following a traffic accident. After two initial surgical procedures that included thorough debridement, fracture fixation, and ALBC placement for infection control, a one-stage skin graft was performed to co-implant AD and autologous STSG (0.15-0.25 mm thick) for wound closure. At the 18-month follow-up, the graft flap exhibits no contraction, and its color, texture, softness, and elasticity closely resemble those of the surrounding normal skin. This ALBC-assisted one-stage transplantation of AD combined with autologous STSG offers a feasible and efficient method for repairing complex wounds involving bone and joint injuries with concomitant skin and soft tissue defects. Moreover, it may reduce treatment duration and simplify the clinical pathway compared with traditional two-stage skin grafting protocols.