Management of avulsion injuries.

The optimal management sequence to treat avulsion injuries in children is particularly difficult because of the following problems: (1) Assessment of these rare but frequently massive injuries can be very difficult and treacherous, as the extent of the injury is often underestimated and treatment therefore considered inappropriate; (2) Avulsion injuries have a high risk of infection: lesions are always contaminated due to the mechanism of injury (mostly vehicle accidents) and subsequent long-term hospitalization adds an additional risk for nosocomial infections; (3) Children with avulsion injuries have an increased risk to develop functional deficits: although the body grows, scars and reconstructed tissues may not adapt sufficiently and this may lead to serious constraints. Because of these problems, avulsion injuries may lead to a high morbidity and even mortality, especially if the injury is mismanaged. Reviewing the most recent data regarding the management of avulsion injuries yields the following key points: (1) A scoring system may help to assess the primary dimension of the defect; (2) Innovative techniques such as the use of a Vacuum Assisted Closure system may lower the risk of infection; (3) Choosing a comprehensive, reconstructive approach taking the growth of the child into consideration, may reduce the development of serious functional deficits and improve cosmetic outcome.

Tissue engineering of skin for wound coverage.

Over the past few decades, important milestones have been reached in the field of skin tissue engineering, bringing the ultimate goal of fabricating an autologous dermoepidermal skin substitute with all its cellular components and skin appendages closer to reality. Yet, scientific progress alone is not enough, clinical demands must be addressed and commercial interests need to be fulfilled. This review gives an overview of commercially available skin substitutes for skin replacement therapies and an insight into the recent development of an autologous full-thickness skin substitute that can readily be transplanted in large quantities onto the patient.