Suction blister transplantation for a refractory venous ulcer

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Compression therapy and local wound care remain the cornerstone of the therapy for patients with venous ulcers. For the ulcers which do not respond to conventional therapy, surgical methods should be considered. We present a 75-year-old male patient with refractory venous ulcer who was sucessfully treated with suction blister grafts.

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Application of suction blister transplants to leg ulcers is an alternative symptomatic treatment to split-skin grafting, i.e. "pinch-grafting". Blisters are produced by the suction device Dermovac at a suction pressure of 250-300 mmHg for 1-2 hours. The blister-roofs are cut off at the periphery and placed on the granulation tissue of the ulcer. The healing time for leg ulcers was 10-14 days. Excellent epithelialization was seen in 10 out of 12 ulcers. The advantages of the method are, that it is easy to perform, no scarring is produced, and the procedure is painless.
There is much progress to be made to optimize the development of laboratory-grown temporary and permanent skin replacements. Replacement of both epidermal and dermal layers is important for achieving optimal take of cultured grafts and for optimizing the quality of wound healing. Although the use of retained cadaver allodermis on the wound bed may improve the performance of cultured epithelium, the development of successful, complete dermal-epidermal skin replacements (composite grafts) would greatly simplify burn management. In the future, handling and stability of the cultured grafts should be improved, and clinical outcomes should be expected to be superior. Unfortunately, funding for this type of applied research has not achieved high priority from the federal government granting agencies, despite the great clinical need for improved technology. Future progress depends largely upon commercial support.