I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Regenerative Healing in Fetal Skin: A Review of the Literature
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Exploration of fetal wound healing began in the 1950s with examination of animal models. Initial studies by Hess1,2 indicated that fetal wounds heal rapidly and show signs of regeneration, in some cases making it difficult to identify the wound site. In subsequent studies,3-7 a lack of inflammation and healing without a scar4 were described in fetal wounds. Similar differences in healing were noted in the human fetus8 and were confirmed when the first human fetal surgeries were performed.9
As experimental studies continued, it became evident that fetal wounds heal differently depending on the gestational age of the fetus (see Figure 1).10-17 In the first and second trimesters of development, fetal skin undergoes rapid healing with little or no inflammation and no scarring. Scarless healing in early fetal skin is a form of regeneration, with renewal of skin appendages such as hair follicles and sebaceous glands in addition to the restoration of a normal dermal matrix and no scar. Near the third trimester, a transition period occurs. At this point, the skin begins to lose its ability to regenerate and instead undergoes fibrotic healing similar to that seen in postnatal skin. After this transition to fibrotic fetal healing, cutaneous wounds heal more slowly, exhibiting inflammation and significant scarring. After the transition period, wounded fetal skin will display typical signs of scar tissue, with the loss of subepidermal appendages and an overproduction of densely packed, disorganized collagen. Pathology reports and basic research studies8,17 have shown that scarless healing occurs in fetal skin until around 22 to 24 weeks of gestation in the human fetus.
The point of transition from scarless to fibrotic healing also has been determined for many animals; they have been used in experimental models of fetal wound healing. The author’s laboratory prefers the mouse model, owing to the abundance of available reagents and the availability of genetically modified mice. In mice, the transition occurs at about embryonic day 16 (E16), so wounds made at E16 or earlier heal without a scar (regenerative or scarless repair) and wounds made later than E16 heal with a scar (fibrotic repair).18-21 Scarless and fibrotic fetal wounds then can be compared and used to identify pathways involved in regenerative healing. It is important to note that scarless fetal repair is somewhat dependent on the size and severity of the wound14 and, with the exception of bone,22 fetal skin appears to be unique in its capacity to heal by regeneration.23
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