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Yang L, Guo J, He J, Shao J. Skin grafting treatment of adolescent lower limb avulsion injury. Front Surg 2022; 9:953038. [PMID: 36189402 PMCID: PMC9521200 DOI: 10.3389/fsurg.2022.953038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Under the influence of various factors, the number of lower extremity avulsion injuries in adolescents is increasing year by year. The main modality of treatment is skin grafting. There are many types of skin grafting. Although many studies on skin grafting after avulsion injuries have been published in the past few decades, there are differences in the treatment options for adolescents with post avulsion injuries. Main body Thorough debridement and appropriate skin grafts are essential for the surgical management of avulsion injuries for optimal prognosis. In the acquisition of grafts, progress has been made in equipment for how to obtain different depths of skin. The severity of the avulsion injury varies among patients on admission, and therefore the manner and type of skin grafting will vary. Especially in adolescents, graft survival and functional recovery are of great concern to both patients and physicians. Therefore, many efforts have been made to improve survival rate and activity. Conclusion This review summarizes the principles of treatment of avulsion injuries, the historical development of skin grafts, and the selection of skin grafts, hoping to be helpful for future research.
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Anbar TS, Moftah NH, El-Khayyat MAM, El-Fakahany HM, Abdel-Rahman AT, Saad EK. Syringes versus Chinese cups in harvesting suction-induced blister graft: a randomized split-body study. Int J Dermatol 2018; 57:1249-1252. [PMID: 29797713 DOI: 10.1111/ijd.14040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Suction blister grafting (SBG) is a technique where the pigmented epidermis is harvested from the donor site by induction of a blister using different suction methods as syringes, Chinese cups, suction device, etc. However, pain, time consumption, incomplete blister formation, and failure of blister development are the main limitations. OBJECTIVE To compare between cups and syringes of similar diameter in inducing suction blisters. PATIENTS AND METHODS In 30 patients with stable nonsegmental vitiligo, 2-cm-diameter (20 ml) syringe was applied on the anterolateral aspect of one thigh and a 2-cm-diameter cup on the corresponding site of the other thigh where right and left sides were chosen randomly. Patients were observed untill complete blister development or for a maximum of 3 hours. Suction blister induction time (SBIT) and the blister diameter were recorded for each patient. Pain during the process of induction was evaluated. RESULTS Incomplete blister development was noted in 9 out of 30 (30%) with 2 cm syringes and 6 out of 30 (20%) with the similar diameter cups with no significant difference (P = 0.49). No significant difference was found between SBIT induced by the 2 cm syringes and the similar size cups (101.17 ± 68.14 minutes, 98 ± 56.84 minutes, respectively) (P = 0.85). Meanwhile, blister diameter induced by either syringe or cup was not significantly different (P = 0.37). Anesthesia was for short duration with xylocaine, and pain was intolerable in both sides in the first seven patients. A combination of xylocaine and bupivacaine was used with prolonged loss of pain in 17 of the remaining 23 patients and tolerable pain in six patients similarly in both sides. CONCLUSION According to present results, the differences in SIBT, diameter of blisters, and number of complete blister formation induced by either syringes or cups of similar size were not significant. Therefore, whatever the available and feasible technique for the surgeon will be the ideal choice. A combination of xylocaine and bupivacaine is recommended to overcome the accompanying pain of the procedure.
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Affiliation(s)
- Tag S Anbar
- Department of Dermatology, STD's and Andrology, Minia University, Minia, Egypt
| | - Nayera H Moftah
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
| | | | - Hasan M El-Fakahany
- Department of Dermatology, STD's and Andrology, Minia University, Minia, Egypt
| | - Amal T Abdel-Rahman
- Department of Dermatology, STD's and Andrology, Minia University, Minia, Egypt
| | - Enas K Saad
- Department of Dermatology, STD's and Andrology, Matay Central Hospital, Minia, Egypt
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Kanapathy M, Smith OJ, Hachach-Haram N, Bystrzonowski N, Mosahebi A, Richards T. Systematic review and meta-analysis of the efficacy of epidermal grafting for wound healing. Int Wound J 2017; 14:921-928. [PMID: 28198101 DOI: 10.1111/iwj.12729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/26/2017] [Indexed: 02/02/2023] Open
Abstract
Autologous skin grafting is an important method for wound coverage; however, it is an invasive procedure and can cause donor site morbidity. Epidermal grafting (EG) enables epidermal transfer to wounds with minimal donor site morbidity. However, data to date have been heterogeneous. This study aims to synthesise the current evidence on EG for wound healing to establish the efficacy of this surgical technique. A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted. The endpoints assessed were proportion of wounds healed and mean wound-healing time. This systematic review was conducted and reported according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We identified 1568 articles, of which seven articles were included in this review - a total of 209 wounds in 190 patients. The mean wound duration was 17·06 weeks (95% CI 8·57-25·55). Of these, 71·5% (95% CI 56·7-84·2) of the wounds achieved complete healing. Mean time for complete wound healing was 5·53 weeks (95% CI 3·18-7·88). The mean donor site healing time was 7·48 days (95% CI 4·83-10·13), with no reported donor site morbidity. The current data are small and lack level 1 evidence.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Oliver J Smith
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Afshin Mosahebi
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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Arora S, Kar BR. Reduction of Blister Formation Time in Suction Blister Epidermal Grafting in Vitiligo Patients Using a Household Hair Dryer. J Cutan Aesthet Surg 2017; 9:232-235. [PMID: 28163453 PMCID: PMC5227075 DOI: 10.4103/0974-2077.197045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Suction blister epidermal grafting (SBEG) is a simple and effective way of surgical repigmentation in vitiligo. The major problem faced is the time taken for the formation of blisters. Temperature at the suction site is one of the factors affecting the blister formation time. Aims and Objectives: To reduce the blister formation time in SBEG by increasing the surface temperature to 44°C. Materials and Methods: This is a left-right comparison study. Total seven patients with lip vitiligo involving both the angles of lips were enrolled. Suction syringes were applied on both the thighs of all the patients. On the right thigh, blisters were raised as per the procedure standardised by Gupta et al. On the left thigh, similar procedure was used, but a hair dryer was used additionally to increase the surface temperature of the skin to 44°C. The time taken for the formation of well-formed, dome-shaped, unilocular blister was noted. Results: The mean time taken for the formation of blister on the right thigh was 121.1 ± 6.2 min and on the left thigh was 69.6 ± 5.4 min. All the seven patients were started on PUVASOL after SBEG. There was complete repigmentation of the grafted sites in all the patients after 2 months. Conclusion: Hair dryer is easily available, affordable and simple to use and the time saved during the procedure is quite significant.
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Affiliation(s)
- Shweta Arora
- Department of Skin and VD, IMS and SUM Hospital, S 'O' A University, Bhubaneswar, Odisha, India
| | - Bikash Ranjan Kar
- Department of Skin and VD, IMS and SUM Hospital, S 'O' A University, Bhubaneswar, Odisha, India
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Kanapathy M, Hachach-Haram N, Bystrzonowski N, Connelly JT, O'Toole EA, Becker DL, Mosahebi A, Richards T. Epidermal grafting for wound healing: a review on the harvesting systems, the ultrastructure of the graft and the mechanism of wound healing. Int Wound J 2016; 14:16-23. [PMID: 27785878 DOI: 10.1111/iwj.12686] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
Epidermal grafting for wound healing involves the transfer of the epidermis from a healthy location to cover a wound. The structural difference of the epidermal graft in comparison to the split-thickness skin graft and full-thickness skin graft contributes to the mechanism of effect. While skin grafting is an epidermal transfer, little is known about the precise mechanism of wound healing by epidermal graft. This paper aims to explore the evolution of the epidermal graft harvesting system over the last five decades, the structural advantages of epidermal graft for wound healing and the current hypotheses on the mechanism of wound healing by epidermal graft. Three mechanisms are proposed: keratinocyte activation, growth factor secretion and reepithelialisation from the wound edge. We evaluate and explain how these processes work and integrate to promote wound healing based on the current in vivo and in vitro evidence. We also review the ongoing clinical trials evaluating the efficacy of epidermal graft for wound healing. The epidermal graft is a promising alternative to the more invasive conventional surgical techniques as it is simple, less expensive and reduces the surgical burden for patients in need of wound coverage.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - John T Connelly
- Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Edel A O'Toole
- Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore, Singapore
| | - Afshin Mosahebi
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery & Interventional Science, University College London, London, UK.,London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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Abstract
Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India. Starting with the simplest punch grafting we have now a multitude of different grafting techniques available in vitiligo. All of these grafting procedures are associated with certain complications. In addition there are certain factors and surgical pearls that can go a long way in improving the cosmetic results achieved with any of these grafting techniques. This paper will try to address these specific factors and complications associated with these grafting techniques and the ways and means to avoid them.
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Affiliation(s)
- Imran Majid
- Department of Dermatology, Government Medical College, CUTIS Skin and Laser Institute, Srinagar, Kashmir, India
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Ueda T, Hamada Y, Nemoto N, Katsuoka K. Electron microscopy of nuclear degeneration in keratinocytes in suction blister roof grafting. Int Wound J 2013; 12:744-5. [PMID: 24373191 DOI: 10.1111/iwj.12207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/20/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
- Takashi Ueda
- Department of Dermatology, School of Medicine, Kitasato University, Kanagawa, Japan.
| | - Yuko Hamada
- Department of Dermatology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Noriko Nemoto
- Research Center for Biological Imaging, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kensei Katsuoka
- Department of Dermatology, School of Medicine, Kitasato University, Kanagawa, Japan
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Oiso N, Suzuki T, Wataya-Kaneda M, Tanemura A, Tanioka M, Fujimoto T, Fukai K, Kawakami T, Tsukamoto K, Yamaguchi Y, Sano S, Mitsuhashi Y, Nishigori C, Morita A, Nakagawa H, Mizoguchi M, Katayama I. Guidelines for the diagnosis and treatment of vitiligo in Japan. J Dermatol 2013; 40:344-54. [PMID: 23441960 DOI: 10.1111/1346-8138.12099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 01/08/2023]
Abstract
Vitiligo is an acquired pigment disorder in which depigmented macules result from the loss of melanocytes from the involved regions of skin and hair. The color dissimilarity on the cosmetically sensitive regions frequently induces quality of life impairment and high willingness to pay for treatment in patients with vitiligo. The Vitiligo Japanese Task Force was organized to overcome this situation and to cooperate with the Vitiligo Global Issues Consensus Conference. This guideline for the diagnosis and treatment of vitiligo in Japan is proposed to improve the circumstances of Japanese individuals with vitiligo. Its contents include information regarding the diagnosis, pathogenesis, evaluation of disease severity and effectiveness of treatment, and evidence-based recommendations for the treatment of vitiligo. The therapeutic algorithm based on the proposed recommendation is designed to cure and improve the affected lesions and quality of life of individuals with vitiligo.
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Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Kim T, Roh HJ, Kim JY, Noh S, Oh SH. Rapid Formation of Suction Blister through Intradermal Injection of Local Anesthetics in Epidermal Graft for Vitiligo. Dermatol Surg 2010; 36:1642-3. [DOI: 10.1111/j.1524-4725.2010.01700.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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