Management of full-thickness skin grafts

Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

PLASTIC SURGERY OF WOUND DEFECTS WITH FREE GRAFTS AFTER MALIGNANT SKIN TUMORS EXCISION: A PILOT STUDY

AIM

To evaluate the effectiveness of applying negative pressure bandages (VAC bandage) in patients with malignant skin tumors after closing defects with free skin grafts and to compare it with fixation of skin grafts by the ordinary ointment bandages.

MATERIALS AND METHODS

61 patients with malignant skin tumors who underwent surgical treatment at the National Cancer Institute from 2019 to 2023 were included in the study. For the wound defects closure, the split skin grafts were applied in all patients. At the time of surgery, after closing a wound defect by a split skin graft, a negative pressure dressing (VAC bandage) was applied in 41 patients for 7 days (group 1). In 20 patients, a transplanted skin graft was fixed after surgery by an ordinary ointment pressure bandage (group 2). The immediate results were evaluated one week after surgery.

RESULTS

Complete engraftment of the flap in group 1 was observed in 53.7 ± 7.8% cases, in group 2 this result was achieved in 5.0 ± 4.8% patients (p = 0.002). The complete graft necrosis occurred in 1 case in group 1 vs. 2 cases in group 2 (p = 0.496).

CONCLUSION

The results of the engraftment in postoperative wounds were significantly better in the VAC-bandage group in terms of the number of the complete engraftments compared to the conventional pressure ointment bandage group.

Delayed primary intention with full-thickness skin graft in distal interphalangeal injury: A rare case report

INTRODUCTION AND IMPORTANCE

The fingertip injury is the most common in the hand area. In this regard, skin grafting can be considered to preserve sensation, due to its functional importance, particularly for distal tip injuries. A full-thickness skin graft (FTSG) results in excellent function after engraftment and should be considered in reconstructing functionally and aesthetically important areas. Moreover, a thorough understanding of FTSG is required for a surgeon to have an excellent outcome.

CASE PRESENTATION

A 38-year-old man had the third fingertip injury of his right hand after being crushed by a mill. Physical examination revealed exposed bone distal to DIP, with intact periosteum and nail plate, negative active bleeding, and negative contaminants. There was no tendon or soft tissue left above the periosteum. In addition, an X-ray of the right manus revealed no fracture. The wound was applied with hydrogel and petroleum gauze to maintain hydration. A wound toilet was performed, followed by the closure of the wound with full-thickness skin grafting (FTSG). Follow-up was done in the first week and the fourth week after the procedure, as they showed good aesthetic results with satisfactory function. The sensory recovery showed normal result for touch and vibration. Meanwhile, sharp pain and warmth object sensation were minimally diminished.

CLINICAL DISCUSSION

A literature review concludes that FTSGs are generally unreliable in cases with over poorly vascularized beds, and FTSG will only work with no serious blood supply issues. Therefore, severe fingertip injury was reconstructed by the graft.

CONCLUSION

This procedure showed excellent graft survival with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages consisted of insufficient volume of soft tissue and graft hyperpigmentation. However, delayed primary wound closure by FTSG may be an option for treating full-thickness finger defects with bone or tendon exposure.

A comparative study of full-thickness skin grafting with and without subcutaneous fat preservation

Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full-thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG.

Epidermal Pulley Sutures and Double Burow’s Full-Thickness Skin Grafts for Large, High-Tension Closures

Large defects in high-tension areas can be difficult to close with primary closures alone. Skin grafts are often used. We describe a technique using epidermal pulley sutures and a Burow’s full-thickness skin graft (FTSG) that allows reconstruction of large defects while optimizing wound coverage and healing.