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Arif N, Baumann L, Felcht M. Combination of secondary intention healing and primary closure to reconstruct large facial defects. J Dtsch Dermatol Ges 2024. [PMID: 39167560 DOI: 10.1111/ddg.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 08/23/2024]
Abstract
Secondary intention healing has been a well-established method to close wounds for more than 200 years. Indeed, it represents the easiest technique in the ladder of plastic reconstruction. Primary wound closure (side-to-side closure, direct wound closure) is the second easiest method. The combination of these two techniques is already an integral aspect of specific surgical procedures, e.g. the reconstruction of the donor site of a paramedian forehead flap. This minireview will show that the combination is also a suitable alternative to classic flaps in reconstruction of different aesthetic subunits of the face. These are the scalp, the lateral cheek, the upper nasal sidewall/medial canthus and the retroauricular region. The advantages and disadvantages will be discussed and illustrated with clinical examples.
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Affiliation(s)
- Nawa Arif
- Department of Dermatology, Venereology and Allergy, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University and Centre of Excellence of Dermatology of Baden-Württemberg, Mannheim, Germany
| | - Lara Baumann
- Department of Dermatology, Venereology and Allergy, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University and Centre of Excellence of Dermatology of Baden-Württemberg, Mannheim, Germany
| | - Moritz Felcht
- Department of Dermatology, Venereology and Allergy, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University and Centre of Excellence of Dermatology of Baden-Württemberg, Mannheim, Germany
- Center of Dermatosurgery, St. Josefskrankenhaus, Academic Teaching Hospital Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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Wu Y, Chen L, Mao X, Ru Z, Yu L, Chen M, Wang J, Chen J, Pang Q. Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage-Clinical Outcome of 34 Patients. INT J LOW EXTR WOUND 2021:15347346211032046. [PMID: 34279133 DOI: 10.1177/15347346211032046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (W/L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (P < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (W/L > 0.5) were more difficult to close than in group B (W/L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.
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Affiliation(s)
- Yaojun Wu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Liang Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinliang Mao
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | | | - Liying Yu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Mimi Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jingnan Wang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiejie Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qingjiang Pang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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Felcht M. Defektdeckung am Nasenflügel durch die kaudolateral gedrehte Transpositionslappenplastik und ihre Varianten. J Dtsch Dermatol Ges 2017; 15:981-988. [DOI: 10.1111/ddg.13318_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Moritz Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim; Universität Heidelberg; Mannheim
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Felcht M. The caudolaterally inserted transposition flap and its variations for reconstruction of defects of the nasal ala. J Dtsch Dermatol Ges 2017; 15:981-987. [PMID: 28840958 DOI: 10.1111/ddg.13318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Abstract
Closure of non-full-thickness defects of the nasal ala can be a surgical challenge. While there is a plethora of various reconstructive techniques, not all of them are easy to learn and carry out. Recently, the dermatosurgeon Andreas Lösler from the Department of Dermatology at the Hornheide Medical Center, Germany, developed and published the caudolaterally inserted transposition flap for the reconstruction of alar defects. Given its relative novelty, this technique, which is characterized by a very low complication rate, is still unknown to most dermatosurgeons and has not yet found its way into standard dermatosurgery textbooks. The present review describes the caudolaterally inserted transposition flap and two modifications thereof, which allow for the closure of large alar defects as well as defects of the alar crease. Comparisons are made to the two flaps most commonly employed for alar reconstruction, the bilobed flap and the cranially inserted nasolabial transposition flap (melolabial flap).
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Affiliation(s)
- Moritz Felcht
- Department of Dermatology, Venerology and Allergy, University Medical Center Mannheim, University of Heidelberg, Manheim, Germany
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