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Othman S, Messa CA, Elfanagely O, Bormann B, Mellia JA, Broach RB, Kovach SJ, Fischer JP. Sticking to What Matters: A Matched Comparative Study of Fibrin Glue and Mechanical Fixation for Split-Thickness Skin Grafts in the Lower Extremity. INT J LOW EXTR WOUND 2024; 23:231-237. [PMID: 34605281 DOI: 10.1177/15347346211047748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Split-thickness skin grafts (STSGs) remain a valuable tool in the reconstructive surgeons' armamentarium. Staple or suture mechanical fixation (MF) serves as the gold standard of care, though fibrin glue (FG) has gained popularity as a fixation modality. We compare STSG outcomes following application of FG versus MF through a study of lower extremity wounds. Methods: A retrospective review (2016-2019) of patients who underwent a STSG was performed. Two cohorts consisting of patients undergoing a STSG with FG or MF (suture or staple) were matched according to wound size, wound location, and body mass index. Results: A total of 67 patients with 79 wounds were included (FG: n = 30, wounds = 39; MF: n = 37; wounds = 40). There was no significant difference between groups regarding time to 100% graft take (FG: 39 days, MF: 35.1 days; P < .384) or 180-day graft complications (FG: 10.3%, MF: 15%; P < .737). Adjusted operative time for FG (51.8 min) was lower than for MF cases (67.5 min) at a level that approached significance (P < .094). FG patients were significantly less likely to require a postoperative wound vacuum-assisted closure (VAC) (FG: 16.7%; MF: 76.7%; P < .001) and required a significantly lower number of 30-day postoperative visits (FG: 1.5 ± .78 visits; MF: 2.5 ± .03 visits; P < .001). The MF group had higher mean aggregate charges ($211,090) compared with the FG group (mean: $149,907), although these were not statistically significant (P > .05). Conclusion: The use of FG for STSG shows comparable clinical outcomes to MF, with a significantly decreased need for postoperative wound VAC, the number of 30-day postoperative visits, and a lower wound-adjusted operative time.
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Affiliation(s)
- Sammy Othman
- University of Pennsylvania, Philadelphia, PA, USA
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2
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Alawi SA, Taqatqeh F, Matschke J, Bota O, Dragu A. Use of a collagen-elastin matrix with split-thickness skin graft for defect coverage in complex wounds. J Wound Care 2024; 33:14-21. [PMID: 38197274 DOI: 10.12968/jowc.2024.33.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation). METHOD A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery. RESULTS Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder. CONCLUSION Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds.
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Affiliation(s)
- Seyed Arash Alawi
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Feras Taqatqeh
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Jan Matschke
- Department of Maxillofacial Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Olimpiu Bota
- Department of Plastic Surgery, First Surgical Clinic, Emergency County Hospital Cluj-Napoca, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
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3
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Dunev VR. A practical method of dressing and immobilizing the penis after using split-thickness skin graft. Int Wound J 2023; 21:e14467. [PMID: 37942545 PMCID: PMC10898387 DOI: 10.1111/iwj.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023] Open
Abstract
In this paper, we introduce a cost-effective and efficient approach for dressing and immobilizing the penis following the use of a split-thickness skin graft (STSG) to treat penile paraffinoma.
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4
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Xianchao D, Yi L, Chang L, Zhixin Y. Comparison of Biatain Ag and Biatain Alginate Ag dressings on skin graft donor sites: a prospective clinical trial. J Wound Care 2023; 32:cxcv-cc. [PMID: 37703218 DOI: 10.12968/jowc.2023.32.sup9a.cxcv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this study was to compare Biatain Ag and Biatain Alginate Ag (both Coloplast, Denmark) as skin graft donor site dressings. METHOD A single-centre, prospective, randomised clinical study was conducted. In patients who had undergone a skin graft operation, adjacent split-thickness skin graft donor sites were dressed with Biatain Ag and Biatain Alginate Ag, respectively. The primary outcomes were time to re-epithelialisation and pain score after the operation. The secondary outcomes were scar scores of the donor site after the operation, haematoma rates, infection rates, and exudation rates before wound healing. Results were compared using the Wilcoxon test and the Chi-squared test. RESULTS A total of 16 paired wounds in 16 patients were studied. The donor sites dressed with Biatain Ag needed more time for >90% re-epithelialisation than those dressed with Biatain Alginate Ag. On day 3 postoperatively, the pain scores with Biatain Ag were significantly less severe than those with Biatain Alginate Ag. On days 6, 9 and 12, the pain scores of both dressings did not differ significantly. The scar scores of the donor site dressed with Biatain Ag were significantly worse than those dressed with Biatain Alginate Ag at 6 months. With respect to infection rates, no significant differences were detected between these two groups. However, the exudation rates of the donor site dressed with Biatain Ag were significantly lower than those dressed with Biatain Alginate Ag. CONCLUSION As skin graft donor site dressings, both Biatain Ag and Biatain Alginate Ag have advantages.
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Affiliation(s)
- Ding Xianchao
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Luo Yi
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Liu Chang
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Yan Zhixin
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
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5
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Lisiecki J, Buta M, Taylor S, Tait M, Farina N, Levin J, Schulz J, Sangji N, Friedstat J, Hemmila M, Wang S, Levi B, Goverman J. Efficacy of Mepliex ® Ag Versus Xeroform ® As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard. Ann Burns Fire Disasters 2023; 36:243-250. [PMID: 38680433 PMCID: PMC11041881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 05/01/2024]
Abstract
Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.
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Affiliation(s)
- J.L. Lisiecki
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M.R. Buta
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - S. Taylor
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M. Tait
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - N. Farina
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Levin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - J. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - N. Sangji
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M.R. Hemmila
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S. Wang
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - B. Levi
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - J. Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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6
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Hu Y, Xiong Y, Zhu Y, Zhou F, Liu X, Chen S, Li Z, Qi S, Chen L. Copper-Epigallocatechin Gallate Enhances Therapeutic Effects of 3D-Printed Dermal Scaffolds in Mitigating Diabetic Wound Scarring. ACS Appl Mater Interfaces 2023; 15:38230-38246. [PMID: 37535406 PMCID: PMC10436249 DOI: 10.1021/acsami.3c04733] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
Morbid dermal templates, microangiopathy, and abnormal inflammation are the three most critical reasons for the scarred healing and the high recurrence rate of diabetic wounds. In this present study, a combination of a methacrylated decellularized extracellular matrix (ECMMA, aka EM)-based hydrogel system loaded with copper-epigallocatechin gallate (Cu-EGCG) capsules is proposed to fabricate bio-printed dermal scaffolds for diabetic wound treatment. Copper ions act as a bioactive element for promoting angiogenesis, and EGCG can inhibit inflammation on the wound site. In addition to the above activities, EM/Cu-EGCG (E/C) dermal scaffolds can also provide optimized templates and nutrient exchange space for guiding the orderly deposition and remodeling of ECM. In vitro experiments have shown that the E/C hydrogel can promote angiogenesis and inhibit the polarization of macrophages to the M1 pro-inflammatory phenotype. In the full-thickness skin defect model of diabetic rats, the E/C dermal scaffold combined with split-thickness skin graft transplantation can alleviate pathological scarring via promoting angiogenesis and driving macrophage polarization to the anti-inflammatory M2 phenotype. These may be attributed to the scaffold-actuated expression of angiogenesis-related genes in the HIF-1α/vascular endothelial growth factor pathway and decreased expression of inflammation-related genes in the TNF-α/NF-κB/MMP9 pathway. The results of this study show that the E/C dermal scaffold could serve as a promising artificial dermal analogue for solving the problems of delayed wound healing and reulceration of diabetic wounds.
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Affiliation(s)
- Yanke Hu
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yahui Xiong
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yongkang Zhu
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Fei Zhou
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xiaogang Liu
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Shuying Chen
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Zhanpeng Li
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Shaohai Qi
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Lei Chen
- Department
of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Guangdong
Provincial Engineering Technology Research Center of Burn and Wound
Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
- Institute
of Precision Medicine, The First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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7
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Kidd T, Kolaityte V, Bajaj K, Wallace D, Izadi D, Bechar J. The use of NovoSorb biodegradable temporising matrix in wound management: a literature review and case series. J Wound Care 2023; 32:470-478. [PMID: 37572341 DOI: 10.12968/jowc.2023.32.8.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
OBJECTIVE NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice. METHOD A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed. RESULTS The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance. CONCLUSION In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer's recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool.
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Affiliation(s)
- Thomas Kidd
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Valdone Kolaityte
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Kuljyot Bajaj
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
| | - David Wallace
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
| | - David Izadi
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Janak Bechar
- Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK
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8
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Raipure A, Patil S, Pathan H. Effectiveness of Early Physiotherapy Rehabilitation Approach for Split Skin Grafting Post-burn in a Pediatric Patient. Cureus 2023; 15:e44083. [PMID: 37750141 PMCID: PMC10518060 DOI: 10.7759/cureus.44083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Childhood is critical for developing social, physical, and cognitive functioning. Burns in children are very different from burns in adults because it is difficult for them to save themselves. Their skin is more sensitive and less heat-resistant; their exposure may last longer, worsening the burn. When neglected, severe disabling and deforming contractures caused by burns in children can result in substantial impairment. Therefore, burn rehabilitation should not be carried out by one person but rather by a multidisciplinary team to ensure that all of the patients' physical, psychological, and social requirements are met while the child is in the hospital and after discharge. The treatment of young burn victims requires a multidisciplinary approach that begins the day of the accident and lasts for several years. To reduce the consequences of the patient's post-traumatic stress and increase functional independence, a thorough rehabilitation programme is needed. The burn team members' dedication, commitment to the patient's care, and encouragement of patient participation and full engagement in rehabilitation can make a difference to juvenile burn patients' long-term quality of life (QOL). We present a seven-year-old female who suffered from a superficial burn over the lateral aspect of her right thigh. Exercise prescriptions should be thoroughly customized to provide the best possible success in rehabilitation, considering the degree of burns and physical limitations. This case report is intended to serve as a practical manual for the necessary clinical knowledge and therapy intervention approaches for managing burn patients successfully.
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Affiliation(s)
- Anushka Raipure
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubhangi Patil
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Heena Pathan
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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9
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Baek S, Park JH. Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft. Medicina (Kaunas) 2023; 59:1342. [PMID: 37512153 PMCID: PMC10386472 DOI: 10.3390/medicina59071342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.
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Affiliation(s)
- Seungchul Baek
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
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10
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Freeman SC, Neill B, Garvey C, Leitenberger JJ. Bilateral Transposition Flaps With Split-Thickness Skin Grafting of Secondary Defects After a Large Mohs Micrographic Surgery Defect With Exposed Calvarium. Cureus 2023; 15:e42191. [PMID: 37602082 PMCID: PMC10439768 DOI: 10.7759/cureus.42191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Large, full-thickness defects of the scalp create a common reconstructive dilemma following Mohs micrographic surgery. In cases with exposed calvarium, transposition flap(s) followed by split-thickness skin graft(s) to the secondary defect is an effective method of reconstruction that allows for same-day repair, full defect coverage, and good functional outcomes. Herein, we present the reconstruction of a large scalp defect utilizing bilateral transposition flaps followed by split-thickness skin grafts of the secondary defects.
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Affiliation(s)
- S Caleb Freeman
- Dermatology, Oregon Health & Science University, Portland, USA
| | - Brett Neill
- Dermatology and Mohs Micrographic Surgery, Swann Dermatology Partners, Springfield, USA
- Skin Cancer Treatment, Cosmetic Dermatology, General Dermatology, Epiphany Dermatology, Rockwall, USA
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11
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Ali SS, Ahmad I, Khurram MF, Chaudhury G, Karad S, Tripathi S, Sharma A. The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site. Indian J Plast Surg 2022; 55:376-382. [PMID: 36683882 PMCID: PMC9859680 DOI: 10.1055/s-0042-1759502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product.
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Affiliation(s)
- Sheikh Sarfraz Ali
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Imran Ahmad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammed Fahud Khurram
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Gautam Chaudhury
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India,Address for correspondence Gautam Chaudhury, MCh Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim UniversityAligarh 202001, Uttar PradeshIndia
| | - Somnath Karad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sudanshu Tripathi
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Aditi Sharma
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Alokaili H, Alsinan TA, Almansour D, Alhablany TM, Alhuwaider E, AlMarshad FA, Bhat TA, Aljasir A. Use of a Bipedicled Pericranial Flap and a Split Thickness Skin Graft for Reconstruction of a Traumatic Scalp Injury: A Case Report. Cureus 2022; 14:e29887. [PMID: 36348929 PMCID: PMC9630487 DOI: 10.7759/cureus.29887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023] Open
Abstract
Reconstruction of a scalp defect should ensure the skull's protection, soft-tissue bulk, and contour maintenance. When calvaria is exposed, each reconstruction option has its own advantages and disadvantages. We report a 2-year-old Saudi boy, a road traffic accident (RTA) victim, otherwise medically stable who sustained partial to full-thickness defects of the scalp involving the left temporoparietal region, measuring 20 × 10 cm2 in size. After optimal debridement of the wound, a bipedicled pericranial flap with a split-thickness skin graft (STSG) was done. This case reports the satisfactory outcomes of using a bipedicled pericranial flap with STSG in traumatic scalp injuries, specifically in the pediatric age population without creating any secondary scalp skin defect and its associated morbidities. Being bipedicled the vascularity of the flap is more reliable and robust.
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Affiliation(s)
- Hesham Alokaili
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Tuqa A Alsinan
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Duaa Almansour
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Tareg M Alhablany
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Ebtisam Alhuwaider
- Department of Plastic and Reconstructive Surgery, Qatif Central Hospital, Qatif, SAU
| | - Felwa A AlMarshad
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Tanveer A Bhat
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
| | - Anas Aljasir
- Department of Plastic and Reconstructive Surgery, King Saud Medical City, Riyadh, SAU
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13
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McBride CA, Wong M, Patel B. Systematic literature review of topical local anaesthesia or analgesia to donor site wounds. Burns Trauma 2022; 10:tkac020. [PMID: 36133279 PMCID: PMC9486980 DOI: 10.1093/burnst/tkac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Topical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use. METHODS Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented. RESULTS There were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels. CONCLUSIONS Topical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.
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Affiliation(s)
| | - Marilyn Wong
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
- Centre for Children’s Burns and Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Australia
| | - Bhaveshkumar Patel
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
- Centre for Children’s Burns and Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Australia
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14
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Gupta S, Jain RK. Application of autologous platelet-rich plasma to graft donor sites to reduce pain and promote healing. J Wound Care 2022; 31:86-90. [PMID: 35077214 DOI: 10.12968/jowc.2022.31.1.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) is widely used for wound healing in medical care because of the numerous growth factors it contains. Traditionally, donor sites are left to heal with a primary dressing so wounds are not left open. However, a delay in healing accompanied by pain at a donor site is often seen. This study primarily throws light on the use of autologous PRP over split-thickness skin graft (STSG) donor sites to promote healing and reduce pain. METHOD The patients enrolled in this study in 2018-2019 were divided into two groups: the intervention group received autologous PRP applied topically at the donor site; in the control group, the wound was dressed traditionally. Pain scales were measured in the immediate postoperative period at six hours, 10 hours and 16 hours. The dressing was opened on the postoperative day 14 and observed for healing by an independent observer. RESULTS A total of 100 patients were included in the study. Patients in the PRP group showed statistically significant faster healing at postoperative day 14 compared with the control group (p<0.05), who required dressings for 3-4 weeks postoperatively. Pain scale scores in the postoperative period were significantly less in the PRP group at six hours postoperatively compared with the control group (p<0.05). There was a reduced incidence of hypertrophic scar formation in the small number of patients in the PRP group who had developed hypertrophic scar previously. CONCLUSION Application of PRP is a safe, cost-effective and easy method to achieve faster healing in graft donor site areas that are troublesome to both patients and doctors. It also reduces postoperative pain at donor sites. The authors recommend PRP is used more often in the management of donor sites for STSGs.
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Affiliation(s)
- Samarth Gupta
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, India
| | - Rakesh Kumar Jain
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, India
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15
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Chiang SH, Xu X, Cheung DST, Hsu YH, Chen CE, Lin CH, Smith R, Lin CC. Comparison between Aquacel and Aquacel Foam dressing on split-thickness skin graft donor site. J Wound Care 2021; 30:S14-S20. [PMID: 34882003 DOI: 10.12968/jowc.2021.30.sup12.s14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the effectiveness of two commonly used moist dressings, Aquacel and Aquacel Foam (both ConvaTec Ltd., UK), in managing split-thickness skin graft (STSG) donor site wounds. METHOD Patients undergoing STSG harvesting for reconstruction were eligible for this quasi-experimental study. After reconstruction surgery, the Aquacel (A) or Aquacel Foam (AF) dressings were applied on the donor site wound. The STSG donor site was assessed by two trained research nurses daily. Clinical outcomes including pain on dressing removal, use of intravenous analgesics, signs and symptoms of wound infection, incidence of exudate leakage and percentage healed were recorded in a standardised form. Cost of the dressing change was retrieved from the hospital billing system. RESULTS Of 50 patients recruited, 25 received dressing A and 25 received the AF dressing for their STSG donor site wound. The average pain score on dressing removal was significantly lower in the AF dressing group compared with the A dressing group (0.8±0.8 versus 3.1±1.5, respectively (p=0.04)). Regression analysis demonstrated that compared with dressing A, the AF dressing was associated with a lower average pain score (beta: -2.27, standard error: 0.33; p<0.001), lower likelihood of pro re nata (PRN) intravenous analgesic use (odds ratio (OR)=0.21, 95% confidence interval: 0.06-0.71; p=0.01) and lower likelihood of exudate leakage (OR=0.11, p=0.01). The differences in time to wound healing, infection and cost were not statistically significant between the two groups. CONCLUSION In this study, the AF dressing demonstrated superior performance in pain response on dressing removal for STSG donor site wounds compared with dressing A. Large-scale randomised controlled trials should be conducted to confirm the findings.
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Affiliation(s)
- Su-Hua Chiang
- Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Xinyi Xu
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | | | - Ying-Hsuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Ching-En Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan
| | - Chin-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan
| | - Robert Smith
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Chia-Chin Lin
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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16
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Mortada H, Alhablany T, Alkahtani D, Rashidi ME, Altamimi A. Meshed Versus Sheet Skin Graft for Scrotum and Perineal Skin Loss: A Retrospective Comparative Study. Cureus 2021; 13:e18348. [PMID: 34692362 PMCID: PMC8526088 DOI: 10.7759/cureus.18348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background A wide array of diseases can lead to skin defects of the male genitalia. Although reconstructive options have been debated in the literature, no study has compared the effectiveness of a meshed split-thickness skin graft (STSG) and a sheet STSG in perineal and scrotal wound coverage. In this study, we report our experience in a tertiary trauma center. Methodology In this retrospective study, we included cases with a skin defect of the male genitalia, for which genital reconstruction with a skin graft was performed at our hospital from December 2017 to February 2020. This study was approved by the institutional review board. The analysis was performed at 95% confidence interval using the Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 27 patients were included in the study. The most common indication for genital reconstruction was Fournier’s gangrene (59.3%). In 15 (55.6%) patients, a meshed skin graft was utilized to cover the defect, whereas a sheet graft was utilized in 12 (44.4%) patients. Out of the 15 patients who underwent genital reconstruction with a meshed graft, 10 (66.6%) had complete graft take. On the other hand, out of the 12 (44.4%) patients who underwent genital reconstruction using a sheet graft, five (41.6%) had complete graft take. A statistically significant relationship was found between aesthetic and functional outcomes and the type of skin graft used. The satisfaction rate was higher among meshed skin graft recipients (86.2%) compared to sheet skin graft recipients (41.7%) (p = 0.014). Conclusions Based on our observational experience, we found that meshed STSG to cover male genital skin defects is safe with satisfactory cosmetic outcomes. Further prospective randomized studies are needed.
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Affiliation(s)
- Hatan Mortada
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, SAU.,Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Tareg Alhablany
- Department of Plastic and Reconstructive Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Dahna Alkahtani
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, SAU
| | | | - Abdulla Altamimi
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, SAU
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17
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Niederstätter IM, Schiefer JL, Fuchs PC. Surgical Strategies to Promote Cutaneous Healing. Med Sci (Basel) 2021; 9:medsci9020045. [PMID: 34208722 PMCID: PMC8293365 DOI: 10.3390/medsci9020045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022] Open
Abstract
Usually, cutaneous wound healing does not get impeded and processes uneventfully, reaching wound closure easily. The goal of this repair process is to restore the integrity of the body surface by creating a resilient and stable scar. Surgical practice and strategies have an impact on the course of wound healing and the later appearance of the scar. By considering elementary surgical principles, such as the appropriate suture material, suture technique, and timing, optimal conditions for wound healing can be created. Wounds can be differentiated into clean wounds, clean–contaminated wounds, contaminated, and infected/dirty wounds, based on the degree of colonization or infection. Furthermore, a distinction is made between acute and chronic wounds. The latter are wounds that persist for longer than 4–6 weeks. Care should be taken to avoid surgical site infections in the management of wounds by maintaining sterile working conditions, using antimicrobial working techniques, and implementing the principles of preoperative antibiotics. Successful wound closure is influenced by wound debridement. Wound debridement removes necrotic tissue, senescent and non-migratory cells, bacteria, and foreign bodies that impede wound healing. Additionally, the reconstructive ladder is a viable and partially overlapping treatment algorithm in plastic surgery to achieve successful wound closure.
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18
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Tyagi A, Gupta A, Martires Iii VI, Romo M, Garg I, Tapia D, Gudino P, Lam S. Efficacy of Platelet-Rich Plasma in Reduction of Post-Operative Split-Thickness Skin Graft Loss and Hematoma Formation: A Meta-Analysis. Cureus 2021; 13:e15160. [PMID: 34168926 PMCID: PMC8215306 DOI: 10.7759/cureus.15160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Split-thickness skin grafting is a very popular technique of wound closure, especially for large wounds. The success rate of a split-thickness skin graft (STSG) has consistently been in the range of 70-90%. Multiple techniques have been introduced to further improve graft survival, for example, the use of autologous platelet-rich plasma (PRP), thrombin gel, platelet-rich fibrin matrix, and negative pressure wound therapy. We evaluated the impact of PRP use on the survival of STSG through a meta-analysis. We conducted the analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol and performed a literature search using the following databases: PubMed, Cochrane, and ClinicalTrials.gov. A total of 126 articles were yielded by the search, out of which four randomized controlled trials (RCTs) were included according to our eligibility criteria and irrelevant articles were excluded. The intervention group received PRP application to the wound bed before applying the graft while the control group received treatment with conventional fixation procedures (sutures and staples). We estimated the pooled odds ratio with a 95% confidence interval (CI). The total number of participants in the analysis was 460. The participants had wounds of varying etiology. Post-operative graft loss and hematoma formation were taken to be the primary and secondary outcome measures, respectively. Thirty-four participants suffered graft loss of differing extent in the control group while three participants suffered graft loss in the intervention group. The pooled odds ratio for graft loss was 0.15 (95% CI: 0.05-0.49; I2=38%; p=0.184) signifying that PRP use decreased the odds of graft loss by 85%. For our secondary outcome measure, 440 participants were studied. Forty-four participants suffered hematoma formation in the control group versus 11 in the intervention group. The pooled odds ratio for hematoma formation was calculated as 0.21 (95% CI: 0.09-0.50; I2=0%; p=0.869) signifying that PRP use decreased the odds of hematoma formation by 79%. PRP appears to significantly impact graft survival, and further studies are needed to strengthen the evidence base for its use in split-thickness skin grafting.
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Affiliation(s)
- Anshika Tyagi
- Department of Plastic Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Apurv Gupta
- Department of Plastic Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Vicente I Martires Iii
- Department of Surgery, University of Santo Tomas Faculty of Medicine and Surgery, Manila, PHL
| | - Moises Romo
- Department of Medicine and Nutrition, University of Guanajuato, Leon, MEX
| | - Ishan Garg
- Department of Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Diego Tapia
- Faculty of Medicine, Pontifical Catholic University of Ecuador, Quito, ECU
| | - Paola Gudino
- Faculty of Medicine, Pontifical Catholic University of Ecuador, Quito, ECU
| | - Sinyun Lam
- Department of Family Medicine, Aviva Health, Roseburg, USA
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19
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Kanapathy M, Hachach-Haram N, Bystrzonowski N, Becker DL, Mosahebi A, Richards T. Epidermal graft encourages wound healing by down-regulation of gap junctional protein and activation of wound bed without graft integration as opposed to split-thickness skin graft. Int Wound J 2021; 18:332-341. [PMID: 33751815 PMCID: PMC8244016 DOI: 10.1111/iwj.13536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
Wound coverage by split-thickness skin graft (SSG) and epidermal graft (EG) shortens healing time, with comparable outcomes. However, the healing mechanism of EG is not as well understood as SSG. The difference in the healing mechanisms of EG and SSG was investigated using gap junctional proteins, proliferative marker, and cytokeratin markers. Paired punch biopsies were taken from the wound edge and wound bed from patients undergoing EG and SSG at weeks 0 and 1 to investigate wound edge keratinocyte migratory activities (connexins 43, 30, and 26), wound bed activation (Ki67), and the presence of graft integration to the wound bed (cytokeratins 14 and 6). Twenty-four paired biopsies were taken at weeks 0 and 1 (EG, n = 12; SSG, n = 12). Wound edge biopsies demonstrated down-regulation of connexins 43 (P = .023) and 30 (P = .027) after EG, indicating accelerated healing from the wound edge. At week 1, increased expression of Ki67 (P < .05) was seen after EG, indicating activation of cells within the wound bed. Keratinocytes expressing cytokeratins 6 and 14 were observed on all wounds treated with SSG but were absent at week 1 after EG, indicating the absence of graft integration following EG. Despite EG and SSG both being autologous skin grafts, they demonstrate different mechanisms of wound healing. EG accelerates wound healing from the wound edges and activates the wound bed despite not integrating into the wound bed at week 1 post-grafting as opposed to SSG, hence demonstrating properties comparable with a bioactive dressing instead of a skin substitute.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore
| | - Afshin Mosahebi
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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20
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Abstract
Background Skin autografting is a common clinical procedure for reconstructive surgery. Despite its widespread use, very few studies have been conducted to non-invasively evaluate and monitor the vascular and structural features of skin grafts. This study, therefore, aims to demonstrate the potential of optical coherence tomography (OCT) alongside OCT-based angiography (OCTA) to non-invasively image and monitor human skin graft health and integration over time. Methods An in-house-built clinical prototype OCT system was used to acquire OCT/OCTA images from patients who underwent split-thickness skin graft surgery following severe burn damage to the skin. The OCT imaging was carried out at multiple locations over multiple time points with a field of view of ~9 mm × 9 mm and a penetration depth of ~1.5 mm. In addition to obtaining high-resolution qualitative images, we also quantitatively measured and compared specific structural and vascular parameters, such as identifiable layer thickness and corresponding vascular area density and diameter. Results Two patients (patient #1 and #2) were enrolled for this preliminary study. Vascular and structural features were successfully imaged and measured in the graft tissue and integration layer immediately beneath at different time points. Revascularization, healing, and integration were monitored with patient-specific details. Results of the quantitative image analysis from patient #1 indicated that integration layer thickness 16-day post-surgery was significantly less (~50%) than that of 7-day post-surgery. Additionally, with patient #2, significant growth (~20%) was seen with the vascular area density of both the graft and corresponding integration layer beneath between 6 and 14 days post-surgery. Conclusions Our preliminary studies show that OCT/OCTA has clinical potential to image and measure numerous features of human skin graft health and integration in the days and weeks following split-thickness surgery. For the first time, we demonstrate the applicability of non-invasive imaging technology for novel clinical uses that could eventually aid in the betterment of surgical practices and clinical outcomes.
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Affiliation(s)
- Anthony J Deegan
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Rajendra Sharma
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Samuel P Mandell
- Division of Trauma, Critical Care, and Burn, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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21
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Takahashi O, Tanaka J, Habu M, Yoshiga D, Sasaguri M, Uehara M, Hayakawa M, Yoshioka I, Tominaga K. A simple sandwich technique using buttons combined with a tie-over technique for an intraoral split-thickness skin graft. J Oral Sci 2020; 63:101-103. [PMID: 33162435 DOI: 10.2334/josnusd.19-0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A simple sandwich technique using buttons to compress grafted tissue combined with a tie-over technique for intraoral split-thickness skin grafts (STSGs) is introduced. This technique yielded an excellent engraftment rate (90.5%) and no instances of total graft failure were recorded. This simple sandwich technique for STSGs is readily applicable and inexpensive, and the present results show that it would be potentially useful for repair of defects in the oral cavity.
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Affiliation(s)
- Osamu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University
| | - Junpei Tanaka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University
| | - Daigo Yoshiga
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University
| | - Masaaki Sasaguri
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University
| | - Masataka Uehara
- Department of Dentistry and Oral and Maxillofacial Surgery, Shimonoseki City Hospital
| | - Mana Hayakawa
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University
| | - Izumi Yoshioka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University
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Grunzweig KA, Son J, Kumar AR. Regional Anesthetic Blocks for Donor Site Pain in Burn Patients: A Meta-Analysis on Efficacy, Outcomes, and Cost. Plast Surg (Oakv) 2020; 28:222-231. [PMID: 33215037 DOI: 10.1177/2292550320928562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Skin graft donor site pain significantly affects pain management, narcotic use, and hospital length of stay. This study is intended to evaluate the efficacy of regional anesthesia in the burn population to decrease narcotic consumption and to assess the impact on hospitalization costs. Methods PubMed/MEDLINE, Embase, and ScienceDirect were searched with the following inclusion criteria: comparative studies, adult populations, burn patients, autologous skin grafting, regional nerve blocks, and traditional narcotic regimens. Outcomes assessed included narcotic consumption, pain scores, and opioid side effects. Meta-analysis obtained pooled values for morphine consumption and side effects. Cost analysis was performed using published data in the literature. Results Final analysis included 101 patients. Cumulative morphine consumption at 72 hours was lower for patients treated with regional anesthesia versus patient-controlled analgesia (PCA; single shot 25 ± 12 mg, continuous regional 23 ± 16 mg, control 91.5 ± 24.5 mg; P < .05). Regional anesthesia decreased nausea/vomiting (P < .05) and lowered subjective pain scores. Regional anesthesia interventions cost less than PCA, single shot less than continuous (P < .05). Conclusion Regional anesthesia at skin graft donor sites significantly decreases narcotic consumption in burn patients. Regional anesthesia is cost-effective, decreases side effects, and may result in shorter hospital stays due to improved pain management.
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Affiliation(s)
- Katherine A Grunzweig
- Department of Plastic & Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ji Son
- Department of Plastic & Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anand R Kumar
- Department of Plastic & Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Uoya Y, Ishii N, Sakai S, Kiuchi T, Uno T, Kishi K. A Novel Technique to Achieve Rapid Wound Healing of Donor Site Wounds in Split-Thickness Skin Grafts of a Patient Undergoing Anticoagulation Therapy. INT J LOW EXTR WOUND 2020; 20:162-166. [PMID: 32734783 DOI: 10.1177/1534734620938169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Split-thickness skin grafts constitute an established and widely used procedure for treating skin ulcers. However, in patients on anticoagulation therapy, wound healing abnormalities can prevent smooth epithelialization of their donor site. We aimed to investigate the usefulness of a technique to facilitate smooth wound healing through partial dimension reduction, and spared skin grafts back of donor sites with split-thickness skin grafts for patients undergoing anticoagulation therapy and investigate its usefulness. Partial dimension reduction and spared skin grafting back was performed on the donor site in 4 cases (group A), and the conventional method (moist dressing) was performed in 3 cases (group B). We compared the time to achieve complete epithelialization, the degree of pain, the frequency of dressing changes during the perioperative period, and the cosmetic results 6 months after surgery in both groups. The spared skin graft achieved good circulation. The time to achieve complete epithelialization was 3.1 weeks (2.5-4 weeks) in group A and 5.7 weeks (3-8 weeks) in group B; group A tended to experience less pain and fewer dressing changes during the perioperative period than group B. In addition, group A yielded superior cosmetic results to group B. Our technique can contribute to increasing the defense against physical stimulation in the donor site. Therefore, rapid wound healing and easy wound management can be achieved. We believe that it may be useful in split-thickness skin grafts for patients undergoing anticoagulation therapy.
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Affiliation(s)
- Yuichiro Uoya
- International University of Health and Welfare Hospital, Tochigi, Japan
| | - Naohiro Ishii
- International University of Health and Welfare Hospital, Tochigi, Japan
| | | | - Tomoki Kiuchi
- International University of Health and Welfare Hospital, Tochigi, Japan
| | - Takahiro Uno
- International University of Health and Welfare Hospital, Tochigi, Japan
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Inatomi Y, Kadota H, Kamizono K, Hanada M, Yoshida S. Securing split-thickness skin grafts using negative-pressure wound therapy without suture fixation. J Wound Care 2020; 28:S16-S21. [PMID: 31393782 DOI: 10.12968/jowc.2019.28.sup8.s16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Negative-pressure wound therapy (NPWT) is generally applied as a bolster for split-thickness skin grafts (STSG) after the graft has been secured with sutures or skin staples. In this study, NPWT was applied to secure STSGs without any sutures or staples. Surgical outcomes of using NPWT without sutures was compared with a control group. METHODS Patients with STSGs were divided into two groups: a 'no suture' group using only NPWT, and a control group using conventional fixings. In the no suture group, the grafts were covered with meshed wound dressing and ointment. The NPWT foam was placed over the STSG and negative pressure applied. In the control group, grafts were fixed in place using tie-over bolster, securing with fibrin glue, or NPWT after sutures. RESULTS A total of 30 patients with 35 graft sites participated in the study. The mean rate of graft take in the no suture group was 95.1%, compared with 93.3% in the control group, with no significant difference between them. No graft shearing occurred in the no suture group. Although the difference did not reach statistical significance, mean surgical time in the no suture group (31.5 minutes) tended to be shorter than that in the control group (55.7 minutes). CONCLUSION By eliminating sutures, the operation time tended to be shorter, suturing was avoided and suture removal was not required meaning that patients could avoid the pain associated with this procedure. Furthermore, the potential for staple retention and its associated complications was avoided, making this method potentially beneficial for both medical staff and patients.
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Affiliation(s)
- Yusuke Inatomi
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Kenichi Kamizono
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Masuo Hanada
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Sei Yoshida
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
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25
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Leong S, Lo ZJ. Use of disposable negative pressure wound therapy on split-thickness skin graft recipient sites for peripheral arterial disease foot wounds: A case report. Int Wound J 2020; 17:716-721. [PMID: 32073214 DOI: 10.1111/iwj.13291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 12/28/2022] Open
Abstract
Split-thickness skin graft (STSG) helps to promote healing of wounds by providing a viable soft tissue cover. However, the success of which is influenced by how well it takes to the recipient site. Studies have demonstrated that negative pressure wound therapy (NPWT) is an excellent modality to promote graft survival. Technological advancements have made possible the invention of disposable, ultraportable, and mechanically operated versions for improved user experience. Alas, little has been discussed about their benefits on STSG. Therefore, the purpose of this case report is to highlight the effective use of disposable NPWT on freshly applied STSG. We report here a novel use of the disposable NPWT (SNAP therapy system) for STSG recipient sites in two patients with peripheral arterial disease (PAD) foot wounds. In both patients, there was 100% STSG uptake, and the lightweight disposable NPWT system makes for a more cost-effective and comfortable experience for patients. Disposable NPWT may be a feasible alternative to conventional NPWT to aid with STSG uptake for PAD foot wound recipient sites.
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Affiliation(s)
- SzeWai Leong
- Vascular Surgery Service, General Surgery Department, Tan Tock Seng Hospital, Novena, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, General Surgery Department, Tan Tock Seng Hospital, Novena, Singapore
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26
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Zajíček R, Šuca H, Grossová I, Fetissov V, Pafčuga I. DERMAL REPLACEMENT WITH MATRIDERM - FIRST EXPERIENCE AT THE PRAGUE BURN CENTRE. Acta Chir Plast 2020; 62:79-82. [PMID: 33685201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The quality of resulting scar tissue plays an important role in patients return to normal life and full functioning in society. The use of artificial skin substitutes in clinical practice improves functional and cosmetic outcomes. This is true for any patient, and not only those suffering from burns. MATERIAL AND METHODS The collagen elastin dermal substitute Matriderm® allows for immediate application of a dermal substitute together with a skin graft. The authors present a group of 10 patients representing their first experience in utilizing Matriderm® as a dermal substitute in the treatment of skin losses due to various etiologies. RESULTS The average healing time in the group was 19.6 days. Healing took place without serious infectious complications and with good functional results. CONCLUSION Matriderm® can be utilized as an alternative to the most commonly used dermal substitute so far, Integra®, in the treatment of acute skin loss due to various etiologies and in reconstructive surgery.
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Eriksson E, Grossman P, Pittinger T, Ellis C, Gillenwater J, Short T. Consensus on the Benefits of the Exsurco Medical Amalgatome SD in the Treatment of Burns and Other Wounds. Eplasty 2019; 19:pb5. [PMID: 31824585 PMCID: PMC6888453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Elof Eriksson
- aBrigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Peter Grossman
- bGrossman Burn Center, West Hills, Calif,cGrossman Burn Center, Bakersfield, Calif,dGrossman Burn Center, Kansas City, Mo
| | | | - Chandra Ellis
- fBothin Burn Unit, St. Francis, San Francisco, Calif
| | - Justin Gillenwater
- gSouthern California Regional Burn Center at LAC and USC Medical Center, Los Angeles, Calif
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28
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Pearce FB, Richardson KA. Negative pressure wound therapy, staged excision and definitive closure with split-thickness skin graft for axillary hidradenitis suppurativa: a retrospective study. J Wound Care 2019; 26:S36-S42. [PMID: 28105901 DOI: 10.12968/jowc.2017.26.sup1.s36] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Bilateral axillary hidradenitis is a chronic, suppurative, and scarring disease that is most effectively treated by complete excision of all hair-bearing tissues. We assessed our staged procedure for excision and placement of a split-thickness skin graft for bilateral axillary hidradenitis in terms of costs, outcomes, and timing of excision. METHOD An IRB approved retrospective case analysis was performed on patients that underwent bilateral axillary hidradenitis skin excision with eventual placement of split-thickness skin grafting using the current LSUHSC/University Health hidradenitis surgical treatment protocol. Using ICD-9 codes (705.83) and CPT codes (11041, 11042, 11451, 11600, 11601, 11602, 11603, 11604) we reviewed cases performed at our institution from 1 January 2008 to 24 Febuary 2014 and we selected patients based on bilateral axillary involvement (alone) and >1 year history of active disease. Patients were excluded if resection of tissue encompassed regions outside of the immediately adjacent axillary. RESULTS A total of seven patients matching criteria for bilateral axillary hidradenitis were selected for analysis. Clinical course, cost and surgical techniques were assessed. Of the seven patients, six required admission throughout their treatment due to lack of funding making use of negative pressure wound therapy at home not possible. These patients stayed an average of 10 days with a mean hospital charge of $35,178 and a mean hospital provider charge of $10,019. No recurrence was demonstrated. All patients attained full range of motion, post grafting. No patient required a further operation due to graft failure. CONCLUSION Split-thickness skin grafting without use of bilayer dermal regenerative templates yielded definitive results with acceptable cosmesis and functionality, without the added cost of treatments such as a bilayer dermal regenerative template.
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Affiliation(s)
- F B Pearce
- Louisiana State University Health Sciences Center (LSUHSC) Department of General/Burn Surgery
| | - K A Richardson
- Louisiana State University Health Sciences Center (LSUHSC) Department of General/Burn Surgery
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29
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Granick MS, Baetz NW, Labroo P, Milner S, Li WW, Sopko NA. In vivo expansion and regeneration of full-thickness functional skin with an autologous homologous skin construct: Clinical proof of concept for chronic wound healing. Int Wound J 2019; 16:841-846. [PMID: 30868746 PMCID: PMC6850009 DOI: 10.1111/iwj.13109] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 01/22/2023] Open
Abstract
A new cell‐tissue technology uses a patient's skin to create an in vivo expanding and self‐organising full‐thickness skin autograft derived from potent cutaneous appendages. This autologous homologous skin construct (AHSC) is manufactured from a small full‐thickness skin harvest obtained from an uninjured area of the patient. All the harvested tissue is incorporated into the AHSC including the endogenous regenerative cellular populations responsible for skin maintenance and repair, which are activated during the manufacturing process. Without any exogenous supplementation or culturing, the AHSC is swiftly returned to the patient's wound bed, where it expands and closes the defect from the inside out with full‐thickness fully functional skin. AHSC was applied to a greater than two‐year old large (200 cm2) chronic wound refractory to multiple failed split‐thickness skin grafts. Complete epithelial coverage was achieved in 8 weeks, and complete wound coverage with full‐thickness functional skin occurred in 12 weeks. At 6‐month follow‐up, the wound remained covered with full‐thickness skin, grossly equivalent to surrounding native skin qualitatively and quantitatively equivalent across multiple functions and characteristics, including sensation, hair follicle morphology, bio‐impedance and composition, pigment regeneration, and gland production.
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Affiliation(s)
- Mark S Granick
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nicholas W Baetz
- Department of Research and Development, PolarityTE, Inc., Salt Lake City, Utah
| | - Pratima Labroo
- Department of Research and Development, PolarityTE, Inc., Salt Lake City, Utah
| | - Stephen Milner
- Department of Research and Development, PolarityTE, Inc., Salt Lake City, Utah
| | - William W Li
- The Angiogenesis Foundation, Cambridge, Massachusetts
| | - Nikolai A Sopko
- Department of Research and Development, PolarityTE, Inc., Salt Lake City, Utah
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30
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Kim Y, Kym D, Cho YS, Yoon J, Yim H, Hur J, Chun W. Use of Fibrin Sealant for Split-Thickness Skin Grafts in Patients with Hand Burns: A Prospective Cohort Study. Adv Skin Wound Care 2018; 31:551-555. [PMID: 30371521 PMCID: PMC6257506 DOI: 10.1097/01.asw.0000547413.61758.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/06/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of fibrin sealant as a topical hemostatic agent and for graft fixation during skin grafting of hand burns. METHODS This prospective cohort study enrolled 40 patients with hand burns from January 2013 to December 2016. They were all treated with excision and split-thickness skin graft and divided into the fibrin sealant with tourniquet group (20 patients) and epinephrine tumescence group (20 patients). MAIN OUTCOME MEASURES Demographic and clinical data such as age, sex, burn characteristics, operation time, estimated blood loss, and take rate were collected from each patient. MAIN RESULTS The demographic and burn characteristics were not statistically different between the two groups. Estimated blood loss per cm (0.30 vs 1.00; P < .001) was significantly lower and the graft take rate (99.2% vs 98.2%; P = .032) was significantly higher in the fibrin sealant with tourniquet group. CONCLUSIONS The use of fibrin sealants accompanied by tourniquets for hand burns exhibited superior results in terms of decreasing blood loss and had a better graft take rate compared with treatment with epinephrine tumescence.
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Affiliation(s)
- Youngmin Kim
- In the Department of Burn Surgery and Critical Care, Hangang Sacred Heart Hospital, Hallym University Medical Center, in Seoul, Korea, Youngmin Kim, MD, is Associate Professor; Dohern Kym, MD, is a Professor; Yong Suk Cho, MD, is Associate Professor; Jaechul Yoon, MD, is Associate Professor; Haejun Yim, MD, is Associate Professor; Jun Hur, MD, is a Professor; and Wook Chun, MD, is a Professor
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31
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Pak CS, Park DH, Oh TS, Lee WJ, Jun YJ, Lee KA, Oh KS, Kwak KH, Rhie JW. Comparison of the efficacy and safety of povidone-iodine foam dressing (Betafoam), hydrocellular foam dressing (Allevyn), and petrolatum gauze for split-thickness skin graft donor site dressing. Int Wound J 2018; 16:379-386. [PMID: 30479060 PMCID: PMC7379600 DOI: 10.1111/iwj.13043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022] Open
Abstract
We evaluated the efficacy and safety of a povidone-iodine (PVP-I) foam dressing (Betafoam) for donor site dressing versus a hydrocellular foam dressing (Allevyn) and petrolatum gauze. This prospective Phase 4 study was conducted between March 2016 and April 2017 at eight sites in Korea. A total of 106 consenting patients (aged ≥ 19 years, scheduled for split-thickness skin graft) were randomised 1:1:1 to PVP-I foam, hydrocellular, or petrolatum gauze dressings for up to 28 days after donor site collection. We assessed time to complete epithelialisation, proportion with complete epithelialisation at Day 14, and wound infection. Epithelialisation time was the shortest with PVP-I foam dressing (12.74 ± 3.51 days) versus hydrocellular foam dressing (16.61 ± 4.45 days; P = 0.0003) and petrolatum gauze (15.06 ± 4.26 days, P = 0.0205). At Day 14, 83.87% of PVP-I foam dressing donor sites had complete epithelialisation, versus 36.36% of hydrocellular foam dressing donor sites (P = 0.0001) and 55.88% of petrolatum gauze donor sites (P = 0.0146). There were no wound infections. Incidence rates of adverse events were comparable across groups (P = 0.1940). PVP-I foam dressing required less time to complete epithelialisation and had a good safety profile.
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Affiliation(s)
- Chang Sik Pak
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - Dae Hwan Park
- Daegu Catholic University Medical Center, Seoul, South Korea
| | | | - Won Jai Lee
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Young Joon Jun
- Seoul St. Mary's Hospital, The Catholic University of South Korea, Seoul, South Korea
| | - Kyung Ah Lee
- Inje University Haeundae Paik Hospital, Seoul, South Korea
| | | | | | - Jong Won Rhie
- Seoul St. Mary's Hospital, The Catholic University of South Korea, Seoul, South Korea
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Kanapathy M, Mosahebi A. Comparative study on the donor site aesthetic outcome between epidermal graft and split-thickness skin graft. Int Wound J 2018; 16:354-359. [PMID: 30440106 DOI: 10.1111/iwj.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
Abstract
Donor site aesthetic outcomes of epidermal graft (EG) vs split-thickness skin graft (SSG) have yet to be objectively compared. Here, we evaluate donor site healing using a validated scar assessment tool and digital colorimetric technique, which compares colour in a consistent and objective manner. Ten patients (SSG (n = 5) and EG (n = 5)) were included. Donor site scarring was evaluated using the Vancouver Scar Scale (VSS) at Week 6 and Month 3. Colorimetric measurement was performed at Weeks 3 and 6 and Month 3. The mean donor site healing time for EG was significantly shorter (EG: 4.6 days (95% c.i. 3.8-5.3), SSG: 16.8 days (95% c.i. 13.3-20.1) (P = 0.003)). The VSS scores of the EG donor site were lower at Week 6 and Month 3(P < 0.001). The colour match between the donor site and surrounding skin for EG was better compared with SSG at all time points and was almost identical to their surrounding healthy skin at Month 3. This study is the first to objectively measure the clinical appearance of the EG donor site against SSG. EG donor site has faster healing with excellent scarring and good colour match with its surrounding normal skin at all time points compared with SSG.
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Affiliation(s)
- Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
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Varon DE, Smith JD, Bharadia DR, Shafique N, Sakthivel D, Halvorson EG, Nuutila K, Sinha I. Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study. J Wound Care 2018; 27:S12-S18. [PMID: 30008255 DOI: 10.12968/jowc.2018.27.sup7.s12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). METHOD Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). RESULTS A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. CONCLUSION The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.
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Affiliation(s)
- David E Varon
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Jessica D Smith
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Deepak R Bharadia
- Plastic Surgery Resident UCSF; Division of Plastic and Reconstructive Surgery, University of California, San Francisco, US
| | - Neha Shafique
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Dharaniya Sakthivel
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Eric G Halvorson
- Plastic Surgeon; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Kristo Nuutila
- Instructor; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Indranil Sinha
- Plastic Surgeon Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
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Abstract
OBJECTIVES To describe our buried penis repair technique that includes penile release, tissue resection, wound closure, and penile reconstruction. PATIENTS AND METHODS In all, 73 patients were treated from 2007 to 2017. Patients can be categorised into five stages: Stage I, involves only a phimotic band; Stage 2, required excision of diseased penile skin with split-thickness skin grafting (STSG); Stage 3, requires scrotal excision; Stage 4, requires escutcheonectomy; and Stage 5, requires panniculectomy. Successful treatment hinges on adequate excision of diseased skin and de-bulking followed by replacement of deficient skin with STSG. RESULTS In all, 36 of 73 (49%) patients had Stage 1-3 disease, whilst 37 of 73 (51%) were Stage 4-5. There were complications within the first 30 days in 44 of 73 (60%) patients. In all, 62 of 73 (85%) patients either had no complications or Clavien-Dindo grade I-II complications and nine (12%) had complications beyond 30 days. Only five of 36 (14%) patients with Stage 1-3 disease had complications. One patient developed recurrent phimosis. CONCLUSION The buried penis is a challenging surgical entity where conservative treatment will most likely lead to failure. Surgery is the only means for a lasting cure in these patients and should be used as a first-line treatment. One should expect complications postoperatively, especially within the first 30 days; however, these are mostly limited to Clavien-Dindo grade I-II complications.
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Affiliation(s)
- Min S Jun
- Urology, Detroit Medical Center, Detroit, MI, USA
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Prodanov SS, Benkova EG, Chokoeva AA. High-voltage electrical injury: Modified surgical technique for optimal defect closuring of extra-large cranial defect. Dermatol Ther 2017; 31:e12581. [PMID: 29193531 DOI: 10.1111/dth.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/22/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022]
Abstract
Electrical burns are group of traumatic injuries with a mortality rate of 3-15%. High-voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high-voltage induced extra-large cranial injury in a 38-year-old man, treated with modified single large rotation flap and a split skin-thickness graft technique, for optimal defect closuring with satisfied aesthetic result.
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Affiliation(s)
- S S Prodanov
- Department of Burns and Plastic Surgery, University Multiprofile Hospital for Active Treatement and Emergency Medicine "N.I.Pirogov", Sofia, 1606, Bulgaria
| | - E G Benkova
- Department of Burns and Plastic Surgery, University Multiprofile Hospital for Active Treatement and Emergency Medicine "N.I.Pirogov", Sofia, 1606, Bulgaria
| | - A A Chokoeva
- Department of Dermatology and Venereology, Medical University of Plovdiv, Plovdiv, 4002, Bulgaria
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Haidar YM, Walia S, Sahyouni R, Ghavami Y, Lin HW, Djalilian HR. Auricular Split-Thickness Skin Graft for Ear Canal Coverage. Otolaryngol Head Neck Surg 2016; 155:1061-1064. [PMID: 27625025 DOI: 10.1177/0194599816667929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/28/2016] [Accepted: 08/16/2016] [Indexed: 11/15/2022]
Abstract
Split-thickness skin graft (STSG) continues to be the preferred means of external auditory canal (EAC) reconstruction. We thus sought to describe our experience using skin from the posterior aspect of the auricle (SPAA) as a donor site in EAC reconstruction. Grafts were, on average, 5 × 10 mm in size and obtained with a No. 10 blade after tumescence injection. The cases of 39 patients who underwent 41 procedures were retrospectively reviewed. Of the 38 patients with both 3- and 6-month follow-ups, no postoperative stenosis or bony exposure occurred. STSG from the SPAA can be a good option in EAC reconstruction. Total EAC/tympanic membrane coverage can be obtained with STSG from the SPAA.
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Affiliation(s)
- Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
| | - Sartaaj Walia
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
| | - Yaser Ghavami
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Irvine, California, USA
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Hofstede TM, Jacob RF, Montgomery P, Wesley P. Surgical preparation of nasal defects to enhance the implant-retained facial prostheses: A case report. Head Neck 2016; 39:E4-E11. [PMID: 27618726 DOI: 10.1002/hed.24574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/26/2016] [Accepted: 07/25/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin. METHODS We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants. RESULTS Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing. CONCLUSION The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck 39: E4-E11, 2017.
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Affiliation(s)
- Theresa M Hofstede
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rhonda F Jacob
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia Montgomery
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peggy Wesley
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Matiasek J, Djedovic G, Unger L, Beck H, Mattesich M, Pierer G, Koller R, Rieger UM. Outcomes for split-thickness skin transplantation in high-risk patients using octenidine. J Wound Care 2015; 24:S8, S10-2. [PMID: 26075514 DOI: 10.12968/jowc.2015.24.sup6.s8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Skin transplantation is a commonly used surgical technique; however, the complication rate, including postoperative infection and delayed wound healing due to inefficient perfusion, is significantly higher in patients suffering from comorbidities. Hence, a subsequent repeat procedure is often necessary. In this report, two case studies are presented in which an octenidine-based antiseptic is used with a tie-over dressing (TOD) instead of povidone iodine (PVP-iodine), following a split-thickness skin graft. The two patients selected were deemed to be at high risk of impaired wound healing due to comorbidities. The first patient, a confirmed smoker with diabetes, presented with a nodular melanoma that was resected and covered with a split-thickness skin graft. After 5 days of negative pressure wound therapy as a TOD, in combination with PVP-iodine, the graft became necrotic. A second split-thickness skin graft was performed and an antiseptic regimen with octenidine in combination with the same TOD resulted in a completely healed transplant. The second patient, also a confirmed smoker with diabetes and receiving oral corticosteroid treatment, was diagnosed with a skin necrosis on her leg. Following the split-thickness skin graft, octenidine and TOD were applied. The patient's skin graft completely healed without any adverse events. These two case studies indicate that the combination of octenidine and TOD following split-thickness skin transplantation is safe, well-tolerated and appears to have positive benefits in the reconstruction of defects in patients with impaired wound healing.
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Affiliation(s)
- J Matiasek
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria
| | - G Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria.,Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, St. Markus Hospital, Frankfurt, Germany
| | - L Unger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria
| | - H Beck
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria
| | - M Mattesich
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria
| | - G Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria
| | - R Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria
| | - U M Rieger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria.,Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, St. Markus Hospital, Frankfurt, Germany
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McBride CA, Kimble RM, Stockton K. Three donor site dressings in pediatric split-thickness skin grafts: study protocol for a randomised controlled trial. Trials 2015; 16:43. [PMID: 25887128 PMCID: PMC4335760 DOI: 10.1186/s13063-015-0557-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 01/07/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND For children requiring split-thickness skin grafting for burn injury, the optimum donor site dressing is an ongoing subject of debate. The most common dressings in use, both regionally and worldwide, are calcium alginates. We will compare an alginate with two other dressings, all of which are in current use in the Pegg Leditschke Paediatric Burns Centre (PLPBC), to determine which dressing performs the best. METHODS/DESIGN This is a randomised, prospective single center parallel three-arm trial comparing three donor site wound (DSW) dressings: Algisite™ M, a calcium alginate dressing; Cuticerin™, a smooth acetate gauze impregnated with water-repellent ointment (petrolatum, paraffin and Eucerite®) and Sorbact®, a gauze mesh coated with a dialkylcarbamoyl chloride (DACC) and amorphous hydrogel. Primary outcomes are days to complete DSW healing, and pain. Previously validated measures will be used for all outcomes. Secondary outcomes are: itch; scar appearance at three, six and 12 months; ease of dressing application and removal and dressing costs and utility. Results will be analysed on an intention-to-treat basis. Donor site thickness will be measured with a small biopsy from the center of the graft, to document the depth of the DSW across the groups. DISCUSSION This study will provide comprehensive short- and long-term data on DSW dressings in pediatric split-thickness skin grafting. The best-performing dressing will become the preferred dressing for the PLPBC. We will provide rigorous data against which other dressings can be compared in future, recognising that alginates are the most common DSW dressing currently in use. Our study design replicates a real-world scenario in order to identify clinically significant differences between the three dressings. TRIAL REGISTRATION This trial was prospectively registered on 8 April 2014 with the Australia and New Zealand Clinical Trials Register (identifier: ACTRN12614000380695 ).
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Affiliation(s)
- Craig A McBride
- Pegg Leditschke Paediatric Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, 300 Herston Road, Brisbane, QLD, 4029, Australia.
- Department of Paediatrics and Child Health, University of Queensland, Level 7, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Pegg Leditschke Paediatric Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, 300 Herston Road, Brisbane, QLD, 4029, Australia.
- Department of Paediatrics and Child Health, University of Queensland, Level 7, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Kellie Stockton
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, 300 Herston Road, Brisbane, QLD, 4029, Australia.
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Mosser P, Kelm J, Anagnostakos K. Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture. J Foot Ankle Surg 2014; 54:2-6. [PMID: 25451209 DOI: 10.1053/j.jfas.2014.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Indexed: 02/03/2023]
Abstract
Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.
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Affiliation(s)
- Philipp Mosser
- Resident, Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jens Kelm
- Orthopaedic Surgeon and Assistant Professor, Chirurgisch-orthopädisches Zentrum Illingen, Illingen, Germany
| | - Konstantinos Anagnostakos
- Orthopaedic Surgeon and Assistant Professor, Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Singh M, Nuutila K, Kruse C, Caterson EJ, Granter SR, Eriksson E. Fate of the dermal component of micrografts in full-thickness wounds. Eplasty 2014; 14:e38. [PMID: 25328571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Background: The harvest of autologous skin graft is considered to be a fundamental skill of the plastic surgeon. The objective of this article is to provide an interesting account of the development of skin grafting instruments as we use them today in various plastic surgical procedures. Materials and Methods: The authors present the chronological evolution and modifications of the skin grafting knife, including those contributions not often cited in the literature, using articles sourced from MEDLINE, ancient manuscripts, original quotes, techniques and illustrations. Results: This article traces the evolution of instrumentation for harvest of skin grafts from free hand techniques to precise modern automated methods. Conclusions: Although skin grafting is one of the basic techniques used in reconstructive surgery yet harvest of a uniform graft of desired thickness poses a challenge. This article is dedicated to innovators who have devoted their lives and work to the advancement of the field of plastic surgery.
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Affiliation(s)
- Faisal Ameer
- Department of Plastic Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, India
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43
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Panagakos P, McDonald P, Norem N, Shapiro H, Boc SF, Mitra A. De-epithelialized fasciocutaneous turnover flap for recurrent calcaneal wound with osteomyelitis. J Foot Ankle Surg 2013; 53:83-7. [PMID: 23910737 DOI: 10.1053/j.jfas.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Indexed: 02/03/2023]
Abstract
Recurrent ulcerations of the foot and ankle almost always present a challenge to lower extremity surgeons. Recalcitrant heel ulcerations with osteomyelitis are especially difficult to treat because of the lack of soft tissue coverage. The turnover flap is a simple, fast, and effective treatment method for lower extremity wounds. It is a de-epithelialized fasciocutaneous flap harvested from the adjacent area of the wound. We believe it is an underused technique for advanced wound closure in the lower extremity. It offers several advantages compared with traditional, more difficult to perform, flaps. We have seen an excellent result 18 months after using the turnover flap in a patient with recurrent posterior heel ulceration with calcaneal osteomyelitis.
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Affiliation(s)
| | - Patrick McDonald
- Associate, Mountain Valley Orthopedics, PC, East Stroudsburg, PA
| | - Nathan Norem
- Chief Resident, Podiatric Medicine and Surgery, Hahnemann University Hospital, Philadelphia, PA
| | - Howard Shapiro
- Assistant Director, Podiatric Medicine and Surgery Residency, Hahnemann University Hospital, Philadelphia, PA
| | - Steven F Boc
- Director, Podiatric Medicine and Surgery Residency, Hahnemann University Hospital; Assistant Professor of Surgery, Drexel College of Medicine, Philadelphia, PA
| | - Amit Mitra
- Chief, Plastic Surgery Department, Hahnemann University Hospital, Philadelphia, PA
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Shanmugam VK, McNish S, Shara N, Hubley KJ, Kallakury B, Dunning DM, Attinger CE, Steinberg JS. Chronic leg ulceration associated with polycythemia vera responding to ruxolitinib (Jakafi(®)). J Foot Ankle Surg 2013; 52:781-5. [PMID: 23953278 PMCID: PMC3925681 DOI: 10.1053/j.jfas.2013.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Indexed: 02/03/2023]
Abstract
We present the case of a 63-year-old white male with bilateral chronic leg ulcers due to polycythemia vera and hydroxyurea therapy who demonstrated dramatic healing of his wounds in response to ruxolitinib (Jakafi(®), Novartis), a novel Janus kinase-1 and -2 inhibitor. This patient's wound had previously been refractory to multiple surgical interventions and immunosuppression. After the initiation of ruxolitinib, the patient underwent successful split-thickness skin grafting, with resultant healing of his wounds. He was stable without prednisone and other immunosuppressant therapy and had healed at 6 months. Ruxolitinib therapy could represent a novel option for patients who develop persistent inflammatory wounds in the setting of polycythemia vera and hydroxyurea therapy.
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Affiliation(s)
- Victoria K. Shanmugam
- Division of Rheumatology, Immunology and Allergy, MedStar Georgetown University Hospital, Washington, DC
| | - Sean McNish
- Division of Rheumatology, Immunology and Allergy, MedStar Georgetown University Hospital, Washington, DC
| | - Nawar Shara
- Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD
| | - Katherine J. Hubley
- Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
| | - Bhaskar Kallakury
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC
| | | | | | - John S. Steinberg
- Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
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