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Kibadi K. [Long-term results of plantar skin grafts versus skin grafts of hairy areas for covering loss of skin substances on the palmar surface of the fingers, palm of the hand and sole of the foot in patients with black skin. Prospective cohort study of 123 total skin grafts]. ANN CHIR PLAST ESTH 2024; 69:258-266. [PMID: 38000976 DOI: 10.1016/j.anplas.2023.11.002] [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] [Received: 10/08/2023] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
CONTEXT Despite the use of total skin grafting in the treatment of loss of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, the data published in the literature on long-term results in black-skinned patients are non-existent. METHODS The present study, filling this gap, used data from a prospective cohort of 123 total skin grafts performed on 93 black African patients who benefited from plantar skin grafts versus skin grafts from hairy areas to cover loss of skin substances. of the palmar surface of the fingers, the palm of the hand and the sole of the foot. This study covers a period of 163 months. RESULTS Sixty-four grafts of hairy areas were carried out in 52 patients, 29 of whom were male and 23 female, for a M/F sex ratio of 1.3; and 59 plantar skin grafts in 41 patients including 21 males and 20 females, M/F sex ratio of 1. The digital palmar surface was the most recipient of the plantar graft, i.e. 35.5% of cases. After a post-operative follow-up of at least 12 months, patients or their entourage judged the functional and aesthetic results of plantar skin grafts to be better and acceptable, unlike the results of hairy area grafts. The texture and color are even better if the total skin graft is taken from an identical histological area. CONCLUSION In view of these results, we recommend a plantar skin graft for black-skinned patients to cover losses of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, if indicated.
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Affiliation(s)
- K Kibadi
- Service de Chirurgie Plastique Reconstructive et Esthétique & Chirurgie de la Main, Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, B.P. 834 Kinshasa XI, République Démocratique du Congo.
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Zou S, Wang K, Chen Z. Application of Artificial Dermis Combined With a Medial Flap From the Second Toe to Repair Degloving Injury of the Fingertip. J Hand Surg Am 2024; 49:385.e1-385.e5. [PMID: 38231171 DOI: 10.1016/j.jhsa.2023.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
There is no standard technique for repairing degloving injuries of the fingertip. Nail bed flap transplantation is a common surgical technique to address this injury, but this procedure inevitably damages the donor site in the toe. This article describes a surgical technique that can restore the appearance of the injured fingernail and preserve the length and function of the injured finger without damaging the toenail.
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Affiliation(s)
- Shiyu Zou
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, Guangdong Province, P.R. China
| | - Kelie Wang
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, Guangdong Province, P.R. China.
| | - Zhiying Chen
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, Guangdong Province, P.R. China
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3
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Josephitis DS. Instrumentation and Devices Specific to Follicular Unit Excision. Facial Plast Surg 2024; 40:180-194. [PMID: 37884033 DOI: 10.1055/a-2198-8686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The volume of hair transplantation procedures done via the follicular unit excision (FUE) harvesting technique has increased tremendously over the last few years. With this growth, new advances in technology have come along. The wide variety of instrumentation and devices can be overwhelming, especially for a novice surgeon. This chapter aims to discuss the relevant aspects of FUE and its relationship to the devices that are used to harvest grafts. The development and overview of all the major types of instrumentation will be reviewed.
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Šuca H, Čoma M, Tomšů J, Sabová J, Zajíček R, Brož A, Doubková M, Novotný T, Bačáková L, Jenčová V, Kuželová Košťáková E, Lukačín Š, Rejman D, Gál P. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res 2024; 296:383-403. [PMID: 38309220 DOI: 10.1016/j.jss.2023.12.043] [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] [Received: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024]
Abstract
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
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Affiliation(s)
- Hubert Šuca
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Matúš Čoma
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Júlia Tomšů
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jana Sabová
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Robert Zajíček
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Antonín Brož
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Doubková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkině and Masaryk Hospital, Ústí nad Labem, Czech Republic; Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lucie Bačáková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Věra Jenčová
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Eva Kuželová Košťáková
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Štefan Lukačín
- Department of Heart Surgery, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Dominik Rejman
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Gál
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic; Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic; Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovak Republic.
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5
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Dunev VR. Surgical treatment and outcomes of acute and chronic ulcers on the penis following injection of foreign substances. Int Wound J 2024; 21:e14866. [PMID: 38584144 PMCID: PMC10999366 DOI: 10.1111/iwj.14866] [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] [Received: 01/07/2024] [Revised: 02/03/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
In this paper, we present our experience with acute and chronic penile ulcers resulting from injection of an exogenous substance and their surgical treatment.
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Affiliation(s)
- Vladislav Rosenov Dunev
- Department of UrologyMedical University Pleven Bulgaria, UMHAT “St. Marina”, Clinic of Urology, “Bulgarian Aviation” strPlevenBulgaria
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Xu XJ, Tang MM, Chen QW, Shi JT, Han L, Jiang B. [Application of V-Y advancement flap with facial artery perforator for the repair of midface skin defects]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 59:238-242. [PMID: 38561262 DOI: 10.3760/cma.j.cn115330-20230814-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: To investigate the efficacy of V-Y advancement flap with facial artery perforator for the repair of midface skin defects. Methods: A retrospective analysis was performed on 18 patients with facial skin cancer, including 11 males and 7 females, aged 65-83 years, who underwent the repair of midface skin defects using V-Y advancement flap with facial artery perforator in the Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University from January 2020 to April 2023. Medium, large or complex midface skin defects developed after surgical resections of the primary lesions. According to the defect site, size, location information of facial vessels, a V-Y advancement flap with appropriate shape was designed for each case. During the operation, the facial vessels and their perforators were retained in the pedicle of the flap, the facial nerve branches were dissected and protected, and the further denuded pedicle was determined according to actual amount of advancement. After the flap was advanced, the facial defect area was repaired without tension, and the anatomical positions and functions of the eyes, nose and mouth were restored as far as possible. Postoperative follow-ups were conducted to observe the survival rate of the flaps, postoperative complications, recurrences and metastases of tumors. Results: Midface defects of 3.0 cm×3.5 cm-6.5 cm×7.5 cm were observed after tumor resections, which involved one or more subregions. The sizes of the flaps were 3.5 cm×9.0 cm-7.0 cm×18.0 cm. All flaps were completely alive except for one with temporary local bruising. With following-up of 4-40 months, 5 of the 12 patients with lower eyelid and inner canthus invasions had lower eyelid ectropion, but no exposed keratitis was found; one case with poorly differentiated squamous cell carcinoma had lymph node metastasis in the submandibular region and underwent neck dissection again; no recurrence or metastasis occurred in the remaining cases. Conclusion: The V-Y advancement flap with facial artery perforator can be used to repair medium, large or complex midface skin defects, with a high survival rate, and the operation method is safe and reliable.
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Affiliation(s)
- X J Xu
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
| | - M M Tang
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
| | - Q W Chen
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
| | - J T Shi
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
| | - L Han
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
| | - B Jiang
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University, Nantong 226361, China
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Ávila León JL, Rivero CR, Guerrero Serrano L, Alviar JD, Rodríguez MA, Arocha AM, Pineda GG. Immediate Results of the Use of Split-Thickness Skin Autografts With and Without Acellular Dermal Matrix in Patients with Burns: A Comparative Study in a Colombian Population. J Burn Care Res 2024; 45:348-355. [PMID: 37668065 DOI: 10.1093/jbcr/irad131] [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] [Received: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Dermal substitutes have become fundamental tools for covering skin defects, most recently with biological subtypes such as glycerolized acellular dermal matrix (GADM). However, literature regarding this matter is scarce in Latin America and Colombia. In this descriptive observational study, we compared the use of partial skin autografts (PSA) combined with GADM and autografts without GADM. Patients were selected from the burn unit of a hospital in northeastern Colombia between 2021 and 2022. Two study groups were defined: one receiving GADM plus PSA and the other control receiving only a partial split-thickness autograft. A total of 29 patients with 68 body areas were included, with an average age of 20 years. Most cases involved third-degree burns caused by flame. Hospitalization time was the same for both groups (41 days). The percentage of grafts taken was similar in both groups; in the GADM with autografts group, it was 94.7% compared with 96% in the control group. The presence of complications was similar in both groups. GADM produced in local tissue banks is a cost-effective alternative. It can be used in a single surgical procedure without increasing complications, providing a postsurgical course similar to autografts alone. Granting the potential long-term benefits that dermal matrices give for healing in these patients, which should be evaluated in subsequent studies.
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Affiliation(s)
- Jorge Luis Ávila León
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - Carlos Ramírez Rivero
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - Linda Guerrero Serrano
- District Institute of Science, Biotechnology, and Innovation in Health (IDCBIS), Bogota, 110110, Colombia
| | - Juan Darío Alviar
- Industrial University of Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | - María Angélica Rodríguez
- Hospital Universitario de Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
| | | | - German Gómez Pineda
- Hospital Universitario de Santander, Plastic Surgery Department, Bucaramanga, Santander, 680001, Colombia
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Zhu J, Yan L, Hu R, Yang C, Wu M, An Y, Li S. Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study. J Wound Care 2024; 33:189-196. [PMID: 38451787 DOI: 10.12968/jowc.2024.33.3.189] [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: 03/09/2024]
Abstract
OBJECTIVE The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. METHOD In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT. RESULTS The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days. CONCLUSION Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft. DECLARATION OF INTEREST This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jin Zhu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Li Yan
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Rui Hu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Chunbao Yang
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Mingzheng Wu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Ying An
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Shanqing Li
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
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9
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Ash A, Brune M, Willson TD, Colbert SH, Klifto KM. Tumescent technique for split-thickness skin graft donor sites: A systematic review of randomized controlled trials. J Plast Reconstr Aesthet Surg 2024; 90:292-304. [PMID: 38394837 DOI: 10.1016/j.bjps.2024.01.009] [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] [Received: 05/10/2023] [Revised: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Split-thickness skin grafting (STSG) is widely used for reconstructive wound management. This review aimed to use level I evidence to determine if tumescent techniques were safe and effective compared to other interventions for STSG donor sites. It was hypothesized that tumescent techniques were safe and effective for STSG donor sites. METHODS Five databases (MEDLINE via PubMed, Embase, Cochrane Library, Web of Science, and Scopus) were searched to identify studies concerning the use of tumescent solutions for STSG. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane's guidelines were strictly followed. RESULTS Nine randomized controlled trials met the criteria. Included studies were published from 2001 to 2021, with results from 40 of 121 possible queried outcomes and complications. Outcomes included patient demographics, formulations of tumescent solutions, tumescent technique, hemodynamics, pain, perfusion, graft take, healing time, and postoperative complications. The tumescent technique reduced estimated blood loss (standard mean differences [SMD]: -2.68, 95%CI: -3.41 to -1.94; participants = 72; studies = 2; I2 = 96%; p < 0.001), and postoperative analgesic use within 24 hours (SMD: -1.75, 95%CI: -2.09 to -1.41; participants = 202; studies = 2; I2 = 96%; p < 0.001), without increasing graft loss/take (SMD: 0.29, 95%CI: -0.02 to 0.61; participants = 158; studies = 3; I2 = 41%; p = 0.07) and infection (risk ratios [RR]: 0.52, 95%CI: 0.08 to 3.54; participants = 87; studies = 3; I2 = 0%; p = 0.58) complications compared to other interventions. CONCLUSIONS Level I evidence demonstrated tumescent techniques were safe and effective for STSG donor sites. Tumescent techniques reduced blood loss and postoperative analgesic use within 24 hours without increasing graft loss/take and infection complications compared to other interventions. Inconsistencies between studies limit conclusions and emphasize the need for standardized protocols regarding tumescent solution formulations, techniques, and reported outcomes.
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Affiliation(s)
- Angela Ash
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Madison Brune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Thomas D Willson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Stephen H Colbert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.
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Jin F, Li X, Chen J, Liu J, Wang Y. Clinical study on the role of platelet-rich plasma in human acellular dermal matrix with razor autologous skin graft repair of giant congenital pigmented nevus in children. J Plast Reconstr Aesthet Surg 2024; 90:305-314. [PMID: 38394838 DOI: 10.1016/j.bjps.2024.01.056] [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] [Received: 09/28/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND NA OBJECTIVE: Evaluate the safety and feasibility of platelet-rich plasma (PRP) in the treatment of giant congenital melanocytic nevi (GCMN) in children with human acellular dermal matrix (HADM) transplantation. PATIENTS AND METHODS A total of 22 children with GCMN were included in the study. They were divided into an experimental and a control group. The experimental group used the method of HADM with Razor Autologous Skin Graft combined with PRP to repair skin and soft tissue defects after giant nevus resection (Group A, n = 11). The control group was treated with HADM with Razor Autologous Skin Graft (Group B, n = 11) only. To compare the survival rate of skin grafts, we used the Vancouver Scar Scale (VSS) for the postoperative skin graft area and the Patient and Observer Scar Assessment Scale (POSAS) to compare the two groups of patients. RESULTS There was no statistically significant difference in age, gender, location of giant nevi, and pathological classification between Group A and Group (P > 0.05). The survival rate of skin grafting and the VSS and POSAS scores of scar tissue in group A were superior to those of group B (P < 0.05). CONCLUSIONS PRP has improved the survival rate of composite skin grafting in children with GCMN, and long-term satisfactory prognosis of scar healing. Therefore, we consider this treatment method a valuable contribution to clinical practice.
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Affiliation(s)
- Fei Jin
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Xiang Li
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Jigang Chen
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Jing Liu
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Yining Wang
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China.
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11
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Zhang C, Pandya S, Alessandri Bonetti M, Costantino A, Egro FM. Comparison of split thickness skin graft versus full thickness skin graft for radial forearm flap donor site closure: A systematic review and Meta-analysis. Am J Otolaryngol 2024; 45:104156. [PMID: 38142610 DOI: 10.1016/j.amjoto.2023.104156] [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] [Received: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The radial forearm flap (RFF) is one of the most commonly used flaps in reconstructive surgery. Split-thickness skin grafting (STSG) has traditionally been used for closure of the forearm. However, full-thickness skin grafting (FTSG) has gained in popularity to achieve more satisfactory results. The aim of the study is to identify the best RFF donor site closure technique by comparing the functional and aesthetic outcomes of STSG and FTSG. METHODS PubMed and EMBASE databases were queried. Only studies comparing complications rate, functional and aesthetic outcomes between STSG and FTSG were included. The primary outcome was graft failure rate. Secondary outcomes included the aesthetic result and functionality of the forearm/wrist. RESULTS A total of 13 studies were included in this review, accounting for a total of 712 patients with mean age of 60.7 years. Overall, 348 patients underwent FTSG and 377 underwent STSG. The mean follow-up was 14.7 months. The rate of graft failure in FTSG was significantly higher compared to STSG (OR: 2.79, 95 % CI 1.38-5.65, p = 0.004). There was no significant difference in rate of tendon exposure (OR: 0.83, p = 0.65) and infection (OR: 1.37, p = 0.42). Regarding the aesthetic outcome, no significant difference between FTSG and STSG based on observer (SMD = -0.37, p = 0.17) and patient (SMD = -0.016, p = 0.93) assessment, respectively. Overall postoperative functional assessment showed a not severely impaired hand and arm function in both groups. Subjective evaluation of pain was similar between groups. CONCLUSION FTSG is associated with higher risk of graft failure than STSG in RFF donor site closure, without significant improvement in aesthetic results.
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Affiliation(s)
- Casey Zhang
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | - Sumaarg Pandya
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | | | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Francesco M Egro
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA.
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Kumar V, Kumar N, Gangwar AK, Singh R. Comparative evaluation of two different xenogenic acellular matrices on full-thickness skin wound healing. J Wound Care 2024; 33:lxxiv-lxxx. [PMID: 38457271 DOI: 10.12968/jowc.2024.33.sup3a.lxxiv] [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: 03/10/2024]
Abstract
OBJECTIVE The purpose of the study was to compare the healing potential of bubaline small intestinal matrix (bSIM) and fish swim bladder matrix (FSBM) on full-thickness skin wounds in rabbits. METHOD Four full-thickness skin wounds (each 20×20mm) were created on the dorsum of 18 rabbits that were divided into three groups based on treatment: untreated sham control (I), implanted with double layers of bSIM (II) and implanted with double layers of FSBM (III). Macroscopic, immunologic and histologic observations were made to evaluate wound healing. RESULTS Gross healing progression in the bSIM and FSBM groups showed significantly (p<0.05) less wound contraction compared with the sham group. The IgG concentration in rabbit sera was significantly (p<0.05) lower in the FSBM group compared with the bSIM group by enzyme-linked immunosorbent assay. The stimulation index of peripheral blood lymphocytes was significantly (p<0.05) lower in the FSBM group compared with the bSIM group by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Implantation of FSBM resulted in improved re-epithelialisation, neovascularisation and fibroplasia. CONCLUSION The FSBM is a more effective dermal substitute when compared with the bSIM for full-thickness skin wound repair in rabbit.
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Affiliation(s)
- Vineet Kumar
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Bihar Animal Sciences University, Kishanganj-855107, Bihar, India
| | - Naveen Kumar
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Anil K Gangwar
- Department of Veterinary Surgery and Radiology, College of Veterinary Science and Animal Husbandry, Acharya Narendra Deva University of Agriculture and Technology, Ayodhya, Uttar Pradesh, India
| | - Rajendra Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
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13
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Fanstone R, Price P. Burn contracture risk factors and measurement in low-middle income countries: A clinical perspective. Burns 2024; 50:466-473. [PMID: 37985269 DOI: 10.1016/j.burns.2023.09.007] [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] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023]
Abstract
We find a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n = 13), Burn injury factors (n = 14), Family and community factors (n = 9), Treatment factors (n = 18), Complications (n = 2), Healthcare capacity factors (n = 19) and Societal and environmental factors (n = 12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians' diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contractures.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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14
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Bairagi A, Tyack Z, Kimble RM, McPhail SM, McBride CA, Patel B, Vagenas D, Dettrick Z, Griffin B. Effectiveness of a Regenerative Epithelial Suspension (RES), on the pigmentation of split-thickness skin graft donor sites in children: the d RESsing pilot randomised controlled trial protocol. BMJ Open 2024; 14:e077525. [PMID: 38417964 PMCID: PMC10900329 DOI: 10.1136/bmjopen-2023-077525] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. METHODS AND ANALYSIS A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. ETHICS AND DISSEMINATION Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx].
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Health, Brisbane, Queensland, Australia
| | - Craig Antony McBride
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe Dettrick
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
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15
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Moors JJE, Xu Z, Xie K, Rashad A, Egger J, Röhrig R, Hölzle F, Puladi B. Full-thickness skin graft versus split-thickness skin graft for radial forearm free flap donor site closure: protocol for a systematic review and meta-analysis. Syst Rev 2024; 13:74. [PMID: 38409059 PMCID: PMC10895847 DOI: 10.1186/s13643-024-02471-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The radial forearm free flap (RFFF) serves as a workhorse for a variety of reconstructions. Although there are a variety of surgical techniques for donor site closure after RFFF raising, the most common techniques are closure using a split-thickness skin graft (STSG) or a full-thickness skin graft (FTSG). The closure can result in wound complications and function and aesthetic compromise of the forearm and hand. The aim of the planned systematic review and meta-analysis is to compare the wound-related, function-related and aesthetics-related outcome associated with full-thickness skin grafts (FTSG) and split-thickness skin grafts (STSG) in radial forearm free flap (RFFF) donor site closure. METHODS A systematic review and meta-analysis will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed. Electronic databases and platforms (PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI)) and clinical trial registries (ClinicalTrials.gov, the German Clinical Trials Register, the ISRCTN registry, the International Clinical Trials Registry Platform) will be searched using predefined search terms until 15 January 2024. A rerun of the search will be carried out within 12 months before publication of the review. Eligible studies should report on the occurrence of donor site complications after raising an RFFF and closure of the defect. Included closure techniques are techniques that use full-thickness skin grafts and split-thickness skin grafts. Excluded techniques for closure are primary wound closure without the use of skin graft. Outcomes are considered wound-, functional-, and aesthetics-related. Studies that will be included are randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies. Case-control studies, studies without a control group, animal studies and cadaveric studies will be excluded. Screening will be performed in a blinded fashion by two reviewers per study. A third reviewer resolves discrepancies. The risk of bias in the original studies will be assessed using the ROBINS-I and RoB 2 tools. Data synthesis will be done using Review Manager (RevMan) 5.4.1. If appropriate, a meta-analysis will be conducted. Between-study variability will be assessed using the I2 index. If necessary, R will be used. The quality of evidence for outcomes will eventually be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION This study's findings may help us understand both closure techniques' complication rates and may have important implications for developing future guidelines for RFFF donor site management. If available data is limited and several questions remain unanswered, additional comparative studies will be needed. SYSTEMATIC REVIEW REGISTRATION The protocol was developed in line with the PRISMA-P extension for protocols and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17 September 2023 (registration number CRD42023351903).
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Affiliation(s)
- Jasper J E Moors
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zhibin Xu
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Kunpeng Xie
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Jan Egger
- Cancer Research Center Cologne Essen (CCCE), West German Cancer Center Essen (WTZ), 45122, Essen, Germany
- Institute of Artificial Intelligence in Medicine, Essen University Hospital, 45131, Essen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
- Institute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany.
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16
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Zhu L, Zhou F, Zhang X, Zhang X, Jin P. Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap. J Orthop Surg Res 2024; 19:118. [PMID: 38310285 PMCID: PMC10838408 DOI: 10.1186/s13018-024-04608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE The reconstruction of medium-sized soft tissue defects of the fingertip remains a challenge for hand surgeons. The aim of this study was to compare the outcomes of modified triangular neurovascular unilateral advancement flap and digital artery dorsal perforator flap in the treatment of this injury. METHODS From May 2018 to May 2022, 70 patients with medium-sized volar soft tissue defects were enrolled. The patients were divided into two groups based on the flap type: modified triangular neurovascular unilateral advancement flap (Group A) and digital artery dorsal perforator flap (Group B). The debridement times, defect size, operation time, and flap survival rate were recorded. At follow-up, hand function, aesthetics, and complications were evaluated. Function was evaluated using the TAM score. The aesthetics of the reconstructed and donor sites were assessed using the vancouver scar scale (VSS). The static two-point discrimination of the finger pulp served as a measure of tactile agnosia. RESULTS A total of 10 patients were lost to follow-up for various reasons, resulting in 30 cases remaining in each group. The general information of the two groups showed no significant differences in age, sex, injury side, cause of injury, time from injury to surgery, and operation time (P > 0.05). Additionally, the debridement times and size of the defect were similar between the groups (P > 0.05). However, the operation time was significantly shorter in Group A compared to Group B (P = 0.001). With regard to complications, there was no significant difference between them. At one-month follow-up, TAM scores indicated that Group B performed significantly better than Group A. However, at the final follow-up period, there was no significant difference in TAM scores between the two groups. When considering the VSS, significant differences were observed between the two groups in both the reconstructed site and donor site. CONCLUSION Both flaps can effectively repair medium-sized fingertip defects. Furthermore, the modified triangular neurovascular unilateral advancement flap offers anatomical reconstruction possibilities, ensuring satisfactory sensation and cosmetic contour.
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Affiliation(s)
- Lixi Zhu
- Department of Operation Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feiya Zhou
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Xian Zhang
- Department of Operation Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xue Zhang
- Department of Operation Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pinghu Jin
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
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17
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Lee KI, Lin YN. One-stage reconstruction of extensive exposed tibia on malnourished patient using single-layer Integra and amino acid supplements: A case report and literature review. Medicine (Baltimore) 2024; 103:e37098. [PMID: 38306507 PMCID: PMC10843514 DOI: 10.1097/md.0000000000037098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Extremity injuries resulting from motor vehicle collisions, especially those leading to bone-exposed wounds, present challenges for achieving effective wound coverage. Such injuries are susceptible to complications including infections, osteomyelitis, and unexpected amputations due to inadequate blood supply. Severe traumatic degloving injuries often entail damage to the surrounding blood vessels, making local or free flaps impractical choices in many cases. Consequently, treatment options may vary based on distinct clinical scenarios, with no standardized guidelines available. Our study introduces an integrated approach utilizing dermal substitutes and skin grafts as a safer treatment modality for managing large-area tibial exposure resulting from traffic accidents. PATIENT CONCERNS A 66-year-old male with a compromised nutritional status was struck by a car while riding a motorcycle. Previous attempts using double-layer Integra and negative pressure wound therapy (NPWT) for two-stage reconstruction have been unsuccessful. DIAGNOSES Computed tomography imaging studies revealed multiple comminuted and displaced fractures involving the left femoral shaft, left proximal tibia, left patella, and proximal fibula, as well as a fracture of the right fibular shaft and an avulsion fracture of the right distal medial femur. The patient's condition corresponded to Type 3B in the Gustilo classification for open fractures, and the patient had an Injury Severity Score of 25. INTERVENTIONS We applied a one-stage reconstruction involving single-layer Integra, split-thickness skin grafts, NPWT, and nutritional supplements containing various amino acids. OUTCOMES By implementing an integrated treatment approach and providing diligent wound care over a total of 2 months, the patient achieved successful healing and expressed satisfaction with the postoperative results. LESSONS This study offers insights into the effectiveness of employing one-stage reconstruction for traumatic injuries with extensive exposed tibias. In addition, it underscores the impact of a patient's nutritional status on wound healing and introduces a potential solution for similar challenging cases.
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Affiliation(s)
- Kuan-I Lee
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yun-Nan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
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18
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Al-Aroomi MA, Mashrah MA, Al-Worafi NA, Zhou W, Sun C, Pan C. Biomechanical and aesthetic outcomes following radial forearm free flap transfer: comparison of ipsilateral full-thickness skin graft and traditional split-thickness skin graft. Int J Oral Maxillofac Surg 2024; 53:109-116. [PMID: 37244863 DOI: 10.1016/j.ijom.2023.04.003] [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] [Received: 01/02/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/29/2023]
Abstract
The radial forearm free flap (RFFF) is associated with donor site morbidity. This study aimed to quantify the functional and aesthetic outcomes after closure of the RFFF donor site using triangular full-thickness skin grafts (FTSGs) harvested adjacent to the flap or traditional split-thickness skin grafts (STSGs). The study included patients who underwent oral cavity reconstruction with an RFFF between March 2017 and August 2021. The patients were divided into two groups based on the donor site closure method: FTSG or STSG. The primary outcomes were biomechanical grip strength, pinch strength, and range of wrist movements. Subjective donor site morbidity, aesthetic and functional results were also analysed. The study included 75 patients (FTSG n = 35; STSG n = 40). Postoperatively, there was a statistically significant difference in grip strength (P = 0.049) and wrist extension (P = 0.047) between the FTSG and STSG groups, in favour of the STSG. Differences between the groups in pinch strength and other wrist motions were not statistically significant. The harvesting time was significantly shorter for the FTSG (P = 0.041) and the appearance of the donor site was better (P = 0.026) when compared to the STSG. Cold intolerance was more frequent in the STSG group (32.5% STSG vs 6.7% FTSG; P = 0.017). Subjective function, numbness, pain, hypertrophic scar, itching, and social stigma did not differ significantly between the groups. Compared with the STSG, the FTSG showed better cosmesis and avoided additional donor sites, with clinically negligible differences in hand biomechanics.
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Affiliation(s)
- M A Al-Aroomi
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China.
| | - M A Mashrah
- Department of Implantology, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - N A Al-Worafi
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - W Zhou
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China
| | - C Sun
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China.
| | - C Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
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Zheng Y, Hallock GG, Levin LS, Zhang Y, Min P. Mini-Shaped Kiss Flap Design for Palmar and Digital Soft-Tissue Resurfacing. Plast Reconstr Surg 2024; 153:411-421. [PMID: 37036310 DOI: 10.1097/prs.0000000000010518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Although palmar and digital soft-tissue resurfacing with intrinsic flaps may provide functional and aesthetic reconstruction, the donor site may result in a tight closure or need for a skin graft once the flap is raised. In this series, the "mini-shaped kiss flap" was used to increase the resurfacing efficiency and preserve hand function. METHODS The mini-shaped kiss flaps, based on common palmar digital arteries (eg, princeps pollicis artery and ulnar palmar digital artery), were developed for the resurfacing of distal or proximal finger areas. The tiny skin paddles were "kissed" together and transferred as pedicled in proposed dimensions and shape. The flap size, donor/recipient site, perforator source, whether free or pedicled, surgical outcome, and donor-site morbidity were evaluated. RESULTS Twenty mini-shaped kiss flaps were harvested for the purpose of palmar and digital resurfacing. The flap sizes varied from 3 × 1.2 cm to 5 × 2 cm. All 19 patients, aged 6 to 52 years (mean, 35 years), achieved successful reconstruction without major complications after 6- to 12-month follow-up. CONCLUSIONS The mini-shaped kiss flap technique exhibited favorable surgical outcomes with excellent color and texture match to the recipient sites. The reverse midpalm, thenar, and hypothenar island flap can be raised at the cost of an unnoticeable linear scar with minimized functional compromise in the donor area. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Youmao Zheng
- From the Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University
| | | | - L Scott Levin
- Department of Orthopedic Surgery, University of Pennsylvania
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine
| | - Peiru Min
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine
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20
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Li G, Zhang B, Ding W, Ouyang H, Long X, Fu A, Liu X. Reconstruction of Concha-Type Microtia Using a Delayed Postauricular Skin Flap. Plast Reconstr Surg 2024; 153:407e-410e. [PMID: 37053447 DOI: 10.1097/prs.0000000000010547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
SUMMARY Understanding how to remove and retain the relatively large residual auricle is important in concha-type microtia reconstruction. The authors present a method for concha-type microtia reconstruction using a delayed postauricular skin flap. A total of 40 patients with concha-type microtia who underwent ear reconstruction using a delayed postauricular skin flap were retrospectively examined. Reconstruction was performed in three stages. The first stage consisted of preparing a delayed postauricular skin flap and dealing with the residual auricle including removal of the upper residual auricular cartilage. In the second stage, an autogenous rib cartilage framework was placed and covered with a delayed postauricular skin flap, postauricular fascia flap, and autologous medium-thickness skin graft. The ear framework was carefully articulated and secured with the retained residual auricular cartilage to achieve a smooth junction between the two. The third stage involved modification of the reconstructed ear. Patients were followed up for 12 months after ear reconstruction. All reconstructed auricles had a good appearance, and there was a smooth connection between the reconstructed auricle and the residual ear, with similar color as well as a flat and thin scar. All patients were satisfied with the results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Gaofeng Li
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Bo Zhang
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Wei Ding
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Huawei Ouyang
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Xiren Long
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Anqi Fu
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Xiaojia Liu
- From the Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
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21
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Soldado F, Prieto-Mere JA, Cherqaoui A, Diaz Gallardo P, Knorr J, Corona P. Plantar intermetatarsal perforator flap for first web skin-graftless syndactyly release: Anatomical study and clinical application. Microsurgery 2024; 44:e31151. [PMID: 38363104 DOI: 10.1002/micr.31151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Foot-syndactyly has long been managed through conventional surgical procedures, each having its own distinct advantages and drawbacks. While these methods, which do not require skin grafts, exhibit a lower incidence of long-term complications, they lead to undesirable scarring on the dorsal side of the foot and reduced patient satisfaction. In this study, we introduce an innovative technique involving an intermetatarsal plantar flap, supported by an anatomical investigation and clinical application. METHODS Eight freshly preserved lower limbs were injected with colored latex to examine the cutaneous vessels on the plantar surface, a skin-flap was designed in an elliptical shape to address first web conjoined toes. The flap was extended from the center of each affected ray measuring ~30% of the sole's length. Using the mentioned novel approach, a flap was created and dorsally extended with a straight incision to release bilateral simple foot-syndactyly in an 8-year-old child presented with Apert's Syndrome. RESULTS We identified cutaneous branches originating either from the medial plantar vessels or the lateral proper artery of the hallux. On average, the mean number of cutaneous branches found over the first intermetatarsal web spaces was 5.8 (ranging from 5 to 8) most of them originating from medial plantar vessels with a mean of 5.1 branches (range 4-6) while proper lateral great-toe digital artery provided a mean of 0.6 branches (range 0-2). Intra-operatively, in our patient, advancing the plantar flap ensured complete coverage of the commissure, obviating the necessity for skin grafts. Incisions healed uneventfully and a wide first web was obtained. Over a 15 months follow-up, no complications were observed. CONCLUSIONS Our findings suggest that the skin-graftless first web release of syndactyly using a plantar intermetatarsal flap is a reliable and straightforward procedure with good cosmetic results, offering a promising alternative to conventional techniques. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit, Barcelona University Children's Hospital HM Nens, HM Hospitales, Barcelona, Spain
| | | | - Abdelmounim Cherqaoui
- Service d'orthopédie Pédiatrique, Hôpital d'Enfants A. Harouchi, Université de Médecine Hassan 2, Casablanca, Morocco
| | | | - Jorge Knorr
- Pediatric Hand Surgery and Microsurgery Unit, Barcelona University Children's Hospital HM Nens, HM Hospitales, Barcelona, Spain
| | - Pablo Corona
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
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22
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Rennekampff HO, Kremer T. [Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults]. Unfallchirurgie (Heidelb) 2024; 127:135-145. [PMID: 38252166 DOI: 10.1007/s00113-024-01417-1] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The treatment of burn injury patients is a unique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with a total body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.
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Affiliation(s)
- Hans-Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein Maas Klinikum, Mauerfelchen 25, 52146, Würselen, Deutschland.
| | - Thomas Kremer
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum St. Georg, Leipzig, Deutschland
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23
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Phelan HA, Holmes JH, Hickerson WL, Cockerell CJ, Shupp JW, Carter JE. Iterative refinement of a histologic algorithm for burn depth categorization based on 798 consecutive burn wound biopsies. Burns 2024; 50:23-30. [PMID: 38040616 DOI: 10.1016/j.burns.2023.10.010] [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] [Received: 02/01/2023] [Revised: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Our group previously reported a burn biopsy algorithm (BBA-V1) for categorizing burn wound depth. Here, we sought to promulgate a newer, simpler version of the BBA (BBA-V2). METHODS Burn wounds undergoing excision underwent 4 mm biopsies procured every 25 cm2. Serial still photos were obtained at enrollment and at excision intraoperatively. Burn wounds assessed as likely to heal by 21 days were imaged within 72 h of injury and at 21 days. A sample of 798 burn wound biopsies were classified by both BBAV1 and BBAV2 algorithms. For nonoperative burn wounds, the proportion of healing versus nonhealing pixels at 21 days after injury were compared. RESULTS The 798 biopsies were classified by BBAV1 as 24% SPT, 47% DPT, 28% FT and by BBAV2 as 3% SPT, 67% DPT, and 30% FT (p < 0.0001). Overall, the proportion of biopsies whose wound reclassification changed from a nonoperative to operative pathway was 21% (95% CI: 18-24%). Nonoperative wounds judged at injury as being SPT contained 12.8 million pixels. Repeat 21-day imaging revealed 11.3 million healed pixels (accuracy = 89.6% (95% CI: 89.59-89.62)). CONCLUSIONS BBA-V2 was associated with a significantly higher concordance with visual assessment for burn wounds clinically judged as deep partial and full thickness.
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24
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Niu Y, Ren C, Liao H, Jin Z, Zhu L. Clinical effects of autologous follicular unit extraction transplantation in the treatment of secondary cicatricial alopecia after infections. J Cosmet Dermatol 2024; 23:585-590. [PMID: 37735949 DOI: 10.1111/jocd.15996] [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] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by infections, and to evaluate its effectiveness. METHODS A retrospective observational study has been conducted, which included nine patients with secondary scarring alopecia caused by infections. All patients underwent initial autologous FUE hair transplantation surgery, and the occurrence of postoperative complications was monitored. Patient satisfaction was evaluated after 12 months post-surgery. RESULTS At the follow-up, postoperative satisfaction was 88.9% in nine patients, with only one case of postoperative infection and no incidence of skin necrosis, significant bruising and swelling, unnatural appearance or temporary hair loss. CONCLUSIONS Autologous FUE hair transplantation is an effective method for treating secondary scarring alopecia caused by infections. This procedure is minimally invasive, resulting in high patient satisfaction and minimal complications postoperatively.
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Affiliation(s)
- Yanchao Niu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Sichuan, Chengdu, China
| | - Ci Ren
- Department of Dermatological Surgery, Shenyang Seventh People's Hospital, Liaoning, Shenyang, China
| | - Hengli Liao
- Department of Dermatology, Chengdu Hengmei Hair Medical Clinic, Chengdu, Sichuan, China
| | - Zhoufeng Jin
- Department of Plastic Surgery, Shenyang Mingliu Plastic Surgery and Aesthetics Hospital, Liaoning, Shenyang, China
| | - Ling Zhu
- Medical Technology Department, Sichuan Nursing Vocational College, Sichuan, Chengdu, China
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Falguière A, Lan R, Manfredi C, Wong-Hee-Kam S, Fakhry N, Salas S, Campana F. Laser Hair Removal for Intraoral Flaps: A Review. Facial Plast Surg Aesthet Med 2024; 26:85-90. [PMID: 37878767 DOI: 10.1089/fpsam.2022.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Importance: Laser hair removal is a noninvasive technique that has been used for patients with oropharyngolaryngeal hair growth related to surgical flap reconstruction after head and neck cancer resection. The purpose of this work was to perform a rapid review of the literature to determine the therapeutic relevance of laser hair removal and identify laser parameters. Observations: A total of 10 publications addressing depilation of the head and neck sphere were selected and analyzed. Conclusions and Relevance: Laser therapy appears to be a promising treatment for hair removal from flaps with few side effects. However, there is no scientific basis for a standardized protocol or determination of the superiority of laser hair removal over another treatment.
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Affiliation(s)
- Arthur Falguière
- Oral Surgery Department, APHM, Aix Marseille University, Timone Hospital, Marseille, France
| | - Romain Lan
- Oral Surgery Department, APHM, CNRS, EFS, ADES, Aix Marseille University, Timone Hospital, Marseille, France
| | - Christelle Manfredi
- Oral Surgery Department, APHM, Aix Marseille University, Timone Hospital, Marseille, France
| | - Stéphanie Wong-Hee-Kam
- Radiotherapy Department, APHM, Aix Marseille University, Timone Hospital, Marseille, France
| | - Nicolas Fakhry
- Otorhinolaryngology-Head and Neck Surgery Department, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Sébastien Salas
- Oncology Department, APHM, Aix Marseille University, Timone Hospital, Marseille, France
| | - Fabrice Campana
- Oral Surgery Department, APHM, INSERM, MMG, Aix Marseille University, Timone Hospital, Marseille, France
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26
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Tang L, Zhou X, Huang S, Zou Y. Combined Great Toe Dorsal Nail-Skin Flap and Medial Plantar Flap for Reconstruction of Degloved Finger Loss. Plast Reconstr Surg 2024; 153:143-152. [PMID: 37039517 DOI: 10.1097/prs.0000000000010517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Historically, the degloved finger with the total loss of nails and skin has been resurfaced in two stages. Furthermore, proximal finger amputation requires an additional bone-tendon graft and an expanded great toe wraparound flap transfer for better outcomes. This article recommends a novel strategy to address these problems in a single stage using a dorsal nail-skin flap and medial plantar artery perforator flap. METHODS From March of 2015 to June of 2018, nine procedures were performed to resurface with skin loss to the metacarpophalangeal joint level, and three amputated fingers were reconstructed with an extra bone-joint-tendon graft simultaneously. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. A standardized assessment of outcome in terms of sensory, functional, and aesthetic performance was completed. RESULTS All flaps survived. The contour and length of the reconstructed digits were comparable with the contralateral finger. The mean static two-point discrimination was 11.0 mm (range, 9.0 to 14.0 mm). The average score of the Disabilities of the Arm, Shoulder, and Hand questionnaire and Michigan Hand Outcomes Questionnaire were 2.5 (range, 0 to 5) and 90.1 (range, 82 to 96), respectively. The mean Foot and Ankle Disability Index score was 95.6 (range, 93 to 99). At the last follow-up, the functional and aesthetic outcomes, and the restored sensation, were satisfactory for all fingers. CONCLUSION This strategy may provide an alternative for selected patients seeking cosmetic resurfacing and functional reconstruction, preserving a weight-bearing plantar area with less morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Lin Tang
- From the Department of Orthopedic, Jiangbei Campus, The First Affiliated Hospital of Army Medical University
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University
| | - Shuqing Huang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University
| | - Yonggen Zou
- Depstableartment of Orthopedics, Guizhou Provincial People's Hospital
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Zhou F, Zhang Y, Gao J, Xiang G, Li Z, Cai L. Reconstruction of foot and ankle defects using the vaccum sealing drainage versus the induced-membrane the elderly: A retrospective comparative study. Int Wound J 2024; 21:e14362. [PMID: 37605359 PMCID: PMC10781590 DOI: 10.1111/iwj.14362] [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] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with vaccum sealing drainage (VSD) or induction membrane (IM) of cement formation and attempt to provide an optimal strategy for elderly patients. A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from October of 2016 and October of 2020 was performed. Based on the different way, the patients were divided into two groups: VSD group (n = 26) and IM group (n = 27). Outcomes were assessed according to the size of the defect, frequency of debridement procedures, hospitalization time, duration of healing, the healing rate, major amputation rate, functional outcomes and complications. Immunohistochemistry (IHC) detection of vascular endothelial growth factor (VEGF) was also be completed. We found that there was no difference in demographic characteristics, size of the defect, debridement times and functional outcomes between the two groups (p > 0.05); however, a significant difference in the wound healing time, hospitalization time and complications were noted between them(p < 0.05). The fresh granulation tissue of both groups showed abundant positive expression of VEGF. Thus, the VSD and IM are both available for foot and ankle reconstruction in elderly patients. However, the IM group offers short hospitalization time, duration of healing and lower frequency of postoperative complications. Thus, we advocate the IM for reconstruction of defects of the foot and ankle region in the elderly patients.
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Affiliation(s)
- Feiya Zhou
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Yingying Zhang
- Department of RadiologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Jianyuan Gao
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Guangheng Xiang
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Zhijie Li
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Leyi Cai
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
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28
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Zhang L, Zhou XL, Shi CJ, Fu GX, Zhao D. Radially Pedicled In-Situ Split-Thickness Skin Grafts, an Alternative to Distal Split-Thickness Skin Grafts. Otolaryngol Head Neck Surg 2024; 170:61-68. [PMID: 37702154 DOI: 10.1002/ohn.521] [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] [Received: 04/15/2023] [Revised: 06/21/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study aimed to introduce a novel radially pedicled in-situ split-thickness skin graft (STSG). The morbidity, esthetic, and functional outcomes of the radially pedicled in-situ STSG were in comparison with those of the distal STSG. STUDY DESIGN Retrospective analysis. SETTING A single-institution review. METHODS Seventy patients with oral cancer who underwent radical surgical resection and simultaneous radial forearm free flap (RFFF) reconstruction from July 2021 to March 2022 were included. De-epithelialized RFFFs and traditional RFFFs were used to repair oral defects of 35 patients in Group A and Group B, respectively, while radially pedicled in-situ STSGs and distal STSGs taken from abdomens were used to repair donor site defects in the above groups, respectively. Patient demographics, wound healing complications, and esthetic and functional outcomes of the forearms were compared between the 2 groups. RESULTS No significant difference between Group A and Group B was observed in terms of donor site and recipient site complications. The esthetic outcome was superior in Group A compared to Group B (P = .011). The extension range, sensation, and pinch strength of operated forearms were significantly reduced in both groups after surgery (P < .05), however, intergroup differences were not observed. CONCLUSION Taken together, our results suggest that radially pedicled in-situ STSG is an applicable technique for direct closure and better esthetic outcomes in the forearm donor site.
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Affiliation(s)
- Lei Zhang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xu-Lin Zhou
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cheng-Ji Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guang-Xin Fu
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Dan Zhao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Oral & Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
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29
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Lee SG, Nam KA, Oh BH, Chung KY, Roh MR. Comparison of full-thickness skin graft and punch grafting in the reconstruction of plantar defects. J Dermatol 2024; 51:76-80. [PMID: 37929298 DOI: 10.1111/1346-8138.17018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023]
Abstract
Acral melanoma commonly occurs on weight-bearing areas of the sole. Reconstruction of such areas presents a surgical challenge due to limited availability and mobility of local skin. Thus, we aimed to compare the scar outcome of full-thickness skin graft (FTSG) and punch grafting in the reconstruction of plantar defects after melanoma surgery. We retrospectively reviewed six patients who underwent both FTSG for nonweight-bearing areas and punch grafting for weight-bearing areas. We compared results of FTSG and punch grafting within the same patient. Photos of completely healed scars were graded using the Stony Brook Scar Evaluation Scale (SBSES). The averages of the FTSG scores and the punch graft scores, as measured by the SBSES, were statistically compared. Punch grafting yielded a better outcome than FTSG, according to the SBSES. The average of the punch grafting scars was 4.67, which was significantly greater (p = 0.004) than that of FTSG scar scores at 1.83. For weight-bearing areas, punch grafting should be considered as the first option of reconstruction, with FTSG as a second option for nonweight-bearing areas. Overall, this combined approach provides an effective and safe method for reconstruction of extensive plantar wounds.
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Affiliation(s)
- Sang Gyun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Ae Nam
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Schlottmann F, Strauß S, Ziesing S, Reineke C, Ipaktchi R, Weyand B, Krezdorn N, Vogt PM, Bucan V. Organization of Hannover Skin Bank: Sterile culture and procurement protocols for viable cryopreserved allogeneic skin grafts of living donors. Int Wound J 2024; 21:e14374. [PMID: 37675770 PMCID: PMC10784195 DOI: 10.1111/iwj.14374] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Preserved allogeneic donor skin still represents one of the gold standard therapies in temporary wound coverage in severely burned patients or chronic wounds. Allogeneic skin grafts are currently commercially available as cryo- or glycerol-preserved allografts through skin tissue banks all over the world. Most of the skin tissue banks rely on human cadaveric skin donations. Due to the chronic shortage of human allogeneic transplants, such as skin, and increasing costs in the procurement of allografts from other skin tissue banks, Hannover Medical School has been building up its own skin tissue bank based on allogeneic skin grafts from living donors who underwent surgical treatment (i.e., body-contouring procedures, such as abdominioplasties). This article presents procedures and protocols for the procurement and processing of allogeneic skin grafts according to national legislation and European regulations and guidelines. Beside protocols, initial microbiological data regarding the sterility of the harvested grafts are presented. The results currently form the basis for further investigations as well as clinical applications. In summary, a microbiological testing and acceptance procedure is presented that ensures adequate patient safety and skin viability.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Sarah Strauß
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Stefan Ziesing
- Department of MicrobiologyHannover Medical SchoolHannoverGermany
| | | | - Ramin Ipaktchi
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
- Department of Plastic and Hand Surgery, InselspitalUniversity Hospital BernBernSwitzerland
| | - Birgit Weyand
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Vesna Bucan
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
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Chen L, Yang J, Wang D, Jiang J, Zhang B, Zhao Z, Chen X, Lv D. Multicenter effect analysis of one-step acellular dermis combined with autologous ultra-thin split thickness skin composite transplantation in treating burn and traumatic wounds. Int Wound J 2024; 21:e14341. [PMID: 37548136 PMCID: PMC10777748 DOI: 10.1111/iwj.14341] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/08/2023] Open
Abstract
To evaluate the efficacy of one-step acellular dermis combined with autologous split thickness skin grafting in the treatment of burn or trauma wounds by a multicenter controlled study. In patients with extensive burns, it is even difficult to repair the wounds due to the shortage of autologous skin. The traditional skin grafting method has the disadvantages of large damage to the donor site, insufficient skin source and unsatisfactory appearance, wear resistance and elasticity of the wound tissue after skin grafting. One-step acellular dermis combined with autologous ultra-thin split thickness skin graft can achieve better healing effect in the treatment of burn and trauma wounds. A total of 1208 patients who underwent single-layer skin grafting and one-step composite skin grafting in the First Affiliated Hospital of Wannan Medical College, Wuhan Third People's Hospital and Lu 'an People's Hospital from 2019 to 2022 were retrospectively analysed. The total hospitalization cost, total operation cost, hospitalization days after surgery, wound healing rate after 1 week of skin grafting and scar follow-up at 6 months after discharge were compared and studied. The total cost of hospitalization and operation in the composite skin grafting group was significantly higher than those in the single-layer autologous skin grafting group. The wound healing rate after 1 week of skin grafting and the VSS score of scar in the follow-up of 6 months after discharge were better than those in the single-layer skin grafting group. One-step acellular dermis combined with autologous ultra-thin split thickness skin graft has high wound healing rate, less scar, smooth appearance and good elasticity in repairing burn and trauma wounds, which can provide an ideal repair method for wounds.
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Affiliation(s)
- Lei Chen
- Department of Burn and Plastic SurgeryFirst Affiliated Hospital of Wannan Medical CollegeWuhuPR China
- Department of BurnsFirst Affiliated Hospital of Anhui Medical UniversityHefeiPR China
| | - Jing Yang
- Department of Burn and Plastic SurgeryFirst Affiliated Hospital of Wannan Medical CollegeWuhuPR China
| | - De‐yun Wang
- Department of Burn and Plastic SurgeryWuhan Third HospitalWuhanPR China
| | - Jun‐mei Jiang
- Department of Burn and Plastic SurgeryWuhan Third HospitalWuhanPR China
| | - Bao‐de Zhang
- Department of Burn and Plastic SurgeryLu'an People's HospitalLu'anPR China
| | - Zun‐jiang Zhao
- Department of Burn and Plastic SurgeryFirst Affiliated Hospital of Wannan Medical CollegeWuhuPR China
| | - Xu‐Lin Chen
- Department of BurnsFirst Affiliated Hospital of Anhui Medical UniversityHefeiPR China
| | - Da‐lun Lv
- Department of Burn and Plastic SurgeryFirst Affiliated Hospital of Wannan Medical CollegeWuhuPR China
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32
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Zhang D, Liu C, Yuan Y, Yu Y, Qi B, Yu A. Monitoring angiogenesis in skin autografts using photoacoustic microscopy. J Biophotonics 2024; 17:e202300317. [PMID: 37669433 DOI: 10.1002/jbio.202300317] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Skin autografts have been broadly used to manage the skin and soft tissue defects. It is important for surgeons to assess the vitality of skin autografts via observing the angiogenesis. However, there is lack of reliable approach for giving the quantitative angiogenesis information on the skin autografts. Recently, photoacoustic microscopy imaging has attracted much attention based on its good performance in angiography. METHODS In this study, we aim to monitor angiogenesis in skin autografts via PAM, and further verify its clinical potential for the early prediction of skin autografts clinical outcome. RESULTS AND CONCLUSIONS The results indicate that PAM is a feasible, precise, high-resolution, noninvasive technique for the early prediction of necrosis of skin autografts via monitoring the angiogenesis, providing a promising tool for surgeons to use this surgical technology.
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Affiliation(s)
- Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Changjiang Liu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Yuan
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Delle Femmine PF, Bruno E, Tosi D, Musumarra G, Amadei F, Ribuffo D, Del Bene M. Reversed distal laterodigital adipofascial flap for nail-bed reconstruction. Microsurgery 2024; 44:e31048. [PMID: 37042799 DOI: 10.1002/micr.31048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Lesions of the distal phalanges of the fingers frequently involve the nail bed. There are few therapeutic options for nail-bed reconstruction and they often lead to painful scars and onychodystrophy. We present our experience with the distal adipofascial laterodigital reverse flap. METHODS Fifteen patients (average age 46.33 years, range 28-73) with tumors or traumatic injuries (crush injuries, nail avulsion, and partial fingertip amputations) of the nail bed, underwent digital reconstruction through the distal adipofascial laterodigital reverse flap from June 2018 to August 2019. The size of the fingertip defect covered with the flap was ranged between 1.1 × 1.1 and 1.6 × 1.2 cm (average size 1.4 × 1.2 cm). The flap was harvested enrolling subcutaneous tissue from the lateral aspect of the middle and distal phalanx from the less damaged side. RESULTS The average size of the harvested flaps was 1.3 × 1.2 cm (range 1.1 × 1.0 to 1.4 × 1.1 cm). All adipofascial flaps survived entirely and the nail bed healed in all patients, with an average healing time of 21 days and a subsequent regrowth of the nail. The follow up ranged from 6 to 12 months, with a mean of 7 months. CONCLUSIONS The distal reverse adipofascial flap provides a very versatile and reliable coverage of the distal finger and its nail bed. It is a rapid and reproducible surgical procedure with poor morbidity for the donor site. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Pietro F Delle Femmine
- Department of Plastic and Reconstructive Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Edoardo Bruno
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Tosi
- Department of Plastic and Reconstructive Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Gaetano Musumarra
- Plastic and Reconstructive Surgery Unit, San Gerardo Hospital, Monza, Italy
| | - Federico Amadei
- Hand Surgery Division, C.O.F. Lanzo Hospital, Alta Valle Intelvi, Como, Italy
| | - Diego Ribuffo
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Massimo Del Bene
- Plastic and Reconstructive Surgery Unit, San Gerardo Hospital, Monza, Italy
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Kim JH, Lee KT. Reconstruction of circumferential fingertip defect using free superficial palmar branch of the radial artery flap: Report of two cases. Microsurgery 2024; 44:e31109. [PMID: 37670431 DOI: 10.1002/micr.31109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/26/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Wide local excision of noninvasive malignant melanomas has been increasingly performed instead of digit amputation, which often results in extensive fingertip defects. Owing to the unique anatomical characteristics of the fingertips, achieving favorable outcomes in both function and cosmesis is challenging during reconstruction. The free superficial palmar branch of the radial artery (SPBRA) flap is advantageous for finger reconstruction. However, its application in circumferential fingertip defects has rarely been reported. In this report, we describe two cases of circumferential fingertip defect reconstruction using a free SPBRA flap after wide local excision of subungual melanoma. The patients were women aged 74 and 63 years at the time of surgery. They presented with subungual melanoma on the right fourth finger and left thumb, in which both biopsies confirmed malignant melanoma in situ (Tis N0 M0), Breslow thickness of 0 mm (noninvasive). After wide local excision, circumferential defects, sized 2.5 × 6 and 2.7 × 7 cm, were formed on their fingertips. A vertically designed free SPBRA flap measuring 2.7 × 6 and 3 × 6 cm was elevated from the unaffected palm in each patient. After performing microvascular anastomosis, the flap was inserted transversely, wrapping the exposed phalangeal bone in a conical shape. The donor site was primarily closed. All flaps survived, and postoperative complications did not develop. Neither local recurrence nor distant metastasis was detected at the latest follow-up in either patient at 24 or 28 months postoperatively. The patients were satisfied with the natural contour of the reconstructed fingertip and recovered functions. In the evaluation of subjective sensory recovery using four scales (excellent, good, fair, and poor), they responded "fair" and "good," respectively. We suggest that the free SPBRA flap could be a reliable reconstructive method for circumferential fingertip defects.
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Affiliation(s)
- Ju Hee Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mosquera C, Weyh A, Malik M, Fernandes R, Bunnell A, Nedrud S. Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review. Microsurgery 2024; 44:e31126. [PMID: 37990820 DOI: 10.1002/micr.31126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Radial forearm free flap (RFFF) donor site closure is traditionally performed with split thickness skin grafts (STSG), which can be associated with poor aesthetics, wrist stiffness, paresthesia, reduced strength, and tendon exposure. Full thickness skin grafts (FTSG) are potentially beneficial as they provide a more durable coverage, and the skin graft donor site can be closed primarily, which is more aesthetic. The aim of this systematic review is to compare the outcomes of STSG versus FTSG for closure of the RFFF donor site. METHODS A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary objective was to answer: do subjects undergoing RFFF harvest, utilizing FTSG to close the RFFF donor site, compared to STSG, achieve superior aesthetics at the RFFF donor site? Included papers compared FTSG and STSG with statistical data. Means were compared with t-test and proportions with Fisher's exact test. RESULTS The initial search resulted in 1851 studies. After applying the inclusion/exclusion criteria, the search resulted in eight studies, with 366 total skin grafts, 197 STSG and 169 FTSG. Six studies evaluated aesthetics utilizing a Likert scale, with the scaled average aesthetic score for FTSG being 7.9/10 compared to 6.9/10 for STSG (p < .001). Tendon exposure was measured in five studies, with a rate of 13.1% for STSG versus 10.6% for FTSG (p = .555). No significant difference in function was observed, however, methods to quantify function were heterogeneous. CONCLUSION FTSG compared to STSG, resulted in statistically significant improved aesthetics, with comparable rates of tendon exposure and function.
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Affiliation(s)
- Camilo Mosquera
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Michael Malik
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Anthony Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Stacey Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Private Practice, Jacksonville, FL, USA
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Henry S, Mapula S, Grevious M, Foster KN, Phelan H, Shupp J, Chan R, Harrington D, Mashruwala N, Brown DA, Mir H, Singer G, Cordova A, Rae L, Chin T, Castanon L, Bell D, Hughes W, Molnar JA. Maximizing wound coverage in full-thickness skin defects: A randomized-controlled trial of autologous skin cell suspension and widely meshed autograft versus standard autografting. J Trauma Acute Care Surg 2024; 96:85-93. [PMID: 38098145 DOI: 10.1097/ta.0000000000004120] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds. METHODS A multicenter, within-patient, evaluator-blinded, randomized-controlled trial was conducted of 65 patients with acute, nonthermal, full-thickness skin defects requiring autografting. For each patient, two treatment areas were randomly assigned to concurrently receive a predefined standard-of-care meshed STSG (control) or ASCS + more widely meshed STSG (ASCS+STSG). Coprimary endpoints were noninferiority of ASCS+STSG for complete treatment area closure by Week 8, and superiority for relative reduction in donor skin area. RESULTS At 8 weeks, complete closure was observed for 58% of control areas compared with 65% of ASCS+STSG areas (p = 0.005), establishing noninferiority of ASCS+STSG. On average, 27.4% less donor skin was required with ASCS+ STSG, establishing superiority over control (p < 0.001). Clinical healing (≥95% reepithelialization) was achieved in 87% and 85% of Control and ASCS+STSG areas, respectively, at 8 weeks. The treatment approaches had similar long-term scarring outcomes and safety profiles, with no unanticipated events and no serious ASCS device-related events. CONCLUSION ASCS+STSG represents a clinically effective and safe solution to reduce the amount of skin required to achieve definitive closure of full-thickness defects without compromising healing, scarring, or safety outcomes. This can lead to reduced donor site morbidity and potentially decreased cost associated with patient care.Clincaltrials.gov identifier: NCT04091672. LEVEL OF EVIDENCE Therapeutic/Care Management; Level I.
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Affiliation(s)
- Sharon Henry
- From the University of Maryland Medical Center (S.H.), Baltimore, Maryland; John Peter Smith Health Network (S.M.), Fort Worth, Texas; Cook County Health (M.G.), Chicago, Illinois; Arizona Burn Center Valleywise Health (K.N.F.), Phoenix, Arizona; University Medical Center New Orleans (H.P.), New Orleans, Louisiana; MedStar Washington Hospital Center, Washington (J.S.), District Columbia; Metis Foundation (R.C.), San Antonio, Texas; Rhode Island Hospital (D.H.), Providence, Rhode Island; Carle Foundation Hospital (N.M.), Urbana, Illinois; Duke University Medical Center (D.A.B.), Durham, North Carolina; Kendall Regional Medical Center (H.M.), Miami, Florida; Lundquist Institute (G.S.), Torrance, California; Ohio State University Wexner Medical Center (A.C.), Columbus, Ohio; Temple University (L.R.), Philadelphia, Pennsylvania; University of California Irvine (T.C.), Irvine, California; University of Arizona (L.C.), Tucson, Arizona; University of Rochester (D.B.), Rochester, New York; Thomas Jefferson University Hospital (W.H.), Philadelphia, Pennsylvania; and Wake Forest Baptist Medical Center (J.A.M.), Winston-Salem, North Carolina
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Shin SE, Spoer D, Franzoni G, Berger L, Hill A, Sayyed AA, Noe N, Steinberg JS, Attinger CE, Evans KK. To Mesh or Not to Mesh: What Is the Ideal Meshing Ratio for Split Thickness Skin Grafting of the Lower Extremity? J Foot Ankle Surg 2024; 63:13-17. [PMID: 37619700 DOI: 10.1053/j.jfas.2023.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 08/26/2023]
Abstract
Split-thickness skin grafts can provide effective autologous wound closure in patients with dysvascular comorbidities. Meshing the graft allows for reduced donor site morbidity and expanded coverage. This study directly compares outcomes across varying meshing ratios used to treat chronic lower extremity wounds. Patients who received split-thickness skin grafts to their lower extremity for chronic ulcers from December 2014 to December 2019 at a single center were retrospectively reviewed. Patients were stratified by meshing ratios: nonmeshed (including pie crusting), 1.5:1, and 3:1. The primary outcome was clinical "healing" as determined by surgeon discretion at 30 days, 60 days, and the latest follow-up. Secondary outcomes included postoperative complications, graft loss, ulcer recurrence, progression to amputation, and mortality. A total of 321 patients were identified. Wound sizes and location differed significantly, with 3:1 meshing applied to the largest wounds (187.8 ± 157.6 cm2; 1.5:1 meshed, 110.4 ± 103.9 cm2; nonmeshed 38.7 ± 55.5 cm2; p < .0001) mostly of the lower leg (n = 18, 75%; 1.5:1 meshed, n = 23, 43.4%; nonmeshed n = 62, 25.7%; p < .0001). Meshed grafts displayed a significantly higher proportion of healing at 30 and 60 days, but no differences persisted by the final follow-up (16.5 ± 20.5 months). Longitudinally, nonmeshed STSG was associated with most graft loss (46, 19.1%; p = .011) and ulcer recurrence (44, 18.3%; p = .011). Of the 3 meshing ratios, 3:1 exhibited the lowest rates of complications. Our results suggest that 3:1 meshing is a safe option for coverage of large lower extremity wounds to minimize donor site morbidity.
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Affiliation(s)
| | - Daisy Spoer
- Georgetown University School of Medicine, Washington, DC; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | | | - Lauren Berger
- Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alison Hill
- Georgetown University School of Medicine, Washington, DC
| | - Adaah A Sayyed
- Georgetown University School of Medicine, Washington, DC; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Niki Noe
- Georgetown University School of Medicine, Washington, DC
| | - John S Steinberg
- Department of Podiatric Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
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Duan R, Liu C, Gao B. Surgical Treatment for Extensive Postburn Facial Deformity Using Tube Flap and Cervicofacial Flap. J Craniofac Surg 2024; 35:e34-e36. [PMID: 37707304 DOI: 10.1097/scs.0000000000009741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
The current concept of facial unit reconstruction has evolved from simple coverage of defects to the reconstruction of the 3-dimensional structure and delicate features. The reshaping of the middle third of the face, including the nose and cheek, remains a challenge for plastic surgeons due to its complex structure and the dynamic relationship between each part. In this article, the authors describe a clinical report of extensive facial burns with skin lesions in the middle third of the face. The 30-year-old female patient sustained burns throughout the full thickness of the skin burns on the entire nose and left cheek with hypertrophic scar. The authors performed an expanded cervical-facial flap and tube flap of the upper extremity to reconstruct the entire nasal and cheek region. The patient underwent 8 stages of the operation successively resulting in a satisfactory level of appearance and function.
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Affiliation(s)
- Ran Duan
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bovenberg MS, Williams PE, Goldberg LH. Assessment of Pain, Healing Time, and Postoperative Complications in the Healing of Auricular Defects After Secondary Intent Healing Versus Split Thickness Skin Graft Placement. Dermatol Surg 2024; 50:35-40. [PMID: 37910639 DOI: 10.1097/dss.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Reconstruction of auricular defects after Mohs surgery is challenging given the prominence of the ear and its complex 3-dimensional architecture. OBJECTIVE Evaluation of postoperative pain, healing time, and postoperative complications of auricular defects after split-thickness skin graft (STSG) placement versus secondary intent healing (SIH). MATERIALS AND METHODS During this prospective, observational study, 30 patients recorded their daily maximum postoperative pain using the numeric pain rating scale from postoperative days 0 to 8. Surgical site healing was assessed at postoperative day 8 and 30. All postoperative complications were collected during the 30-day follow-up window. RESULTS Patients undergoing STSG experienced significantly more pain during the first 3 postoperative days than patients in the SIH group. Maximum pain was experienced on the night of surgery, with a mean pain score of 3.6 in the STSG groups versus 0.8 in the SIH group. Healing was significantly faster in the STSG group, with 87% of patients fully healed at 1 week versus 21% in the SIH group. No major complications were experienced in either group. CONCLUSION Split-thickness skin graft and SIH healing are well tolerated and provide excellent repair choices for auricular defects.
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Affiliation(s)
- Maria Sarah Bovenberg
- Department of Micrographic Surgery and Dermatologic Oncology, The Methodist Hospital, Houston, Texas
- DermSurgery Associates, Houston, Texas
| | - Paige E Williams
- Department of Micrographic Surgery and Dermatologic Oncology, The Methodist Hospital, Houston, Texas
- DermSurgery Associates, Houston, Texas
| | - Leonard H Goldberg
- Department of Micrographic Surgery and Dermatologic Oncology, The Methodist Hospital, Houston, Texas
- DermSurgery Associates, Houston, Texas
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Yang HN, Liang Y, Han DW, Liu L, Xie JF, Tian SM, Xia CD, Wei Y. [Effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:1180-1184. [PMID: 38129306 DOI: 10.3760/cma.j.cn501225-20231101-00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To explore the effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns. Methods: A retrospective observational study was conducted. From January 2017 to December 2022, 14 children with bone and/or tendon exposed wounds in fingers after electric burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 9 males and 5 females, aged 2 to 11 years. A total of 38 fingers were affected, with 1 wound per finger. After debridement, artificial dermal coverage combined with vacuum sealing drainage was performed in all the wounds in the first stage, with wound area of 2.0 cm×1.0 cm-4.5 cm×2.5 cm after debridement. The second stage surgery was performed to close the wound with autologous thin intermediate thickness skin graft. Then the children were told to perform functional rehabilitation exercise as early as possible. The survival of autologous skin graft was observed at the 7th day after the second stage surgery. The wound healing time was recorded. After 12 months of follow-up, the Vancouver scar scale was used to evaluate the scar hyperplasia at the skin grafting site of the affected finger; the total action mobility (TAM) of the affected finger joint was measured for evaluating the functional recovery of the affected finger; a self-made efficacy satisfaction rating table was used to investigate the parents' satisfaction with the curative effect of the children. Results: At the 7th day after the second stage surgery, all the children had good survival of autologous skin grafts. The wound healing time was (24.1±2.7) d. After 12 months of follow-up, the scar score at the skin grafting site of the affected finger was 5.2±2.4; the TAM of the affected finger joint was (177±40)°; the functional assessment was good in 12 fingers, medium in 23 fingers, and poor in 3 fingers; the parents' satisfaction with the curative effect of the children in the survey was very satisfied in 10 cases, satisfied in 3 cases, and dissatisfied in 1 case. Conclusions: The combination of artificial dermis and autologous thin intermediate thickness skin graft is an alternative surgical method that can effectively repair the bone and/or tendon exposed wounds in fingers of children after electric burns. After wound healing, the scars are slight, the finger function is well recovered, and the parents of the children are highly satisfied with the curative effect of the children, which is worthy of clinical promotion.
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Affiliation(s)
- H N Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - Y Liang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - D W Han
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - L Liu
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J F Xie
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - S M Tian
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C D Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - Y Wei
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
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李 学, 张 玲, 孙 长, 张 辉, 李 文. [Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1496-1500. [PMID: 38130193 PMCID: PMC10739656 DOI: 10.7507/1002-1892.202310038] [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] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. Methods Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. Results All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. Conclusion The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.
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Affiliation(s)
- 学川 李
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 玲玲 张
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 长胜 孙
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 辉 张
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 文君 李
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
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Choi JH, Lee SH, Kim KS, Shin JH, Hwang JH, Lee SY. Palmar reconstruction using full-thickness skin grafts from the groin and lateral malleolus regions: A comparison of long-term outcomes. Medicine (Baltimore) 2023; 102:e36487. [PMID: 38115368 PMCID: PMC10727646 DOI: 10.1097/md.0000000000036487] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Using the skin of the lateral malleolus region for reconstruction of smaller areas of the palm may yield better outcomes than using the skin of the groin region. However, no previous study has provided long-term data comparing the groin and lateral malleolus regions as donor sites for full-thickness skin grafts (FTSGs) in palmar reconstruction. Therefore, this study aimed to compare the groin and lateral malleolus regions as donor sites for FTSGs in palmar reconstruction over a long-term follow-up period. The patients were classified into groin and lateral malleolus region groups (n = 15 each). Measurements were obtained at the graft site, the contralateral site corresponding to the graft site, and the donor site. A chromameter was used to measure skin color, and the Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the scar at the skin graft site. Compared to the groin region group, the lateral malleolus region group showed skin colors that were closer to the original color of the palm in terms of lightness and red/green values. Additionally, the lateral malleolus region group received better esthetic ratings in the POSAS. Our results revealed that using the lateral malleolus region for FTSGs in palmar reconstruction resulted in better outcomes than using the groin region, even over a long period.
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Affiliation(s)
- Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Hyuk Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Jeollanam-do, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Yousif J, Ceresnie MS, Hamzavi IH, Mohammad TF. Practical guidelines for the treatment of vitiligo with the melanocyte-keratinocyte transplantation procedure. Arch Dermatol Res 2023; 316:10. [PMID: 38038734 DOI: 10.1007/s00403-023-02761-9] [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] [Received: 08/24/2023] [Revised: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 12/02/2023]
Abstract
Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.
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Affiliation(s)
- Jenna Yousif
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI, USA
| | - Marissa S Ceresnie
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Tasneem F Mohammad
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA.
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Sanchez Figueroa N, Zheng E, Kuruoglu D, Martinez-Jorge J. The use of Integra Dermal Regeneration Template in the surgical management of revision penile inversion vaginoplasty: A case series. J Plast Reconstr Aesthet Surg 2023; 87:91-97. [PMID: 37826968 DOI: 10.1016/j.bjps.2023.08.001] [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] [Received: 03/28/2023] [Revised: 07/04/2023] [Accepted: 08/12/2023] [Indexed: 10/14/2023]
Abstract
Since its initial design and use for the temporary coverage of severe full-thickness burn defects, Integra® (Integra LifeSciences) Dermal Regeneration Template has been increasingly used all over the body, yielding successful results in coverage of wound beds with insufficient vascularity and suboptimal conditions for proper healing. In this study, we report an institutional case series and outcomes of gender-affirming vaginoplasty revision for vaginal lengthening or reopening of the canal via placement of Integra® to assist in optimizing the wound bed for subsequent skin grafting when wound conditions were deemed to be suboptimal. A retrospective chart review was conducted in patients who underwent this technique by a single surgeon (JM) at the authors' institution. Demographics, vaginal depth, and complications were recorded and compared. Our patient population thus far includes 178 primary vaginoplasties, of which 9 of those needing revision were treated with this approach. The age at revision mean was 47 ± 13.5 years, and the body mass index mean was 31 ± 4.1. All patients had comorbidities and five were former smokers. Eight patients had prior revision conducted without Integra®, with a mean of 1.89 ± 1.76 and the time to first revision mean was 15.89 ± 14.2 months. No long-term complications after Integra® reported and most of the patients did not require further revision. The follow-up mean was 8.48 ± 8.66 months. A mean of 6.77 ± 5.35 cm was gained after the Integra® revision (4.92 ± 4.1 cm before versus 12.54 ± 3.07 cm after). The final depth after Integra® + full-thickness skin graft mean was 13.34 ± 4.65 cm. Overall, the depth gain mean was 7.48 ± 5.77 cm; in total, seven patients gained depth after revision with an average of 78% skin graft take. Overall, Integra® presents an alternative option for revision vaginoplasty with complicated wound beds potentially aiding in the healing process before grafting.
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Affiliation(s)
| | - Eugene Zheng
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns 2023; 49:1816-1822. [PMID: 37369613 PMCID: PMC10721718 DOI: 10.1016/j.burns.2023.06.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION In lieu of limited studies on the timing of burn wound eschar excision for burns, a more comprehensive analysis is indicated to determine the effects of early wound excision following burns. This study aims to address the outcomes of early wound excision in burn patients. METHODS Data collection were from TriNetX research database. Three groups of burn patients were stratified by the number of days in which they received burn wound excision within 14 days of injury. Five outcomes were observed: death, wound infection, sepsis, myocardial contractile dysfunction, and blood transfusion. Risk and incidence of various health outcomes were compared between the groups after propensity-matching age, sex, ethnicity, race and burn size using a z-test with p < 0.05 considered significant. RESULTS We identified 6158 burn patients with wound excision within 14 days of injury, the majority of whom (60.1%) received burn wound excision between 0 and 3 days after burn. 72.5% of patients had burns covering less than 20% of total body surface area. After propensity matching, we found a significantly lower risk of mortality in those who received burn wound excision within the first three days (3.84%) as compared to 8-14 days after burn (6.09%) (p < 0.05). Moreover, we found a decreased risk of wound infection in patients with burn wound excision within 0-3 days (37.84%) compared to those 4-7 days (42.48%) (p < 0.05). No statistical difference was detected in propensity-matched groups for myocardial contractile dysfunction, blood transfusion, or sepsis. In addition, the risk of hypertrophic scaring significantly decreased when wound excision was performed within 0-3 days (22% within 0-3 days, 28% within 4-7 days, p < 0.05). CONCLUSION Burn wound excision within 3 days of injury is beneficial when comparing to later treatment between 4 and 14 days, which results in a significantly lowered risk of mortality and infection in burn patient.
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Affiliation(s)
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Tsola Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Alejandro Joglar
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - George Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, United States
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, United States.
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Gupta V, Singh G, Chanda A. Modeling of metamaterial based incision patterns for generating high expansions in skin grafts. Clin Biomech (Bristol, Avon) 2023; 110:106118. [PMID: 37806083 DOI: 10.1016/j.clinbiomech.2023.106118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Split-thickness skin grafting is a widely used treatment for burn patients. It requires removing a small portion of healthy skin, making parallel incisions on it, stretching it, and surgically implanting it into the burn site. Although skin graft mesher companies claim to significantly expand the size of the skin graft, in reality, the amount of expansion achieved is much smaller. METHODS This study aimed to improve the expansion potential of skin grafts by designing new incision patterns with auxetic properties, using a skin simulant material and additive manufacturing. The mechanical properties and digital image correlation was used to analyze the strain, effective Poisson's ratio, local strains, void area, and meshing ratio of the auxetic skin graft simulants. FINDINGS The results showed that the Y-shaped skin graft simulant had the highest effective negative Poisson's ratio, largest areal expansions, lowest maximum induced stresses and strains, and uniform strain distribution properties, making it the best choice for generating high expansions in skin grafts. INTREPRETATION The study found that the expansions were highly strain sensitive, with higher auxeticity observed at lower strains. The novel findings with auxetic skin graft simulants are expected to provide valuable insights for developing skin grafts with higher expansion potential in the future.
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Affiliation(s)
- Vivek Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India
| | - Gurpreet Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India
| | - Arnab Chanda
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), Delhi, India..
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Wu Y, Wang T, Song X, Xu A, Dai Y. Treatment of perioral vitiligo with a combination of upper hair follicle transplantation and the application of a 308 nm excimer laser. Skin Res Technol 2023; 29:e13547. [PMID: 38115595 PMCID: PMC10730977 DOI: 10.1111/srt.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Yi Wu
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Tao Wang
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Xiuzu Song
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Ai'e Xu
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Yeqin Dai
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
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Wang H, Hu X, Zhou H, Chen X, Wang M. The safety and effectiveness of a self-made negative pressure suction device in the treatment of chronic wounds. Skin Res Technol 2023; 29:e13415. [PMID: 38062667 PMCID: PMC10704041 DOI: 10.1111/srt.13415] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Chronic wounds are wounds that are not healed or have no healing tendency for more than 1 month due to various factors. In clinical nursing, chronic wounds are often not properly treated, and the treatment efficiency is low. Therefore, it is very important to explore effective methods to deal with chronic wounds. OBJECTIVE To explore the effect of a self-made negative pressure suction device (NPSD) in the nursing of chronic wounds in the elderly. METHODS A total of 50 elderly patients with chronic wounds who were hospitalised in our hospital from January 2020 to December 2022 were selected as participants by convenient sampling. According to the random number table method, they were divided into a control group and an observation group, with 25 people in each group. The control group was treated with chloroplast foam dressing, debridement gel and alginate dressing. The observation group was treated with a self-made NPSD on the basis of the control group. The wound healing of the two groups was observed. RESULTS After the intervention of the self-made NPSD, the granulation tissue coverage rate and wound volume reduction rate of the observation group were significantly increased (p < 0.05), and the positive rate of bacterial infection was significantly decreased (p < 0.05). After 3 months of intervention, the total effective rate of the observation group was significantly higher than that of the control group (χ2 = 3.869, p = 0.0492). CONCLUSION The self-made NPSD can effectively promote the healing of a chronic wound.
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Affiliation(s)
- He‐Ping Wang
- Department of NursingThe Second Affiliated Hospital Of Wannan Medical CollegeWuhuChina
| | - Xiu‐Li Hu
- Department of Wound Stomy ClinicThe Second Affiliated Hospital Of Wannan Medical CollegeWuhuChina
| | - Hua‐Qin Zhou
- Department of NursingThe Second Affiliated Hospital Of Wannan Medical CollegeWuhuChina
| | - Xi‐Shan Chen
- Department of NursingThe Second Affiliated Hospital Of Wannan Medical CollegeWuhuChina
| | - Meng‐Xin Wang
- Department of NursingThe Second Affiliated Hospital Of Wannan Medical CollegeWuhuChina
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Ma H, Zhong Q, Hou L, Feng L, He S, Lian M, Zhao Y, Wang R, Fang J. Application of prolonged submental perforator flap to repair the postoperative defect of upper airway malignancy. Eur Arch Otorhinolaryngol 2023; 280:5507-5518. [PMID: 37530858 PMCID: PMC10620253 DOI: 10.1007/s00405-023-08131-5] [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] [Received: 03/21/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy. MATERIALS AND METHODS This study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years. SITE OF LESIONS 15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages T2-4N0-2M0. SURGICAL METHOD The extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap. RESULTS Before the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis. CONCLUSIONS This study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.
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Affiliation(s)
- Hongzhi Ma
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Qi Zhong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Lizhen Hou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Ling Feng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Shizhi He
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Meng Lian
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Yanming Zhao
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Ru Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China
| | - Jugao Fang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China.
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China.
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张 子, 袁 玲, 金 文, 张 凤, 魏 在. [Anatomic study and clinical application of iliac crest chimeric tissue flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1418-1422. [PMID: 37987054 PMCID: PMC10662414 DOI: 10.7507/1002-1892.202307080] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023]
Abstract
Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
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Affiliation(s)
- 子阳 张
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 玲 袁
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 文虎 金
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 凤玲 张
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
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