The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site

Background  Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods  This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation  We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion  Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product.

A Study of Clinical Applications of Perforator-Based Propeller Flaps in Leg Reconstructive Surgery: A Single-Center Experience of 40 Cases

Soft tissue management in lower limb poses a considerable challenge to a reconstructive plastic surgeon. Perforator-based propeller flaps can cover large wounds without sacrificing a major vascular axis and allows reconstruction using nearby similar tissues, thereby following the principle of replace like with like. This study was undertaken with the objective to look for the results of propeller flap in lower limb reconstruction and how the results can be improved. This was a retrospective study on 40 patients who underwent the reconstruction of soft tissue defects of lower limb with propeller flap. All the relevant data were collected and analyzed. Patients with soft tissue defect anywhere in the leg were included, but patients who had history of degloving injury, peripheral vascular disease, and diabetes mellitus were excluded. All these patients were divided in 2 groups according to the angle of rotation of propeller flap. Group I had 20 patients in which the flap was rotated by 150° to 180°. Group II had 20 patients, and the flap was rotated by 90° to 150°. Postoperatively, the first 2 cases in Group I showed total flap congestion and had complete necrosis, which were debrided and an alternate method was used to reconstruct. Thereafter, no patient had total flap necrosis. Minor complications were seen in 3 patients who showed transient venous congestion of the flap. Group II had no flap necrosis except for mild dehiscence, which was managed by secondary suturing. In most cases, the aesthetic result was acceptable and patients were completely satisfied. When parameters of the defect are suitable for treatment with a propeller-based local flap, this technique may be considered as the first option for surgical reconstruction. Proper planning, location of perforator with preoperative and intraoperative audio Doppler, and use of magnification would make this procedure more successful and definitely decrease the use of long-duration microvascular surgery.

Vacuum-Assisted Wound Closure Therapy in Pediatric Lower Limb Trauma

Although the importance of vacuum-assisted wound closure therapy has been well established as road to definitive treatment of trauma wound in the adult population, its use in pediatric patients is not well described in the literature. This study was conducted to evaluate the outcome of vacuum-assisted wound closure therapy in pediatric patients. Twenty-two patients were prospectively treated for soft tissue defect in lower limb using vacuum-assisted wound closure device, as these wounds were not amenable for primary closure. After wound evaluation, thorough wound debridement was done. Vacuum-assisted wound closure dressing was applied once hemostasis was achieved. Dressings were changed as per protocol. After the development of healthy granulation tissue, wound coverage was achieved with skin graft or flaps. Mean age of patients was 9.455 years, ranging from 4 to 14 years. Early, healthy granulation tissue had formed in all patients. The average number of vacuum-assisted closure (VAC) dressings required was 2.682. Average duration of VAC therapy was 8.045 days. The sizes of soft tissue defects reduced from an average 69.18 cm2 to 50.73 cm2 after VAC therapy with a mean decrease of 26.66%. There was no complication because of VAC therapy. Vacuum-assisted wound closure therapy accelerated the process of healthy granulation tissue formation, and thus shortened the healing time. VAC therapy lessens the morbidity and pain associated with large wounds in pediatric patients and brings cheer and smile in growing children.

Hand amputations: epidemiology, management and resurfacing options for soft tissue coverage

OBJECTIVE

Agricultural hand injuries occur mainly among young adults, many affecting the dominant hand, thereby impeding patients' ability to work or cope with social obligations. This study was carried out with the aim of collecting data on the epidemiology and management of agricultural hand injuries in Indian subjects.

METHOD

The study was conducted in the Department of Plastic and Reconstructive Surgery, JN Medical College, AMU, Aligarh, India, from October 2009 to December 2013. Patients with agricultural hand injuries were included. Data collected included socio-demographic details, mode and type of injury, type of reconstruction, complications, length of hospital stay and assessment of post-reconstruction status. These data were tabulated and analysed.

RESULTS

The typical patient was young (mean 33.2 years), of lower socio-economic status and with a total disregard for safety regulations. There is clustering of cases during the wheat harvest season (April-June). Wheat thresher injuries were the most common cause of partial hand amputation (51%), especially during this season. This was followed by fodder cutting (kutti/chara) machine injury, especially in females and children (36%). A simple classification for these injuries has been described and Grade II injury was the commonest. Reverse radial forearm flap was the most suitable regional flap for coverage, whereas thoraco-umbilical flap was the most commonly used distant flap. Patients who had the single-stage procedure had a significantly shorter stay.

CONCLUSION

Agricultural hand injuries are not totally avoidable and their incidence can be reduced by proper education, but the low economic and literacy status of the patients is a big hurdle. The forearm offers many flaps for reconstruction of hand, which can be used in defects on dorsal or palmar aspect of hand and results in early discharge from the hospital and early rehabilitation. In patients with associated injury to the forearm, abdominal flaps can be used for cover.

Inferiorly based thigh flap for reconstruction of defects around the knee joint

Background:

Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint.

Aims and Objectives:

The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh.

Materials and Methods:

This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint.

Results:

Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site.

Conclusions:

The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.

Hemisoleus muscle flap in the reconstruction of exposed bones in the lower limb

OBJECTIVES

To evaluate the efficacy of soleus muscle flap for covering complex defects of the middle and lower leg. The study also outlines functional gain after the reconstructive procedure, the donor site morbidity and the technical details of the operative procedure.

METHOD

This prospective study consists of a total of 40 patients with middle and lower third defects with exposed bone present in the leg. In all cases, a proximally-based hemisoleus flap was used. All patients were between 15-65 years of age. Depending upon the position of the defect and ease of rotation, either the medial or lateral hemisoleus was used to cover the defects. In 7 patients with large defects, both the hemi-gastrocnemius and hemisoleus flap were used.

RESULTS

Most of the patients studied (52.5%) had defects in the middle third of their leg. A further 12(30%) patients had defects over the upper part of the lower third of the leg and 7(17.5%) cases involved large defects exposing bones comprising both the middle and lower thirds of the leg. All the flaps survived well except 5 which developed partial skin graft loss, and 1 where complete flap loss was observed. Out of 5 patients who developed partial graft loss, 3 patients achieved complete healing by regular dressings and 2 required regrafting. The patient who developed complete flap loss required below knee amputation. No donor site morbidity was observed, except minimal depression in the posterior leg.

CONCLUSION

Due to a high degree of reliability, versatility, minimal donor site morbidity, less operating time, low cost and good functional gain, this procedure is highly suitable for the treatment of complex middle and lower leg defects.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.