The 'Slide-by-Side' Full-Thickness Skin Graft for Large Donor Site Closure.

Local full-thickness skin graft of the donor arm—a novel technique for the reduction of donor site morbidity in radial forearm free flap

Introduction:The radial forearm free flap (RFFF) is a commonly used free flap for the reconstruction of orofacial defects because of its versatility and reliability. The donor site is closed with either split or full-thickness skin graft, and one of the common donor site morbidities is skin graft failure. Various techniques to minimise skin graft failure were reported, and we compared the skin graft techniques with and without plaster back slab dressing in the radial forearm donor site.Materials and Methods:This is a retrospective study of 75 patients who had RFFF for reconstruction of oral cavity cancer at two different tertiary teaching hospitals in the United Kingdom between April 2015 and March 2020. Thirty-nine patients from Hospital one had volar back slap, bolster dressing and crepe bandage. In contrast, 36 patients from Hospital two had only pressure dressing without a back slab.Results:The mean age of the study population was 60.65 (P = 0.274). In both groups, two patients had donor site complications. However, there was no significant difference in the donor site skin graft complications with a P = 0.662.Discussion:There was no evidence in the literature to support an ideal bandage for skin graft at the RFFF donor site. Our comparison of two techniques of skin graft dressings with and without back slap did not show any difference in the skin graft take, and the volar back slab did not add any additional benefits. The simple use of foam as a bolster dressing without a back slab is ideal for the radial forearm free flap donor site.

To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns.Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022.

One preferred technique to replace lost skin on the face is to use a full-thickness postauricular skin graft. Many years ago, when requiring a full-thickness skin graft after removal of a large skin cancer on an older lady, I noted that when she was lying down she had a remarkable amount of excess skin in the preauricular area. She had a rather stiff neck, and it seemed that taking a postauricular skin graft would aggravate her stiff neck, and perhaps mine as well. I therefore took a preauricular skin graft, marking an ellipse as required. I incised through the skin, barely into the dermis, and removed the graft quite readily with a number 10 blade, much as one would de-epithelialize the area around a nipple with a breast reduction. The skin taken required no further modification, and was simply used in the defect left by removal of the tumour. Closure of the donor site was readily accomplished by excising the residual elements of dermis and some fat. A subcuticular repair was readily performed, which turned out to leave an indiscernible mark, much as with a facelift incision. Her only complaint was that the donor site cheek looked so much better than her opposite cheek because the skin had been tightened to an extent that made her look somewhat younger. I have continued to use the preauricular skin graft as the procedure of choice for full-thickness skin grafts on the face since that time. I find the skin is in fact superior in quality to the postauricular graft. The donor site scar is minimal, because the typical person requiring a graft of this sort usually has a significant excess of skin on the cheek. The donor site morbidity is also much reduced. With the traditional postau-ricular skin graft, the patient’s glasses often irritate the incision line. The largest area I have taken to date measures 55 mm × 25 mm. I also have found that the time required to peform this procedure is about one-half of that required to harvest postauricular skin. A typical donor and recipient site are shown at two months postoperatively (Figures 3 and ​and44). Figure 3) Typical donor site two months postoperatively Figure 4) Typical recipient site two months postoperatively In summary, a preauricular skin graft, in my opinion, has many advantages and is much less of a pain in the neck for all concerned.

Dorsal hand coverage

Biomechanical and aesthetic outcomes following radial forearm free flap transfer: comparison of ipsilateral full-thickness skin graft and traditional split-thickness skin graft

Use of vacuum sealing drainage therapy in the closure of a radial forearm flap donor site defect with a full-thickness skin graft

Donor site morbidity in cross-finger flaps

Full thickness skin graft (FTSG) gives better outcomes than split thickness skin graft (STSG), but it has the drawback of limited donor sites. Anterolateral thigh (ALT), a popular donor site of STSG, is also a popular donor site of perforator flaps. This area has the advantage of large flap size available with primary closure. Based on this we harvested FTSG instead of STSG from the ALT. We retrospectively reviewed 10 cases of FTSG from the ALT, with the recipient site of foot in 3, ankle in 2, lower leg in 2, forearm in 2, and wrist in 1 patient. In all cases elliptical full thickness skin was harvested from the ALT, and the donor site was closed primarily. The skin was defatted and placed onto the defect with vacuum-assisted closure (VAC). The skin size ranged 7-30 cm in length and 3-12 cm in width. Mean follow up period was 7 months (range, 3-13). FTSG from the ALT provided durable wound coverage, with excellent color and texture matching. Partial (< 20%) graft failure was observed in 1 case, but no additional surgery was necessary. No patient reported donor site pain at postoperative 2 weeks. No donor site complications were encountered. No patient complained a feeling of tension in the thigh at final follow-up. FTSG from the ALT is feasible with the aid of VAC. Considering the skin quality, large skin size available, early pain relief, and little donor site morbidity, the ALT should be revisited as a donor site of FTSG.

ObjectivesFull thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery.Materials and MethodsIn a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records.ResultsThe width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%).ConclusionFTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Full thickness skin grafts (FTSGs) remain a good option for resurfacing defects of the face, neck, and dorsum of the feet. It results in soft, pliable, functional skin with minimal contraction. However, FTSG may result in patchy or irregular "take" resulting in recurrent contractures and pigmentary discrepancies. This study examines the use of a negative pressure dressing (NPD) to increase FTSG take. Wounds resulting from trauma, postburn contracture release, and an excision of a congenital nevus were included in the study. The wounds were prepared by surgical excision or debridement. A NPD was then applied for a period of 7 days, at which time the wounds were inspected and, if there was sufficient granulation tissue, covered with a FTSG. If the wound had not yet granulated sufficiently another NPD was placed and reassessed in 7 days. The FTSGs were harvested from the groin and abdominal area exactly to the size of the defect. A sponge bolster dressing was then applied. The take of the FTSG was judged using a grid of 1 x 1-cm squares. The wounds were measured and the amount of graft take was calculated as a percentage of the wound size. Complications in both the wound as well as the donor sites were noted. Twenty-four patients were included in the study. The mean age was 6 years (range 1-14 years), including 9 burn contracture excisions, 14 road traffic accident-related injuries, and 1 excision of a congenital nevus. The site involved was the foot (6 patients), ankle (9 patients), axilla (2 patients), forearm (4 patients), face (2 patients), and the neck (1 patient). The average surface area of the defect was 78 cm2 (range 18-264 cm2). Groin skin was harvested in all the cases. The NPD was applied on average for 8 days (range 7-15 days). The mean graft take was 95% (range 70%-100%). Only 1 patient had significant graft loss of 30%. Donor site morbidity was low, attaining primary closure in all but 2. Mean follow-up was 9 months. The results of this study confirm that the use of NPD enhances FTSG take.

Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management. Between January 2010 and January 2020, all perineal debridement operation notes were examined. The primary conclusions were that a large majority of defects could be repaired using split skin grafts to reduce surgical time and donor site morbidity. To avoid secondary contracture and the need for revision surgery, full-thickness skin grafts should be used whenever possible to treat penile defects.

BACKGROUNDGrafting split-thickness (STSGs) and full-thickness skin grafts (FTSGs) are common techniques to replace missing skin and to restore the skin barrier in burn, trauma and remaining skin defects after tumor resections. The defect coverage with skin grafts offer many advantages, but also disadvantages such as donor site morbidity like possible sensory disturbances, scarring, risk of infection, contour changes and pigment disorders. We aimed to assess the preferred distribution of donor site for STSGs and FTSGs in patient’s skin grafting for plastic-surgical defect coverage.METHODSPatients and their accompany persons referred to the Department of Plastic Surgery were interviewed for defect coverage with STSGs or FTSGs, the preference in donor site was investigated and the detailed advantages and disadvantages were clarified. RESULTSWe evaluated 85 participants (male=43, female=42) with a median age of 42 years (mean=46 years). The definition of the donor site (n=188 markings) was mainly based on the physicians recommendation (32.98%), mobility (23.40%), aesthetic results (22.34%) and pain (21.28%). Feared complications (n=152) were mainly wound healing disorders (32.24%), circulation disorders (28.29%), scars (20.39%) and bleeding risks (19.08%). Among all participants, 79 split-skin graft preferences were specified, while 32% favored the scalp as a donor site, as well as 29% the frontal part of the left thigh and 10% the frontal part of the right thigh. CONCLUSIONThere were preferred anatomical donor sites for skin grafting. Nevertheless, in conscious patients, the donor site has to be selected in a consent talk and joint approval, preoperatively. The options of taking STSGs from the occipital region with all its advantages should be discussed intensively as it is an attractive graft donor site.

A Comparison of Full and Split Thickness Skin Grafts in Radial Forearm Donor Sites