Abdominal Skin Graft Research Articles

The application of mixed reality technique in oromaxillo-facial reconstruction with the perforator flap for malignant tumor patients.

The integration of quantitative imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with mixed reality (MR) technology holds promise for enhancing the diagnosis, prognosis, and treatment monitoring of cancer. This study compares the characteristics and effects of MR and color Doppler ultrasound (CDU) in the localization of perforator blood vessels in the lower extremities. Two techniques were used to locate the perforator vessels in 40 cases of maxillofacial defect repair using perforator flaps from the lower extremities. The number of perforator vessels located in the flap area and the actual number of perforator vessels explored during the surgery were recorded. The recognition rate was calculated and the operation time and blood loss were recorded for each case. The recognition rates of MR technology and CDU in perforating vessels of the lower limbs were 93.9% and 97.2%, respectively (p > 0.05). The operation time was 52-74 minutes, 65-88 minutes (p > 0.05). The average bleeding volumes were 24 and 56ml (p < 0.05), respectively. All perforator flaps were alive. One flap had a crisis and recovered after emergency exploratory treatment. Thirty donor sites of the lower extremities were directly sutured, and wounds were closed by abdominal skin grafting in 10 cases. MR technology for successfully identifying perforator vessels can shorten the operation time, reduce the amount of bleeding in the donor site, and reduce trauma to the donor site.

Functional and aesthetic outcomes of abdominal full-thickness skin grafts in paediatric postburn digital and palmar flexion contractures.

The study aimed to assess the functional and aesthetic outcomes of abdominal full-thickness skin grafts (FTSGs) in paediatric postburn digital and palmar flexion contractures. The digital and palmar functions and aesthetics of 50 children who met the criteria were evaluated at pre-operation, the 3rd- and 12th-month post-operation, respectively. In the evaluation, the Vancouver Scar Scale (VSS), total active movement (TAM), and Jebsen-Taylor Hand Function Test (JHFT) were used. The contralateral, unaffected hand served as the criteria for functional recovery. The complications of donor sites were observed, and the take rate of skin grafts was calculated. The VSS scores at the 3rd and 12th months post-operation were lower than those before the operation. The TAM of each finger was improved at the 3rd and 12th months post-operation, compared with that before the operation. There was a significant difference in the time to complete the JHFT between the affected hand and the unaffected at the 3rd month post-operation, but no significant difference between them at the 12th month post-operation. The excellent and good take rate of the skin grafts was 90.00%.No donor site complications were observed. The abdominal FTSGs are effective in repairing paediatric digital and palmar scar contractures, with satisfying functional and aesthetic results, especially in large defects after scar release and resection.

Urethral Reconstruction by Full Thickness Abdominal Skin Graft – Our Experience

Introduction: This study is an effort to develop an alternative to available graft sources for complex and long-segment strictures. For this to assess the outcome of harvesting a full-thickness abdominal skin graft for urethral reconstruction we conducted this study. Material and Method: The study was prospective type of observational study. Data were collected between June 2019 and November 2021 from patients underwent urethroplasty using full thickness skin grafts harvested from abdominal skin. Result: Total 16 patients followed up. Mean stricture length was 8 + 3.38 cm (range 5-12 cm). The aetiology [Figure 2] of urethral stricture included urethritis (6 patients), urethral trauma (7 patients), failed hypospadias repair (2 patient) and unknow (1 patient). The mean prepared graft length was 8.68 + 4.58 cm (range 7–14 cm), the mean operation time was 86.45 + 30.28 minutes (range 55 –130 minutes). Median follow-up was 24 months. 2 patients developed febrile urinary tract infections requiring oral antibiotics. 1 patient with history of urethritis developed recurrent stricture. So overall success rate is 93.75% with p value of &lt; 0.001; that is statistically significant. Conclusion: Selective use of abdominal skin grafts may be well suited for patients with long-segment urethral strictures in one or two stages when other graft sources are not available or feasible. Bangladesh J. Urol. 2021; 24(2): 175-180

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

Revision Vaginoplasty with Abdominal Full-Thickness Skin Graft

ABSTRACT Introduction Graft nonadherence can complicate the postoperative course of gender-affirming vaginoplasty with penile skin inversion. Some of the patients might be amenable to management with neovaginal packing. However, those with nonadherence involving the whole canal that persists despite prolonged packing would benefit from a revision surgery. Objective Herein, we report a case with poor graft take after penile inversion vaginoplasty (PIV) who was salvaged with a redo procedure using a full-thickness abdominal skin graft to resurface the neovaginal cavity. Methods This is a 53-year-old trans female who underwent PIV. Her postoperative course was complicated with complete graft nonadherence and neovaginal prolapse which persisted despite numerous packing/depacking sessions. Additionally, she developed urethro-neovaginal fistula due to packing-induced pressure necrosis. Urethral fistula was repaired primarily over a Foley catheter. At the last packing exchange session, her cavity was found to be patent with preserved dimensions. However, poor graft take did not resolve with conservative measures. The shared decision was to proceed with a redo procedure using abdominal skin to line the vaginal cavity. Results Vaginal packing and the previous skin graft were removed at the beginning of the procedure. Vaginal canal was copiously irrigated with 3 liters of saline. Cystoscopy confirmed urethral patency. There were no signs of fistula or stricture. Foley catheter was exchanged. A full-thickness skin graft, measuring 16 cm in length and 14 cm in diameter, was harvested from the abdomen. Graft was defatted and tubularized around a dilator (3.6 cm width x 14 cm length). The abdominal skin was elevated and midline was plicated with 2 sutures placed lateral to the umblicus. Abdomen was closed in a layered fashion over 2 15 Fr. drains. The skin graft was sutured to the apex of the vaginal canal as well as the side walls and introitus. Vault was suture fixated (with Prolene) to the levator side wall via anchoring device (Anchorsure system, Neomedic International). Graft was then quilted to the side walls by way of interrupted 2/0 Vicryl stitches, starting at the apex advancing towards introitus. A 15 Fr. drain was placed in the vaginal cavity beneath the skin graft and brought out through a seperate incision. Cavity was packed with vaginal pack soaked in Sulfamylon and lubricating gel. Procedure lasted 3 hours with an estimated blood loss amount of 250 ml. Packing was exchanged on day 7 and removed on day 14. She did well in the long run with no further problems with graft take and no recurrence of neovaginal prolapse. She was put on anticholinergics due to de-novo OAB symptoms. Conclusions Graft nonadherence after PIV can be initially managed with neovaginal packing. In patients with complete graft nonadherence refractory to packing and preserved neovaginal patency and dimensions, resurfacing the cavity with full-thickness abdominal skin graft can be considered as a viable salvage option. Fixating the apical part of the cavity to the levator side walls with an anchoring device will aid in preventing recurrence of neovaginal prolapse. Disclosure No

Repair of Donor Site Defects After Forearm Free Flap Harvest With Dual Triangular Flaps and in Situ Small Full-thickness Skin Flaps.

The aim of this study was to introduce a method for repairing donor site defects after harvesting forearm free flaps with dual triangular flaps combined with in situ small full-thickness skin flaps. Free forearm skin flaps were applied to repair defects after tumor resection in 25 patients with oral squamous cell carcinoma. Although forearm free flaps were prepared, dual triangular flaps and adjacent full-thickness skin flaps were designed and fabricated to repair donor site defects in situ. Twenty-five cases of forearm donor site defects were successfully repaired with dual triangular flaps combined with in situ small full-thickness skin grafts. All adjacent full-thickness skin grafts used to close the donor site defect of the forearm survived, and the wound healed well without delayed wound rupture or serious complications at the donor site. The movement of the elbow and wrist joint on the side of the flap was normal, the blood supply in the palm was normal, and the skin color at the donor site of the forearm skin flap was similar to that of the surrounding tissue. There was no dent deformity or contracture deformity. Moreover, there was no significant difference in swelling and wrist movement between the adjacent forearm skin grafting group and the abdominal skin grafting group, but the former technique reduced the risk of scar infection and tendon exposure and greatly improved the esthetics of the surgical site on the forearm. Modified donor dual triangular flaps combined with adjacent full-thickness skin grafts can reduce the recovery time during and after surgery and avoid trauma at a third surgical site. This method is worthy of practical application in the preparation of forearm skin flaps for oral and maxillofacial surgery.

Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study.

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ± 5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ± 6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ± 6.7 days) than in the skin grafts group (24.1 ± 5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.

Stricture of Urethra: Patterns and Outcomes of Management from a Single Centre in Pakistan Over 7 Years.

To determine the outcomes of urethroplasty and its complications from a large cohort of patients managed in a single centre. Descriptive study. Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from January 2010 to December 2016. A total of 546 patients with stricture urethra at different locations underwent urethroplasty from January 2010 to December 2016 were included. All patients had an ascending urethrogram followed by retrograde ± antegrade urethroscopy to assess the location and length of the stricture. Technique of urethroplasty was chosen according to the site, length and etiology. Following appropriate procedure, patients were followed up in the dedicated urethral stricture clinic. Procedure was considered successful if either no further therapeutic intervention was required and the maximum flow rate (Qmax) was >20 ml/sec with a voided volume of at least 200 mls. The procedure was regarded as unsuccessful, if further treatment was required or Qmax was <10ml/sec. A total of 546 patients with mean age of 32.3 +13.1 years (range: 12-74) involving anterior (n=323, 59.2%) or posterior (n=223, 40.8%) urethra were treated. Mean follow-up was 43.6 months (range: 3-84). The success rates of bulbar urethral strictures after excision and primary anastomosis (EPA) was 93. 3%, non-transecting urethroplasty 84.6% and oral mucosal graft (OMG), 81.8%. In penile urethral strictures, OMG, Orandi procedure and Johanson's techniques yielded success rates of 88.4%, 66.6% and 57.1%, respectively. In posterior urethral strictures, after excision and bulboprostatic anastomosis, good results were seen in 88.3%. In pan-urethral strictures, abdominal skin graft repair, combined tissue transfer and OMG urethroplasty yielded success rates of 74%, 78.5% and 75%, respectively. The complications/ adverse events were encountered in 251 / 546 (45.9%) patients in this series. Anastomotic urethroplasty yielded best outcomes followed by OMG urethroplasty. In the long-term follow-up, erectile dysfunction (ED), infertility and recurrence of stricture are the main complications which need individualised management.

Application of free modified first toe web skin flap for repair of finger web defect

Objective To explore the repair method and clinical efficacy of finger web defect of hand. Methods From January 2014 to December 2017, 7 cases with finger web defects were repaired by the first toe web flaps. Full-thickness abdominal skin grafts were used in all donor sites. Results All the 7 flaps survived and the donor site healed well. The follow-up period ranged from 6 to 12 months with an average of 8 months. The appearance and sensation of the free first toe web flaps recovered well after the operation. There was no obvious contracture in the reconstructed finger webs. The abduction angle was close to the normal finger web. There was no obvious scar hyperplasia in the donor site, and the walking function of the foot was good. Conclusion It is a better method to repair finger web defect with the first toe web skin flap, which can achieve satisfactory appearance and function of the hand. Key words: Surgical flaps; Transplantation; Finger webs; Microsurgery

Application of foot commonpedicle bilobed flap combined with iliac crest bone graft for repair of penetrating finger injuries

Objective To investigate the clinical efficacy of foot commonpedicle bilobed flap combined with iliac crest bone graft for reconstruction of penetrating finger injuries. Methods From November 2013 to December 2017, 7 cases of penetrating finger injuries were treated by foot commonpedicle bilobed flap or tibial second toe flap with iliac crest bone graft. The donor site of the toe was covered by lower abdominal free skin graft. Results All the flaps survived uneventfully. Partial necrosis of the toe donor site occurred in 1 case which healed after dressing change. The rest donor sites achieved primary healing. The healing time of bone was 2. 0 to 2. 5 months. Postoperative follow-up ranged from 3 to 12 months with an average of 6 months. No bone resorption was found in the transplantation of iliac bone. The flap had good texture and no obvious bulky appearance. The sensation of fingers and flaps recovered to S2to S4. Local scar hyperplasia in the donor site occurred in 1 case. There was no significant scar contracture and influence on foot function. The proximal interphalangeal joint activity of 6 cases without involvement of the proximal interphalangeal joint injuries ranged from 60° to 80° averaging 70°. Joint fusion in functional position was performed in 1 case of damaged proximal interphalangeal joint. Conclusion Foot commonpedicle bilobed flap combined with iliac crest bone graft is an ideal method for reconstruction of penetrating finger injuries. Key words: Finger injuries; Surgical flaps; Commonpedicle; Microsurgery

Cutaneous Breast Radiation-associated Angiosarcoma: Anterior Chest Wall Reconstruction Options Following Extra-radical Resection.

Radiation-associated angiosarcoma (RAAS) of the breast is a rare complication following breast irradiation with high rates of recurrence and death. To improve survival, we have advocated for an extra-radical resection where the entire irradiated skin and subcutaneous tissue is excised. This results in very large chest defects for which we describe our reconstructive experience. We performed a retrospective review of patients diagnosed with RAAS and treated with extra-radical resection followed by immediate reconstruction between 1999 and 2017. We analyzed reconstructive options, complications rates, length of stay, and operative times. Extra-radical resections were performed in 35 patients. We reconstructed these large defects with abdominal advancement flaps with split-thickness skin grafting in 25 patients and added a pedicled latissimus dorsi or omental flap in the 10 other patients. Skin grafts took well over the irradiated pectoralis major muscle with a median take rate of over 90%. Average operative times were 150 minutes for those treated with an abdominal advancement flap and skin grafting with a median length of stay of 5 days for all patients. Large anterior chest soft-tissue defects caused by extra-radical resections leaves defects too large to be covered by traditional breast reconstruction flaps. Abdominal advancement, latissimus dorsi muscle, and omental flaps along with skin grafts can be safely performed while leaving other traditional options open for future breast reconstruction.

Architecture of the Corpus Spongiosum: An Anatomical Study

Urethral reconstruction is performed for urethral stricture or hypospadias correction. Research on urethral tissue engineering is increasing. Because the corpus spongiosum is important to support the urethra, urethral tissue engineering should ideally be combined with reconstruction of a corpus spongiosum. We describe a method to visualize and measure the architecture of the corpus spongiosum, which is needed for scaffold design. The penis was dissected from 2 unembalmed male cadavers. One penis was flaccid and the other was erect, as induced by saline infusion. Both were frozen in ice. At 6 sites sections were obtained in the transverse and frontal directions. After digitalizing the stained sections the images were edited, area measurements were taken and a 3-dimensional reconstruction was made. In transverse sections the mean area of the vascular lumen was 60% and 77% in the flaccid and the erect corpus spongiosum, and in frontal sections it was 53% and 74%, respectively. This indicated a 129% transverse increase and a 140% longitudinal increase in erection. Section sites did not essentially differ except in the glans penis. Frontal sections showed larger vascular cavities and more incomplete septae than transverse sections. This study provides what is to our knowledge novel information on corpus spongiosum architecture, which is relevant for scaffold design in tissue engineering. The study protocol can be used in future research with a larger number of specimens and more extensive analyses.

Novel Local Full-Thickness Skin Grafts for Closure of Free Fibular Osteocutaneous Flap Donor Sites

The fibular flap donor site after skin paddle harvest is usually covered with abdominal full-thickness skin grafts. However, this kind of skin graft creates an inevitable third operative area and additional esthetic damage. The aim of this report was to present a novel approach to manage fibular donor site defects using a full-thickness skin graft from the adjacent area and avoid further esthetic damage in a third area. Seventeen patients underwent mandibular and maxillary defect reconstruction using free fibular osteocutaneous flaps and the fibular donor-site defects were covered with full-thickness skin grafts from the adjacent area. The skin harvesting sites were closed primarily. The skin donor sites were closed without dehiscence in all cases. Fifteen full-thickness skin grafts survived completely, whereas 2 grafts were partial failures. There were no complete skin graft losses. All fibular osteocutaneous flaps were viable, and the recipient sites had no complications. This study shows that adjacent full-thickness skin grafts provide a straightforward and reliable technique for closure of the free fibular osteocutaneous flap donor site. The primary advantage of this technique is the avoidance of a third surgical site, an additional surgical scar, and subsequent additional esthetic impairment.

Non-grafted Vaginal Depth Augmentation for Transgender Atresia, Our Experience and Survey of Related Procedures.

Neovaginal atresia especially following male-to-female transgender vaginoplasty is a distressing concern. A pelvic space must be re-created. Traditionally, an epithelial or mucosal lining is employed to cover the space. However, in our series of 18 patients, a non-grafted approach has been equally efficacious, as previously described by others. To follow the outcome of male-to-female transsexuals undergoing secondary depth enhancement without use of graft or flap. Patient selection included two operated on elsewhere, one of whom had a lower abdominal skin graft, and the remainder done here using an inverted penile skin flap supplemented by a scrotal graft extension as needed. The time lag from primary to revision surgery varied from 5 months to 23 years, average 3.7 years. The fascial plane of Denonvilliers was reopened and packed for 7 days to facilitate maintenance of a pelvic space. Patients are requested to perform serial self-dilations with a stent set indefinitely to maintain patency and procure additional depth. Immuno-histochemistry staining was performed to demonstrate estrogen receptor (ER) presence in male genital skin. Estrogen cream may be utilized to facilitate wound healing. Main outcome measures were post-operative depth results and Female Sexual Function Index (FSFI) scores. Several attempts were made to contact all patients for completion of a FSFI. Ten out of 18 responded. Following revision of the pelvic space, static depths increased two-fold on average, from 2.4 in. (6.2 cm) to 5.0 in. (12.7 cm). The FSFI domain scores (of desire, arousal, lubrication, orgasm, satisfaction, and pain) were all mid-range or above. Full scale FSFI scores (compilation score) averaged 23.4 (range limits 2-36). Histologic staining showed the presence of ER in genital skin of all genetic males tested regardless of estrogen usage and perceived gender. Given adequate development of the rectal-vesical space and preservation of that space with self-dilation, epithelialization will ensue providing sexual gratification for patient and partner (as per patient). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Risk of urethral stricture recurrence increases over time after urethroplasty.

To report a single institutional experience with urethroplasty outcomes and success rates at long-term follow up. A retrospective review was carried out of all urethroplasties performed by a single surgeon from 2000 to 2010. A total of 347 patients underwent urethroplasty during this time period, of which 227 had minimum 1-year follow-up data available. Demographic, clinical, pathological and outcome data were reviewed. Recurrence was defined by patient reported urinary symptoms or need for subsequent intervention. Statistical analyses were carried out using SPSS statistical software. A total of 26% of all patients had a recurrence at a mean follow up of 62 months (range 13-147 months). The recurrence rate after anastomotic urethroplasty was 18%, as compared with 31% after substitution urethroplasty. Mean time to recurrence was 34 months (range 5-87). On univariate analysis, use of abdominal skin graft, history of prior urethroplasty, lichen sclerosus and length of follow up were statistically significant predictors of recurrence. On multivariate analysis, only history of prior urethroplasty and length of follow-up time exceeding 48 months were statistically significant predictors of recurrence. Urethroplasty for urethral stricture is the most durable treatment modality, regardless of surgical approach. However, there is an ongoing risk of recurrence with the passage of time. Patients should be counseled appropriately on the potential for late recurrence of stricture disease after urethroplasty.

Long-term Outcomes of Urethroplasty With Abdominal Wall Skin Grafts

To report the long-term outcomes of urethroplasty using abdominal wall skin (AWS) grafts. Men with long-segment strictures, prior urethroplasty, and lichen sclerosus (LS) pose challenges in surgical management, including the choice of graft tissue for urethral reconstruction. AWS grafts are an alternative when buccal mucosa or penile grafts are not feasible or chosen by the patient. We retrospectively reviewed 238 patients who underwent urethroplasty (2000-2010) with at least 1 year of follow-up. Demographics, etiology, comorbidities, prior procedures, and surgical technique were analyzed for correlation with recurrence. Mean age was 42.9 years (range, 15-79 years), mean stricture length 5.6 cm (1-24 cm), and median follow-up of 59.3 months (12.5-147 months). A total of 58.4% patients had prior intervention, of which 15 patients (6.3%) had urethroplasty and 41 patients (17.2%) had hypospadias repair. Twenty-six patients (10.9%) underwent urethroplasty with AWS graft, whereas 107 (45.0%) and 12 (5.0%) patients were augmented with buccal mucosa or genital skin. Sixty-six patients (27.7%) had stricture recurrence at a mean of 34.5 months (range, 1.87-87.1 months). On univariate analysis, patients with AWS graft had longer strictures (P = .0001), were more likely to have LS (P = .0002), prior urethroplasty (P = .007), and recurrence (P = .002). On multivariate analysis, prior urethroplasty (odds ratio [OR], 5.3; P = .009), diabetes (OR, 2.6; P = .04), and LS (OR, 2.8; P = .05) were significantly associated with recurrence, whereas AWS graft was not (OR, 2.0; P = .28). AWS grafts are an alternative tissue source for urethral stricture, but may be associated with greater risk of recurrence. This may be secondary to patient selection, with this population often having other risk factors for recurrence.

Staged management of the open abdomen and enteroatmospheric fistulae using split-thickness skin grafts

BackgroundManagement of the open abdomen with polyglactin 910 mesh followed by split-thickness skin grafts allows safe, early closure of abdominal wounds. This technique can be modified to manage enteroatmospheric fistulae. Staged ventral hernia is performed in a less inflamed surgical field. MethodsA retrospective review was performed of 59 consecutive patients who underwent abdominal skin grafting for open abdominal wounds from 2001 to 2011. ResultsThe median length of follow-up was 215 days. Thirty-one percent of patients presented with preexisting enteroatmospheric fistulae, and 41% required polyglactin 910 mesh placement before skin grafting. Partial or complete skin graft failure occurred in 7 patients. Four patients required repeat skin grafting. All patients ultimately achieved abdominal wound closure, and none developed de novo fistulae. ConclusionsWith proper technique, skin grafting of the open abdomen with a planned ventral hernia repair is a safe and effective alternative to delayed primary closure.

Comparison of scalp and abdomen as split-thickness skin graft donor sites for aural stenosis repair

To evaluate and compare the scalp and the abdomen as split-thickness skin graft donor sites for aural stenosis repair. A total of 34 patients with aural stenosis were included in the study. All the patients underwent meatoplasty using split-thickness skin grafts. Among them, the skin graft donor site was the scalp in 11 patients and the abdomen in the other 23 patients. The surgical team followed the patients in the outpatient department for at least 6 months after surgery. Evaluations concerned healing of the donor site, hair regeneration of the donor site, survival of split-thickness skin grafts, reoccurrence of aural stenosis and hair growth in the ear canal. The incidences of reoccurrence of aural stenosis in the two groups were compared. Subjective scar evaluation of the donor sites was performed using the Patient Scar Assessment Scale (PASA). The scale items were pain, itching, color, stiffness, thickness and irregularity. All the scalp and abdominal donor sites healed well with no sign of infection. Hair regrowth and reepithelialization was observed at all the scalp donor sites. Pink discoloration was observed at the scalp donor sites in six patients 2-3 months after surgery and disappeared 6-9 months after surgery. Scars were observed at the scalp donor sites in two patients 6 months after surgery. No alopecia was observed at the scalp donor sites. The scars and pink discoloration were hidden in the hair. Scars and/or discoloration were observed at all the abdominal donor sites 12 months after surgery. All the scalp and abdominal skin grafts survived with no sign of infection. Hair growth was observed in the ear canals in two patients in the scalp group. The incidences of reoccurrence of aural stenosis were 0 % (0/23) in the abdominal group and 9.1 % (1/11) in the scalp group, respectively (Chi square test, p > 0.05). The PASA values about color, stiffness, thickness and irregularity were higher in the abdominal group than in the scalp group (Mann-Whitney U test, p < 0.001). The PASA values about pain and itching were the same (Mann-Whitney U test, p > 0.05). The scalp meets most requirements of an ideal donor site of skin grafts for aural stenosis. The advantages of scalp as a donor site include easy accessibility in the operative field, simple postoperative care, low risk of infection, rapid wound healing, minimal interference with rehabilitation, and minimal scar formation.

Mini-Abdominoplasty in Burn Reconstruction

The excision of excessive fat and subcutaneous tissue in the infraumbilical region, also known as "mini-abdominoplasty, " can be used to harvest skin for burn reconstruction. The resultant full-thickness grafts are less prone to contracture than split-thickness grafts. They are particularly useful in areas where mobility is important, such as the neck and areas overlying major joints. It allows a single-stage reconstruction with little donor site morbidity and favorable long-term functional outcomes. Multiple other donor sites have been reported, most commonly the groin and small pinch grafts on the trunk, but they provide only small amounts of skin when compared with the abdomen. The authors report 12 cases of patients who were treated for sequelae of burns with full-thickness abdominal skin grafts that were procured by mini-abdominoplasties for the sole purpose of obtaining the skin. The mini-abdominoplasty in this series was found to be an effective, safe technique that provides large amounts of full-thickness skin for reconstruction. While the size of the grafts varied with age and size of the abdomen, up to 40 × 15 cm can be obtained in adults. The donor site complications are rare but most commonly include seromas and dehiscence of the wound.

Urethroplasty With Abdominal Skin Grafts for Long Segment Urethral Strictures

Buccal derived graft tissue has been proven to be useful in urethral reconstruction. However, nonbuccal sources are often needed for long segment strictures or for those with prior buccal harvest. We describe a technique using full-thickness abdominal skin grafts for long segment urethroplasty and present the short-term outcomes. A total of 21 men underwent urethroplasty for strictures of an average of 11 cm (range 4 to 24) using abdominal wall skin. Prior urethroplasty was performed in 52% of patients and multistage repair was conducted in 48%. The recurrence rate following urethroplasty was 19%, with 9.5% requiring revision after first stage urethroplasty. Complications included hair from the skin graft during the early part of the series (14.5%), glans dehiscence (9.5%), urethrocutaneous fistula (9.5%) and periurethral abscess (1 patient). Histological evaluation at 6 months demonstrated excellent uptake of grafts with minimal keratinization. In men with significant penile scarring, lichen sclerosis and long segment urethral strictures the use of abdominal skin limits donor site morbidity, and provides a useful alternative graft source for urethroplasty when buccal mucosa or genital skin are not available or sufficient. Grafts should be harvested from nonhair bearing areas to minimize the risk of urethral hair development.