Burow's Graft Research Articles

Reconstructive options for cutaneous dorsal hand defects.

Moderate to large dorsal hand defects pose reconstructive challenges owing to the small surface area, immobile adjacent finger tissue, and thin, fragile skin. To present reconstructive options for moderate to large dorsal hand defects. First, a brief review of dorsal hand reconstructive options is discussed. Then, three approaches to reconstructing dorsal hand defects are presented based on the amount of available underlying tissue and location of the defect on the hand. In the authors' opinion, for larger defects on the mid-distal 1st-3rd metacarpals, the single arm rotation flap is preferable. For medium-sized defects with underlying soft tissue, a Burow's graft is appropriate. The O-Z flap is best for medium- to large-sized defects on the proximal half of the metacarpals. Defects of the digits are excluded. The O-Z rotation flap, single arm rotation flap, or Burow's graft can be used to reconstruct the majority of moderate to large dorsal hand defects.

Aesthetic Outcomes of Nasal Burow's Grafts With Interdomal Sutures After Mohs Micrographic Surgery.

Post-Mohs reconstruction of distal nasal defects is challenging. Many repair options exist, each with advantages and disadvantages. Utilization of a Burow's graft in combination with manipulation of the underlying nasal cartilages with interdomal sutures is an underreported yet effective repair option. To present the authors' experience with Burow's grafts facilitated by interdomal sutures for repair of nasal defects after Mohs micrographic surgery (MMS). Patients who underwent repair with Burow's grafts and interdomal sutures from 2013 to 2017 at a single university were identified. Demographics, follow-up, and complications were recorded. Two independent, board-certified dermatologists evaluated photographs for cosmesis and alar symmetry. Thirty-one patients were identified. A total of 5/31 patients (16.1%) experienced minor complications without permanent sequelae. A total of 4/31 (12.9%) patients underwent cosmetic revision. No incidences of pincushioning, nasal valve dysfunction, or graft necrosis occurred. Aesthetic ratings were good to excellent with mean visual analog score of 80.8. Alar symmetry was excellent. A Burow's full-thickness skin graft facilitated by an interdomal suture to maintain nasal tip orientation and projection is an elegant repair technique for distal nasal oncologic defects with good to excellent aesthetic outcomes. It should be considered in the armamentarium for repair of distal nasal defects after MMS.

Applications of Burow's Grafts in the Reconstruction of Mohs Micrographic Surgery Defects.

Surgical defects in anatomically challenging locations, such as near free margins or crossing cosmetic subunits, may present reconstructive challenges to the dermatologic surgeon. For selected defects, Burow's grafts may produce functional and aesthetic results in a single operative session. To describe the applications of the Burow's graft technique for the repair of defects after Mohs micrographic surgery. An institutional review board-approved retrospective database review of surgical defects repaired with Burow's grafting after Mohs micrographic surgery at the Medical University of South Carolina was performed. The general technique of Burow's grafting is described, emphasizing proper graft sizing and direction of tension vectors. Varying anatomic locations and defect types are presented, with site-specific considerations and operative photographs. Burow's grafting provides ideal color and textural match, preserves subunit boundaries, results in a compact single-site wound, and may avoid complications of alternate repair choices. The tension vectors produced in closing the graft's harvest site may be designed to prevent distortion of free margins. Burow's grafting may be combined with hinge flaps to repair deep or avascular defects. Burow's grafts are reproducible, aesthetic, and useful reconstructive choices for a variety of surgical wounds.

Single-Stage Reconstruction of Nasal Ala and Perialar Defect with Island Pedicle Flap and Burow's Graft

Single-Stage Reconstruction of Nasal Ala and Perialar Defect with Island Pedicle Flap and Burow's Graft

Single-Stage Reconstruction of Nasal Ala and Perialar Defect with Island Pedicle Flap and Burow's Graft

The authors have indicated no significant interest with commercial supporters.

Fusiform Elliptical Burow's Graft: A Simple and Practical Esthetic Approach for Nasal Tip Reconstruction

Reconstruction of cutaneous nasal tip and supratip defects presents a common challenge in which esthetic outcomes are dependent on appropriate flap or graft selection and execution. We describe the fusiform elliptical Burow's graft, a modified full-thickness skin graft, for repair of moderately sized nasal tip and supratip defects. It has the advantage of being a one-stage procedure with incisions and undermining similar to a primary closure. This technique allows the defect to become smaller in size and shallower in depth while taking the shape of a fusiform ellipse confined to a single cosmetic subunit. The color and texture match of the adjacent Burow's skin graft combined with its fusiform elliptical shape allow it to blend in more naturally with the nasal tip contour compared with the traditional circular-shaped Burow's graft, which is typically used on the nose. The fusiform elliptical Burow's graft is a simple, reliable, easily reproducible, and esthetically pleasing technique for repair of defects on the nasal tip and supratip.

Combined Linear Closure and Burow's Graft for a Dorsal Nasal Defect

An 80-year-old man with a history of nonmelanoma skin cancers of the head and neck presented for treatment of a basal cell carcinoma of the nose. Physical examination revealed a poorly defined, exophytic, ulcerated nodule of the mid-dorsal nose. Given the size, location, and ill-defined margins of the tumor, Mohs micrographic surgical excision was indicated. The tumor was excised in three stages with microscopic control. The final defect was full thickness of the dermis, sparing the underlying muscle and measuring 3.2 x 2.4 cm on the mid-dorsal, supratip, and lateral aspects of the nose (Figure 1). How would you repair this defect?

Burow's grafts in the facial region

Full-thickness skin grafts are an important tissue source for reconstructive surgery. Burow's grafts are full-thickness skin grafts that use adjacent lax skin as the donor site. This technique has also been referred to as island grafts, dog-ear grafts or adjacent-tissue skin grafts. The objective was to describe the technique of Burow's grafts for reconstruction of facial defects taking account of its benefits and limitations. The operative technique is simple: after a circular excision of the cutaneous lesion, we enlarged the excision line (towards one or both sides of the defect) following the relaxed tension lines. We created a secondary triangular defect by excising skin that is then used for the graft (as donor site). After adequate undermining, we proceeded to direct linear closure of this secondary defect. Finally, the graft was placed and sutured in the remaining defect. The proximity of the donor site provides an excellent tissue match because colour, hair density, texture, sebaceous features and thickness are similar to the recipient site. A good cosmetic result is therefore ensured. Burow's grafts can be a good choice for reconstruction of extensive facial surgical defects because of aesthetic results. In addition, it is a simple technique that can be performed in one sole surgical act, with local anaesthesia and without changing the operative site.

Fusiform Elliptical Burowʼs Graft

BACKGROUND Reconstruction of cutaneous nasal tip and supratip defects presents a common challenge in which esthetic outcomes are dependent on appropriate flap or graft selection and execution. OBSERVATION We describe the fusiform elliptical Burow's graft, a modified full-thickness skin graft, for repair of moderately sized nasal tip and supratip defects. It has the advantage of being a one-stage procedure with incisions and undermining similar to a primary closure. This technique allows the defect to become smaller in size and shallower in depth while taking the shape of a fusiform ellipse confined to a single cosmetic subunit. The color and texture match of the adjacent Burow's skin graft combined with its fusiform elliptical shape allow it to blend in more naturally with the nasal tip contour compared with the traditional circular-shaped Burow's graft, which is typically used on the nose. CONCLUSION The fusiform elliptical Burow's graft is a simple, reliable, easily reproducible, and esthetically pleasing technique for repair of defects on the nasal tip and supratip.

The use of the melolabial Burow's graft in the reconstruction of combination nasal sidewall-cheek defects.

Combination defects involving both the nasal sidewall or ala and cheek can be challenging to reconstruct. Patients with skin cancers involving the nasal sidewall or ala and medial cheek treated with Mohs micrographic surgery were reconstructed using a cheek advancement flap in combination with a melolabial Burow's graft. This technique provides a simple, reproducible, and cosmetically excellent method of repairing these defects. The use of this repair provides superb tissue matches and maintains natural aesthetic subunits, yielding an excellent result with minimal morbidity.

The Use of the Melolabial Burowʼs Graft in the Reconstruction of Combination Nasal Sidewall–Cheek Defects

BACKGROUND Combination defects involving both the nasal sidewall or ala and cheek can be challenging to reconstruct. METHODS Patients with skin cancers involving the nasal sidewall or ala and medial cheek treated with Mohs micrographic surgery were reconstructed using a cheek advancement flap in combination with a melolabial Burow's graft. RESULTS This technique provides a simple, reproducible, and cosmetically excellent method of repairing these defects. CONCLUSION The use of this repair provides superb tissue matches and maintains natural aesthetic subunits, yielding an excellent result with minimal morbidity.

The use of full-thickness skin grafts to repair nonperforating nasal defects

Background: Full-thickness skin grafts are traditionally thought of as inferior alternatives to local flaps in nasal reconstruction. Objective: Our purpose was to demonstrate that full-thickness skin grafts are viable alternatives to local flaps in the reconstruction of nonperforating defects extending through the dermis of the nose. Methods: The literature was reviewed to determine the best donor sites for full-thickness skin grafts to repair defects on different regions of the nose. Results: The optimal donor site for the repair of defects on the thin skin of the upper two thirds of the nose (dorsum and sidewall) is the preauricular area. The best donor site for the repair of defects on the thick, sebaceous skin of the lower one third of the nose (tip and ala) is the conchal bowl of the ear. Defects located on the transition zone between the upper two thirds and lower one third of the nose are best repaired with Burow's grafts or nasolabial fold grafts. Conclusion: Full-thickness skin grafts are excellent alternatives to local flaps in the reconstruction of nonperforating nasal defects provided that the surgeon selects the appropriate donor site based on whether the surgical defect is located on the thin, pliable skin of the upper nose or the thick, sebaceous skin of the lower nose. (J Am Acad Dermatol 2000;42:1041–50.)

Answers to Self-Assessment examination of the American Academy of Dermatology

Postoperative defects of the distal aspect of the nose are a common challenge for reconstructive surgeons. Options for the defect depicted in Fig. 5 of the examination include a bilobed transposition flap, bilateral rotation flaps from the dorsal aspect of the nose (i.e., Peng flap), a full-thickness skin graft from a postauricular donor site, and a full-thickness skin graft from a superior Burow's triangle after partial primary closure (i.e., Burow's graft). Except in a patient with a broad nasal tip or with a small defect, primary closure is often impossible.

Burow's grafts

The Burow's graft is a useful technic for wound reconstruction with the use of a full-thickness skin graft obtained from skin adjacent to the wound. This donor site provides skin with a better color, texture, and thickness match than traditional donor sites. The indications, technic, and disadvantages are discussed.