Donor Site Wound Research Articles

Use of a posterior pedicle nasal septum and floor mucoperiosteum flap to resurface the nasopharynx after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma

Endoscopic nasopharyngectomy is a new salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC). However, how to resurface the nasopharyngeal defects in endoscopic endonasal approaches to avoid persistent postoperative headache, to the best of our knowledge, has not been reported. From September 2009 to August 2010, we used a modified posterior pedicle nasal septum and floor mucoperiosteum flap (nasal septum and floor flap, NSFF) after endoscopic nasopharyngectomy in 12 patients with locally recurrent NPC. Most of the nasal septum and floor mucoperiosteum, except for the posterior pedicle, was harvested to cover the nasopharyngeal defects. All NSFFs successfully covered the entire nasopharyngeal defects and relined the nasopharynx with good functional recovery. The nasopharyngeal wounds recovered in 28 days (range, 14 to 56 days), and the donor-site wounds recovered in 46.5 days (range, 24-84 days). No reconstruction-related complications or disease recurrences were observed. The NSFF is a safe and promising reconstructive option to resurface the nasopharyngeal defect after endoscopic nasopharyngectomy in patients with locally recurrent NPC.

Improved skin wound epithelialization by topical delivery of soluble factors from fibroblast aggregates

IntroductionTimely coverage of an excised burn wound with a split-thickness skin graft, and efficient epithelialization at the donor site wound are key components in the treatment of burn patients. Prompt healing is dependent on paracrine support from underlying dermal connective tissue fibroblasts. Study aimUsing the skin graft donor site in pig as a model for epithelialization, our aim was to evaluate if dermal signals, derived from cultured dermal fibroblast aggregates (Finectra), can promote epidermal regeneration. Materials and methodsPartial-thickness skin wounds were made with a dermatome on the backs of three domestic pigs. After randomization, topical treatment was initiated by application of Finectra (n=6) or factors from standard fibroblast monolayer cultures (n=6) trapped in a slow-clotting fibrin matrix. Saline was applied to contralateral wounds to serve as corresponding untreated controls (n=12). After 3 days, full-thickness skin samples representing the whole wound area were obtained. Histological sections of these samples were analyzed for epithelialization, cell migration from lateral wound edges and hair follicles, as well as for formation of granulation tissue. ResultsIn response to topical delivery of Finectra, a significant acceleration of epithelialization (p<0.001) across the wound surface as well as from the wound edges was evident. Marked increase in thickness of granulation tissue (p<0.001) was noted in wounds treated with Finectra. Epihelialization originated from adnexal structures in which epithelial islets showed positive staining for cytokeratin-14 and PCNA. ConclusionThese data show that the fibroblast aggregate-derived paracrine mediators, Finectra, stimulate epidermal regeneration in vivo.

Clinical Trial Comparing 3 Different Wound Dressings for the Management of Partial-Thickness Skin Graft Donor Sites

A review of the literature reveals a lack of consensus regarding local management of skin graft donor sites. This study was undertaken to determine the effects of 3 different dressings on healing of donor sites and patient discomfort related to donor sites. This study is a comparison cohort study. We recruited 34 burn patients scheduled for partial-thickness skin grafts; their mean age was 36 ± 18 years (mean ± SD, range 20 to 54 years), and 63% were male. All subjects were managed at Burn Unity Care, located in Sao Paulo, Brazil. Subjects were randomly allocated to 1 of 3 groups: (1) a study group (group A) whose donor sites were dressed with a bovine collagen calcium-alginate dressing covered with transparent polyurethane film; (2) a second intervention group (group B), whose donor sites were dressed only with transparent polyurethane film dressing; and (3) a control group whose donor sites were dressed with rayon soaked in 0.9% saline (group C). Two independent observers assessed donor site wounds for epithelialization, scabbing, quantity and characteristics of exudate, and complications. Pain was measured using the visual analog scale, the brief pain inventory, and Index of Pain Management. Subjects managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film (group A) achieved the greatest epithelialization (6.3 vs 8.2 for thin film dressing only P < .02 and 6.3 vs 11.7 days for control group P < .01). Patients managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film also reported less pain that subjects allocated to the control (group C) or thin film only group (group B), (P < .05). Ninety percent of subjects allocated to the calcium alginate covered with thin film dressing reported mild pain intensity on the Visual Analog Scale, 85% of did not report pain localized to the donor site on the brief pain inventory, and scores on the Index of Pain Management ranged from 23 to 11. Study findings suggest that use of a collagen calcium-alginate dressing with a transparent film covering reduces the time for complete epithelialization and may reduce pain related to skin graft donor sites.

Which dressing do donor site wounds need?: study protocol for a randomized controlled trial

BackgroundDonor site wounds after split-skin grafting are rather 'standard' wounds. At present, lots of dressings and topical agents for donor site wounds are commercially available. This causes large variation in the local care of these wounds, while the optimum 'standard' dressing for local wound care is unclear. This protocol describes a trial in which we investigate the effectiveness of various treatment options for these donor site wounds.MethodsA 14-center, six-armed randomized clinical trial is being carried out in the Netherlands. An a-priori power analysis and an anticipated dropout rate of 15% indicates that 50 patients per group are necessary, totaling 300 patients, to be able to detect a 25% quicker mean time to complete wound healing. Randomization has been computerized to ensure allocation concealment. Adult patients who need a split-skin grafting operation for any reason, leaving a donor site wound of at least 10 cm2 are included and receive one of the following dressings: hydrocolloid, alginate, film, hydrofiber, silicone dressing, or paraffin gauze. No combinations of products from other intervention groups in this trial are allowed. Optimum application and changes of these dressings are pursued according to the protocol as supplied by the dressing manufacturers. Primary outcomes are days to complete wound healing and pain (using a Visual Analogue Scale). Secondary outcomes are adverse effects, scarring, patient satisfaction, and costs. Outcome assessors unaware of the treatment allocation will assess whether or not an outcome has occurred. Results will be analyzed according to the intention to treat principle. The first patient was randomized October 1, 2009.DiscussionThis study will provide comprehensive data on the effectiveness of different treatment options for donor site wounds. The dressing(s) that will prevail in effectiveness, satisfaction and costs will be promoted among clinicians dealing with such patients. Thus, we aim to contribute a well-designed trial, relevant to all clinicians involved in the care for donor site wounds, which will help enhance uniformity and quality of care for these patients.Trial registrationhttp://www.trialregister.nl, NTR1849. Date registered: June 9, 2009

Anatomically safe and minimally invasive transcrestal technique for procurement of autogenous cancellous bone graft from the mid-iliac crest

Open iliac bone harvesting techniques can result in significant complications and residual morbidity. In reconstructive procedures where a small volume of autogenous cancellous bone graft is required, a minimally invasive technique for bone harvesting applied at the mid-iliac crest has been deemed satisfactory. We sought to assess the application of a well-established surgical technique to procure adequate volume of autogenous cancellous iliac bone graft with minimal trauma to adjacent structures. We retrospectively reviewed the cases of patients who underwent a minimally invasive transcrestal mid-iliac bone graft procurement technique between May 2003 and December 2007. The technique was performed using a 3.5-mm Steinmann pin as a trocar and a 4.5-mm AO drill sleeve as a trephine. We administered a questionnaire, either in the clinic or by mail, to assess a number of parameters, including postoperative pain, dysthesia, parasthesia, status of the donor site wound and patient satisfaction. Of the 37 consecutive patients who underwent the procedure, data from 26 patients were available for assessment. Donor site pain resolved within a few days of the surgery, and none of the patients experienced symptoms of chronic pain. At the final review, none of the patients reported any unpleasant signs and symptoms related to the residual scar. We recommend that the described minimally invasive trephine method be used when a small cancellous bone graft is needed. We found that patient morbidity was significantly lower with the trephine harvest technique than with open bone harvesting methods at the anterior iliac crest.

Periosteum: A Highly Underrated Tool in Dentistry

The ultimate goal of any dental treatment is the regeneration of lost tissues and alveolar bone. Under the appropriate culture conditions, periosteal cells secrete extracellular matrix and form a membranous structure. The periosteum can be easily harvested from the patient's own oral cavity, where the resulting donor site wound is invisible. Owing to the above reasons, the periosteum offers a rich cell source for bone tissue engineering; hence, the regenerative potential of periosteum is immense. Although the use of periosteum as a regenerative tool has been extensive in general medical field, the regenerative potential of periosteum is highly underestimated in dentistry; therefore, the present paper reviews the current literature related to the regenerative potential of periosteum and gives an insight to the future use of periosteum in dentistry.

Multiple soft tissue defects of hand repaired by muliplefoliated tissue flap only pedicled by descending branch of lateral circumflex femoral artery

Objective To introduction of perforator flaps, muscle flaps pedicled by descending branch of lateral circumflex femoral artery, method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.Methods Fifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled by descending branch lateral circumflex femoral artery. At first, the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap, fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects. The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time. Results No vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months (the average was 8.7 months). Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent. Conclusion Multiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand. Key words: Hand; Lateral circumflex femoral artery; Tissue flap ; Microsurgery

Comparative Clinical Study of Bactigras and Telfa AMD for Skin Graft Donor-Site Dressing

The Bactigras® paraffin tulle coated with chlorhexidine is normally used for the treatment of donor-site wounds in burn patients who received split-thickness skin grafts in several centers. It has some disadvantages, such as adhesion to wound surfaces and pain from the irritation caused by this dressing. The Telfa AMD®, a non-adherent wound dressing which consists of absorbent cotton fibers impregnated with polyhexamethylene biguanide enclosed in a sleeve of thermoplastic polymers, is a new option for donor-site wound care which causes less adherence to the wound. The purpose of this study was to compare clinical efficacy of these two dressings for the management of donor-site wounds. Thirty-two patients who received split-thickness skin grafts by donor site harvesting from the thigh were enrolled in this study and randomized into two groups receiving either the Bactigras® or the Telfa AMD® wound treatment. Re-epithelialization, pain, infection and cost-effectiveness analyses were compared between both groups. The results showed that there was no significant difference in age, area of donor sites or length of hospital stays between the groups (p > 0.05). However, the day of re-epithelialization (≥90%) was significantly shorter in patients treated with the Telfa AMD® compared to the Bactigras® group (14.00 ± 3.05 vs. 9.25 ± 1.88 days for Bactigras® and Telfa AMD® groups, respectively, p < 0.001). The average pain score was also significantly lower in the Telfa AMD® group (1.57 ± 0.55 vs. 4.70 ± 1.16, p < 0.001). There was no difference in the cost of treatment between the groups (4.64 ± 1.97 vs. 5.72 ± 2.54 USD, p = 0.19). This study indicated that the Telfa AMD® was an effective dressing for the treatment of donor-site wounds.

Fibula Flap Donor Site Wound Healing with Compression Stockings

Objective: Investigate the efficacy of graduated compression stockings (GCSs) at improving donor site skin graft take after fibula free flap (FFF). Method: Retrospective review of 12 patients (13 donor sites) that underwent FFF for mandibular reconstruction over a 1-year period. One-third of the patients were instructed to use graduated compression stockings after removal of the initial wound-vac dressing. Wound healing was followed closely for all patients. Operative and comorbid factors were reviewed. Results: Two patients reported regular GCS use and 2 were non-compliant. Both patients with regular use had excellent wound healing and 90% to 100% skin graft take. Of the remaining 11 donor sites, 3 had no wound complications, 4 had minor wound complications, 3 had major wound complications, and 1 was lost to follow-up. Skin graft area varied with an average of 25 cm2 for GCS patients and 60 cm2 for non-GCS. Cardiovascular disease, alcohol use, and smoking were more common among the non-GCS group with strong tendency toward patients with major wound complications. Other operative and comorbid factors were similar between groups. Conclusion: Graduated compression stocking use demonstrates some promise for use in fibula free flap donor site healing. Patients wearing GCSs had excellent wound healing and no morbidities related to their use. Further studies are warranted to determine if improvement in fibular donor site wound healing occurs with GCS use.

Modified Lotus Petal Flap for Vulvo-Vaginal Reconstruction after Resection for Vulvar Cancer − A Single Institution Experience

Tumour of the vulva is an uncommon pathology that requires radical surgery with wide tumour excision associated with lymphadenectomy. The reconstruction after demolitive surgery is necessary, and the need of new flaps has led us to evaluate the feasibility and efficacy of the previously described lotus petal flap, a local subcutaneous pedicle rotation flap. However, the lotus petal flap has not yet come into wide use, moreover, in the literature there are still only few papers on this topic. From July 2007 to October 2010 we performed 69 modified lotus petal flaps in 41 patients at San Gerardo Hospital, Monza. 28 were bilateral flaps and 13 singular flaps. We report very few complications: 1 case of partial skin flap necrosis, 1 case of total flap necrosis and 2 cases of donor site wound breakdown. Mean age was 72 years (range: 53−87 years) and mean surgery time was 1 h 25 min (range: 45 min–2 h 45 min). The mean length of follow-up was 15 months (range: 4–42 months). Functional and ­aesthetic results were considered optimal. We believe that this flap represents an optimal solution to perineal reconstruction after radical vulvectomy because it has a low rate of complications, it is safe, easy and fast to perform and it has a good functional and ­aesthetic result.

Topical haemostatic agents for skin wounds: a systematic review

BackgroundVarious agents and techniques have been introduced to limit intra-operative blood loss from skin lesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon's preference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after split skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the effectiveness of haemostatic agents in donor site wounds.MethodsWe searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the Cochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and performed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were wound healing, adverse effects, and costs.ResultsNine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin sealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than thrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an up to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not directly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity, meta-analysis was impossible.ConclusionAccording to best available evidence, epinephrine and fibrin sealant appear superior to achieve haemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn debridement.

Toe artery terminal branch island flap for finger reconstruction and remodeling

Objective To study the feasibility of using toe artery terminal branch island flap for remodeling and reconstruction of finger shape. Methods From March 2008 to December 2009,19 fingers of 17 cases that were reconstructed by toe transfer had the toe artery terminal branch island flap inserted in the neck of the second toe during the toe transfer surgery to correct the appearance deficit caused by the narrow area. Results All 19 reconstructed fingers and the inserted toe artery terminal branch island flaps survived after the surgery. Donor site wound had primary healing. Postoperative follow-up lasted 6 to 17 months,with an average of 8 months. The appearance of reconstructed fingers was greatly improved. There was good recovery of pulp sensation,with two-point discrimination being 8 to 12 mm. Patients feel quite satisfied. Conclusion Toe artery terminal branch island flap corrects the deficit in appearance of fingers the palm side of the finger. Key words: Transplantation; Toes; Surgery,plastic; Finger reconstruction

Acute Propranolol and Insulin Infusion Stimulates Synthesis and Deposition of Muscle Protein Post Partial Thickness Donor Site Wound

Introduction Severe burn injury induces muscle catabolism. Harvesting of normal skin from non-burned donor sites is a preferred surgical option in severe burns, but it may provoke additional muscle breakdown. The aim of this study was to test whether propranolol or insulin administration improve muscle protein synthesis after surgical creation of partial thickness skin donor wounds. Methods A partial-thickness skin donor wound was created on the back of 21 rabbits. Catheters were placed in the carotid artery and jugular vein. A nasogastric feeding tube was placed for enteral feeding. On day 5, stable isotope tracers were infused. Animals were randomly assigned to control, insulin (2.5 mU/kg/min) or propranolol groups (1 mg/kg/h) (n=7 each). Arterial blood and leg muscle were collected during tracer infusion. The difference between groups was evaluated by non-parametric tests (Kruskal-Wallis and Wilconxon Rank-sum tests). A P value of < .05 was considered significant. Results The propranolol infusion decreased heart rate by 21%. The protein fractional synthetic rate in muscle was greater in the insulin and propranolol group (4.42 ± 0.26, 3.66 ± 0.20 vs. 3.10 ± 0.21 %/day, P < 0.05). Muscle protein fractional breakdown rates were not significantly different (P=0.092). The rate of protein deposition (synthesis - breakdown) was increased in both the insulin and propranolol groups vs. control (3.15 ± 0.39, 0.43 ± 1.13 vs. −0.22 ± 0.7%/day, P= 0.022). Conclusions Propranolol and Insulin infusion increased muscle protein synthetic rate and increased muscle protein deposition rate. These changes reflect a systemic response to the β-adrenergic blockade and to insulin treatment after surgical stress inflicted by harvesting of skin.

2D luminescence imaging of physiological wound oxygenation

In cutaneous wound healing, the role of oxygen in vivo is poorly understood. We studied wound surface pO(2) during physiological wound healing in humans. Split-thickness skin graft donor sites (n=12) served as standardized wound models. Wound surface pO(2) was measured at 1, 6 and 14days after split-skin harvesting using two-dimensional luminescence lifetime imaging (2D-LLI) of palladium(II)-meso-tetraphenyl-tetrabenzoporphyrin (Pd-TPTBP) in polystyrene-co-acrylonitrile (PSAN) particles on transparent foils. In another experiment, we removed the stratum corneum (SC) on the volar forearm (n=10) by tape strippings to study the impact of the SC on the epidermal oxygen barrier. Split-skin donor site pO(2) significantly decreased during the time course of physiological healing. Regional differences in pO(2) within donor site wounds were visualized for the first time in literature. No difference was found in pO(2) before and after SC removal, showing that the SC is not a major constituent of the epidermal oxygen barrier.

An Alternative Coverage for Split Thickness Skin Graft Donor Site Wounds

Diabetic foot and ankle soft tissue reconstruction poses a difficult challenge to the treating surgeon, especially in cases associated with previous infection or amputation. Maintenance of a functional, plantigrade limb is important with regard to prevention of persistent or recurrent cutaneous compromise following diabetic limb salvage. Wound coverage by means of application of a split thickness skin graft (STSG) is a useful technique; however, donor site wounds require care during the early postoperative period, and can pose a challenge to wound healing in and of themselves. In this article, we describe a technique of management of STSG donor site wounds that we have found to be useful and well tolerated by our patients.

Is the red-yellow-black scheme suitable to classify donor site wounds? An inter-observer analysis

Background The red-yellow-black-scheme (RYB) is a well-known and validated scheme to classify chronic and acute wounds, based on wound color and moistness. We investigated whether this RYB-scheme is also useful to classify donor site wounds uniformly (DSW). Methods Twenty-three digital photographs of DSWs in various stages of wound healing were presented to internationally renowned wound scientists ( n = 11), surgical doctors ( n = 31), specialized wound nurses ( n = 55), and surgical nurses ( n = 28). These observers classified the color and moistness of the wound according to the RYB-scheme, yielding seven wound categories. Inter-observer agreement (IOA) was expressed as a kappa ( κ) value. Results IOA's among specialized wound nurses were moderate when based on wound color and moistness ( κ = 0.41; 95% CI 0.33–0.49), wound color only ( κ = 0.41; 95% CI 0.29–0.53), or moistness only ( κ = 0.54; 95% CI 0.45–0.64). However, these IOA's tended to be better than those among the scientists, doctors and nurses. Scientists showed the lowest agreement ( k-values between 0.17 and 0.25). Doctors scored slightly better than nurses. Conclusion Clinicians and scientists have difficulty with classifying DSWs by means of the RYB-scheme. Therefore, this scheme does not appear useful to classify donor site wounds in a uniform manner.

Repair of cervicai cicatricial contracture with cervico-shoulder island skin flap

Objective To explore a better method to repair cervical cicatricle contracture deformity.Methods The cervicai cicatrical contraction deformity was repaird by the cervico-shoulder island skin flap with blood supply crossing and abundant anastomotic branches of the neck-shoulder blood vessels. After removing the cervical scar, the flaps were designed according to the size of the wound to be repaired, and the clinical anatomy of crossing and abundant anastomotic branches of the neck-shoulder blood vessels. The secondary wound of donor site was closed directly if the donor region was small, or closed by skin graft. Results Sixteen patients in this clinic were operated with this method, and venous return dysfunction occurred in 1 case, but blood circulation was improved after treatment. All the flaps survived with good appearance and texture. The extensive flap was created and transferred to the anterior neck by one stage without pre-expansion which met some patients'requirement of repairing cervical cicatricle contracture deformity. Conclusion The cervico-shoulder island skin flap, with abundant blood supply, is a new method to repair cervical cicatricle contracture deformity. Key words: Cervico-shoulder island flap; Repair; Cervicai cicatricial contracture; Deformity

Intensive insulin treatment increases donor site wound protein synthesis in burn patients

In the treatment of burns, patients' own skin is the preferred material to cover burn wounds, resulting in the need to create a donor site wound. Enhancement of healing of the donor site wound would be beneficial in burn patients. Insulin, an anabolic agent, is used routinely to treat hyperglycemia after injury. We investigated whether intensive insulin treatment increases fractional synthesis rate (FSR) of the donor site wound protein and decreases the length of hospitalization normalized for total body surface area burned (LOS/TBSA). FSR of the donor site wound protein was measured in pediatric patients randomized to control (n = 13) and insulin (n = 10) treatments. Depending on the postoperative day when the tracer study was done, studies were divided into "early" (days < 5) and "late" (days ≥ 5) periods. FSR of the donor site wound protein was greater in the insulin group at the "early" period of wound healing (control vs insulin, 8.2 ± 3.8 vs 13.1 ± 6.9% per day; P < .05); but not at the "late" (control vs insulin, 19.7 ± 4.6 vs 16.6 ± 4.0% per day; P > .05). Despite these differences, LOS/TBSA was not decreased in the insulin group. Correlation analyses demonstrated that, independent of the treatment regimen, FSR positively correlated (P < .05) with time after creation of the donor site and negatively correlated (P < .05) with LOS/TBSA. Insulin treatment increased FSR of the donor site wound protein in the early period of wound healing; FSR correlated with LOS/TBSA independent of the treatment regimen.

The Use of Glycerol-Preserved Skin Allograft in Conjunction with Reconstructive and Flap Surgery: Seven Years of Experience

Major reconstructive surgery may be extensive and prolonged, and it may cause edema and compromise the flap pedicle if closed under tension. Glycerol-preserved skin allograft (GPA) can provide a means for tension-free closure and temporary cover of the wound. Seven years of analysis on GPA used in conjunction with major reconstruction was undertaken to highlight its indications, results, and outcomes. Forty-seven patients were included, aged between 9 and 73 years. Majority of patients had reconstruction following tumor resection and trauma. The main indication for use of GPA was temporary, loose cover of the wound in 44% of cases; flap pedicle protection in 31% of cases; donor site wound cover in 10%; flap monitoring in one case; and management of flap-related complications in 6% of cases. Free flap reconstruction was performed in 72% of cases. In conclusion, GPA is a useful adjunct in reconstructive surgery. It can be used temporarily to allow tension-free wound closure, as well as to protect the flap pedicle until edema subsides and the pedicle becomes stable. This latter approach allows secondary wound closure and good esthetic outcome.

Reconstruction of Volar Digital Defects: Clinical Experience with the Hipothenar Flap

Soft tissue defects of the little finger especially for flexor injuries located on area ll, secondary to traumatic loss or contracture of soft tissue, infection or tumor, are challenging procedures for any hand surgeon. The reconstructive goal is to provide stable coverage to all noble structures exposed. Reconstructive options for this particular area include local, regional and free flaps, but all of them offer an important donor site morbidity. We present tree clinical cases of soft tissue defects of the little finger using the hipothenar fasciocutaneous reversed island flap, designed from the skin located over the abductor digiti minimi, which is on the basis of ulnar palmar digital artery. The donor site was closed primary. Clinical results were satisfactory and donor site wound healing was adequate.