Free Skin Graft Research Articles

СОВРЕМЕННЫЕ СПОСОБЫ ВЫПОЛНЕНИЯ СВОБОДНОЙ КОЖНОЙ ПЛАСТИКИ ПОЛНОСЛОЙНЫМИ АУТОТРАНСПЛАНТАТАМИ

СОВРЕМЕННЫЕ СПОСОБЫ ВЫПОЛНЕНИЯ СВОБОДНОЙ КОЖНОЙ ПЛАСТИКИ ПОЛНОСЛОЙНЫМИ АУТОТРАНСПЛАНТАТАМИ

Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm multiply 4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect, and an end-to-side anastomosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap's vascular pedicle. A split thickness free skin graft was used to cover the muscle flap and around the flap's vascular pedicle. The vascular pedicle was cut off after 28 days and the muscle flap survived completely. After 3-year follow-up postoperatively, the right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations. This technique can be used to preserve the flow and patency of recipient arteries.

Anatomical and histological study to determine the border of sole skin.

Transfer of a free skin graft from the submalleolar or plantar instep area to the palmoplantar area and finger defects is widely performed; however, the sites and the border of plantar skin have yet to be examined in detail. The aim of this study was to determine the border of sole skin. Twelve paraformaldehyde-fixed cadavers were examined. Skin specimens were harvested from an area from the top of the medial malleolus extending to the top of the lateral malleolus of the right foot. The paraffin-embedded skin specimens were analyzed using histological (hematoxylin and eosin, Fontana-Masson, and elastica van Gieson stains) and immunohistochemical (cytokeratin 9) techniques. CK9-positive cells were present at the points between 21 and 78% of the intermalleolar distance measured from the tops of the medial and lateral malleoli. The melanin index abruptly changed at the points 25±7.1 and 75±4.2%. The skin thickness and amount of elastic fibers changed greatly at the points between 20 and 30% and between 70 and 80% of the intermalleolar distance. Submalleolar skin is quite different from sole skin. The border of sole skin lies at the points between 20 and 25% of the intermalleolar distance from the medial malleolus, which macroscopically corresponds to the border of skin maceration. It would be better to use the submalleolar area for grafts for the dorsum of the fingers or toes, and the plantar instep area for the ventral areas of the fingers or toes.

Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching

Early application of autologous skin may lead to the loss of split thickness skin graft due to unclarified wound bed. Allogeneic skin grafts are performed on patients with extensive burn injuries after escharotomy, tangential excisions and deep debridement for the purpose of stabilizing the general condition and reducing the scope of local complications. The aim of this paper is to determine how the use of allografts improves the conditions for the intake of autografts in burns treatment, and how it accelerates wound healing in comparison to the autografts-only option. In 2012-2013, allogeneic skin was grafted on 46 patients, and in 8 cases grafting was repeated several times. An autologous split-thickness skin graft was applied to 32 patients. The analysis included the relationship between the duration of hospitalization and the number of skin transplantations, the relationship between the time of admission to debridement of the necrotic tissues and the total duration of hospitalization. Statistical analysis encompassed also pain assessment. The results suggest that multiple applications of autografts not only do not lead to quicker recovery, but even lengthen the hospitalization time. The dependency is visible also in the patients who underwent the skin grafting procedure in allogeneic and autologous systems twice or more. There was a statistical significant difference between the duration of hospitalization in groups of patients who underwent STSG preceded by allogeneic skin graft transplantation when compared to the group of patients who underwent allogeneic skin application (p < 0.05) and the group of patients who were grafted with autologous skin (p < 0.05). Allogeneic skin grafts are a perfect dressing when wound vascularization is insufficient to take free split-thickness skin graft. In patients with comparable burn surface areas, multiple applications of free autologous split-thickness skin grafts (STSG) extend the hospitalization time in comparison to application of allogeneic skin dressing as the first-line therapy.

EXTENSIVE NECROTIC TROPHIC FOOT AND LEG ULCER IN THE PRESENCE OF ESSENTIAL THROMBOCYTHEMIA

We are to present a rare occurrence of large limb-threatening ulcer of the leg and foot in patient with thrombocytosis. Essential thrombocythemia was diagnosed based on peripheral blood platelet count and gen test findings. The improving of platelet count was obtained by oral hydroxyurea. Complex surgical treatment, including free-skin grafting, was performed with the excellent result. Two-year follow-up was retraced without any sign of ulcer recurrence.

Large and giant melanocytic nevi of the maxillofacial area in children: features of the morphological structure and surgical treatment

Background. Congenital melanocytic nevus is a benign pigmented neoplasm composed of nevus cells that clinically manifest at birth. When choosing a treatment for nevi, the possibility of recurrence as well as the threat of tumor malignancy should be considered. The aim of this work is to justify the surgical removal of a large and giant nevi of the face as a method of treatment justified by the pathomorphological structure. Materials and Methods. In 40 children of different ages born with large and giant nevi of the face, we used various types of plastic surgery to eliminate any defects formed after the excised nevi. We accounted for the features of the maxillofacial area: local plasty, expander dermotension, and transplantation of free skin grafts. We performed a total of 68 surgical interventions. Sixteen patients underwent the surgery once and 24 patients underwent secondary surgery (from 2 to 4). We also developed a scheme of the staged surgical treatments and conservative methods. Results. All patients had stable positive results that were studied by comparing the outcomes of different surgical treatment options and accounting for various morphological characteristics of the removed nevi.

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

ABSTRACTPurpose: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery.Methods: This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50–75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft.Results: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort.Conclusion: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.

Application of Halo-vest head ring in replantation of total scalp avulsion

To investigate the clinical effect of Halo-vest head ring in the treatment of replantation of total scalp avulsion. We treated 11 cases of total scalp avulsion with the anastomosis of arteriovenous vessels and Halo-vest head ring from December 2006 to February 2015. One patient's replanted scalp got necrosis because of serious contusion which was healed without hair growth after free skin graft and dressing. All the scalp flaps in the other 10 patients survived. After 3-96 months follow-up, the wound completely healed, the scalp and hair grew well with satisfactory appearance. The use of Halo-vest head ring for replantation of total scalp avulsion can effectively improve the survival rate and survival area.

Treatment chronic wounds with a combination of adjacent flaps and free skin graft covered by vacuum sealing drainage

Objective To explore the clinical value of combination of adjacent flap and free skin covered by vacuum sealing drainage (VSD) in the treatment of chronic wounds. Methods 40 cases with chronic wounds were repaired by combination of adjacent flap and free skin covered by VSD.There were 33 males and 7 females, with an average age of 62.5 years (ranged from 32 to 90 years), and 17 cases with diabetic foot and 23 cases with pressure sore.The size of wound varied from 5cm×8cm-15cm×20cm.Meantime, there were 18 cases with chronic osteomyelitis, and 25 cases with paraplegia.After wound bed grew freshly, wounds were repaired by combination of adjacent flap and free skin covered by VSD.The survival rate and the heal quality of the adjacent flap and the skin graft area were followed up postoperatively. Results 40 patients with chronic wounds were effectively repaired by combination of adjacent flap and free skin covered by VSD.The patients were followed up for an average of 12.8 months (6-24months), the survival rate and the heal quality of the adjacent flap and the skin graft area were well and with satisfactory outline. Conclusion Patients with chronic wounds can be effectively treated with a combination of adjacent flap and free skin covered by VSD, which can effectively repaired of wound and significantly shortened the treatment, and maximized enhancement of the quality of life. Key words: Surgical flaps; Skin transplantation; Drainage; Negative-pressure wound therapy

Vacuum Sealing Drainage as Treatment of Severe Buttocks and Perianal Infection

Vacuum sealing is a therapeutic concept to achieve secure and rapid wound healing in traumatic soft tissue damage. Its application and effect in the treatment of severe buttocks and perianal infection are unclear.We describe a case of buttocks and perianal infection using the vacuum sealing drainage (VSD) technique. A 58-year-old man was admitted with buttocks and perianal severe infection, which was caused by injection. The size of the wounds was 40 × 30 cm. Colostomy was applied prior to the prompt surgical debridement to prevent defecation and keep the perianal region clean. Emergency debridement was then conducted. After the wounds were thoroughly washed with conventional disinfection solution, they were then covered by VSD system.The infection was controlled 9 days after the first surgery by prompt surgical debridement, the application of VSD treatment, and the use of narrow-spectrum antibiotics based on susceptibility result. After 3 applications of VSD treatment, skin grafting harvested from the left leg was conducted. All free skin grafts survived at 8 weeks. Colon was placed back into the abdominal cavity finally.Initial colostomy and debridement, the temporary VSD cover followed after several days by skin grafting is a reliable treatment regimen for severe buttocks and perianal infection.

Periosteal Flap Technique for Elevation of the Pinna in Microtia.

For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts). The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting. The periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.

Reconstruction of deep wounds in old patients with cutaneous malignant tumor after artificial dermis combined with negative pressure wound therapy

To evaluate the effects of artificial dermis combined with negative pressure wound therapy on repairing wound aft er resection of cutaneous malignant tumor in elderly. The clinical data of 34 hospitalized patients with cutaneous malignant tumor from July, 2009 to February, 2014 were retrospectively analyzed. The patients received local enlarged excision, artificial dermis covered wounds and 12-16 days of negative pressure wound therapy plus a free skin graft transplant on the surface with an artificial dermis. Recovery and complication aft er operation were assessed. All wounds were restored successfully with good appearance. None severe infection happened. Artificial dermis combined with negative pressure wound therapy can repair wound efficiently aft er cutaneous malignant tumor resection was performed for old patients.

Limited experience, high body mass index and previous urethral surgery are risk factors for failure in open urethroplasty due to penile strictures

Objective. The aim of this study was to evaluate outcomes and possible risk factors for failure of open urethroplasty due to penile urethral strictures. Materials and methods. A retrospective chart review was undertaken of 90 patients with penile stricture undergoing 109 open urethroplasties between 2000 and 2011. In 80 urethroplasties, a one-stage procedure was performed: 68 of these had a pediculated penile skin flap, nine had a free buccal mucosal graft and three had a free skin graft. A two-stage procedure using buccal mucosa was performed in 29 urethroplasties. Failure was defined as when further urethral instrumentation was needed. Results. The mean age in the one-stage and two-stage groups were 50 and 54 years, respectively. The success rates in the corresponding groups were 65% and 72%, with follow-up times of 63 and 40 months, respectively. Multivariable analyses disclosed body mass index (BMI) and previous urethral surgery to be significant risk factors for failure in the one-stage group. Failure over time significantly decreased during the study period. Conclusions. Both one- and two-stage penile urethroplasty demonstrated success rates in line with previous reports. Limited experience, high BMI and previous urethral surgery appear to be associated with less favourable outcome.

A Rational Approach to Estimating the Surgical Demand Elasticity Needed to Guide Manpower Reallocation during Contagious Outbreaks

BackgroundEmerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs.AimTo quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks.Materials and MethodsBased on a nationwide research database in Taiwan, we extracted the monthly volumes of major surgery types for the period 1998–2003, which covered the SARS period, in order to carry out a time series analysis. The demand elasticity of each surgery type was then estimated by autoregressive integrated moving average (ARIMA) analysis.ResultsDuring the study period, the surgical volumes of most selected surgery types either increased or remained steady. We categorized these surgery types into low-, moderate- and high-elastic groups according to their demand elasticity. Appendectomy, ‘open reduction of fracture with internal fixation’ and ‘free skin graft’ were in the low demand elasticity group. Transurethral prostatectomy and extracorporeal shockwave lithotripsy (ESWL) were in the high demand elasticity group. The manpower of the departments carrying out the surgeries with low demand elasticity should be maintained during outbreaks. In contrast, departments in charge of surgeries mainly with high demand elasticity, like urology departments, may be in a position to have part of their staff reallocated.ConclusionsTaking advantage of the demand variation during the SARS period in 2003, we adopted the concept of demand elasticity and used a time series approach to figure out an effective index of demand elasticity for various types of surgery that could be used as a rational reference to carry out manpower reallocation during contagious outbreak situations.

Penile cancer: organ-sparing surgery.

Penile cancer is a devastating disease, usually diagnosed late, that requires wide excisions, which causes alterations in self-esteem and body image, affecting sexual and urinary functions, which compromise quality of life. Recently, an increasing interest in penile-sparing surgeries (PSSs) has emerged, aiming to spare patients from these complications. Several options of PSS have been popularized for selected cases (Ta-1, Tis and some T2), such as wide local excision, circumcision, partial penectomy, total or partial glansectomies with or without glans-resurfacing procedures, as well as new glans reconstructions using spatulated urethral advances or free skin grafts. These options, in general, achieve good local control, with adequate functional results and satisfactory cosmetic appearance. The local recurrences, however, are slightly higher than amputations. Contemporary techniques such as laser or cryotherapy can be performed in selected cases. PSS must be indicated only for superficial penile cancer cases, such as Tis and Ta-1, and for selected invasive lesions (small distal pT2 tumors). Candidates for PSS should be adherent to follow-up requirements, allowing early detection of local recurrences. Prompt and effective salvage procedures are mandatory in these situations.

Negative pressure wound therapy augmented full-thickness free skin grafting in the cat: outcome in 10 grafts transferred to six cats.

The aim of this clinical evaluation was to describe the technique and outcomes of negative pressure wound therapy (NPWT) augmented skin grafting in cats. Cats with soft tissue and skin defects (n = 6) underwent open wound management. Wounds were initially covered using a NPWT system that was changed to polyurethane foam dressing once infection was controlled and granulation started. Final closure was achieved after establishment of a healthy, fully granulated wound bed by grafting of free full-thickness skin from the lateral abdominal wall. The freshly grafted skin was then treated with an NPWT dressing at a pressure of -125 mmHg for 3 days, with dressing changes performed daily. Percentage graft take, complications, wound bioburden and cosmetic outcome were recorded. The mean duration of open wound management was 21.4 days (range 3.0-45.0 days), with a mean duration of NPWT of 8.0 days (range 3.0-14.0 days). Five cats received a single graft, while one cat had five grafts transferred to the right hindlimb. In 7/10 grafts, graft take was 100%, in two grafts take was 95% and in one graft take was 80% (mean take rate 97%). Therapy was well tolerated in all patients. The grafted site displayed normal hair regrowth in four cats, sparse hair regrowth in one and no hair growth at all in one patient. Skin sensation was normal in all grafted patients. Skin graft augmentation using NPWT in cats is a feasible option that allows graft fixation, even in anatomically demanding areas. Graft take rate reported here is slightly higher than documented in previous reports.

Severe forms of concealed penis without hypospadias: Surgical strategies.

Introduction:Concealed penis (CP) may vary in severity and includes megaprepuce (MP) as a variant. Many different surgical strategies have been described in order to maximize penile exposure and to deal with skin deficiency. We describe the strategies that we use to overcome technical problems in severe cases of CP.Materials and Methods:Six consecutive cases of severe CP (including 3 with MP) were treated in a 2-year period between January 2011 and April 2013. These patients were treated using extensive degloving, removal of dysplastic dartos, Alexander's preputial flap, scrotal flaps and skin grafts. Three patients had been previously circumcised. Cases associated with hypospadias, obesity, disorders of sexual differentiation and micropenises were excluded.Results:All six patients attained good results, with good exposure of the penis, ability to void standing with a well-directed flow and reasonable esthetic results. A technical algorithm for the treatment of primary or recurring cases of CP is proposed.Conclusion:Alexander’ s distally based ventral preputial flap is a useful technical resource to treat MP cases. Free skin grafts and/or laterally based scrotal flaps may be used to cover the penis after release in severe cases of CP.

The Effect of Low Level Green LASER on Autologous Full-Thickness Free Skin Graft in Rats

The effect of green LED laser on free full-thickness autologous skin graft was tested in rats. Ten adult male Wistar rats were divided into two groups of in each group as test (Low level green LED laser irradiation) and the control group. A full-thickness square incision with the sides of three centimeters was created at the dorsal region of animals. Then, the skin was removed and replaced with a rotation of 90 degrees and sutured. Green LED irradiation (1 J/cm2, 60 s, and 532 nm) was performed immediately in the test group daily over a period of 6 days post-operatively. Biopsy taking was carried out on 3, 5, 7 and 14 days after surgery and was sent to the pathology laboratory. The size of graft was recorded on determined days. The results showed that the laser with the amount of has ability to maintain tissue autograft in the surgical site. Macroscopic and microscopic studies showed that the graft tissue in the control group showed significantly (P>0.05) shrinkage and fibrosis.

Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand

One-stage coverage of multiple or jumping defects in the hand remains a great challenge in reconstructive surgery. A medial sural artery perforator-based conjoined or chimeric flap can be a potential candidate for reconstruction and a versatile donor site for tendon and nerve grafts. Between September 2009 and December 2012, two free conjoined and three free chimeric medial sural artery perforator flaps were transferred to reconstruct multiple soft tissue defects in the hands. Only patients with more than two perforators in the preoperative Doppler analysis were admitted to this surgical approach. The anatomy, surgical technique, and clinical follow-up for up to 24 months are described. A variation of two to four perforators was found during dissection. All the flaps survived completely, and one patient developed wound dehiscence, which healed after continuous dressing changes. Two patients received tendon and nerve grafts simultaneously. Three donor sites received an additional free skin graft from the groin region. Follow-up of the five patients ranged from 6 to 24 months (mean 13 months) postoperatively. No obvious donor-site morbidity was observed. The patients were satisfied with the single-stage procedure and the aesthetic outcome of the hands. The free conjoined or chimeric medial sural artery perforator flap can provide a single-stage solution for multiple defects in the hand. The versatile donor site also provides the option to harvest a segment of a tendon or nerve graft for single-stage composite tissue reconstruction.

My Beautiful Hair

Abstract Introduction This is a problem-base-learning (PBL) teaching case intended for first-year medical school human gross anatomy during the course of anatomical dissection and discussion sessio...