Free Skin Graft Research Articles

Repair of great foot and ankle wounds with posterior tibial artery perforator-based dicyto-pattern flaps from interoposterior compartment of calf

：Objective To investigatethe method of repairing great wounds on foots and ankles with posterior tibial arteryperforator-based dicyto-pattern flaps from interior and posterior compartment of leg.Methods Eighteen patients with great foot wound were repaired with posterior tibial arteryperforator-based dicyto-pattern flaps from interoposterior compartment of calf fromJanuary 2006 to December 2008. The patients were at age of 16-52 years, with flap areasfor 20 cm ×6 cm-25 cm × 10 cm. The donor sites of flaps were repaired with free skingraft. Results All the flaps primarily survived except for one patient with partialnecrosis (4.0 cm × 1.0 cm) in the distal part of the flap. Twelve patients were followedup for from two months to two years, which showed good color, texture and appearance ofthe flaps. Conclusion This kind of flap is one of ideal flaps to repair great foot andankle wounds, for it takes advantages of reliable blood supply, wide repair scope, safeoperation and avoidance of damage to the major artery.

Staged Surgery for Severe Soft Tissue and Bone Loss of the Knee

A 20- year-old female student was involved in a motor vehicle accident. She sustained a severe friction injury to the left knee that resulted in considerable soft tissue and bone loss. There was also damage to the knee extensor mechanism, tibialis anterior muscle, femoral trochlea, the anterior half of the tibial plateau extending distally to the proximal tibia and skin. However, there was no crushing of the limb or resultant neurovascular deficit but cancellous bone and the remainder of the joint were exposed. Repeated surgical debridement was performed and was followed by covering of the soft tissue using a latissimus dorsi free flap and skin grafts. The bony defect was reconstituted with antibiotic bone cement to prevent flap adherence and shrinkage, enhance stability and prevent fracture. The cement was later removed at the time of arthrodesis at which time an ipsilateral double barrel vascularised fibular graft supplemented with autogenously cancellous bone and a ring fixator was used. Computer tomography confirmed union at three months post procedure. The fixator was then removed and a tibialis posterior transfer was performed.

Czerniaki złośliwe regionu głowy i szyi w materiale Kliniki Chirurgii Onkologicznej i Rekonstrukcyjnej Centrum Onkologii IMSC w Gliwicach

About 25% of melanomas are localized in head and neck skin, and this particular localization is most difficult to treat, and the prognosis is less favorable. The depth of melanoma infiltration (Clark and Breslau grade) into the skin is the main factor of local advancement of the disease. Surgical treatment is an essential therapeutic modality in patients with melanoma. The aim of this study was to evaluate results of our surgical treatment of melanomas in head and neck localisation, treated from 1997 to 2007 in Department of Oncological and Reconstructive Surgery in Center of Oncology IMSC in Gliwice. We analysed group of 47 patients (aged 26 to 75 years, mean 49), treated by surgical excision of malignant melanoma in the head and neck region. Most of the patiens required to use free flaps or skin graft technique to close posexcisional defect, on basis of clinical considerations. The 5-year total survival for all patients was 62% and were dependent on depht of melanoma infiltration and regional lymph node metastasis. The significant prognostic factors were: localization of primary focus, local progression of disease, free microscopical excision margins sex and age. Prognosis in the patients with melanoma of the head and neck is unreliable and dependent on local advancement of disease and localization of primary focus. Surgical treatment is an essential therapeutic modality in patients with melanoma. Adiuvant radiotherapy after surgical treatment of melanoma of the head and neck is intended for the patiens with high risk of local or regional recurence of disease.

Anterior craniofacial resection — for paranasal sinus tumors involving anterior skull base

Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the "gold standard" for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.

Reverse Modified Hughes Procedure for UpperEyelid Reconstruction

To describe the outcome of the reverse modified Hughes procedure for the reconstruction of extensive full-thickness defects of the upper eyelid. Seventeen cases of full-thickness extensive upper eyelid defects were reconstructed using the reverse modified Hughes procedure. Extensive defects were characterized as those with a width of 80% or more of the eyelid after tumor excision. Posterior lamella reconstruction was achieved using a pedicled tarsoconjunctival flap from the donor lower eyelid. For anterior lamella reconstruction, the orbicularis oculi muscle superior to the defect was mobilized and transposed over the tarsoconjunctival flap. A cutaneous advancement flap using redundant skin adjacent to the defect or a free postauricular skin graft in cases of insufficient lax skin was used to cover the orbicularis oculi muscle flap. The tarsoconjunctival pedicle was divided 3 to 8 weeks after the primary operation. Seventeen patients from 40 to 81 years of age were included in the study. The underlying diagnoses included sebaceous gland carcinoma (13), squamous cell carcinoma (3), and Merkel cell carcinoma (1). Follow-up of 6 to 80 months revealed no cases of flap ischemia or identifiable necrosis after division. The functional and aesthetic outcomes were generally satisfactory throughout follow-up. Postoperative complications included epithelial keratopathy (4), lagophthalmos (3), upper eyelid entropion (2), granuloma formation (2), and lower eyelid entropion (1). The reverse modified Hughes procedure with orbicularis muscle mobilization was successful in repairing extensive full-thickness upper eyelid defects greater than 80% of the eyelid width. The mobilization of the orbicularis oculi muscle, with its robust vascular supply, enhances the viability and cosmetic appearance of the reconstructed eyelid.

Jaques-Louis Reverdin (1842-1929): el cirujano y la aguja

With the development and rise of abdominal laparoscopic techniques, the old Reverdin needle has had a revival, because it proved to be useful for the endoscopic closure of laparoscopic access ports, in order to lower the incidence of incisional hernias. Several new modifications of the Reverdin needle, with different names, are in the market now. This new use of an old instrument, prompted a review of the life and work of Jaques-Louis Reverdin, the Swiss surgeon trained in Paris and founder of the modern Swiss surgery.Biographical and bibliographical review of Jaques-MLouis Reverdin and his contributions to surgeryJaques-Louis Reverdin (1842-1929), born in Geneva, completed his medical studies in Paris, where he practised in several well-known hospitals such as La Pitié (with Goselin), Saint Louis (with Guérin), Lariboisiére, and Necker (with Guyon). In 1869 he published and presented in several meetings, a pioneering experience of successful free skin graft procedure, that is still performed in some cases and constitutes the first organ transplantation. In 1870 he presented his doctoral thesis "Etude sur l'uréthrotomie interne" with the expeience of his master Guyon (63 operations), gaining the Civiale prize and the bronze medal of the Paris Faculty of Medicine. He returned back to Geneva in 1872 to begin a long surgical practice and Faculty teaching, and he made seminal contributions to the knowledge of thyroid diseases, in particular on the clinical presentation of function deficiency following exeresis of the thyroid gland ( postoperative myxoedema). His contributions paralleled that made by Theodor Kocher in Bern, the surgeon that received in solitary the Nobel prize for these studies in 1909. With Jean6hyphen;Louis Prevost and Constant Picot, they founded the "Revue medicale de la Suisse romande", the most important Swiss medical journal of the 20th century. He is remembered in the field of Urology for a special needle designed to pass through a suture in a time were catgut and silk were the most employed sutures to control organ pedicles.Reverdin, that pertains to the glorious epoch were surgery -performed under anaesthesia and with the antisepsis postulates of Lister and Pasteur-, reached most of his goals, is remembered for the first human transplant (skin grafting), and, fortunately, one of the several surgical instrument he designed, the Reverdin needle, had a revival in current laparoscopic surgery.

Vacuum sealing drainage therapy for complex infective extremity wounds following an earthquake

Objective To evaluate the vacuum sealing drainage (VSD) therapy for management of complex infective extremity wounds following an earthquake. Methods From May 2008, we treated 10 complex infective extremity wounds in 8 cases (6 males and 2 females) following an earthquake. Their mean age was 35.8 years (range, 20 to 62 years). Two-stage operations, preparative VSD therapy followed by closure surgery, were performed for every patient. Preoperative bacterial cultures were conducted at each stage. Results The follow-up persisted till one month after every wound healed completely and none had evidence of infection recurrence. The mean operative duration was 20 days (range, 7 to 32 days) from the preparative VSD therapy to the closure surgery and each patient underwent 3.5 times (range, 2 to 5 times) of operations averagely. Nine out of the 10 bacterial cultures were positive before the first surgical debridement and none before the closure surgery. Four wounds were closed by direct suture, 5 by free-skin grafting and one by local flap transplantation. Conclusion Since the VSD therapy can promote the growth of granulation tissues and help eradicate infection, it is safe and effective for management of complex infective extremity wounds. Key words: Extremities; Wound and injuryies; Infection; Vacuum sealing drainage

Dorsal urethroplasty with labia minora skin graft for female urethral strictures

to report a new dorsal labia minora skin-graft urethroplasty as a simple, safe and effective therapeutic alternative for female urethral strictures, as although distal urethral strictures can be treated by meatoplasty, proximal and mid-urethral strictures need appropriate urethroplasty. eight women with a confirmed proximal or mid-urethral stricture had indications for urethroplasty with the use of a thin free labia minora skin graft using a dorsal (6 o'clock position) urethroplasty technique. Full informed consent was obtained. From the inner aspect of one labium minora a thin free skin flap was prepared. The strictured urethra and the anterior vaginal wall were transected and the graft sutured into the defect. All scar tissue was removed and the anterior vaginal wall closed in two layers over the area of the urethroplasty. Continence was evaluated by a stress test with a full bladder. all patients were operated on with no complications during or after surgery. After 1 and 2 years of follow-up seven and six of the eight patients had no recurrence of stricture disease. All patients remained continent. the urethroplasty using an inlay of free thin genital skin graft was safe, uncomplicated and effective.

Single-stage dorsal inlay full-thickness genital skin grafts for hypospadias reoperations: Extended follow up

To report our extended experience with single-stage genital skin graft urethroplasty for complex hypospadias reoperations. Thirty-one patients with failed hypospadias surgery were included. The urethral plate had been removed or was scarred in all. After excision of fibrotic tissue a free full-thickness skin graft was quilted to the corpora cavernosa. The neourethra was then tubularized followed by glanuloplasty. Voiding cystograms, urethral ultrasound and flow measurements were performed in all. Outcome was considered a failure when postoperative instrumentation was needed. Follow up was 78.45 +/- 18.18 months. Shaft skin was used in 13 and internal prepuce in 18. Average graft length was 3.66 +/-1.56cm. Eighteen patients required glanuloplasty. Initial graft healing was successful in all. There was no postoperative infection involving the inlay. We did not note complications from the graft donor sites. Four patients underwent redo surgery yielding a complication rate of 12.9%. Urethral stricture of the proximal anastomosis was most frequent. This single-stage approach using dorsal inlay skin grafts is reliable, creating a substitute urethral plate in the long term. Complication rates are equivalent to those of staged strategies. This is a safe option for hypospadias reoperations if the urethral plate is compromised.

Myocutaneous Pedicle Flap Combined with a Free Skin Graft for Upper Eyelid Reconstruction

Purpose: Repair of large upper eyelid defects can be accomplished by both 1-stage and 2-stage techniques some of which are complicated and time consuming. I here present a simple 1-stage technique for upper eyelid reconstruction.Methods: The records and the peroperative and postoperative photographs of two patients who underwent reconstruction of large full-thickness upper eyelid defects after tumor removal were reviewed. The posterior lamella was reconstructed with lip mucosa in one patient and with a hard palate graft in the other. The anterior lamella was reconstructed with a myocutaneous pedicle flap from the remaining upper eyelid with its base medially or laterally. The resulting skin defect under the eyebrow was covered by a free skin graft from the contra lateral upper eyelid.Results: In both patients the flap healed without necrosis or any other complications. In the case where the posterior lamella was reconstructed with lip mucosa the cosmetic appearance was excellent, and the cornea remained unaffected throughout the postoperative period. In the case where a hard palate graft was used the cosmetic appearance was good, but the corneal epithelium developed an edema and a soft contact lens was needed. The visual acuity was 20/20 and 20/40, respectively, 3 months postoperatively.Conclusion: Large upper eyelid defects can successfully be reconstructed by a pedicle flap from the infra brow area, which subsequently is covered by a free skin graft.

The Use of Pericranial Flaps for Reconstruction and Elevation of the Lower Eyelid

Purpose: We present the novel approach of using pericranial flaps to reconstruct posterior lamellar eyelid defects or to achieve lower eyelid elevation. This technique has been employed in patients where standard tarso-conjunctival flaps are not an option and free posterior lamellar grafts cannot be supported due to the lack of viable anterior lamellar flaps.Methods: Pericranial flap, comprising inferiorly based forehead periosteum and the overlying loose areolar tissue, is constructed using a vertical paramedian forehead incision. Flaps are tunnelled subcutaneously to emerge at the proximal aspect of the eyelid defect and extend to the lateral orbital rim. They are secured with absorbable sutures. An overlying full-thickness free skin-graft or flap is used for the anterior lamella.Results: Eight patients underwent reconstruction or lower lid elevation. All patients achieved the predicted lower eyelid height with good cosmesis. Median follow-up 7.5 months (6–24 months). Indications were lower lid scarring/retraction (4), facial palsy (1), post BCC reconstruction (2), and exposed keratoprosthesis (1). In 2 (of 5) patients who had free skin-grafting, the overlying free skin-graft did not survive but acted as a biological dressing. All such patients still had good outcomes after epithelialisation of the flap. The posterior aspect of the pericranial flaps seems to act as an ideal substrate for conjunctivalisation, with little detrimental effect on the cornea. The robustness of the flap prevents the development of lid laxity over time.Conclusion: The pericranial flap is a versatile and robust flap that yields good cosmetic and functional outcomes when used in the reconstruction of posterior lamellar eyelid deficits. It is likely that, even when not viable, overlying free skin-grafts act as an excellent biological dressing until epithelialisation occurs.

Oncological Outcome and Patient's Satisfaction of Skin-Sparing Mastectomy and Immediate Breast Reconstruction: A Prospective Observational Study.

Abstract INTRODUCTION: The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis. METHODS: One hundred and twenty five consecutive women underwent 137 SSMs with IBR (12 bilateral), using the LD flap plus implant (n=85) or implant alone (n=42), indications included breast cancer (n=130)and prophylaxis (n=7). Most tumours (99.2%) were Tis, T1, or T2 and only one tumour was T3 stage. Nipple reconstruction was performed in 69 patients, using a small local flap technique (n=61), nipple sharing (n=6), free skin graft (n=1) or Monocryl mesh (n=1). Thirty patients underwent contra-lateral surgery in order to optimise symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). RESULTS: There was no local recurrence (LR) after a mean follow-up of 33.2 months (range=3-98 months). Overall survival was 99.2%, seven patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Eighty two (65.6%) of 125 patients completed the questionnaire with a median satisfaction scores of 9 (range=5-10). CONCLUSION: SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3113.

The aesthetic wrap-around flap technique for thumb reconstruction

Objective In addition to restoring thuntb function in wrap-around flap transfer for thumb reconstruction, modification was done to improve the appearance of the reconstructed thumb and minimize donor site morbidity. Methods Thirty-nine thumb defects were reconstructed using Morrison＇ s procedure and modified great toe wrap-arotmd flap. The donor site was covered with free skin graft in 30 cases, with flap and skin graft in 8 eases and with flap in 1 case. Results Of the 39 transferred wrap-around flaps, 38 survived. One case failed. Postoperative follow up ranged from 3 months to 2 years. The reconstructed thumbs presented various degrees of reduction in diameters, thin skin and shallow fingerprint. Atrophy was most prominent in the nails. The mean static 2-point discrimination was 10 mm in the pulps. In 4 cases secondary skin graft or closure after partial phalanx resection was required to heal the wound of the donor great toe site. Wound healing was achieved in donor sites of the other cases. Most patients experienced mild pain of the donor foot during ambulation within the first 3 months after the surgery. Pain gradually disappeared when follow up interval exceeded 6 months. Standing, walking and nmning were near normal. Conclusion Attention should be paid to the design of bone construct, nail harvest and multiple nerve coaptations in wrap-around flap transfer. Modified flap harvest procedure reduces damage to the donor site and improves appearance of the reconstructed thumb. Key words: Transplantation ; Thumb; Microsurgery

Study of surgical techniques of divided nevus of eyelids

To investigate the surgical techniques of divided nevus of the eyelids with different locations and sizes. Retrospective observational case series. Thirty cases (30 eyes) of divided nevus of the eyelids in Zhongshan Ophthalmic Center from July 1997 to November 2006 were retrospectively reviewed. There were three different surgical methods. Excision of the nevus and direct suture after excision in 3 cases. Excision of the nevus and free skin graft transplantation in 5 cases. Excision of the nevus and transfer of skin flap, which included a two stages reconstruction, was performed in 22 cases. The upper or lower eyelid was treated first and another eyelid was treated after three months. Lacrimal punctum and lacrimal canaliculus were excised if they were involved in 8 cases among 22 cases. The mean follow-up time was 60 months (ranging from 2 years to 11 years). Only one case recurred after two years during follow-up and was excised after five years. Pathologic examination indicated malignant transformation. Excision with histopathological control was performed and the nevus did not recur during follow-up time. Recurrence or malignant transformation did not occur in other cases. Aesthetical results of skin flap transplantation were better than skin graft transplantation. The results of two stages reconstruction and transfer of skin flap after excision of the divided nevus are better than free skin graft transplantation. Close observation is required after excision of the divided nevus for early detection of malignant transformation.

Treatment of Calcaneal Osteomyelitis with Free Serratus Anterior Muscle Flap Transfer

Chronic calcaneal osteomyelitis is a difficult problem to eradicate. The infected bone and soft tissue can rarely be successfully treated conservatively. But after aggressive debridement, there is usually a large defect in the calcaneus and soft tissue. Free serratus anterior muscle flap can not only fill the defect but can help eliminate the infection of the bone and soft tissue. Thirteen patients with calcaneal osteomyelitis were treated with free serratus anterior muscle flap transfer and skin graft from 2000 to 2006. The mean patient age was 36 (range, 18 to 48) years. Four patients were women and nine were men. The followup averaged 34 months (range, 6 months to 6 years). All flaps survived and there was no infection recurrence. The mean operation time was 6.3 +/- 1.3 hours. Partial skin graft necrosis was found in one patient, which resolved uneventfully after another skin graft. There was minimal donor site morbidity. Winged scapula or dysfunction of the shoulder was not found in any of the patients. The serratus anterior muscle has many advantages owing to its anatomical features. We believe it is a good option for treatment of calcaneal osteomyelitis.

Dorsal Onlay versus Ventral Onlay Urethroplasty for Anterior Urethral Stricture: A Meta-Analysis

Background: Ventral and dorsal sides of urethra were chosen to place grafts in free graft onlay urethroplasty. As the advantages and disadvantages of these two sites are still unclear, we systemically analyzed clinical articles reported in the literature. Materials and Methods: The literature till October 2007 regarding the use of ventral/dorsal graft urethroplasty in anterior urethral strictures was searched using the MEDLINE, Cochrane Library, and EMBASE databases. ‘Urethral stricture’ or ‘urethral stenosis’ and ‘urethroplasty’ or ‘urethral reconstruction’ were used as search terms. Data were analyzed independently by two reviewers. Results: 49 studies (1,263 cases) were included. The success rates of ventral onlay urethroplasty (750 cases) and dorsal onlay (513 cases) were 82.5 and 86.9% (p = 0.034). Buccal mucosa graft had the highest success rate (88.1%) and had a similar rate between the dorsal and ventral onlay techniques (89.2 vs. 87.6%, p = 0.472). For free skin graft, the dorsal onlay success rate was higher than ventral (84.7 vs. 74.7, p = 0.016). Bulbar urethral stricture achieved the higher success rate than pendulous urethral stricture (87.4 vs. 77.6%, p = 0.019). Conclusions: Dorsal onlay is better than ventral onlay in free skin graft urethroplasty. Bulbar urethra is the most suitable site for graft onlay urethroplasty, and buccal mucosa graft is helpful for achieving good results.

Application of pedicled muscular flaps of brachioradialis in repairing wounds at proximal forearm resulted

To explore the clinical effects of pedicled muscular flaps of brachioradialis in repairing wounds at proximal forearm resulted from hot crush injury. From February 2003 to December 2008, 5 wounds at proximal forearm resulted from hot crush injury were repaired with pedicled muscular flaps of brachioradialis. The size of muscular flaps ranged from 6 cm x 4 cm - 9 cm x 5 cm. The wounds at donor sites were closed directly or by free skin grafts. All the muscular flaps of brachioradialis were survived completely. 4 patients were followed up for 3 to 36 months. The cosmetic and functional results were satisfactory both in recipient areas and in donor sites. Pedicled muscular flap of brachioradialis can not only repair wounds at proximal forearm resulted from hot crush injury, but also repair extensor muscle defects. It is an ideal method and is very practical.

Bilateral microtia reconstruction

Ear reconstruction for congenital microtia is a challenge for the plastic and reconstructive surgeon. Ten percent of microtia cases are bilateral. However, the published literature contains relatively little information about auricular reconstruction in bilateral microtia. Some authorities prefer to reconstruct each side at different stages. In this article, we introduce an operative method to reconstruct both sides simultaneously. This is completely feasible, and saves time and cost. Furthermore, this method allows comparison between sides during surgery, and facilitates carving of bilateral ear frameworks of equal size and shape. From March 2007 to June 2008, 21 cases of congenital bilateral microtia were treated by post-auricular skin flap expansion, autogenous rib cartilage framework implantation, post-auricular fascial flap lifting, followed by split-thickness free skin grafting to reconstruct bilateral external ears during the same stage. With a follow-up duration of 6 months to 1 year, two cases in a total of 21 showed different levels of absorption and cartilage deformation. The rest (19 cases) of the bilateral reconstructed ears showed good symmetry in size, shape and location. The bilateral reconstructed ears looked symmetrical and similar in outline, with well-defined structures. Simultaneous bilateral congenital microtia reconstruction is feasible and effective. The authors recommend it as the treatment of choice for bilateral microtia reconstruction.

Occlusive dressing for large soft tissue defects following soft tissue tumor excision

BackgroundReconstructive surgery using pedicles or free muscle-skin flaps and skin grafting reduces wound complications and promotes favorable limb function; however, the sacrifice of normal tissue remains problematic and complicated. Occlusive dressings are widely employed for management of injuries, burns, and surgical wounds. However, their effectiveness for treating soft tissue defects following a soft tissue tumor excision has not been fully elucidated. The purpose of this study was to evaluate the effectiveness and safety of an occlusive dressing treatment method for soft tissue defects following soft tissue tumor excisions. MethodsWe retrospectively reviewed eight patients (three men, five women) whose wounds were treated with polyurethane foam occlusive dressings to allow reconstruction of the soft tissue defect following soft tissue tumor excision. Their mean age was 64.5 years (range 23-83 years), and the mean size of the defect was 60.1 cm2 (range 20-144 cm2). The wound was covered with a hydrophilic polyurethane dressing material. The treatment periods, incidence of complications, and ultimate outcomes were evaluated. ResultsSeven defects were completely healed by secondary intention without the requirement of any additional surgery. Mean treatment periods were 21.6 weeks (range 13.5-44.0 weeks). Mean follow-up periods were 33.1 months (range 15.8-48.6 months). One patient with a recurrent malignant fibrous histiocytoma (MFH) who had a history of radiotherapy required a posterior thigh flap 44 weeks after the surgery. Recurrence due to a positive surgical margin was observed in only one patient with recurrent MFH. None of the patients exhibited clinical evidence of superficial or deep infection. ConclusionsThis treatment method is simple, safe, and reliable. We concluded that the highly favorable indications of this treatment are ideal for patients who wish to avoid sacrificing their normal tissue, have no history of radiotherapy before surgery, and do not require chemotherapy or radiotherapy after the operation.

Reconstruction of full thickness scalp defects after tumour excision in elderly patients: Our experience with Integra ® dermal regeneration template

Scalp reconstruction after wide tumor excision is particularly challenging. Free tissue transfers, local flaps, or skin grafts can be used but present some disadvantages especially with old patients with local advanced cancers, systemic diseases and in patients with a prior history of recurring scalp skin cancers in which the risk of burying a recurring tumor with a flap is likely. The Authors expose their early experience with Integra dermal regeneration template for scalp reconstruction after scalp tumor excision. Eight patients with primary or secondary scalp tumor underwent a first surgical procedure under local anaesthesia for tumor removal and Integra positioning followed by a second operation performed three weeks later to reconstruct the defect by removing the superficial silicon layer of Integra and by covering the defect with a split thickness skin graft. The average surface area of the defect was 143.27 cm(2). The average operating time was 30.4 minutes for the first operation and 45.6 minutes for the second operation. In six cases Integra was grafted as a classic full-thickness skin graft. In the remaining two cases the Integra template was meshed. The artificial derma was attached to the edge of the wound by either sutures or staples. There was a full graft take on all cases. The mean follow-up was 24 months. In two cases we were able to detect early tumor recurrence two months after the operation. Satisfactory cosmetic and functional results were obtained in all patients. In the scalp defect reconstructions after tumor excision, Integra allows to obtain a thicker and more durable coverage than skin graft on the skull, allowing to detect a tumor recurrence earlier than a flap reconstruction with no risk of burying an eventual underlying residual tumor. These operations are performed under local anaesthesia and are therefore suitable for elderly patients.