Free Skin Graft Research Articles

Upper and lower eyelid reconstruction for severe disfiguring necrobiotic xanthogranuloma

BACKGROUND Necrobiotic xanthogranuloma is a rare disease featuring generalized xanthomatous inflammatory skin lesions associated with paraproteinemia and possible lymphoproliferative diseases. Eyelid involvement can be unilateral or bilateral and ranges from minor xanthelasma-like lesions to severe ulcerative disease with consecutive keratitis and scleritis. CASE REPORT The authors report the case of a 67-year-old woman with extensive necrobiotic xanthogranuloma involving the eyelids, head and neck, anterior chest, and both upper and lower extremities. Periorbital involvement caused severe upper and lower lid ectropium with chronic conjunctival inflammation and unilateral exposure keratitis. During a persistent period of low disease activity, granulomatous lesions and scars were widely excised, lids partially shortened and large full-thickness skin grafts applied. Uninvolved parts of the upper arms had to serve as donor sites, as other possible donor sites were not available. After successful reconstruction of the left side and no local recurrence of the disease, the right side was corrected in the same way. Full eyelid closure was achieved and skin grafts healed without complications. No recurrence of the disease appeared at the sites of operation, despite continuous new lesions elsewhere. CONCLUSION Severe cicatricial eyelid deformation caused by necrobiotic xanthogranuloma can be treated with success by excision and free skin grafting. The mechanisms of recurrence at excision sites described by others remain unclear, but at least during phases of low activity, the described treatment is safe and recurrence is not to be expected.

Comparison of Double Vertical Incision with Various Tubularization Techniques and Its Clinical Application

Introduction: Tubularization is one of the indispensable practices of reconstructive surgery, especially in the repair of hypospadias. In all procedures of forming a tube, the desired diameter should be reached without any complication. Materials and Methods: We used as a new technique, ‘double vertical incision’, in 8 rabbits and compared it with free skin graft, local flap and single vertical incision. We formed 32 tubes randomly around an 8-french catheter using 7/0 PDS suture. Twenty-one days after the operation, the tubes were taken, randomized to staining with hematoxylin and eosin and with Masson’s trichrome and then subjected to histopathological examination. Inflammation, fibrosis and lumen diameter were statistically evaluated. Results: Widest lumen diameters were found in the double incision group and this result was statistically different when compared with the results of the other groups (p < 0.001). Conclusions: Double vertical incision is promising in that it is easier to perform, provides a desired amount of tissue in cases in which the urethral bed is narrow, and causes no scar. Based on the results we obtained, we applied double vertical incision, a modification of tubularized incised plate urethroplasty popularized by Snodgrass, in 4 patients. The tubes were not distended, their long-term follow-up showed no complication and a urethra of the desired diameter was obtained.

Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defects.

Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting. The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients. All patients (52-76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm(2), and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns. Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results.

Reconstruction of iatrogenic skin defects of the Achilles tendon region: an analysis of 25 consecutive patients

Achilles tendon surgery is quite common, typical indications being acute tendon rupture and chronic tendinitis. Post-operative wound infection or skin necrosis occurs in 2.4–5% of these operations. Soft tissue reconstruction of the Achilles tendon region presents a challenge due to the limited amount of local tissue available. We interviewed 25 consecutive patients with a post-operative skin defect, caused by infection or skin necrosis, after Achilles tendon surgery at mean 30 (range 6–56) months after reconstructive surgery. Of the patients 12 had acute tendon rupture and 13 had chronic tendinitis. The method of reconstruction after debridement was direct closure in one, total revision of the tendon and free skin graft in four, local flap in three, bipedicle skin flap in 10 and free microvascular flap in seven. All patients healed without event, however the patients whose reconstruction was done with a free flap had a somewhat slower return to work (mean 2.25 months vs 1.9 months) and had, after physical activity, pain in the operated area. We conclude that the type of soft tissue reconstruction in the Achilles area should depend on the size and shape of the defect as well as the general health of the patient.

Management of Iatrogenic Vaginal Constriction

In Brief OBJECTIVE To prospectively assess the outcomes of four approaches to the surgical management of iatrogenic vaginal constriction. METHODS A prospective study was initiated to evaluate all women who presented to our practice with the complaint of apareunia or dyspareunia secondary to postoperative vaginal constriction. All participants were initially offered and failed a trial of manual dilation. Between 1997 and 2002, 20 women underwent one of four surgical procedures: Z-plasty, vaginal incision of constriction ring, vaginal advancement, or placement of free skin graft. All 20 participants have been followed postoperatively, including assessment of dyspareunia and postoperative vaginal length and caliber. RESULTS Three patients underwent Z-plasty, eight had incision of vaginal ring or ridge, eight had vaginal advancement, and one underwent placement of a free skin graft. Mean follow-up was 17 months (range, 3–32 months). Subjective cure was defined as resumption of pain-free vaginal intercourse. Objective cure was defined by findings on physical examination. The overall subjective and objective cure rates were 75% and 85%, respectively. CONCLUSION The appropriate surgical procedure depends on the site and extent of the vaginal constriction, the state of the surrounding tissue, and the overall length and caliber of the vagina. Most cases of postoperative vaginal constriction can be successfully treated by simple vaginal procedures.

Management of iatrogenic vaginal constriction.

To prospectively assess the outcomes of four approaches to the surgical management of iatrogenic vaginal constriction. A prospective study was initiated to evaluate all women who presented to our practice with the complaint of apareunia or dyspareunia secondary to postoperative vaginal constriction. All participants were initially offered and failed a trial of manual dilation. Between 1997 and 2002, 20 women underwent one of four surgical procedures: Z-plasty, vaginal incision of constriction ring, vaginal advancement, or placement of free skin graft. All 20 participants have been followed postoperatively, including assessment of dyspareunia and postoperative vaginal length and caliber. Three patients underwent Z-plasty, eight had incision of vaginal ring or ridge, eight had vaginal advancement, and one underwent placement of a free skin graft. Mean follow-up was 17 months (range, 3-32 months). Subjective cure was defined as resumption of pain-free vaginal intercourse. Objective cure was defined by findings on physical examination. The overall subjective and objective cure rates were 75% and 85%, respectively. The appropriate surgical procedure depends on the site and extent of the vaginal constriction, the state of the surrounding tissue, and the overall length and caliber of the vagina.

The selection of the most appropriate materials and the timing of procedures for dura, bone, and skin reconstruction in patients with wartime head injuries

During the 5-year war in former Yugoslavia 294 patients were surgically treated for head injuries at the Neurosurgical Department of the Emergency Center, Clinical Center of Serbia in Belgrade. In addition to other problems related to direct trauma of brain tissue, some specific problems related to other tissue defects and their importance in further complications which changed the final outcome have been noted. This study analyzed methods and materials used for dura, bone, and skin reconstruction in a search for better management of this problem. We conclude that for dural reconstruction in these patients the best materials are autologous (autotransplantation of periosteum, galea aponeurotica, or fascia lata) since this results in fewer complications and better results. Local skin flaps were used for small skin defects, but more extensive skin defects required larger flaps with free skin grafting of secondary defects. Both dura and skin reconstruction should be performed as soon as possible to prevent infection and other complications, but delayed surgery is recommended for bone defects. Only bone defects with diameter over 3–4 cm were treated surgically (alloplastic material, Palacos, being used) after 6–12 months in cases with no signs of infection. This strategy yielded the best results.

Management of periocular post burn scarring in the epileptics.

To assess the clinical presentation and management of patients with epilepsy presenting with periocular post burn scarring. Prospective and descriptive study. Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi from September 1999 to September 2002. This study included 23 patients who had epilepsy and presented with periocular post-burn scarring to the eye department for management. All patients had contractures of their lids with variable amounts of corneal scarring and damaged to the eye ball. The surgical procedure performed consisted of release of contracture, horizontal lid shortening and application of free skin graft. There were 18 (78.26%) female and 5 (21.73%) male patients. The age range was from 18 to 45 years with a mean of 28 years. In 17 (73.91%) patients, lid contracture was released to cover their eyeballs. In 6 (26.08%) patients the eyeball was lost due to late presentation. There should be a high index of suspicion in facial burns for ophthalmic damage and early referral to an ophthalmologist should be made to prevent complications. Early release of contracture with application of full or partial thickness skin grafts is advisable.

Reconstruction of axillary scar contractures—retrospective study of 124 cases over 25 years

We present a retrospective study of 134 axillae treated in 124 cases of axillary scar contractures with the use of skin grafts and various flaps over the last 25 years in our department. Free skin grafts were performed in 25 axillae, and local flap transfers including skin elongation procedures such as z-plasty were performed in 76 regions. As regional flap transfers, i.e. pedicled axial local flap transfers, latissimus dorsi flaps, para-scapular flaps, superficial cervical artery flaps (SCA flap) and bilateral combined scapular flaps were used for the reconstruction of 23 severe axillary scar contractures. Free flaps and scarring flaps were also used for five severe contracture cases. The results were generally satisfactory, but five problematic cases and seven cases of recurrence were encountered. In this report, we classify axillary contractures into five types and present our conclusions on the criteria for selecting appropriate surgical methods according to contracture type. Our results suggest there are four key scar features to be considered in the selection of surgical methods for axillary reconstruction: (1) size; (2) depth; (3) location and (4) shape. We also discuss and evaluate the various methods of reconstruction.

Hemiscrotectomy With Contralateral Testicular Transposition for Scrotal Cancer

Wide excision of scrotal tumors results in serious defects to such an extent that in some cases the contents of the scrotum cannot be preserved. We describe a hemiscrotectomy technique with transposition of the testis to the contralateral hemiscrotum that facilitates closure of the surgical wound and allows preservation of the testis. Our procedure was used in 3 patients with scrotal neoplasia, including 2 with squamous cell carcinoma and 1 with extramammary Paget's disease. After excision of the hemiscrotum affected by the tumor, which includes all layers of the scrotal wall, the testis is transposed into the contralateral hemiscrotum through a slit made in the medial scrotal septum. The defect is easily closed by apposing the surgical wound edges. The 3 men were disease-free 8, 7 and 4 years after surgery, respectively. After intervention they remained pain-free. None had hydrocele or epididymitis secondary to placement of the 2 testes in the same hemiscrotum. In appropriate candidates this technique allows the scrotal defect to be easily reconstructed after tumor excision without any need for skin flaps or free skin grafts. The procedure makes it possible to preserve the scrotal content and perform more radical treatment since the scrotal wall is completely excised.

A Case For 2-stage Repair of Perineoscrotal Hypospadias With Severe Chordee

In the majority of children hypospadias can be corrected in a single stage procedure. However, there is a subgroup of patients with perineoscrotal meatus and severe chordee who frequently exhibit some degree of penile scrotal transposition. It is this subgroup of patients in whom a critical review of the long-term results is examined.Between 1980 and 1995, 1,934 children underwent repair of hypospadias and chordee. Of these patients 51 had perineoscrotal hypospadias with severe chordee and 40 underwent single stage repair (23), which included either full thickness skin graft urethroplasty (6), a proximal Thiersch procedure with distal free preputial skin graft (7) or an island tubularized flap (10). The chordee were corrected by either Nesbit or tunica albuginea plication. A 2-stage repair was performed in the remaining 11 children. Stage 1 consisted of chordee repair by either dermal (5) or tunica vaginalis (6) grafting of the ventral tunica albuginea surface, while stage 2 urethroplasty was performed 6 months later. These 2 groups were compared in regard to function status and cosmetic results.Of the patients 34 (61%) were available for a greater than 5-year followup. An excellent outcome (terminal meatal voiding, near normal appearance, no complications) was obtained in only 5 (21%) patients of the single stage repair group, while satisfactory (subterminal meatus, irregularities in meatal, glandular or penile skin) or complicated results were obtained in 4 (17%) and 14 (61%), respectively. The overall complication rate was 61% (14 of 23 patients), including fistula, urethral diverticulum, distal breakdown or stricture formation. Recurrent chordee was noted in 5 (22%) children. Of the 2-stage group excellent results were obtained in 7 (63%), patients, while satisfactory and complicated results was seen in 2 (18%) and 2 (18%), respectively. Overall complication rate was 18%, and included fistula and diverticular formation. However, no recurrence of the initial chordee was noted.Our long-term followup suggests that ventral grafting of the corporal wall in patients with severe chordee as a staged procedure is superior to the dorsal plication or Nesbit procedure. The overall functional and cosmetic results are excellent with the 2-stage compared to the single stage repair.

Treatment of soft tissue defects with exposed bone in the head and face region with alginates and hydrocolloid dressings

Purpose: In cases of soft tissue defects with exposed bone surfaces in the head and face region, there is the option of treating the defect with free split-thickness skin grafts following appropriate wound granulation. Secondary granulation on free bone surfaces is often a lengthy process, as granulation primarily occurs from the edges of the wound. Hydrocolloid dressings are gaining increasing attention in this context. The question arises as to whether the positive properties of hydrocolloid dressings can bring about rapid and positive conditioning of the base of the wound in soft tissue defects with exposed bone in the head and face region, with a view to subsequent split-thickness skin graft transplantation. Materials and Methods: In the period from 1997 to 2000, a total of 25 patients with soft tissue defects with exposed bone surfaces in the head and face region were treated with hydrocolloid dressings in the framework of a prospective clinical study. Results: The average time taken for complete granulation of the bone surface was 39.44 days (minimum, 10 days; maximum, 72 days). As a rule, this necessitated 12.8 changes of dressing (minimum, 3; maximum, 26). The granulation tissue was of good quality, generously vascularized, and occasionally exuberant at the edges of the wound Conclusion: On the whole, the combination of hydrocolloid dressing and alginate compress was found to have significant advantages as regards conditioning the exposed bone surface. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1126-1130, 2002

Penile Reconstruction With Prosthesis and Free Skin Graft in a Patient With Land Mine Blast Injury

Penile Reconstruction With Prosthesis and Free Skin Graft in a Patient With Land Mine Blast Injury

Penile Reconstruction With Prosthesis and Free Skin Graft in a Patient With Land Mine Blast Injury

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 May 2002Penile Reconstruction With Prosthesis and Free Skin Graft in a Patient With Land Mine Blast Injury AHMET FUAT PEKER, IBRAHIM YILDIRIM, SELAHATTIN BEDIR, FAHRI SÜMER, and MURAT DAYANÇ AHMET FUAT PEKERAHMET FUAT PEKER More articles by this author , IBRAHIM YILDIRIMIBRAHIM YILDIRIM More articles by this author , SELAHATTIN BEDIRSELAHATTIN BEDIR More articles by this author , FAHRI SÜMERFAHRI SÜMER More articles by this author , and MURAT DAYANÇMURAT DAYANÇ More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65107-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Penile Reconstruction With Prosthesis and Free Skin Graft in a Patient With Land Mine Blast Injury." The Journal of Urology, 167(5), pp. 2133–2134 References 1 : Management of shotgun injuries to the pelvis and lower genitourinary system. Urology2000; 55: 193. Google Scholar 2 : Genital wound caused by low-speed fire arm. Arch Esp Urol2001; 54: 69. Google Scholar 3 : Incomplete penile amputation: diagnostic and therapeutic challenge. Harefuah1997; 133: 522. Google Scholar From the Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 167Issue 5May 2002Page: 2133-2134 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsamputation, traumaticpenisinjury, blastpenile prosthesisMetricsAuthor Information AHMET FUAT PEKER More articles by this author IBRAHIM YILDIRIM More articles by this author SELAHATTIN BEDIR More articles by this author FAHRI SÜMER More articles by this author MURAT DAYANÇ More articles by this author Expand All Advertisement PDF downloadLoading ...

Treatment of Urethral Defects: Skin, Buccal or Bladder Mucosa, Tube or Patch? An Experimental Study in Dogs

We studied 3 graft materials and 2 urethroplasty techniques in 24 adult male mongrel dogs. The animals were divided into 2 equal groups. In group 1 a 4 cm. segment of perineal urethra was excised and tubed urethroplasty was performed using free full-thickness skin, buccal and bladder mucosa grafts in 4 dogs each. In group 2 a 4 cm. urethral strip was excised and onlay urethroplasty was performed using the same graft materials in 4 dogs each. Retrograde urethrography was done and the animals were sacrificed at week 12. Autopsy specimens were calibrated with a 10Fr catheter. Hematoxylin and eosin stained sections were examined. Masson's trichrome stain was used to determine the extent of fibrosis. Urethral stricture was diagnosed by radiology and confirmed by calibration in 8 of the 12 dogs (66%) in group 1 but in only 1 of the 12 (8%) in group 2 (p <0.004). Buccal mucosa grafts were associated with the lowest stricture rate of 12%, followed by 37% for bladder mucosa and 62% for skin (p <0.2). There was no difference in neovascularization among the 3 grafts. Graft shrinkage was less than 10% for buccal mucosa compared with 20% to 40% for skin and bladder mucosa. The shrinkage rate was similar for the onlay and tube techniques. The intensity of chronic inflammation and fibrosis was highest in the skin grafts. Circumferential fibrosis was noted in association with tubed urethroplasty but not with the onlay technique. The theoretical advantages of buccal mucosal grafts were pathologically demonstrated. When possible, grafts should be used as an onlay rather than as a complete tube.

Nevo palpebral dividido - "kissing nevus": relato clínico-patológico e tratamento cirúrgico de três casos

Objetivo: Relatar aspectos clínico-patológicos e tratamento cirúrgico em três casos de nevo palpebral dividido -"kissing nevus". Métodos: Revisão dos prontuários de três pacientes portadores de nevo palpebral dividido. Análise dos aspectos clínico-patológicos, das técnicas cirúrgicas e resultados do tratamento. Resultados: A cura das lesões com bom resultado estético e funcional foi conseguida em todos os casos. Conclusões: A exérese do nevo palpebral dividido, em mais de um tempo cirúrgico utilizando deslizamento de retalhos cutâneos palpebrais e, em um caso, transplante de pele da pálpebra superior contralateral foi curativa nos três casos estudados.

Advancement flaps for large defects of the eyebrow, glabella, forehead, and temple.

To describe a system for reconstruction of large defects of the eyebrow, glabella, forehead, and temple. The system maximizes the use of direct approximation and advancement flaps before resorting to less aesthetic techniques. This was a retrospective cohort study drawn from approximately 70 patients with post-Mohs defects of the eyebrow, glabella, forehead, and temple. Surgical intervention involved the graded application of direct approximation, horizontally oriented advancement flaps, rotational flaps, and free skin grafts. The selection of individual and combined techniques was based on defect area and depth, elasticity of adjacent tissues, and relations of the defect to the neighboring eyebrows and hairlines. Reconstructive techniques applied to defects of the eyebrow, glabella, forehead, and temple can be arranged in an incremental scale that provides progressively more tissue but at an escalating aesthetic cost. The usual defect size limits for direct approximation and advancement flaps can be expanded. To avoid the limitations of large rotational flaps and skin grafts in this region, maximal use of direct approximation and advancement flaps is recommended.

Reconstruction of the thumb using a forearm osseofasciocutaneous reverse flap

This paper presents the experiences of the thumb reconstruction with osteofasciocutaneous reverse flap (OFCR flap). In the period between 1987 and 2000 the OFCR flap was used in 15 patients. The youngest of them was 18 and the oldest was 38 years of age. The average age was 25.4. All the patients had posttraumatic amputations. Defects on proximal phalangae and a part of metacarpal bone occurred in two cases. In one case there was an amputation on the base level of proximal phalanx and the metacarpophalangeal (MPH) joint was preserved. In all cases of reconstruction the OFCR flap was used, which included antebrachial skin nervs that were anastomosed with digital nerv. The flap nutrition was carried out through the reverse circulation of a. radialis, and the venous drainage through the comitant vein of a. radialis. Superficial veins were not anastomosed. Secondary defects were covered with a free skin graft. All the flaps survived. The bone graft was healed in the period of eight weeks. The sensibility of this flap was regained in the period of three to six months after the surgery. The distance of two-point discrimination (TPD) was increased for 30% compared to the same region on the other hand after six months. The opposition of the reconstructed thumb to the other fingers was possible, as well as abduction, adduction and normal grasp. The method of reconstruction of the amputated thumb with the OFCR flap was better than other classical methods because it allowed the reconstruction of all the structures in one surgical operation. The sensibility that was regained represented good protection from injuries. There were no functional damages on the secondary defect. The esthetic result was not good due to the lack of a fingernail.

Extensive angiosarcoma of the scalp involving the cranium

A case of angiosarcoma of the scalp involving the underlying bone is presented. Wide local excision of the scalp and full-thickness excision of the underlying calvarium and dura followed by reconstruction with latissimus dorsi free flap and skin graft was performed. Despite an initial negative frozen section of the margins, the final pathologic specimen showed microscopic involvement of the inferior margin. The positive margin was re-excised accomplished with the aid of mapping biopsies. This case demonstrates the typical nature of this rare tumor in terms of the difficulty of histologic diagnosis and surgical management.

Treatment of leg ulcers in β‐thalassaemia intermedia: use of platelet‐derived wound healing factors from the patient's own platelets

The interesting report by Josifova et al (2001), describes complete healing of an intractable ankle ulcer of nearly 20 years duration after 141 d of treatment with a combination of platelet-derived wound-healing factors (PDWHFs) in a patient with β-thalassaemia intermedia. We have used the same procedure except that the patient's own platelets were used as a source of PDWHFs in a β-thalassaemia intermedia patient with an ankle ulcer of > 4 years duration who was unresponsive to other procedures, including free skin grafting. Use of the patient's own platelets is potentially safer, and because thalassaemia intermedia patients usually have thrombocytosis it is particularly attractive. Platelets were obtained by apheresis from the patient, a 26-year-old, transfusion-independent splenectomized man with haemoglobin levels around 9 g/dl. More than 900 × 109/l platelets, were aliquoted in single-dose 2 ml vials under sterile conditions and frozen at −80°C. The preparation was thawed at room temperature before application. We applied a sterile gauze swab moistened with the thawed PDWHFs and firmly bandaged the area, every day from d 1 to d 10 and when granulation tissue developed, on alternative days (d 11 to d 32). The ulcer surface area was 13 cm2 on d 1 and complete healing was achieved at d 28 of treatment. As described by Josifova et al (2001), PDWHFs, in our case obtained from the patient's own platelets, may aid the treatment of ulcers in thalassaemia intermedia patients.