Free Skin Research Articles

Comparing Innervated and Non-Innervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes.

Volar soft tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compares innervated toe pulp (TP) and non-innervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes. Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at our institution for volar digital soft tissue injuries, comprising 75 TP and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire, Disabilities of the Arm, Shoulder and Hand Questionnaire, Foot and Ankle Disability Index, and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis utilized the Mann-Whitney U test and Pearson correlation coefficients. The study cohort included 29 participants (15 TP, 14 MP) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP group. TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and non-innervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects.

Abstract B056: Empowering underserved communities: The impact of the Sun Bus and Texas Tech on skin cancer awareness and prevention in “Sun City”

Abstract Purpose: Ultraviolet radiation is the primary cause of skin cancer.1,2 Other risk factors include fair skin, moles, family history, and history of sunburns.1,3 Photoprotective practices and regular skin examinations can help prevent skin cancer associated with ultraviolet radiation,5-8 underlining the importance of prevention and early detection. However, dermatological health disparities, such as limited access to dermatologists and inadequate awareness of sun protection practices, present significant challenges to effective prevention and early detection efforts. Recognizing and addressing these barriers is crucial, particularly amongst minoritized groups, who carry a higher burden of skin cancer morbidity and mortality.9 The Sun Bus, affiliated with the Colorado Melanoma Foundation, travels across the United States providing free skin cancer screenings and prevention education to reduce the incidence of skin cancer.1 In collaboration with the Sun Bus, Paul L. Foster School of Medicine and Myth Busters at Texas Tech University Health Sciences Center El Paso organized a bilingual skin cancer education and screening community event in El Paso, Texas. The main objectives were to debunk skin cancer myths prevalent in underserved communities and to strengthen prevention initiatives. Methods: Participants were administered optional surveys assessing their skin cancer knowledge and prevention behaviors before and after attending the session. Demographic data was collected, and pre-event and post-event knowledge were quantified using unpaired T-tests. Results: The event was attended by over 100 people. Over 80% of the event attendees were Hispanic. Among them, approximately one-third had only graduated high school, another third had completed college, and one-quarter held advanced degrees. The ages of participants ranged from 18 to over 75. Notably, 22% of respondents were uninsured. All survey respondents reported learning something new from the event. The performance from the pre-test to the post-test improved significantly by 7.04% (p=0.017). Additionally, attendees reported better knowledge about where to apply sunscreen and the importance of wearing sun-protective clothing. Conclusion: The Sun Bus Community Initiative proved to be an effective method for participants to learn about sun protection, skin cancer prevention and screening. This initiative could serve as a model to implement in other underserved communities to improve skin cancer awareness and prevention. Citation Format: Daniel Lovasz, Brian Kan, Hannah Riva, Shravya Kichena, Fabiola Ramirez, Whitney Shaffer, Julia Guido, Mariana Arajuo-Rincon, Jessica Chacon. Empowering underserved communities: The impact of the Sun Bus and Texas Tech on skin cancer awareness and prevention in “Sun City” [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B056.

Abstract C012: Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students

Abstract Introduction: Medical student curriculum is lacking in standardized training of skills for conducting the skin cancer screening examination. Dermatology is not a standard clinical rotation during medical school, and many medical students do not have much exposure to the specialty of dermatology for hands-on training in skin examinations by dermatologists. We sought to create an event in conjunction with the Sun Bus that included education about dermatology and skin examination for medical students. Objectives We sought to assess how the effects on knowledge of dermatology and skin cancer prevention and screening among participating medical students changed from participating in the educational event. Methods: The Health Education and Awareness Team of Texas Tech University Health Sciences Center El Paso collaborated with The Sun Bus to organize a training event for medical students. During this event, students had the opportunity to listen to a panel about dermatology as well as the basics of skin cancer screening from working dermatologists. Students also received a brief training on skin cancer screening provided by The Sun Bus and conducted screenings alongside dermatologists during a free skin cancer screening event. Students completed voluntary pre-event and post-event surveys. Results The vast majority of students did not feel confident in their ability to screen for skin cancer prior to attending the event. This research showed improved student confidence in providing skin cancer screenings and identifying suspicious skin lesions from the intervention. Conclusion: Medical students lack standardized training in dermatology and in the dermatologic skin cancer screening examination. This student educational event represents a meaningful intervention that improved medical students’ confidence in providing skin cancer screenings and identifying suspicious skin lesions. Bibliography The Sun Bus. https://www.thesunbus.org/about-us Accessed 11 Dec 2023. Compres E, Holzem K, Ibler E, Bierman JA, Rademaker AW, Kundu RV. A Brief Dermatology Curriculum in Skin Cancer Detection and Prevention to Improve Medical Student Knowledge and Confidence. MedEdPORTAL. 2020;16:11049. Published 2020 Dec 29. doi:10.15766/mep_2374-8265.11049 Moore MM, Geller AC, Zhang Z, et al. Skin cancer examination teaching in US medical education. Arch Dermatol. 2006;142(4):439-444. doi:10.1001/archderm.142.4.439 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Citation Format: Elian A. Martin Lopez, Hannah Riva, Shravya Kichena Kichena, Daniel Lovasz, Brian Kan, Tannis Hogg, Jessica Chacon. Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C012

Three-Layer Reconstruction of a Full-Thickness Nasal Alar Defect after Basal-Cell Carcinoma Removal

Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect’s size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon’s expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method.

Is It Possible to Monitor the Safest Time to Perform Secondary Surgery on Free Flaps? A Clinical Evaluation of the Tewameter®.

Background and Objectives: Postoperative monitoring, following free flap surgery, plays a crucial role in ensuring the survival of the flap. However, in microsurgery, not only the immediate postoperative monitoring period but also the choice of the right time for secondary surgeries is crucial for the free flap survival. There is no clear consensus concerning the right choice of timing for secondary surgery. Our aim was to evaluate transepidermal water loss (TEWL), with the objective evaluation tool Tewameter® in free flap surgery to monitor flap autonomization. Materials and Methods: Transepidermal water loss was assessed in 20 patients with microsurgically transplanted free anterior lateral thigh (ALTP) flaps. The transplantation of the ALTP-flap and the postoperative care were administered in accordance with the standard of care of the department. Measures were taken on the free flap and normal skin at follow-ups of 1, 3, and 6 months after initial free flap transplantation. Results: Transepidermal water loss gradually increased to the values found in normal skin, after 6 months. The differences between the two areas demonstrated the smallest variance after 6 months, specifically in the ALTP-flap region. The largest disparities were observed between month 1 and month 6, followed by month 3 and month 6, and month 1 and month 3. Conclusions: Free flap autonomization and physiology are complex processes. TEWL might be a valuable parameter to monitor flap autonomization. Our results indicate that TEWL in the free flap is nearly "normal" after six months. For a clear consensus of when to perform individual secondary surgery, further studies are needed.

Clinical application of perforator-based propeller flaps in repair of hand wound

To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.

Awareness of skin cancer screening coverage in U.S. healthcare plans: Is there a need to better educate the public?

ObjectivesTo understand whether financial barriers or the lack of accessibility to dermatology services was a significant motivation for the public to seek free skin cancer screening. MethodsAn anonymous and voluntary survey was administered to participants of The Sun Bus free skin cancer screening program in 2023 at U.S. outdoor events in Colorado, Texas, Arizona, New Mexico, Iowa, Wyoming, Missouri, and Montana. 491 respondents answered questions on motivation, healthcare coverage, and demographics. Survey data was analyzed using Qualtrics’ crosstab IQ and statistical tests software. ResultsSkin screening found suspicious lesions in 45 % of 1300 participants with 18 % of respondents sharing a previous history of skin cancer. Concern for a lesion or Curiosity were the two top reasons for 60 % of respondents to seek free skin screening and remained the top reasons after data was stratified by gender, age, or income. Only 15 % of respondent were motivated by the cost of dermatology services or a long wait to see a dermatologist. A total of 38 % of people surveyed reported comprehensive plans covering skin screening while 46 % were unaware of the inclusion of screening in their healthcare plan. Notably, this unawareness increased up to 52 % among younger and less affluent respondents. Additionally, females were less likely than males to be aware of skin screening options in their healthcare plans. ConclusionsThis work highlights the significance of promoting public awareness of dermatology services covered by health insurance and the need for continued efforts in skin cancer education and screening programs.

A Multiparty Collaboration to Engage Diverse Populations in Community-Centered Artificial Intelligence Research

Artificial Intelligence (AI)-enabled technology has the potential to expand access to high-quality health information and healthcare services. Learning how diverse users interact with technology enables improvements to the AI model and the user interface, maximizing its potential benefit for a greater number of people. This narrative describes how technology developers, academic researchers, and representatives from a community-based organization collaborated to conduct a community-centered project on emerging health technologies. Our project team comprised representatives from Stanford Medicine, Google, and Santa Clara Family Health Plan’s Blanca Alvarado Community Resource Center. We aimed to understand the usability and acceptability of an AI-driven dermatology tool among East San Jose, CA, community members. Specifically, our objectives were to: test a model for cross-sector research of AI-based health technology; determine the utility of the tool in an ethnically and age-diverse population; obtain in-depth user experience feedback from participants recruited during community events; offer free skin health consultations; and provide resources for receiving follow-up care. We describe a collaborative approach in which each party contributed expertise: knowledge of the community from the community health partner, clinical expertise from the academic research institution, and software and AI expertise from the technology company. Through an iterative process, we identified important community needs, including technological, language, and privacy support. Our approach allowed us to recruit and engage a diverse cohort of participants, over 70% of whom preferred a language other than English. We distill learnings from planning and executing this case study that may help other collaborators bridge the gap between academia, industry, and community in AI healthcare innovation.

Application of Cross-Groin Flap for Coverage of Large Skin and Soft Tissue Defects of the Foot and Ankle in Children

In children with large soft tissue defects of the foot and ankle, it is difficult to cover the wound completely using a local skin flap, and skin grafting of the donor area for repair causes secondary damage. Free skin flaps require good vascular anastomoses and are prone to vascular crises. The authors evaluated the effectiveness and safety of cross-inguinal flaps for the repair of large soft tissue defects of the foot and ankle in children. The records of 15 children who underwent cross-groin flap transplantation between June 2017 and June 2021 were analyzed retrospectively. All the flaps survived without infection, necrosis, or other complications. The flap shape was good, the donor area was sutured directly, and the damage was minimal. This surgical method is simple, effective, and safe and can replace microsurgery, making it suitable for use in primary-level hospitals that are not equipped for microscopic surgery.

Single-stage Auricular Reconstruction in Hemifacial Microsomia With Low Hairline by Using Temporoparietal Fascia Flap.

Auricular reconstruction is one of the most complicated operations in plastic surgery and is more difficult for patients with a low hairline due to limited skin availability. In traditional operations, the skin of the mastoid area was used to cover the front of the ear scaffold, and the retroauricular fascia, combined with a free skin graft, was used to cover the back of the ear framework. This may cause problems such as inadequate skin coverage and affecting the shape of the reconstructed ear when the hairline is low. Hemifacial microsomia patients with low hairline have little skin flap to perform the ear reconstruction, and we refined a single-stage ear reconstruction surgery to solve the problem. The temporoparietal fascia is used to cover the entire costal cartilage scaffold, and its surface is covered with a free split-thickness skin taken from the chest wall, thigh, and other parts. From December 2019 to December 2020, 12 patients with hemifacial microsomia underwent single-stage reconstruction with temporoparietal fascia. The duration of patient follow-up was 6 to 24 months. The application of this technique can solve the problem of insufficient available skin flap, complete the ear reconstruction through 1 operation, reduce the treatment cycle, achieve a good shape of the reconstructed ear, and the postoperative effect is satisfactory. According to the characteristics of the HFM patients with low hairline, we recommend this new, improved single-stage auricular reconstruction using the temporoparietal fascia for these patients. This method is a suitable choice for HFM patients with low hairline.Level of Evidence: Level-IV, Cases Study.

Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps

To investigate the accuracy of positioning perforator of medial sural artery with three-dimensional ultrasound technique guided by a wide band linear matrix array volume transducer probe before operation, and the effectiveness of the flap design based on this in repairing the dorsal foot wounds. Between January 2019 and December 2022, 30 patients with skin and soft tissue defects of the dorsal foot were treated. There were 19 males and 11 females, with an average age of 43.9 years (range, 22-63 years). There were 12 cases of traffic accident injury, 15 cases of heavy crushing injury, and 3 cases of machine injury. The time from injury to hospitalization was 1-8 hours (mean, 3.5 hours). The wounds in size of 5 cm×3 cm to 17 cm×5 cm were thorough debrided and covered with vacuum sealing drainage dressing. Then the wounds were repaired with the medial sural artery perforator flaps after no obvious infection observed. To obtain the complete three-dimensional image, the number and position of the medial sural artery perforator branches and the position of the main blood vessels in the muscle were detected and recorded by wide band linear matrix array volume transducer probe before operation. Suitable perforating branches were selected to design the flap and guide the flap incision on this basis. The size of the perforating flap ranged from 6 cm×4 cm to 18 cm×6 cm. The sensitivity and positive predictive value were calculated by comparing preoperative exploration with intraoperative observation of perforating branches, so as to evaluate the positioning accuracy of three-dimensional ultrasound technique. The donor sites were sutured directly in 25 cases and repaired with free skin grafting in 5 cases. The 60 perforating branches of medial sural artery were found before operation and 58 during operation in 30 patients. Among them, pre- and intra-operative perforations were consistent with 56. The sensitivity was 93.3% and positive predictive value was 96.6%. The intramuscular position and route of the main blood vessels were basically consistent with the pre- and intra-operative observation. All flaps survived and wounds healed by first intention. All incisions at the donor sites healed by first intention, and all skin grafts survived. All patients were follow up 9-24 months (mean, 14.7 months). The appearance, color, and texture of the flaps were good, and no obvious effect on wearing shoes and walking. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind score ranged from 80 to 92, with an average of 87.5. The patient satisfaction was excellent in 29 cases and good in 1 case. The three-dimensional ultrasound technique guided by the wide band linear matrix array volume transducer probe can accurately locate the perforating branch of the medial sural artery, and the three-dimensional imaging is more intuitive, which can be used to guide the design and incision of the medial sural artery perforator flap.

Application of mixed reality technology in free fibular flap transplantation for repairing mandibular defects

To explore the feasibility and effectiveness of mixed reality technology for localizing perforator vessels in the repair of mandibular defects using free fibular flap. Between June 2020 and June 2023, 12 patients with mandibular defects were repaired with free fibular flap. There were 8 males and 4 females, with an average age of 61 years (range, 35-78 years). There were 9 cases of ameloblastomas and 3 cases of squamous cell carcinomas involving the mandible. The disease duration ranged from 15 days to 2 years (median, 14.2 months). The length of mandibular defects ranged from 5 to 14 cm (mean, 8.5 cm). The area of soft tissue defects ranged from 5 cm×4 cm to 8 cm×6 cm. Preoperative enhanced CT scans of the maxillofacial region and CT angiography of the lower limbs were performed, and the data was used to create three-dimensional models of the mandible and lower limb perforator vessels. During operation, the mixed reality technology was used to overlay the three-dimensional model of perforator vessels onto the body surface for harvesting the free fibular flap. The length of the fibula harvested ranged from 6 to 15 cm, with a mean of 9.5 cm; the size of the flap ranged from 6 cm×5 cm to 10 cm×8 cm. The donor sites were sutured directly in 7 cases and repaired with free skin grafting in 5 cases. Thirty perforator vessels were located by mixed reality technology before operation, with an average of 2.5 vessels per case; the distance between the exit point of the perforator vessels located before operation and the actual exit point ranged from 1 to 4 mm, with a mean of 2.8 mm. All fibular flaps survived; 1 case had necrosis at the distal end of flap, which healed after dressing changes. One donor site had infection, which healed after anti-inflammatory dressing changes; the remaining incisions healed by first intention, and the grafts survived smoothly. All patients were followed up 8-36 months (median, 21 months). The repaired facial appearance was satisfactory, with no flap swelling. Among the patients underwent postoperative radiotherapy, 2 patients had normal bone healing and 1 had delayed healing at 6 months. In free fibular flap reconstruction of mandibular defects, the use of mixed reality technology for perforator vessel localization can achieve three-dimensional visualization, simplify surgical procedures, and reduce errors.

36-year Follow-up on Scalp Reconstruction Using Free Latissimus Dorsi Muscle Flap, Skin Grafting, and Scalp Expansion.

Immediate coverage of a large area of exposed skull is the first step in reconstructing a major scalp loss. In the 1970s, the free omental flap was used for scalp reconstruction, replacing removal of the external table and skin grafting only. Introduction of flaps and expanders has revolutionized reconstruction of major scalp losses. A free muscle flap is used to cover the exposed skull. Skin graft covers the muscle flap, and next, the expanded scalp is used to restore the scalp to its original shape. In certain cases, a hair transplant could help create a more natural hairline. In this case, in 1987, a free latissimus dorsi muscle flap and skin grafting were used in a 27-year-old man with major scalp loss. The left latissimus dorsi muscle was harvested with its vascular pedicle intact. Left superficial temporal vessels were used as recipients. After complete healing of the free flap, scalp and forehead skin were expanded and used to restore the scalp to its preinjury shape. Coverage of the exposed parietal skull with free latissimus dorsi muscle flap and skin graft was successful. Then, scalp tissue surrounding the defect and forehead skin were expanded and used to restore the scalp to its original shape. This 36-year follow-up in a patient who had major scalp reconstruction using free latissimus dorsi muscle and skin grafting followed by scalp and forehead expansion shows that this method provides an excellent and reliable long-term coverage for such an injury.

Pecial features of surgical approach for patients with Dupuytren's contracture (our experience)

Objective. Although many years history of study, the issue of treating patients with Dupuytren's contracture keeps on being relevant. It is due to high incidence of this pathological condition among the population (up to 8.2%), the lack of a unified surgical treatment approach, and a high risk of postoperative complications (up to 40%). Existing approaches to the treatment do not ensure the absence of condition recurrence and are related to a long recovery period (up to 12 months).Purpose of the study: to improve the outcomes and reduce the treatment period of the patients with Dupuytren's contracture by creating and integrating algorithm for choosing the optimal surgical intervention in clinical practice.Material and methods. The study involved two parts. In the first part data of surgical treatment performed for 8962 patients with Dupuytren's contracture (10213 surgeries) operated during the period of 2007–2022 were analyzed. 6632 male (74%) and 2330 female (26%) were enrolled in the study. The patients’ mean age was (57 ± 6) years old (from 24 to 92 years old). 9396 needle fasciotomies (92%), 562 subtotal fasciectomies (5.5%), and 255 inspection interventions for recurrence after subtotal fasciectomy (2.5%) were performed.In the second part of the study, we suggested a universal algorithm for choosing the optimal technique of surgical treatment of patients with Dupuytren's contracture, depending on the severity, the presence of concomitant skin problems in the operation site (tightening scars or trophic lesions), the number of recurrences, and the method having caused them.Results and discussion. The follow-up period ranged from 3 to 15 years. Treatment outcomes were assessed using the qDASH scale and the treatment satisfaction subjective scale. Perfect treatment outcomes were obtained in 56.8% of cases, good – in 28.2%, satisfactory – in 11.1%, and unsatisfactory – in 3.9% of cases. Complications (iatrogenic damage to the dactylar nerves and arteries, flexor tendons, ruptures and deep skin cracks, and superficial infectious complications) occurred in less than 8% of patients. Contracture recurrences were noted in 5370 cases (52.6%).The analysis of our own 15-year experience (more than 10000 surgeries) as well as the study of colleagues’ experience (according to the literature) allowed us to formulate the guidance for choosing the approach of treating the patients with various forms of Dupuytren's contracture.In primary Dupuytren's contracture, we recommend needle fasciotomy (or collagenase injections) as a quick, minimally invasive surgical procedure causing minimal complications and contraindications (less than 8%). In severe cases, rehabilitation under the monitoring of a hand physician is recommended after the surgery.If the recurrence takes place after needle fasciotomy, a repeated minimally invasive procedure may be conducted. The condition recurring three or more times, we recommend considering the open surgery – subtotal fasciectomy accompanying by obligatory epidermic grafting (not palmar skin): cross-finger flap, dorsal metacarpal artery bond flap (Quaba/Maruyama), or full-thickness free skin graft taken from the forearm.The recurrence after subtotal fasciectomy occuring, the presence of tightening scars and trophic lesions should be assessed. In some cases, the tightening scars lack, a needle fasciotomy may be conducted by specialists having mastered the technique. In other cases, trophic lesions absent, we consider the inspection subtotal fasciectomy accompanied by the obligatory closure of the soft tissue defect using a full-thickness skin autograft or bond flap (not palmar skin) must be performed.Obligatory patients’ follow-up for two years (medical examinations every six months) after the surgery to identify the early signs of recurrence, collagenase or steroids injections into the palmar aponeurosis nodes (and/or physiotherapy with Fermencol) in case of disease progression, or prophylactic radiotherapy immediately after the surgery virtually allow to eliminate the risk of the condition recurrence.Conclusions. Analysis of the treatment outcomes of patients with Dupuytren's contracture of varying severity allowed us to work out a universal algorithm for choosing the optimal tactics of surgical treatment of the condition enabling improving the outcomes, reducing the recovery period, and decreasing the risk of recurrence.

Modelling of electromagnetic wave propagation at free space-human skin interface

The proliferation of the ambient environment with many wireless communication infrastructures has constituted a source of concern, at least from health point of view. Hence, there is a need for the investigation of electromagnetic wave interaction with human tissue. This paper models electromagnetic wave propagation at the free-space-human tissue interface, in an attempt to understand how electromagnetic waves interact with the human skin. Maxwell’s equations were used to derive the governing equations of propagating electromagnetic waves in free space while the solution of the boundary-value problem arising from the incident electromagnetic wave at the free space-human tissue interface was found through the use of appropriate boundary conditions. The solution led to the emergence of four Fresnel equations, a pair each for perpendicular and parallel polarizations of the incident wave, at the boundary. Through the use of the Fresnel equations obtained, components of the incident electromagnetic wave power at the boundary can be quantified. Typical profiles of the normalized reflected and absorbed powers at the free space-human skin interface at 28, 60, and 73 GHz were computed, using measured values of permittivity of human tissue. It is found that the total absorption of the power of the incident wave by the human skin occurs when the angle of incidence is between 690 and 770 for the three frequencies used. This is irrespective of the polarization of the incident wave. Information on such distinct angles of incidence for total absorption of power does not appear to exist in the literature as they represent new, previously unreported facts in the existing body of research. Furthermore, computed profiles of reflected power versus incidence angle displayed here, for perpendicular polarization, demonstrate strong alignments with established literature, thus reinforcing the credibility of the results presented in this paper.

Clinical application of V-shaped folded submental flap in the repair of oral defect.

The repair of small and medium-sized defects in the oral has always been a challenge, free skin flap and distal pedicled tissue flaps are difficult to meet clinical needs, and the traditional under-chin flap has the risk of donor-area injury. This study aims to investigate the efficacy of V-shaped folded submental flap in the repair of small-sized and medium-sized oral defects. The clinical data of 28 patients with oral defect lesions, who were hospitalized in the Department of Stomatology, Third Xiangya Hospital of Central South University from March 2019 to December 2022, were retrospectively analyzed. Patients were divided into a V-shaped folded group (17 cases) and a conventional group (11 cases) according to different surgical methods. The V-shaped folded group was treated with a V-shaped folded submental flap for postoperative soft tissue repair, while the conventional group was treated with a conventional submental flap for repair. The postoperative follow-up time was 6-48 months. The survival status, repair time, and repair effect of the 2 groups were compared. There was no significant difference in flap survival rate, flap size, flap preparation time, repair surgery time, and postoperative hospital stay between the 2 groups (all P>0.05). At 6 months after the surgery, the V-shaped folded group had no difficulty in raising the head or everting the lower lip, no "cat ear" deformity in the submental skin. Scars in the V-shaped folding group were hidden at the lower edge of the mandible. The wound aesthetics and functional scores in the V-shaped folded group were significantly higher than those in the conventional group (both P<0.05). The V-shaped foldable submental flap has the advantages of flexible design, simple preparation, reliable blood supply, and protection of the donor area, which can effectively protect the appearance of the chin and avoid functional disorders.

KISSING NEVUS RECONSTRUCTION WITH A SUPRACLAVICULAR GRAFT: A RARE CASE REPORT

Introduction : Kissing nevus is a rare form of congenital nevus that occurs on upper and lower eyelid of one eye, forming a large nevus when the eyelids are closed. This condition causes functional and aesthetic problems thus the reconstruction is essential.&#x0D; Case Illustration : A 23-years old female presented to our ophthalmology outpatient clinic with complain of having painless, black colored, non-progressive nevus over left upper and lower eyelids since birth that cosmetically unpleasing. The dark brown-black colored was sized 55x30 mm with hypertrichosis covering approximately two third of both left upper and lower eyelid margins and extending to cheek. The entire nevus was excised and reconstructed by supraclavicular full thickness skin graft, lateral canthopexy and canthoplasty. Three weeks after operation showed satisfactory results. Histological examination revealed intradermal nevus pigmentosus.&#x0D; Discussion : The reconstruction of eyelid after excision remains a challenge because of its specialized function and cosmetic significance. Ideally, the reconstruction should provide a stable eyelid margin, protect the ocular surface, and sustain mobility. Free skin grafts harvested from the control lateral eyelid, postauricular, supraclavicular, and upper arm region have been the most common reconstructive approach. The supraclavicular area is a reliable donor option to cover large head and neck defects due to its similarity in colour, thickness, and flexibility.&#x0D; Conclusion : Free supraclavicular graft is safe, reliable and cosmetically acceptable choice for reconstruction head and neck defects.

Vezani muskulokutani režanj trapeziusa u rekonstrukciji defekta u regiji ramena nakon resekcije mekotkivnog sarkoma - prikaz slučaja i pregled literature

Introduction: Soft tissue sarcomas (STS) in the extremities require complex treatment involving limb-sparing surgery with adjuvant therapy. The treatment involves tumor resection with wide margins along with additional radiation and/ or chemotherapy. In addition to tumor resection, an important aspect is the reconstruction of the resulting soft tissue defect. For extensive reconstructive procedures in the upper extremities, literature suggests the use of free or pedicled flaps. In the shoulder region, due to its complex regional anatomy, selecting an appropriate flap is the surgical imperative. Recently, there has been significant interest in the use of the pedicled trapezius musculocutaneous flap, which offers certain advantages over other flaps. Case report: A female patient (31 years old) with STS in the left shoulder region, was surgically treated three times. The first surgery involved an intralesional procedure - R2 resection when a pleomorphic dermal sarcoma was diagnosed. After five months, a recurrence of the disease was detected based on magnetic resonance imaging (MRI) findings at the site of the surgical scar. Tumor resection was performed, and the soft tissue defect was covered with a free Thiersch partial-thickness skin graft. Histopathological analysis revealed a high-grade leiomyosarcoma. Two months after the second surgery, MRI findings confirmed a recurrence of the disease. Wide tumor resection was conducted, and the soft tissue defect was covered with a pedicled lower trapezius musculocutaneous flap. Conclusion: The literature lacks studies describing the outcomes of the use of trapezius flaps in the reconstruction of defects in the shoulder region following STS resection. Additionally, there is no unanimous official opinion on the resection margin width that is considered safe. The treatment outcome of our patient indicates the significant potential and advantages of the trapezius flap, as compared to other flaps of that region.

A-157 - The practice of using Vacuum-Assisted Closure in combination with free skin grafts in the treatment of wound defects after removal of malignant skin neoplasms

A-157 - The practice of using Vacuum-Assisted Closure in combination with free skin grafts in the treatment of wound defects after removal of malignant skin neoplasms

Обзор спектрофлуориметрических исследований кожных покровов

Background. Nicotinamide adenine dinucleotide (NADN) is involved in many important biochemical reactions in human metabolism, including participation in mitochondrial energy production. Mitochondrial activity, which affects skin microcirculation and the efficiency of local blood supply, can be indirectly assessed by the fluorescence of NADH in its reduced form. Changes in major skin fluorophores have been studied in both animals and humans, at rest and under different conditions, using spectrofluorimetry. The purpose of the work is, based on scientific literature data, to evaluate the possibility of using a spectrofluorimetric study of NADH levels, as well as the NADH/FAD ratio when assessing the condition of both free skin flaps and pedicled flaps after reconstructive operations, in particular in ophthalmology. Materials and methods. A search of scientific publications in PubMed, Google Scolar and Elibrary was conducted, as a result 61 articles for the period of 1957-2022 were selected for the final scientific review. Results and discussion. A brief historical background of the first spectrofluorimetric studies is presented. A brief overview of spectrofluorimetric methods for studying the skin of both humans and experimental animals, as well as other organs and systems, is given. The disadvantages and advantages of various research methods are listed. A review of changes in spectrofluorimetric parameters of the skin in patients with various somatic diseases of organs and systems was carried out. Conclusion. A review of the abovementioned methods for assessing tissue metabolism is applicable in surgical treatment, plastic surgery and onco-ophthalmology. Of particular value for surgery will be research methods that make it possible to predict the likelihood of rejection of transplanted skin flaps and their cicatricial changes. The presented literature review confirms the effectiveness of spectrofluorimetry for assessing metabolic disorders in the skin. The relevance of the method for predicting cosmetic outcomes during plastic surgery, including on the adnexal apparatus of the eye, requires continued research into the main fluorophores of the skin.