Full-thickness Graft Research Articles

021. Outcomes of Adult Patients That Got Full Thickness Skin Graft with Skin Defects After the Surgical Wide Excision: Observational Case Series Study

Background: Full-thickness skin grafting plays an important role in reconstruction for excessive skin defects after the surgical wide excision. For closed defect consideration, full-thickness skin grafts can be used, The most common full-thickness skin graft donor sites include the retroauricular region, supraclavicular region, inguinal fold, buttock fold, hypothenar area, and anterior wrist fold. In this study. Methods: This is a single institutional, retrospective, observational case series study. We included 8 patients who underwent skin reconstruction using full-thickness skin grafts to close skin defects caused by the excision of skin tumor or trauma, between January 2024 and July 2024. Demographic data, including sex, age, location and photographs, and were collected. Results: the follow up for 8 patients that got full-thickness skin graft, we can make conclusion that full-thickness skin graft, can be the choice to closed the defect. The outcome of the patient is good with the defect is closed. Conclusion: Full-thickness skin grafting is a common technique for reconstructing skin defects after surgical wide excision. This case series demonstrates that using full-thickness grafts can effectively close these defects. Despite the challenges posed by the extent and location of the defects, the grafts provided a reliable solution when primary closure was not possible. Overall, this study highlights the importance of full-thickness skin grafting in the field of reconstructive surgery.

Effect of Quadriceps Tendon Autograft Preparation and Fixation on Graft Laxity During Suspensory Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis.

Favorable collagen fibril density and thickness combined with advances in graft preparation and fixation have significantly increased interest in the quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction. While various suspensory techniques have been described, the biomechanical profile of these constructs is largely undefined. To compare the biomechanics of suspensory techniques for soft tissue QT autograft fixation in an in vitro model of ACL reconstruction. Controlled laboratory study. Full-thickness QT grafts were harvested using a 9-mm graft blade. Adjustable-loop devices (ALDs) were secured to the graft (n = 6 per group) with a combination implant containing the ALD and suture tape-reinforced whipstitching (tape-reinforced [TR] group), tethered superficially to the graft with a whipstitch (onlay [OL] group), luggage-tagged through and around the graft (luggage tag [LT] group), or staggered behind superficial suturing (staggered [SG] group). Grafts were tested on an electromechanical testing machine following a validated in vitro reconstruction model of intraoperative workflow and postoperative ACL kinematics, cyclic loading, and load to failure. The TR group had significantly less postcyclic tension loss (mean, 24%) compared with the OL (56%; P = .002), LT (69%; P < .001), and SG (90%; P < .001) constructs. Cyclic elongation was below the 3.0-mm threshold defined as clinical failure for TR (1.6 mm), but not for OL (3.3 mm), LT (7.9 mm), and SG (11.3 mm). All constructs were within native ACL stiffness limits (220 ± 72 N/mm) without significant differences. Ultimate loads significantly exceeded a normal ACL loading limit of 454 N for TR (739 N; P = .023), OL (547 N; P = .020), and LT (769 N; P = .001), but not for SG (346 N; P = .236). The TR ALD construct demonstrated the most favorable time-zero biomechanical properties of modern soft tissue QT suspensory constructs, with 32% less tension loss and 52% less cyclic elongation versus the closest construct. Failure loading of all constructs was acceptable with respect to the native ACL except for the SG group, which had suboptimal ultimate load. TR ALD implants may protect soft tissue QT autografts before graft-bone healing in ACL reconstruction by minimizing time-zero laxity and fixation failure.

Taste Disturbance After Endoscopic Tympanoplasty with Tragal Cartilage Graft and Improvement Strategies.

Objectives: To explore the risk factors of early postoperative taste disturbance (EPTD) after type I endoscopic tympanoplasty and operative modification strategies to improve taste disturbance. Methods: This was a controlled study. One hundred and twenty-four patients who underwent type I endoscopic tympanoplasty with tragal cartilage graft were separated evenly into control and modified groups. The full-thickness tragus cartilage graft was placed close to the bony annulus to ensure drum integrity in the control group, and in the modified group, the cartilage graft was not in contact with the posterior-superior bony annulus, and the inferior-posterior of the scutum. Univariate and multivariate models were used to analyze the possible factors affecting EPTD and the prognosis of taste recovery. Results: The incidence of EPTD was significantly lower in the modification group (24.19%) than in the control group (56.45%) (OR: 4.24, 95% CI: 1.93-9.33, P < .001). Surgical manipulation of the chorda tympani nerve resulted in a higher incidence of EPTD (OR: 2.43; 95% CI: 1.06-5.57, P = .035). The size of the graft did not affect taste disturbance. No difference in the taste recovery rate was observed between the control and test groups (Z = -1.57, P = .116) after 3 months. The recovery rate of patients with manipulated chorda tympani nerves was still lower than that of patients without at 3 months (Z = -2.74, P = .006). Conclusion: Modified surgery and reduced manipulation of the chorda tympani nerve effectively reduce EPTD. Manipulated chorda tympani nerves may have a persistent effect on taste recovery.

Safety of intraoperative autologous plasma incubation of corneal grafts for reducing endothelial cell loss: a pilot study.

Corneal endothelial cell loss contributes to transplant failure. Autologous plasma products (APP) activate salvaging pathways that can prevent oxidative stress perioperatively. This study aimed to evaluate the safety of intraoperative incubation of full-thickness corneal grafts in platelet-rich plasma (aPRP) and plasma rich in growth factors (PRGF-Endoret) in mitigating postoperative corneal endothelial cell loss (ECL). Pilot study including patients undergoing penetrating keratoplasty (PK) for various indications between June 2021 and December 2022. Patients were randomly assigned to receive either aPRP or PRGF-Endoret incubation, while those who declined intervention served as the control group. Demographic and clinical data were collected, including preoperative and postoperative endothelial cell count, intraocular pressure, pachymetry, and adverse reactions. Thirty individuals who underwent PK completed follow-up: eight from the aPRP group, 10 from the PRGF-Endoret group, and 12 from the control group. No adverse events related to APP treatment were recorded. In the first and third postoperative months, the APP group had significantly lower ECL percentages (37% vs. 25%, p = 0.02, and 44% vs. 33%, p = 0.02, respectively); this trend was maintained in the sixth month. When stratified, the PRGF-Endoret group showed significant differences in ECL reduction compared to controls at both time points (p = 0.03 and p = 0.05, respectively). The aPRP group showed a similar statistically significant outcome exclusively on the third postoperative month (p = 0.04). APP tended to reduce corneal edema faster than controls. Hexagonality was significantly better in the APP groups in the first and third months, particularly in the PRGF-Endoret group (p < 0.005). Preoperative incubation with APP is safe and promotes better endothelial cell quality and quantity in the early postoperative period following PK. These findings suggest a potential clinical benefit in enhancing graft outcomes and warrant further investigation.

“Mosaic graft” technique and surgical dermal glue in Mohs micrographic surgery and general dermatologic surgery

After Mohs Micrographic Surgery dermsurgeons utilise local flaps, full or partial thickness grafts, with good or acceptable cosmetic results. When we are dealing with older and problematic patients, blood thinner users, and non-collaborative people with large facial neoplasms, using flaps may be very difficult and grafts become the best choice. Our aim was to assess a technique to graft very easily, quickly and safely, full thickness skin grafts in facial wounds and have good cosmetic results in those older and problematic people. Ten elderly patients who underwent Mohs Surgery or other surgical procedures have been grafted with this technique that we called “Mosaic graft”, made possible using a dermal glue in a new way. In some cases, for bigger defects, we also assessed the “Stripes” variant of this technique. Graft survival was almost always complete in all cases and after 6 months the cosmetic outcomes were good. This “Mosaic graft” technique and its “Stripes” variant showed good reliability, fast execution, easy harvesting with tissue saving, good cosmetic outcomes, making this technique a very good choice for older and problematic patients.

Synchronic basal skin cancer: resection and double full-thickness dermoepidermal graft in a comorbid patient. complex to simple

Synchronic basal skin cancer: resection and double full-thickness dermoepidermal graft in a comorbid patient. complex to simple

One-stage secondary debulking procedure: A unique technique to restore the differential contour of digit after groin flap reconstruction

BackgroundPedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility and sensation especially while providing strict thin skin coverage still exist. Patients and MethodsA total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat was debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow up. ResultsThe average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5cm of digit was preserved for the non-replantatable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients’ satisfactory outcomes of the reconstructed digits was judged as “very satisfying” in 12 patients (75%) and “good results” in four (25%). ConclusionsOne-stage secondary debulking procedure resulted in excellent functional and aesthetic outcomes for digit according to different structure of dorsal and volar sides. Level of EvidenceIV, Retrospective

Management of Immobile Scalp Skin Tumors and Analysis of Skin Graft Survival on Burred Calvaria.

Surgeons face challenges associated with adherent cutaneous scalp malignancy. Traditional general anesthetic excision involves periosteal removal and burring of the outer table of the calvaria for deep margin clarity and tissue reconstruction. Research on this practice is limited, and graft survival in burr-treated bones is underexplored. This study aimed to assess the clinical margin accuracy for immobile scalp malignancies, identify deep-invading malignancy types, and evaluate graft survival in burr-treated calvariae. It compares split-thickness grafts (STSGs) and full-thickness grafts (FTSGs). Twelve fixed scalp malignancies were excised under anesthesia, allowing immediate STSG or FTSG for defect reconstruction. Postsurgery, graft take, malignancy type, and margin clearance were evaluated. Histopathological diagnosis identified seven squamous cell carcinomas, two melanomas, one basal cell carcinoma, one adenocarcinoma, and one metastatic squamous cell carcinoma. Deep margins ranged from 0 to 0.9 mm, and peripheral margins ranged from 0 to 15 mm. The graft take was 100% in eight cases, with total failure in two cases, and 75%-90% in two cases. The five STSGs had 100% take and 90% take. The three FTSGs had 100%, 75%, and two failed. Clinical examination effectively gauges the tumor fixation depth, but large lesions may require imaging. Most deep-invading tumors were SCCs. STSGs performed better on burr-treated Calvaria than FTSGs.

Fourteen-Year Experience in Burn Eyelid Reconstruction and Complications Recurrence: A Retrospective Cohort Study.

Loss of vision and other ocular defects are a concern with eyelid burn sequelae. This most commonly progresses from eyelid contracture to cicatricial ectropion and lagophthalmos. When left untreated, these may lead to exposure keratitis, ulceration, infection, perforation, and loss of vision. In the case of full-thickness eyelid burns, release and grafting are required. However, there is a paucity of studies on outcomes in eyelid burn surgery treatment, despite concern for permanent ocular damage or loss of vision. The aim of the study is to describe the complication rates in burn eyelid reconstruction at a single center for 14 years. A retrospective cohort study was performed of all patients who had sustained eyelid burns and required reconstruction between April 2009 and February 2023. Medical records were obtained from patients' charts. Collected data include demographics, medical history, type of injury, indication for surgery, procedure performed, and complications. A total of 14 patients and 25 eyelids underwent eyelid reconstruction of the 901 total patients with burn-related injuries requiring plastic surgery reconstruction. These patients underwent 54 eyelid surgeries with a mean follow-up time of 13.1 ± 17.1 months. Patients were 71% men and 29% women, with a mean age of 45.1 ± 15.6 years. In 53.7% (n = 29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. The reconstruction of the upper and lower eyelid alone represented a smaller percentage (25.9% and 20.4%, respectively). On average, the patients received 3.9 ± 3.5 eyelid surgeries. The overall complication rate was 53.7% (n = 29). The most common complication was ectropion (42.6%, n = 23). Other complications included eye injury (25.9%, n = 14), lagophthalmos (24.1%, n = 13), local infection (7.4%, n = 4), and graft loss (5.6%, n = 3). Periorbital burns represent a major challenge that may require complex surgical intervention. Full-thickness skin graft remains the standard of care for patients with eyelid burns. However, there is a high incidence of ectropion that may require reoperation. Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment.

Early Intervention and Use of Autologous Grafts in Growing Skull Fractures Results in Better Outcomes: Experience From a Tertiary Pediatric Neurosurgery Center.

Growing skull fracture (GSF) is a rare complication of pediatric head trauma. Definitive treatment is surgical repair. We have attempted to assess whether use of autologous grafts for duraplasty and cranioplasty leads to better outcomes. We have also attempted to understand how timing of surgery might affect the degree of underlying damage to cortical tissue. This is a single-center retrospective observational study based on review from the Great Ormond Street Hospital Neurosurgery prospective surgical database. All patients undergoing surgery for GSF repair between 1991 and 2015 were included. Surgical techniques included split calvarial grafts in 4 patients, whereas rest had full-thickness bone grafting. In all cases with full-thickness graft, the donor site was covered with morselized bone chips mixed with fibrin glue (Salami technique). Twenty-eight patients were identified (16 males, 12 females). The average age at the time of injury was 13 months. The mean duration of onset of symptoms from the time of injury was 4.4 months. The time interval from symptom onset to surgical repair was 5.92 months. Seven patients had Type I GSF (leptomeningeal cyst with minimal brain parenchyma), 13 had type II (hernia containing gliotic brain), and 8 had type III (porencephalic cyst extending through the skull defect into subgaleal space). Patients with delayed presentation had severe brain injury (Type III) and had more long-term complications (refractory epilepsy requiring temporo-occipito-parietal disconnection and development of hydrocephalus requiring ventriculoperitoneal shunt insertion). Autologous pericranium for duraplasty and split-thickness bone graft or the Salami technique are recommended for cranioplasty. Synthetic materials should be used if the index operation fails or there are complications. Patients with high-risk findings should be identified at the time of initial presentation and followed up in clinic early to prevent onset of neurological deficit. Early repair is associated with better neurological outcomes.

Hand Reconstruction with Posterior Interosseous Flap. A Review

For the greatest functional outcome, hand reconstruction with soft tissue abnormalities requires an early, single-stage, well-vascularized cover. Since important tissues including tendons, bones, and joints are exposed, a full thickness graft is typically needed, and subsequent repair is frequently necessary. Reverse flow flaps in the posterior interosseous artery provide a flexible and dependable means of covering intricate soft tissue abnormalities in the hand in full thickness.

A Comparative Analysis of the Outcomes of Various Graft Types in Burn Reconstruction Over the Past 24 Years: A Systematic Review.

Burn injuries, a major global health concern, result in anestimated 180,000 fatalities annually.Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, andxenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts.The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using theCochranerisk-of-bias tool forrandomized trials version 2(RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which10studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias.The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts.The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.

Skin grafting with the modified Meek technique in the standing horse using full thickness skin: Evaluation of acceptance, wound contraction and wound closure in chronic wounds.

The modified Meek technique is not commonly used in equine wound management, despite the consistent reliable and superior results compared with other grafting techniques. Major drawbacks are the need for specialised, expensive equipment and general anaesthesia. To describe adjustments of the modified Meek technique enabling use in the standing horse without the need for the full equipment. This implied the use of full-thickness skin grafts manually harvested from the pectoral area and manually cut into micrografts. Graft acceptance; healing progress; and final functional and cosmetic result were outcome parameters. Descriptive case series. Eight horses with traumatic wounds at the dorsal side of the carpus or tarsus, healing by second intention, were treated. Original wound areas and areas of graft acceptance and rejection were determined from post-processing of digital photographs and percentage acceptance, wound contraction and epithelialisation were calculated. The initial mean wound area was 55.4 cm2. Graft acceptance was 95.3 ± 2.5%. Wound closure was due to 46.0 ± 25.6% wound contraction and 54.0 ± 25.6% epithelialisation and resulted in 96.8 ± 1.9% reduction of the initial wound area 28.0 ± 8.5 days after grafting. The scar was flat, flexible and functional, usually with thin and regular hair growth. The adapted procedure was fast and efficient, with a learning curve for the increased manual work. Small study population. This adapted modified Meek technique can successfully be performed in the standing horse and obviates the need for the full expensive equipment and general anaesthesia. The acceptance of the full-thickness grafts is excellent resulting in fast and satisfactory healing.

Experience in use of full-layer skin autografts in treatment of post-burn cicatricial deformities

Despite technologically advanced approaches to the treatment of patients with thermal lesions of II–III degree, a high percentage of development of cicatricial deformities and contractures with the formation of functionally significant disorders remains. According to a number of authors, post- burn cicatricial deformities and contractures develop in 45.0 %–76.5 %. In order to eliminate cicatricial deformities and contractures, various types of skin grafting are used in clinical practice, which depends both on the localization of scars, the state of surrounding and underlying tissues, the presence of donor sites, and on the goals and expected result of the planned surgical intervention. Considering these aspects and possibilities, the question of choosing the method of surgical treatment of cicatricial deformities and contractures of functional and aesthetically significant areas remains debatable. An analysis was made of the results of treatment of 603 patients who underwent reconstructive and restorative operations. In order to eliminate cicatricial contractures, accompanied by functional disorders in the area of the joints, as well as in aesthetically significant areas, reconstructive operations were performed, mainly using full-thickness autografts. Analysis of the results of surgical treatment of cicatricial contractures of functional and aesthetically significant areas using free autodermoplasty with full-thickness grafts showed its effectiveness, as it made it possible not only to eliminate functional disorders in the operated area and restore the mechanics of movements, but also to minimize the risk of recurrence of cicatricial contractures – repeated reconstructive operations amounted to no more than 1.5 % of all operated patients. Conclusions. In order to eliminate cicatricial contractures, as well as to improve the aesthetic results of treatment in patients with the consequences of a burn injury, it is most advisable to perform autodermoplasty with full-layer autografts in functional and aesthetically significant areas.

Application of the rectus abdominal muscle in reconstructive and recovery surgery of chest wall defects

Introduction. Autologous plastic tissues (muscles and greater omentum) are preferable in the reconstruction of chest wall defects in infectious and inflammatory diseases of the chest wall. Extended and deep defects can be eliminated by flaps of the rectus abdominis muscle.Aid. To study the effectiveness of various options for the use of flaps of the rectus abdominis muscle in plastic surgery of chest wall defects of infectious and inflammatory origin.Object and methods. A retrospective analysis of the results of treatment of 34 patients with osteomyelitis of the sternum and ribs of various etiologies was carried out for the period from January 1, 2012 to May 30, 2023. In 32 patients, the main diagnosis was poststernotomy mediastinitis, 2 patients had post-radiation osteomyelitis of the sternum and ribs after combined cancer treatment. mammary gland. The majority of patients (n = 29) underwent a two-stage approach to treatment using vacuum therapy at the stage of relief of acute inflammation. All patients underwent plasty with a flap of the rectus abdominis muscle. The options for surgical intervention and the outcome of treatment were studied.Results. The area of the defect to be repaired in patients ranged from 50 cm2 to 270 cm2 (mean 143.1 ± 15.3 cm2). There were no intraoperative complications in the patients. The postoperative period was complicated by various wound complications in 9 patients. Marginal necrosis of the skin part of the graft was revealed in 3 patients with full-thickness permanent graft plasty. In 3 patients, despite wound drainage, postoperative seromas were detected. Reoperations were performed in 2 patients: in one case, bleeding from the vein of the fullthickness flap was stopped, in the other case, partial necrosis of the full-thickness flap was detected, which required a second operation and revision of the flap. In 1 patient, the hematoma was emptied 3 days after the operation. The average duration of inpatient treatment of patients was 19.3 ± 2.8 days (range 17 to 38 days). There were no lethal outcomes in patients with muscle plasty with a permanent graft flap. In 1 patient, a postoperative hernia was formed in the region of the anterior abdominal wall. Recurrence of osteomyelitis of the ribs was diagnosed in 1 person 16 months after surgery.Conclusions. The rectus abdominis muscle as an isolated and full-thickness flap is the optimal plastic material for eliminating defects in both the lower part of the sternum and extensive defects in the anterior and lateral surfaces of the chest wall.

Differences in the microanatomy of skin of sole and palm in humans

Background: The prevalence of skin diseases has increased over the last few decades and they contribute to a significant burden on the health-care systems all across the world. In some forms of reconstructive or plastic surgery, palm skin has successfully been replaced with sole skin, removed to form a full-thickness graft that covered almost the entire palm of the hand without impairing the weight-bearing areas of the feet or encumbering the gait. In cases such as these, the skin of the palm and sole is preferred for grafts. Aims and Objectives: The study was conducted to learn the microanatomy of palm and sole. Materials and Methods: The present observational study was carried out in the Department of Anatomy, King George Medical University, Lucknow, from the period of September 2017 to August 2018. Ethical clearance was obtained from Institutional Ethics Committee (Ref. code:63/Ethics/R-Cell-18). For the present study, skin was procured from the palm and sole of six freshly embalmed human cadavers (three males and three females). The mean age of the cadavers was 67 years. Tissues were preserved in 10% of formaldehyde for 48 h, fixed, Stained in H and E, and observed under light microscope. Results: The study showed that the thickness of epidermis and ratio of epidermis to stratum corneum (Edp: sc) of the sole are greater than palm, dermoepidermal junctions were more in sole. Thickness of dermis both papillary and reticular dermis was more in sole than palm. Conclusion: The values of thickness of skin of palm and sole region provide data for plastic surgeons to plan cosmetic surgeries.

Full-thickness versus split-thickness skin graft reconstruction of scalp defects with and without calvarium exposure

Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction. Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016. χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression. A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P=0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P=0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P≤0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes. Skin grafts, especially full-thickness, provide a versatile, reliable, and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, full-thickness grafts can succeed when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation, and immunosuppression may result in decreased graft take and increased complications. 3b.

Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction.

Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR). To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR. Controlled laboratory study. A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables. A significant speed×depth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P < .001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, -57.0 ± 10.5 N·m, P < .001; 180 deg/s, -26.0 ± 10.2 N·m, P = .020; 300 deg/s, -20.3 ± 8.9 N·m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD0-25 (0-25% of the range of motion), -131.3 ± 50.9 N·m/s, P = .018; RTD25-50, -197.0 ± 72.5 N·m/s, P = .014; RTD50-75, -113.3 ± 39.8 N·m/s, P = .013; RTD75-100, -149.4 ± 35.9 N·m/s, P < .001). Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds. The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.

Microbial Infections After Boston Keratoprosthesis: A Case Series

Purpose: This article presents a case series of microbial keratitis in eyes that underwent Boston keratoprosthesis implantation. Methods: A thorough examination of medical records and microbiology results was conducted for patients who experienced microbial keratitis subsequent to Boston keratoprosthesis (KPro) implantation from July 2019 to July 2023. Results: The review included 3 eyes of 3 distinct patients. In case 1, a patient with a history of chemical burns in the right eye underwent type I KPro implantation. Infectious keratitis, caused by Corynebacterium amycolatum, developed 9 years post-implantation. Despite the keratitis, the KPro remained in place, and treatment with vancomycin and ceftazidime agents, along with a C-collar full-thickness corneal graft for corneal melt, was administered. In case 2, Streptococcus pneumoniae-induced keratitis occurred 2 months following a type I KPro implantation. The infiltration resolved entirely after 4 weeks of topical and systemic antimicrobial treatment. Case 3 involved a patient with a history of Stevens-Johnson syndrome who underwent type II KPro implantation with autologous auricular cartilage reinforcement in the left eye. Bacterial keratitis and endophthalmitis caused by Streptococcus mitis/oralis developed 2 years after the surgery, ultimately resulting in phthisis. Conclusions: Both C. amycolatum and S. mitis/oralis can breach commensalism barriers, leading to opportunistic infections in eyes with implanted keratoprosthesis and compromised ocular surfaces. Post-keratoprosthesis microbial keratitis remains a significant concern and is often associated with adverse outcomes.

Quality by Design: Development of Safe and Efficacious Full-Thickness Acellular Dermal Matrix Based on EuroGTPII Methodologies.

The activities of tissue establishments are constantly and rapidly evolving. The development of a new type of allograft, full-thickness acellular dermal matrix, with high mechanical properties to be used in tendon repair surgeries and abdominal wall reconstruction, has determined the need for quality by design process in order to assess evidence of quality, safety and efficacy. The EuroGTPII methodologies were specifically tailored to perform the risk assessment, identify and suggest tests in order to mitigate the potential risk consequences of a novel tissue preparation implementation. The new allograft and associated preparation processes were assessed using the EuroGTP methodologies and characterized to properly evaluate the novelty (Step 1), identify and quantify the potential risks and risk consequences (Step 2), and define the extent of pre-clinical and clinical assessments required to mitigate the risks identified in the assessment (Step 3). Four risk consequences associated with the preparation process were identified: (i) implant failure related with tissue procurement and the reagents used during the decellularization protocol; (ii) unwanted immunogenicity related with the processing; (iii) disease transmission linked with the processing, reagents used, reduction in the reliability of microbiology testing and the storage conditions; and (iv) toxicity related to the reagents used and handling of the tissue during clinical application. The outcome of the risk assessment was a low level of risk. Nevertheless, it determined the need for a series of risk mitigation strategies proposed to reduce each individual risk and to provide additional evidence of the safety and efficacy of full-thickness acellular dermal matrix grafts. EuroGTPII methodologies allow us to identify the risks and ensure the correct definition of pre-clinical assessments required to address and mitigate the potential risk consequences, before proceeding with clinical use of the new allografts in patients.