Full-thickness Skin Autografts Research Articles

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.

Effect of homologous platelet rich fibrin matrix and injectable platelet rich fibrin on full thickness skin autograft healing in dogs

Effect of homologous platelet rich fibrin matrix and injectable platelet rich fibrin on full thickness skin autograft healing in dogs

NECROTIZING FASCIITIS OF THE FACIAL SKIN IN PEDIATRIC PATIENT: CASE REPORT

Background: Necrotizing fasciitis is a potentially life-threatening soft tissue infection, characterized by necrosis of the fascia, subcutaneous tissue, adipose tissue and can be fatal. NF is most common in immunocompromised hosts but may also occur in healthy patients without apparent antecedent injury. It is usually caused by either Group A streptococci or a polymicrobial, synergistic infection. The case that we present is unique in the Republic of Armenia, necrotizing fasciitis of the face in a child. Methods: We report the case of 3,5-year-old children who were treated for NF in our unit, inclusive, were reviewed retrospectively. Information recorded included medical history, clinical characteristics, diagnostic procedures, treatment methods, and the outcome. Results: The essence of the treatment was to prevent further development of necrosis, taking the child out of the state of general intoxication, in connection with, early surgical debridement, anti-intoxication, antibacterial therapy were carried out in several stages. In result, auto transplantation by full thickness skin autograft has been done, maintaining the aesthetic appearance of the wound. Conclusion: Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. Despite the fact that it is rare in children, according to our data, it turned out that the reason for the penetration of microorganisms may be an incomplete injection. Clinicians should be aware of these infections, as early treatment can increase survival.

Surgical treatment of combined injuries of the neck and shoulder joints

To develop the algorithm for effective surgical restoration of shoulder joint and neck functions and acceleration of social and labor rehabilitation. There were 116 patients with combined consequences of burns of the neck and shoulder joints between 2012 and 2021. These ones amounted to 29.4% of all patients with lesions of the neck or shoulder joints. Simultaneous surgeries with correction of post-burn cicatricial deformities and contractures were performed in 66 patients (56.9%). Age of patients ranged from 18 to 72 years, and 96% of them were employable. There were 89 (76.7%) women and 27 (23.3%) men. We assessed spread and localization of cicatricial process, as well as restriction of mobility of the neck and shoulder joint to select optimal surgical approach. Classification of neck deformities and contractures of shoulder joints considering severity of cicatricial lesion and functional impairment made it possible to systematize the approach to reconstructive procedures. Reconstructive surgery included repair with local tissues including skin-fatty flap, non-perforated split or full-thickness skin autograft, rotated flaps including those based on perforator vessels, as well as preliminary skin stretching. In general, 116 patients with combined lesions of the neck and shoulder joints underwent 314 surgeries. To accelerate rehabilitation, we performed simultaneous surgeries with correction of deformities and contractures in 66 patients (56.9%). Staged reconstructive surgeries were carried out in 50 patients. Acute dermotension and skin-fatty neck flap grafting were the most common for deformities and contractures of the neck. Skin-fatty axillary flap was used in most patients with contractures of shoulder joints. Simultaneous surgeries can accelerate rehabilitation. Correct algorithm of staged surgical treatment reduces rehabilitation period and eliminates functional disorders.

Свободная кожная пластика как способ устранения рубцового выворота нижнего века (клинический случай)

Abstract. Cicatricial eyelids deformations associated with fractures of orbital walls may result in development of eyelids ectropion and lagophthalmos. Gaping of the eye slit results in secondary lesions of the cornea and a decrease of visual acuity which requires reconstructive plastic surgery with skin flaps transplantation. This report presents a case of cicatricial lower eyelid ectropion elimination after osteosynthesis with metal implant for a fracture of zygomatic orbital complex and lower orbital wall using full-thickness skin flap from preauricular face zone. The paper presents step-by-step description of the surgical technique as well as of the early and late post-op period. As the result of surgery, complete engraftment of the skin graft, elimination of ectropion, restoration of eyelids excursion and closing were achieved. Use of full-thickness skin autograft from preauricular face zone is an adequate choice in reconstructive surgery of the eyelids. The graft has high viability providing minimal risk of rejection. The technique is simple to perform and provides high functional and aesthetic results. Key words: cicatricial ectropion of the lower eyelid; full-thickness skin graft; reconstruction of the eyelids.

Pathomorphological characteristics of the wound bed prior to skin autografting

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.

Nigeria bee honey-enhanced adherence, neovascularisation and epithelisation of full-thickness skin autografts on distal extremities of dogs

BackgroundFull thickness skin grafts (FTSGs), although ideal for resurfacing large defects of the distal extremities in veterinary patients, have a high failure rate due to issues of adherence, infection and inadequate revascularisation because of its thickness and high nutritional demand. This study investigated the effect of Nigeria bee honey on FTSG take at the distal extremities of dogs. The study was conducted on 6 adult male Nigerian indigenous dogs using 3 of the 4 limbs of each dog randomly divided into 3 treatment groups: Nigerian bee honey (HON group), platelet-rich plasma (PRP group) and normal saline (CON group). Full‐thickness skin wounds (3 cm × 1.5 cm) were created on the lateral aspect of the radioulnar or metatarsal areas and dressed till adequate granulation tissues formed. Donor skins harvested from the lateral thorax of each dog were sutured to the recipient bed following application of the assigned treatment, and evaluated grossly and histologically on days 0, 4, 7, 10, 14, 17, and 21.ResultsA higher percentage (4/6 representing 66.7%) of complete graft take was observed in the HON and PRP groups as compared to 3/6 (50%) in the CON group. The HON group had a greater percentage (5/6 representing 83.3%) of adhered grafts as compared to the PRP (4/6 representing 66.7%) and CON (3/6 representing 50%) groups at day 4. There was a significant decrease (p = 0.022) in percentage necrosis between the CON and HON/PRP groups on day 10, 14 and 17. The percentage open mesh area for the HON group was significantly lesser at day 4, 7 and 10 when compared with CON (p < 0.001) and at day 4 when compared with PRP (p = 0.001). At histology, graft neovascularisation score was highest in the HON group on days 4, 14 and 21.ConclusionNigeria bee honey enhanced take of meshed full-thickness skin autografts by promoting adherence to the recipient bed, enhancing fibroblast proliferation and collagen laydown, and accelerating the rate of neovascularisation suggesting promising application as an alternative modality to enhance FTSG take.

Features of free skin grafting to correct post-burn neck deformities in children

BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results.&#x0D; AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures.&#x0D; MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery.&#x0D; Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture.&#x0D; RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%).&#x0D; Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs.&#x0D; Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results.&#x0D; CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures.&#x0D; Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.

Characteristics of mechanisms of the distant stimulating effect of skin flap autograft on microvascular perfusion in local and systemic microcirculation disorders

Objective : to study the characteristics of mechanisms of the distant stimulating effect of full-thickness skin autograft (FTSG) on microvascular perfusion in local and systemic microcirculation disorders. Materials and methods. The experiment was carried out on 87 white male rats, divided into 5 groups: 1) control; 2) animals with local microcirculation disorders induced by sciatic nerve transection and neuroraphy; 3) animals with systemic microcirculation disorders caused by alloxan-induced diabetes; 4) animals that underwent FTSG after sciatic nerve transection and neurography; 5) animals that underwent FTSG in alloxan-induced diabetes. Laser Doppler flowmetry (LDF) was used to study microcirculation of the dorsal skin of the rear paw. Serum concentrations of vasoactive substances, including catecholamines (CA), histamine, and vasculoendothelial growth factor (VEGF) in the experimental animals were measured. A morphological study of the tissues of the autograft site was carried out on day 42 of the experiment. Results . On day 42 of the experiment, FTSG normalized perfusion in local and systemic microcirculation disorders. FTSG decreases CA level in nerve injury, and to a greater extent in alloxaninduced diabetes. Serum histamine increase under FTSG was more pronounced in rats with nerve injury. Serum VEGF in rats with nerve injury and FTSG increased, which was not observed in alloxan-induced diabetes. Histological assay of the autograft site revealed degenerative changes in the epidermis and dermis of the autotransplant in both experimental models of microcirculatory disorders. Eosinophilic infiltration of the autograft site was more pronounced in nerve injury than in alloxan-induced diabetes. Conclusion. FTSG has a distant stimulating effect on microcirculation, which manifests itself in the same degree in both local and systemic microcirculation disorders. The distant stimulating effect of FTSG on microcirculation is multicomponent in nature and includes a set of regulatory reactions, whose severity differs in local and systemic microcirculatory disorders.

SURGICAL ASPECTS OF FULL-THICKNESS SKIN AUTOGRAFT ENGRAFTMENT ON A GRANULATING WOUND

Background. The paper presents the clinical results of treating patients using full-thickness skin autografts for granulating wounds.Objective. To study the surgical aspects of full-thickness skin autograft engraftment on a granulating wound. Material and methods In traumatology and burn research, to achieve the best cosmetic results, transplantation methods of free full-thickness skin autografts are used. In the Regional Clinical Hospital #1, a method of skin grafting with a full-thickness autograft was developed, which allows to close the defect in the conditions of a purulent wound: granulations are excised before skin transplantation, and a vacuum is applied after grafting.Results. Annually, the specialists of the Burn Center of the Scientific Research Institute – Regional Clinical Hospital #1 assist more than 1300 patients. Of these, from 20 to 25 cases are face burns. 132 patients with burns of the face have been admitted to the hospital over the past 10 years. 37 patients underwent plastic surgery with a full-thickness skin autograft. The authors presented the technology for the surgical treatment of deep burns on the face. After cleansing the wound from areas of necrosis and granulations, usually 20 days after the injury, the upper layers of granulation tissue are removed with a dermatome parallel to the skin surface, to a depth of 1–2 mm. Then, plastic surgery with the free full-thickness skin autograft is carried out on the skin of the face with the formation of cuts for the nose, mouth, eyes. The wound is tightly bandaged with 5–7 rounds of a medical bandage or a vacuum-assisted closure is applied.Conclusion. In case of traumatic skin detachment, plastic surgery according to Krasovitov should be performed in the first hours from the moment of injury. Our study allows transplantation of a full-thickness skin graft to granulating wounds as well. After 5 days, the condition of skin autografts is assessed at the first dressing. Their engraftment is observed on the 7th day. In the postoperative period, scar tissue does not form.

A 10-year experience of facial plastic surgery with one full thickness skin autograft

A 10-year experience of facial plastic surgery with one full thickness skin autograft

Features of plastic surgery with a full-thickness skin autograft in patients with traumatic skin detachment depending on clinical state and soft tissue destruction

Features of plastic surgery with a full-thickness skin autograft in patients with traumatic skin detachment depending on clinical state and soft tissue destruction

Surgical treatment of nasal non-melanoma skin cancer in elderly patients using dermal substitute

Conclusions: The nose is often involved by non-melanoma skin cancer (NMSC) and the increase in the incidence of such tumors, the morbidity and treatment-related costs represent a significant burden to healthcare systems. A bioresorbable dermal substitute (Hyalomatrix®) has been used for immediate dermal coverage and nose restoration after excision of infiltrating nasal NMSCs in elderly ASA III patients. Further studies on dermal substitutes are needed to improve benefit to patients.Objective: Surgical treatment of nasal non-melanoma skin cancer (NMSC) in elderly patients.Materials and methods: Ten elderly ASA III patients with nasal defects after resection of infiltrating NMSC were reconstructed in a two-stage strategy. The surgical protocol targeted an initial wide tumor excision and apposition of a dermal induction template (Hyalomatrix®) and successive full thickness skin autograft. Results were documented by photography, visual analog scale for patient satisfaction, and Vancouver scar scale for evaluation of final graft characteristics.Results: All patients were tumor-free during the 2 years follow-up. The procedure achieved acceptable nose reshaping and graft scarring evolution. Patient satisfaction was good-to-high.

Blood supply--susceptible formation of melanin pigment in hair bulb melanocytes of mice.

Background:Allogeneic skin grafts onto C57BL/6 mice are rejected, and the rejected skin is replaced by surrounding skin with black hair. In contrast, syngeneic skin grafts are tolerated, and gray hair grows on the grafts.Methods:To explore the mechanism of gray hair growing on the tolerated skin grafts, we prepared full-thickness skin (2-cm square) autografts, 2 (2 cm + 2 cm) horizontal or vertical parallel incisions, and U-shaped (2 cm × 2 cm × 2 cm) flaps with or without pedicle vessels. The grafts, incisions, and flaps were fixed by suturing with string and protected by a transparent bandage. On day 14 after the operation, the bandages were removed to observe the color of the hair growing on the skin.Results:Skin autografts from wild-type or hepatocyte growth factor-transgenic (Tg) C57BL/6 mice survived with gray hair, whereas those from steel factor (Kitl)-Tg C57BL/6 mice survived with black hair. In addition, U-shaped flaps lacking both of the 2 main feeding vessels of wild-type mice had gray hair at the tip of the flaps. Light microscopy after staining with hematoxylin and eosin or dihydroxyphenylalanine showed that the formation of melanin pigment in the follicles, but not in the interadnexal skin, was susceptible to the blood supply.Conclusions:Melanin pigment formation in the hair bulb melanocytes appeared to be susceptible to the blood supply, and melanocytosis was promoted in the follicles and in the epidermis of Kitl-Tg C57BL/6 mice.

Düşük Yoğunluklu Kırmızı ve Kızılötesi Lazer Işın Tedavisinin Tavşanlarda Birbirine Geçmeyen Tam Kalınlıklı Serbest Deri Otogrefti Üzerine Etkisi: Bir Hayvan Modeli

Summary The effect of laser on wound healing has been approved but the role of Low Red (LR) and Infrared Low Level Laser (ILLL) on unmeshed full-thickness free skin autograft (UFFSA) is not clear yet. The aim of the present experimental study is to determine the effectiveness of LR and ILLL in UFFSA in rabbits. The study was conducted on 15 New-Zealand white rabbits were divided into three groups, Control (C), Low Red (LR), Low Infrared (LIR). A 5×5 cm UFFSA was obtained then rotated 90 degrees and repositioned on its own bed and sutured. The rabbits in LR and LIR received LR and ILLL for 6 days post-operatively. On days 3, 5, 7, 14, and 30 skin biopsies were obtained. Graft size was measured. There were significant differences in epitheliazition, polymorphonuclears, fibroblast, and collagen among groups on days 3 and 5 and new vessels on day 3. LR and LIR had similar role in new vessels till day 5 and collagen synthesis on day 3 for group C. There was no significant difference in epithelialization in groups on days 7, 14, and 30. LIR showed significant differences of length, area, peripheral, and diameter during study and of width on day 7. We concluded LIR played the more effective role on early phase (on day 5) of healing and more acceptable appearance to LR and C groups on quantitative measures.

Involvement of melanocortin‐1 receptor in the hyperpigmentation of human skin autografts

Hyperpigmentation frequently occurs in human skin autografts resulting in an unsatisfactory appearance. This study aimed to elucidate the role of melanocortin-1 receptor in the hyperpigmentation process of skin autografts by analyzing the expression of melanocortin-1 receptor. The data were correlated with the amount of melanin in autografted human skin and normal skin determined in a previous study. Immunohistochemistry, western blotting and quantitative real-time polymerase chain reaction were carried out to detect the expression and distribution of melanocortin-1 receptor in skin autografts including full-thickness skin autografts, split-thickness skin autografts and normal full-thickness skin. Fontana-Masson stain was used to detect melanin in all types of skin specimens. The expression level of melanocortin-1 receptor in autografted skin was much higher than that in control normal skin, and thinner split-thickness skin autografts had higher levels of expression of melanocortin-1 receptor than thicker grafts. The amount of melanin in skin autografts was significantly increased compared with normal skin. The expression of melanocortin-1 receptor correlated well with the amount of melanin in the epidermis of skin autografts. These results indicate that melanogenesis is dramatically enhanced in skin autografts by the melanocortin-1 receptor, and suggest that overexpression of melanocortin-1 receptor may play an important role in the hyperpigmented process of skin autografts. This study provides a novel mechanism for hyperpigmentation in skin autografts.

Effect of skin autograft with different thickness on the transdifferentiation of fibroblasts after deep partial thickness burn in rats

To investigate the effect of thin split-thickness skin, inter-mediate thickness skin and full-thickness skin autograft on the differentiation of fibroblasts into myofibroblasts in rats after deep partial thickness burn. A total of 40 SD rats were divided randomly into two groups (Group A & Group B, n = 20 each). In Group A, tissue samples were collected at Day 2 after skin-grafting while Day 7 in Group B. In each group, every rat was scalded to cause deep partial thickness wound with an area of 10% of total body surface. The wounds received eschar shaving instantly coupled with skin-autograft, covering with thin split-thickness skin, inter-mediate thickness skin and full-thickness skin respectively. Meanwhile the control wound on the same rat was scalded only. Then the expression of α-SMA was detected by immunohistochemistry in each wound. And the numbers of myofibroblasts (α-SMA positive cells) and fibroblasts (negative cells) were counted to calculate the conversion ratio of myofibroblasts. In Group A, the conversion ratios of myofibroblasts of control, thin split-thickness skin autograft, inter-mediate thickness skin and full-thickness skin groups were (76.3 ± 3.3)%, (69.8 ± 1.6)%, (57.5 ± 1.6)% and (44.7 ± 1.7)% respectively. In Group B, the ratios were (72.9 ± 6.1)%, (63.6 ± 4.7)%, (50.2 ± 1.6)% and (32.3 ± 1.2)% respectively. The ratio was higher in control group than that in any other one (P < 0.01). There was statistic difference between thin split-thickness skin, inter-mediate thickness skin and full-thickness skin autograft groups (P < 0.05). A direct association may exist between the conversion ratio of myofibroblasts and the application of skin-grafting in rats after deep partial thickness scalding. It is probably related with varying degrees of scar contracture in the long-term.

The involvement of alpha-melanocyte-stimulating hormone in the hyperpigmentation of human skin autografts

Hyperpigmentation occurs frequently in human skin autografts, resulting in an unsatisfactory appearance. Objective This study aims to elucidate the role of α-melanocyte-stimulating hormone (α-MSH) in the hyperpigmentation process of skin autografts by analysing the expression of α-MSH and the amount of melanin in human autografted skin and normal skin. Methods Immunohistochemistry and reverse transcription-polymerase chain reaction methods were carried out to detect the expression and distribution of α-MSH and pro-opiomelanocortin (POMC) in skin autografts, including full-thickness skin autografts, split-thickness skin autografts and normal skin. The Fontana–Masson stain was used to detect the amount of melanin in all the skin specimens. Results The level of α-MSH and POMC expression in autografted skin was much higher than that of control normal skin, and thinner split-thickness skin autografts expressed higher levels of POMC mRNA and α-MSH protein. The amount of melanin in skin autografts was significantly higher compared with normal skin. The expression of α-MSH correlated well with the amount of melanin in skin autograft epidermis. Conclusions These results indicate that the function of melanogenesis, transfer of melanin in melanocytes, was dramatically enhanced in skin autografts by α-MSH. The over-expression of α-MSH may play an important role in the hyperpigmentation process of skin autografts and provide a novel mechanism of this process.

Repair of cicatricial ectropion in a harlequin baby

The ichthyoses are a collection of scaling skin diseases or keratinizing skin disorders giving the appearance of "fish skin," of which harlequin ichthyosis is the most severe form. It is characterized by profound thickening of the keratin skin layer, armorlike scales that cover the body, and contraction abnormalities of the eyes, ears, and mouth. We report a case of a 6-week-old boy with harlequin ichthyosis and severe bilateral upper and lower eyelid cicatricial ectropion who underwent surgical repair with full-thickness postauricular skin autografts. To our knowledge, this is the youngest reported case and the only case of harlequin ichthyosis in which postauricular skin grafts were used.

Burned Breast Reconstruction by Expanded Artificial Dermal Substitute

Full-thickness anterior chest wall burns result in contractures that may restrict the development of breast in young female patients. The management of postburn contractured anterior chest wall scars and unilateral breast hypoplasia with the expansion of bilayered artificial skin is herein presented for the first time in literature to the best of our knowledge. A 21-year-old female with chest wall contractures after thermal injury she had suffered at the age of 27 months was managed in three stages. The first stage included release and excision of contractures and scars, submuscular insertion of anatomical tissue expander, and coverage of the anterior chest wall with Integra artificial skin (Skin, Johnson & Johnson Medical, Division of Ethicon, Inc., Sommerville, NJ). One month later, the outer silicone layer of Integra was substituted by a split-thickness skin autograft and the expander was partly inflated with saline. During the third stage and after overexpansion of the expander had been completed, the expander was removed and a permanent silicone implant was subsequently inserted. No immediate or late complications were observed. At 17 months, the breast contour remains stable, no recontracture has occurred, and the patient evaluates the result as very satisfactory. Expansion of artificial skin Integra appears to be a reliable and safe alternative for reconstruction of the burned breast, lacking the morbidity associated with deep donor sites of full-thickness skin autografts or flaps.