Full-thickness Skin Graft Group Research Articles

Correction of Congenital Syndactyly of the Hand with Minimal Full-Thickness Skin Graft from the Weight-Bearing Midline Plantar Area.

Traditional skin grafts for syndactyly often cause color mismatches and unsightly donor sites, whereas no-skin-graft methods leave noticeable dorsal hand scars. This study presents plantar full-thickness skin graft (FTSG) from the weight-bearing midline area for syndactyly repair, a novel approach not previously reported in the literature. The study included three groups of patients with congenital syndactyly of the hand who underwent primary operations with plantar FTSG (n=70), groin FTSG (n=20), and no-skin-graft techniques (n=22). Postoperative outcomes were evaluated by an assessment panel, and guardians' satisfaction scores were measured. Color similarity between the graft and surrounding skin was assessed using a three-dimensional color space. The plantar FTSG group demonstrated a significantly higher likelihood of receiving an 'excellent' rating compared to the groin FTSG group, with an odds ratio of 6.30 (p<0.001). Color difference analysis showed that plantar FTSG more closely matched surrounding skin color than groin FTSG (6.33 vs. 22.57, p<0.001). Guardians reported greater satisfaction with outcomes on the hand in the plantar FTSG group compared to the groin FTSG and no-skin-graft groups (7.16 vs. 5.05 and 4.36, p<0.001). Satisfaction with donor sites was also significantly higher in the plantar FTSG group than in the groin FTSG group (8.23 vs. 6.30, p<0.001). Correction of congenital hand syndactyly using midline plantar FTSG from the weight-bearing area can reduce scarring on the hand dorsum, ensure superior color similarity with surrounding skin, and offer inconspicuous donor sites compared to no-skin-graft or groin FTSG techniques.

Donor Site Defect Coverage of the Forearm with Dermal Substitute After Harvesting Radial Forearm Free Flap for Phalloplasty: Is MatriDerm® Worth the Effort?

An aesthetically and functionally pleasing phalloplasty is most commonly performed by a free radial forearm flap. However, the problem with donor site morbidity on the forearm remains unsolved. The aim of this study was to evaluate if the use of a dermal template such as MatriDerm® on the donor site significantly decreases the incidence of complications based on the Clavien–Dindo classification, such as wound healing disorders and reoperation rate, and if it could shortens the duration of hospital stay. A case series analysis was conducted at our institution. A total of 21 patients divided into two groups undergoing the phallic construction after the Gottlieb and Levine design in a single center underwent the donor site defect coverage either by MatriDerm® and split-thickness skin graft from the thigh or by full-thickness skin graft from the groin area. The use of MatriDerm® and split-thickness skin graft showed to have a statistically significant impact on the rate of complications (p = 0.008). Complications that were treated conservatively as well as that require surgical revision were significantly lower in the MatriDerm® group than in the full-thickness skin graft group (p = 0.002). Complications occurred not only at the forearm but also at the groin, where the full-thickness skin graft was harvested. The large dimension of the free radial forearm flap used for phalloplasty resulted in a significant donor site morbidity, leading to wound healing disorders, reoperations, and extended length of hospital stay. Therefore, we consider the use of dermal templates such as MatriDerm® as worth the additional effort and costs in this patient collective.

Objective and Subjective Comparisons of Split Thickness Skin Graft and Full Thickness Skin Graft for Radial Forearm Flap Donor Sites Using a New Measuring Method.

A split thickness skin graft (STSG) or a full thickness skin graft (FTSG) are commonly used for donor site closure after raising a radial forearm flap. The aesthetic outcome of the donor site is frequently not satisfying for the patient. This study evaluated the aesthetic outcome of the donor site of a radial forearm flap covered with an STSG or FTSG using an objective measurement method. The forearms of 30 patients (15 FTSG, 15 STSG) were scanned with an optical three-dimensional scanner. The surface of the forearm at the skin transplant was cut out and filled by an automatic hole-filling algorithm. The mean surface deviation between the original and the filled forearm was acquired. This method was validated with a control group of 15 volunteers. A questionnaire investigating aesthetical and healing satisfaction, postoperative pain and scarring was filled in by the patients. The mean surface difference in the STSG group was 0.9907 ± 0.3120 and 0.6177 ± 0.2245 mm in the FTSG group. The difference in the surface deviation between STSG and FTSG groups was significant (P = 0.0009). Correlations between the surface deviation and the subjective aesthetical satisfaction of the patient were not significant. In the questionnaires no significant differences between STSG and FTSG group were measured. Both FTSGs and STSGs resulted in good aesthetical outcomes after closure of a radial forearm flap donor site. Scanning the radial forearm flap donor site with an optical three-dimensional scanner supplied an objective, fast, and reliable measuring method of aesthetical outcomes.

Fibonacci sequence ‘snail’ flap versus skin grafts in scalp reconstruction: a comparative study

Scalp defects commonly occur as a result of tumour excision or trauma. The reconstruction of medium to large defects can be challenging due to the scalp laxity and hair growth pattern. We compare the outcome of patients who have had snail flap reconstruction in comparison to skin grafts. We conducted a retrospective case study of 45 consecutive patients’ over a 3-year period (2016–2018), across three sub-groups, viz. Fibonacci sequence flap, split skin graft and full-thickness skin grafts. The sub-cohorts were all matched for age, sex, indications and defect sizes before being analysed in terms of complication rates and wound healing rates over a 4-month period. The Fibonacci ‘snail’ flap was found to heal significantly faster than the full-thickness skin graft group and with lower complication rates overall, compared to skin grafts, but the latter outcome did not reach statistical significance. The aesthetic outcome of the Fibonacci flap though was superior to skin grafts both in terms of colour and contour match as well as hair restoration. The Fibonacci ‘snail’ flap is a sound option for the reconstruction of medium to large size defects of the scalp, even in those with poor performance scores, especially since its lower flap: defect ratio allows it to be performed under local anaesthesia. The advantage of the ‘snail’ flap over other scalp flaps will be determined in a future comparative study. Level of evidence: Level III, therapeutic study.

Comparison of Skin Graft for the Defect of the Radial Forearm Free Flap

Background and Objectives This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. Subjects and Method Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. Results The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p＜0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p＜0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p＜0.05). Conclusion FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs. Key words: Forearm ㆍ Free tissue flaps ㆍ Reconstructive surgical procedures ㆍ Skin transplantation

Radial forearm free flap in head and neck cancer treatment: may dermal substitutes have a role in minimizing the donor site morbidity?

Head and neck cancer treatment often involves the need for extensive soft tissues removal and a subsequent reconstructive phase in order to close the defect. Free flap reconstruction is a safe and effective reconstructive option in head and neck surgery. The radial forearm free flap (RFFF) has been widely used as a reliable reconstructive solution as it provides thin soft tissues, particularly useful to reconstruct the oral cavity and other head and neck regions. The donor site defect resulting after the free flap harvesting inevitably needs to be managed as it can potentially lead to complications or functional and aesthetic impairment. Several closure techniques of the donor site have been described, and among these, two of the most frequently used are the full-thickness skin graft (FTSG) and the cellular dermal matrix (ADM). The aim of this study was to compare the donor site functional morbidity and aesthetic outcomes in two cohorts of patients treated with FTSG and ADM after RFFF reconstruction for head and neck cancer. Two groups were treated with Integra (group 1) and FTSG (group 2), to manage the radial free flap donor site after head and neck reconstruction. The patients were evaluated with patient self-assessment scale (P-SAS) and observer self-assessment scale (O-SAS) after 1 year and with the disabilities of the arm, shoulder, and hand (DASH) score. A total of 21 patients, aged between 52 and 84 years (mean, 72.3 years) underwent RFFF reconstruction after head and neck cancer resection during the study period. The P-SAS showed an average score of 21.3 in group 1 and 8.3 in group 2 while the O-SAS registered an average score of 18.8 and 9.7, respectively, without statistically significant differences. The DASH scale showed an average score of 28.7 in group 1 and 13.1 in group 2, reaching a statistically significant value (p = 0.5). No significant statistical difference in terms of aesthetic outcomes between the use of Integra and FTSG was recorded. The DASH score results suggest that the Integra reconstructive strategy seemed to be associated with the better overall final result when compared with that in the FTSG group. The dermal substitute appeared to provide a faster healing time and can be safe and effective also for wide defects. In our study, we can conclude that the use of the dermal substitute when dealing with RFFF donor site repair can be considered more pleasant both from subjective and objective points of view when compared to the FTSG alone. Level of evidence: Level IV, therapeutic study.

Outcomes of lower eyelid retractor recession and lateral horn lysis in lower eyelid elevation for facial nerve palsy.

PurposeTo report outcomes and complications of lower eyelid retractor recession and lateral horn lysis (RR) for lower eyelid elevation in patients with facial nerve palsy (FNP).Patients and methodsRetrospective review. Patients with FNP undergoing RR alone (group 1) or with adjunctive procedures (canthal suspension-group 2, tarsorrhaphy-group 3, and full-thickness skin graft-group 4) during a 5-year period were included. Patient demographics, lagophthalmos, occurrence of eyelid malpositions, recurrent retraction, and repeat procedures were noted from medical records. Measures of lower eyelid height (LEH) and lid lag on downgaze were obtained from standard photographs.ResultsForty-two patients (23 females, mean age was 59 years) were included. Mean follow-up was 24 months (range 6-77). Median improvement in LEH following surgery was significant in Group 1 (0.90 mm, IQR: 0.37-0.91, P=0.20) and in Group 2 (0.51 mm, IQR: 0.30-1.37, P<0.001), respectively. Median improvement in blink lagophthalmos was 3.00 mm (IQR: 3.00-3.50, P=0.02) in Group 1 and 3.50 mm (IQR: 1.75-5.00, P<0.001) in Group 2. Median improvement in lagophthalmos on gentle eye closure was 2.00 mm (IQR: 1.50-3.00, P=0.02) in Group 1 and 1.00 mm (IQR: 0-2.13, P=0.006) in Group 2. No new cases of ectropion were noted. 23.5% of patients required a repeat RR at a mean interval of 20 (range 1-70) months and a further 9.8% required a third procedure at a mean interval of 21 (range 18-29) months.ConclusionRR improves lower eyelid retraction and lagophthalmos in FNP either alone or when combined as an adjunctive procedure. It does not aggravate paralytic ectropion although repeated retractor recessions may be required to improve retraction.

Medial canthal defects following tumour excision: To reconstruct or not to reconstruct?

ABSTRACTLaissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1–80 months) for LFS and 30 months (range 6–60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

Combining Ventral Buccal Mucosal Graft Onlay and Dorsal Full Thickness Skin Graft Inlay Decreases Failure Rates in Long Bulbar Strictures (≥6 cm)

To evaluate the efficacy of augmenting ventral onlay buccal urethroplasty using a using a double-sided graft technique by adding a second, full-thickness skin graft (FTSG) dorsally in long strictures≥4 cm, we hypothesized that a double-sided graft technique would improve surgical outcomes over buccal mucosal graft (BMG) ventral onlay urethroplasty alone. Retrospective chart review was performed comparing 15 patients who had undergone double-sided BMG+ FTSG urethroplasty for long strictures≥4 cm to a cohort group of 115 patients who had undergone BMG onlay urethroplasty for strictures of similar length. Comparisons of age, stricture lengths, time-to-failure, follow-up intervals, and failure rates were analyzed. Further analysis included age and stricture length matched control comparisons between BMG+ FTSG patients to BMG only patients. Mean patient age, stricture length, and time to stricture recurrence were 44 years, 5.1 cm, and 10months, respectively, in the BMG group. For the BMG+ FTSG group, mean age was 52 years, stricture length 5.9 cm, and time to recurrence was 9 months. Overall, the BMG group had a decreased failure rate; 17% compared to 21%. Further analysis showed BMG ventral onlay had decreased failure rates for strictures<6 cm; 16% compared to 33%. However, for strictures≥6cm, the BMG+ FTSG had a 0% failure rate compared to 24% in the BMG ventral onlay group (P= .005). Combined BMG and FTSG urethroplasty for very long bulbar urethral strictures≥6 cm improve success rates compared to using BMG urethroplasty alone.

Beware of the Small Finger and/or the Proximal Interphalangeal Joint? Skin Lacerations following Collagenase Injection in Dupuytren Contracture

Sir:FigureWe read with great interest the recent Viewpoint by Dr. Hallock highlighting a skin laceration of the small finger necessitating full-thickness skin grafting following collagenase injection in Dupuytren contracture.1 As reported in the Collagenase Option for Reduction of Dupuytren's I randomized controlled trial, skin lacerations occurred in 10.8 percent of all collagenase-treated patients.2 In addition, ecchymosis occurred in every fourth treated patient in the Collagenase Option for Reduction of Dupuytren's I study, and blood blisters occurred in 3.4 percent. In addition, two flexor tendon ruptures have been reported in the Collagenase Option for Reduction of Dupuytren's I study, both occurring at the small finger following proximal interphalangeal joint–targeted collagenase injections.3 The reported skin laceration in Dr. Hallock's case also occurred following proximal interphalangeal joint–targeted collagenase injection. One is tempted to ask whether the small finger proximal interphalangeal joint in Dupuytren contracture is a hazardous area. After the European approval of collagenase histolyticum in May of 2011, we have so far encountered two skin lacerations in collagenase-treated patients. The first female patient treated in our institution presented with a long-standing fourth ray Dupuytren contracture of 135 degrees following 15 Gy of radiotherapy. Immediately following cord breaking, a blood blister and subsequently a skin laceration occurred over her proximal phalanx. Using Steri-Strips and a custom-made plaster, healing by secondary intention was achieved within 10 days, surprisingly, in the previously irradiated hand. The second patient suffering with a skin laceration following collagenase injection was a 58-year-old man who had been previously operated on, with a fixed contracture of 120 degrees following selective fasciectomy of his ring finger (Fig. 1, above, left). A colleague had previously suggested ring finger amputation. He was treated with collagenase injection and, during cord breaking, a skin laceration occurred near the proximal interphalangeal joint of his ring finger. (See Video, Supplemental Digital Content 1, which demonstrates skin laceration during cord breaking 24 hours after collagenase injection in a male patient with recurrent Dupuytren contracture of this ring finger following selective fasciectomy, https://links.lww.com/PRS/A519.) Using Repithel ointment and daily dressing changes on a customized Dupuytren glove (Fixxglove) (Fig. 1, above, right, and below, left), the wound healed within 10 days albeit with exposed flexor tendons using a McCash open palm4 analogon (Fig. 1, below, right).Fig. 1: (Above, left) Male patient with recurrent Dupuytren contracture of his ring finger before collagenase injection. (Above, right) Forty-eight hours after skin laceration during cord breaking. (Below, left) Customized Fixxglove for postinterventional splinting following collagenase injection. (Below, right) Ten days after skin laceration with exposed flexor tendons at the proximal interphalangeal joint, complete reepithelialization following collagenase injection is shown.Video: Supplemental Digital Content 1 demonstrates skin laceration during cord breaking 24 hours after collagenase injection in a male patient with recurrent Dupuytren contracture of this ring finger following selective fasciectomy, https://links.lww.com/PRS/A519.In 2004, the Journal published an interesting prospective though nonrandomized clinical comparison of the McCash open palm technique and full-thickness skin grafting.5 Disabilities of the Arm, Shoulder and Hand scores improved in both groups from 37 to 30. Healing time was significantly faster in the full-thickness skin graft group compared with the McCash group (28 days versus 40 days). Furthermore, the recurrence rate was 50 percent for the McCash open palm group and 0 percent for the full-thickness group. Similar results in terms of reduced recurrence rates following full-thickness skin grafts have been reported by a number of authors in nonrandomized trials.6,7 However, a randomized trial with 79 patients with proximal interphalangeal joint Dupuytren contractures randomized to either firebreak full-thickness skin grafting or fasciectomy did not find any significant difference in recurrence rates at 3-year follow-up.8 Coming back to Dr. Hallock's case, it is tempting to speculate on how the recurrence rate will be influenced, if at all, by full-thickness skin grafting for skin lacerations following collagenase injections. The published 8-year follow-up results of eight patients report a 66 percent metacarpophalangeal joint and a 100 percent proximal interphalangeal joint recurrence rate.9 Therefore, we should follow the patients especially following skin lacerations with or without skin grafting in the future to elucidate the aforementioned question. Karsten Knobloch, M.D., Ph.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery and, Burn Center, Hannover Medical School, Hannover, Germany DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.

Patient Assessment of Psychosocial Dysfunction following Nasal Reconstruction

Postoperative psychosocial distress is a critical aspect of surgery, particularly in aesthetically sensitive areas. In this study, the authors assess the level of psychosocial distress associated with nasal reconstruction. The authors also compare postoperative distress levels associated with different reconstructive techniques throughout the healing process. The authors conducted a prospective study of patients undergoing nasal reconstruction following excision of cutaneous malignancy. The main outcome measure was the Derriford Appearance Scale 24, a measure of psychosocial distress. The Derriford Appearance Scale was administered at preoperative assessment, 1 < x < 4 weeks, 4 ≤ x < 12 weeks, and x ≥ 12 weeks. The entire cohort was analyzed with respect to distress levels before and after surgery. Reconstructions were categorized as interpolated, local tissue, or full-thickness skin graft. Analyses were performed for reconstruction type, patient, and defect data. Fifty-nine patients were enrolled. Reconstructions included 14 interpolated flaps, 17 local tissue flaps, and 28 full-thickness skin grafts. For the entire cohort, distress levels were significantly higher at the first postoperative visit (p < 0.05), with normalization at subsequent follow-up evaluations. At the first assessment, the interpolated flap group had significantly higher levels of distress in comparison with the full-thickness skin graft group (p < 0.05). At late follow-up, levels of distress were equivalent. Nasal reconstruction is associated with short-term increases in psychosocial distress that corrects by approximately 12 weeks after surgery. Interpolated flaps cause significantly higher distress at early assessment. Distress levels at late follow-up appear to be equivalent to those following a full-thickness skin graft despite larger and deeper initial defects. Therapeutic, II.

Full-Thickness Grafts Procured from Skin Overlying the Sentinel Lymph Node Basin; Reconstruction of Primary Cutaneous Malignancy Excision Defects

Radical excision of a cutaneous malignancy may require skin-graft closure. The skin overlying the sentinel lymph node (SLN) basin may be procured as a full-thickness skin graft (FTSG), eliminating a problematic and painful third wound, the donor site. However, the potential for implantation of malignant cells transferred from the nodal basin to the primary site, resulting in increased perigraft recurrence rates with the FTSG technique, has not been evaluated. We retrospectively reviewed all patients with a cutaneous malignancy who underwent SLN biopsy and skin-graft closure to evaluate the outcomes of full-thickness sentinel node basin procured skin grafts compared with partial-thickness grafts (PTSG). Fifty-seven patients underwent FTSG reconstruction, and 39 patients had PTSG placed at the time of wide excision and SLN biopsy. Eighty-five percent of patients had melanoma; median melanoma thickness for FTSG patients (N = 53) was 2.0 vs. 2.8 mm (N = 29) for the PTSG group (P = .0007). Positive sentinel nodes were identified in nine of 57 patients (16%) and 11 of 39 patients (28%) in the FTSG and PTSG groups, respectively. Perigraft recurrence rates were not significantly different (5 vs. 10%) between the two groups. Graft take rate for the FTSG group was slightly higher than the PTSG group (median = 88% vs 80%, P = .008). FTSG cosmetic results were generally excellent. This FTSG closure method eliminates a painful third wound and often results in a better cosmetic outcome. Perigraft recurrences do not appear to be increased with FTSG. This technique should be in the armamentarium of surgeons who treat cutaneous malignancy.

Radial Forearm Free Flap Donor Site Outcomes Comparison by Closure Methods

To compare the functional and aesthetic outcomes of radial forearm free flap (RFFF) donor sites reconstructed with full-thickness skin graft (FTSG), split thickness skin graft (STSG) alone, and STSG overlying an acellular dermal matrix (AlloDerm). A cross-sectional cohort study at a tertiary care hospital. Twenty-five head and neck cancer patients who underwent reconstruction with RFFF completed the evaluations (STSG = 10, FTSG = 8, STSG with AlloDerm = 7). Subjective evaluations of postoperative function by questionnaires showed no significant differences among the 3 groups (P = 0.93). In blinded evaluations by surgeons, the STSG group obtained the highest aesthetic outcome score (3.39 of 5.0), followed by FTSG (2.89) and STSG with AlloDerm (2.80). However, the difference was not statistically significant (P = 0.32). Objective measurements of postoperative function by certified occupational therapists were comparable among the 3 groups with the exception of a mildly decreased range of wrist flexion (P = 0.036) and ulnar deviation (P = 0.016) in the FTSG group. The 3 methods of reconstruction have comparable postoperative functional and aesthetic outcomes. Each of the 3 methods of reconstruction has low morbidity and satisfactory aesthetic and functional outcomes.

Maxillofacial growth after neck burn injury at a young age: an experimental study in the rabbit.

An experimental model was designed to define alterations in the normal mandibular growth process under the influence of postburn neck contractures. Additionally, this craniofacial growth model was used to compare two early treatment modalities of neck burns in their capability to minimize contracture and hence allow for normal mandibular growth and development. Growth implies increase in size as well as change in shape and position. These three aspects of growth were defined accordingly to Björk as rotations. The intramatrix rotation expresses the change in mandibular shape, and the matrix rotation expresses the change in mandibular position relative to surrounding structures. The total rotation expresses both, and together with the measurement of the mandibular length, they represent the increase in mandibular size. Thirty-two 7-week-old rabbits were divided at random in four groups of eight rabbits each and randomized for selection for the 14 operation days defined as t = 0: Group A: controls to define normal mandibular growth Group B: untreated third-degree neck burns Group C: third-degree neck burns treated by a full-thickness skin graft Group D: third-degree neck burns treated by a myocutaneous flap All animals underwent placement of two bone markers in the maxilla. With biweekly intervals, standardized lateral skull roentgenographs were taken until the rabbits reached the age of 21 weeks. In this time period, major growth accelerations including the pubertal growth spurt took place. By the use of 13 reference points and 7 reference lines, rotations and distances were calculated. Statistical analysis of the data was performed. The results show that the normal mandibular length was unaffected in all groups. There were no statistically significant changes in matrix, intramatrix, and total rotations of the mandible and the maxilla. There was a statistically significant difference in the displacement of the mandibular reference point between all groups, suggesting a variable degree of normal backward skull rotation, namely, due to group B. Explanations to be considered concerning the fact that the only minor differences were found in group B: 1. Drawbacks of the animal model: differences in skin texture, postnatal mandibular growth, and head position compared with those of humans. 2. Other functional adaptation mechanisms such as changes in head position, which are recruited at first in adapting to disturbances of homeostasis, were not measured. Soft-tissue compensation probably has overcome major bony deformations. Nevertheless, some drawbacks of the model can be viewed as ideal concerning treatment of neck burns.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of Skin Graft in Postburn Finger Contractures: An Integrated Technique of Evaluation

Objective: This prospective clinical study was conducted between July 2003- June 2005 at Dhaka Medical College Hospital, Dhaka, Bangladesh to make a comparative evaluation of the outcome of skin graft on patients of postburn contractures of the fingers using integrated scores for measuring several outcomes together. Materials &amp; Methods: A total of 56 subjects of postburn contractures of the fingers were selected consecutively and were evaluated at baseline by number of digits affected, surface area involved, extension deficit, fingers with maximum extension deficit and duration of contracture. Thirty two subjects were assigned to Full-thickness skin graft group (Group-A) and 24 to Split-thickness skin graft group (Group-B). Respective graft coverage was applied to the wound following release of contracture. Immediate outcome was evaluated in terms of graft take and number of graft-site complications, while follow up outcome was evaluated in terms of extension deficit six months after correction using specific scores for defined outcome. Results: Over 70% of the subjects were &lt; 15 years with mean ages of Group-A and Group-B were 9.38 ± 1.66 and 9.94 ± 1.42 years respectively. In both groups maximum extension deficit was found in little finger (78% in Group- A and 54% in Group-B). The Interphalangeal (IP) joints were observed to be most frequently involved (78% in Group-A and 75% in Group-B). The duration of contracture, number of digits involved and surface area of the fingers involved were almost identically distributed between the groups. Outcome shows that donor-site morbidities (discolouration and hypertrophic scars) were significantly less in Group-A compared to that in Group- B (p &lt; 0.001 and p = 0.047). Similarly the Group-A was significantly superior compared to Group-B in terms of minimal extension deficit (0 - 10°) 6 months after correction (59.4% vs. 25%, P &lt; 0.05). About two-third of the subjects in both the groups demonstrated 100% graft take and around 80% had 2 or &lt; 2 graft-site morbidities. The excellent outcome was significantly higher in Group- A (37.5%) than that in Group-B (12.5%) (p &lt; 0.05). Conclusion: Full-thickness skin graft is a better option of intervention than Split-thickness skin graft for coverage after release of contracture. However, the findings need to he validated by a larger sample size. Key words: Postburn flexion deformity, full-thickness skin graft, split-thickness skin graft, graft take, donor-site morbidity, graft-site morbidity and extension deficit. DOI: 10.3329/jbcps.v27i1.4240 J Bangladesh Coll Phys Surg 2009; 27: 25-29