Full-thickness Skin Graft Research Articles

Surgical Considerations in the Management of Constriction Ring Syndrome.

Surgical management of constriction ring syndrome (CRS) is individualised due to the heterogenic presentation of the condition. CRS includes constriction rings, acrosyndactyly, nubbins and short digits. Involvement of more than one limb is common and children often need multiple surgeries. Each limb may need staged surgeries. If the child has vascular or lymphatic compromise secondary to a constriction ring, the ring needs to be excised and released in the first few days of life. The rings are released using multiple big Z-plasties in one or two stages. Nerve palsy associated with the rings need early intervention. Tendon transfers may be advised when nerve procedures like neurolysis and nerve reconstruction fail. Acrosyndactyly can be corrected with separation of the fused fingertips. At times, the web is more distal than usual and requires web deepening using partial syndactyly separation techniques and may need full thickness skin grafting. Complex type of acrosyndactyly is difficult to treat as it needs proper planning and staged surgical correction to achieve a five-digit hand. Separation of the syndactyly with web deepening gives more functional length and independence to the digits. The short fingers, especially the thumb, need reconstruction. Non-vascularised toe phalangeal transfer or a microvascular toe transfer can reconstruct a missing digit. Level of Evidence: Level V (Therapeutic).

Design of an Innovative Method for Measuring the Contractile Behavior of Engineered Tissues.

Hypertrophic scarring is a common complication in severely burned patients who undergo autologous skin grafting. Meshed skin grafts tend to contract during wound healing, increasing the risk of pathological scarring. Although various technologies have been used to study cellular contraction, current methods for measuring contractile forces at the tissue level are limited and do not replicate the complexity of native tissues. Self-assembled skin substitutes (SASSs) were developed at the "Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX" and are used as permanent full-thickness skin grafts. The autologous skin substitutes are produced using the self-assembly method, allowing the cultured cells to produce their extracellular matrix leading to a tissue-engineered substitute resembling the native skin. The level of contraction of the SASSs during the fabrication process is patient-dependent. Thus, because of its architecture and composition, SASS is an interesting model to study skin contraction in vitro. Unfortunately, standard measurement methods are unsuited for SASS contraction assessment, mainly due to incompatibilities between the SASS manufacturing process and the current contraction force measurement methods. Here, we present an innovative contraction measurement method specifically designed to quantify the contractile behavior of tissue-engineered substitutes, without disrupting the protocol of production. The method uses C-shape anchoring frames that close at different speeds and magnitudes according to the tissue contractile behavior. A finite element analysis model is then used to associate the frame deformation to a contractile force amplitude. This article shows that the method can be used to measure the contraction force of tissues produced with cells displaying different contractile properties, such as primary skin fibroblasts and myofibroblasts. It can also be used to study the effects of cell culture conditions on tissue contraction, such as serum concentration. This protocol can be easily and affordably applied and tuned to many regenerative medicine applications or contraction-related pathological studies. Impact Statement The protocol presented in this article is a new and simple method to quantify contraction forces present in tissue-engineered substitutes. Using finite element analysis, it allows for the measurement of a contraction force rather than a surface reduction as usually provided by other tissue contraction measurement methods. The results shown are in correlation with the current literature relevant to tissue contraction. It can be easily implemented, and hence, this method will open up new avenues to study tissue contraction of living substitutes engineered with various cell types and to optimize culture conditions.

Syndactyly release with full-thickness skin graft harvested from the wrist: About 24 webspaces

The management of congenital syndactylies often requires the use of a full-thickness skin graft to reconstruct the affected web space. Traditionnally, full-thickness skin grafts are harvested from the groin region, but using the anterior aspect of the wrist may offers benefits in terms of scar quality while simplifying surgical time.This descriptive study evaluates scar quality (at donor and recipient site) associated with full-thickness skin graft harvested from the volar wrist in syndactyly release.We conducted a retrospective single-center study including patients who underwent syndactyly release with full-thickness skin graft harvested from the anterior wrist. Scar assessment was performed using the Observer Scar Assesment Scale, the Vancouver Scar Scale and the Withey Score.Overall, our results show high scores for scars at both donor and recipient sites.In conclusion, harvesting full-thickness skin graft from the volar wrist in syndactyly release is a simple and effective option for covering defects on the digits, while producing high-quality scars.

A systematic review of the Novosorb® Biodegradable Temporizing Matrix in the treatment of complex wounds

BackgroundRestoringafunctionaldermisfollowingextensive,deepwounds,suchasthosecausedbysevereburns,presentsasignificantreconstructivechallenge. Although split thickness skin graft (STSG) and full thickness skin graft (FTSG) can provide adequate coverage, dermal templates are becoming increasingly important in restoring function. The purpose of this systematic review is to assess the efficacy, advantages and limitations of employing NovoSorb® Biodegradable Temporizing Matrix (BTM) in the treatment of complex wounds. MethodsThe systematic review was carried out in accordance with PRISMA and MOOSE guidelines when appropriate. All studies until April 2024 involving patients treated with NovoSorb® BTM were considered. Infection,adverseevents,andBTMlosswereamongtheoutcomesevaluated. ResultsWe identified 725 studies, and 69 were included after screening. The included studies involved 880 participants and were mostly concerned with the management of burns, but other difficult wounds were also addressed. The infection rate was 10%, yet only few reported losing their BTM as a result of this consequence. The incidence of adverse events was low, with the majority of trials reporting no adverse events related to BTM. ConclusionOur systematic review focused primarily on case series and case reports that demonstrated the efficacy of Novosorp BTM and the rarity of side effects. However, there were very few comparison research. More research is needed to fully analyze the efficacy, limitations, and downsides of using Novosorb (BTM).

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.

Comparative Retrospective Analysis of Cross-Finger Flap Outcomes: A Study on Split-Thickness Skin Graft vs. Full-Thickness Skin Graft in Donor Fingers

Comparative Retrospective Analysis of Cross-Finger Flap Outcomes: A Study on Split-Thickness Skin Graft vs. Full-Thickness Skin Graft in Donor Fingers

Photobiomodulation on Full-Thickness Skin Graft Survivalin Rats.

To evaluate the photobiomodulation effects on the receptor area for full-thickness skin graft integration. Thirty-Six Wistar rats were divided: red laser (660 nm), infrared laser (808 nm), and control. A skin segment with 5 × 3 cm was removed. In the control, the skin was reallocated after a 180° rotation. For the 660 nm and 808 nm, the receptor area was first irradiated, and then the skin was reallocated the same as the control. Euthanasia occurred on the third and seventh days after the procedure, and macroscopical of necrosis and histological analysis were realized. The 660 nm reached the lowest necrosis percentage on Day 7. In the 808 nm, necrosis increased between the two periods. Similar morphological findings were observed for the control and 660 nm; however, the 808 nm showed significant alterations in fibrosis and inflammatory infiltrate. The infrared wavelength showed inferior performance on skin graft integration compared to the control and the red wavelength.

Bilateral Syndactyly Release of Third and Fourth Fingers

Syndactyly is amongst the most frequent congenital hand anomaly. Syndactyly is termed simple when the digits are connected by soft tissue only, complex when one or more phalanges are fused. In complicated syndactyly, there are additional bony elements in between the digits making it challenging if not impossible to separate safely. The patient in this case is a 1-year-old male with complex syndactyly of the left hand and simple syndactyly of the right hand. Here, we release both sides, with the left side involving a full-thickness skin graft taken from the patient's groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.

Outcomes of an Alternative Bolstering Technique for Full-Thickness Skin Grafts: A Single Institution Retrospective Review.

Outcomes of an Alternative Bolstering Technique for Full-Thickness Skin Grafts: A Single Institution Retrospective Review.

Modified Mustardé rotation cheek flap with full-thickness skin graft for reconstruction of large cheek defects.

Modified Mustardé rotation cheek flap with full-thickness skin graft for reconstruction of large cheek defects.

Temporoparietal Fascia Sandwich Technique in the Immediate Reconstruction of Human Bite Ear Amputation.

Traumatic ear amputation is a rare injury. Ear replantation is the gold standard in dealing with amputated ears. However, this is not always feasible. In this case series, the authors discuss the immediate reconstruction of traumatic ear amputation using temporoparietal fascia with the same skin from the amputated ear, which provided a high esthetic result and patient satisfaction. The authors present a case series of 3 patients from July 2018 to May 2020 who suffered from traumatic ear amputation due to a human bite and were successfully reconstructed using temporoparietal fascia and the same skin from the amputated ear as FTSG.The cartilage was sutured back, the temporoparietal fascia was raised and flipped over the exposed cartilage, and the FTSG previously harvested from the same amputated ear was put on the fascia. Quilting sutures were taken to ensure proper inset of the graft on the fascia. The authors measured the patient-reported outcome using an Ear-Q validated questionnaire. All patients were males, with a mean age of 30.6 years. They were all smokers, and none of them had any comorbidities. No major complications occurred. However, partial graft loss occurred in one patient and healed properly with secondary intention. All patients had high satisfaction scores of more than 70 in the EAR-Q questionnaires. Traumatic human bite ear amputations can be reconstructed with good esthetic outcomes by using single-stage temporoparietal fascia and the same skin of the amputated ear as a full-thickness skin graft whenever replantation is not feasible.

Comparative analysis of one-step and two-step full thickness skin grafting and secondary intention healing for skin defects after surgical management of plantar malignant melanoma.

Plantar malignant melanoma is largely managed surgically, particularly in its early stages. However, the plantar region has a lower survival rate of skin grafts than other regions. Furthermore, complete wound healing occurs over a long period of time, postoperatively. Thus, in this study, we retrospectively analyzed the use of skin grafts to reconstruct skin defects, as postoperative complications of plantar malignant melanoma. Forty-nine patients, (23 males, 26 females; mean age 70.4-years) underwent excisional surgery for plantar malignant melanoma at our hospital, between March 2018 and December 2022. The time from initial surgery to wound healing was analyzed, using a multivariate Cox proportional hazards model, to identify related factors. We excluded cases with lesions in non-weight-bearing areas and cases with segmental layer grafts, based on multivariate analysis, to eliminate bias when comparing a one-step resection and reconstruction technique to resection followed by waiting for granulation to occur before reconstruction. Patients were categorized into three cohorts. The first and second cohorts had undergone one-step and two-step skin grafting, respectively. Patients in the third cohort underwent secondary intention healing without skin grafting. The results revealed that the factors associated with wound-healing time included a defect size of >1800 mm2, in addition to two-step and split-thickness skin grafting. Therefore, Kaplan-Meier curves were constructed across the three cohorts, based on the data of 37 patients. Nine cases of non-weight-bearing areas and three cases of split-thickness skin grafts were excluded from the original total of 49 patients. The median times from the initial surgery to wound healing were 14.6, 12.0, and 21.9 weeks for the one- and two-step skin grafting and secondary intention healing cohorts, respectively. A statistically significant difference in the treatment time between the skin grafting and secondary intention healing cohorts was observed (p < 0.001) Moreover, a statistically significant difference in the treatment time between the one- and two-step skin grafting cohorts was noted (p = 0.046). Thus, two-step skin grafting after surgical treatment for plantar malignant melanoma may shorten the overall treatment duration by allowing granulation to occur.

Carbon footprint of non-melanoma skin cancer surgery.

Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited. A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated. The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29-8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29-22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80-49.06 kgCO₂eq) and full-thickness skin graft (31.58-37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England. This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis.

52991 Objective Structured Assessment of Technical Skills (OSATS) for layered repair, adjacent tissue transfer, and full-thickness skin graft

52991 Objective Structured Assessment of Technical Skills (OSATS) for layered repair, adjacent tissue transfer, and full-thickness skin graft

Bisected full-thickness skin graft for reconstruction after Mohs micrographic surgery

Bisected full-thickness skin graft for reconstruction after Mohs micrographic surgery

54128 Outcomes of an Alternative Bolstering Technique for Full-Thickness Skin Grafts

54128 Outcomes of an Alternative Bolstering Technique for Full-Thickness Skin Grafts

Fingertip Reconstruction in Hand Injuries

Fingertip amputations are a significant issue in the United States, with approximately 45,000 performed annually, with a 7.5 per 100,000 incidence rate. The primary cause of finger injuries is metal objects and bladed hand instruments, which can lead to cuts, loss of limbs, or damage to nerves and blood vessels. Therapy aims to restore sensation, long-lastingness, and bone support for nail development. Inadequate management can result in cosmetic issues, cold sensitivity, skin soreness, and persistent impairment in functionality. Nail bed injuries, such as lacerations, avulsions, and crush injuries, can result in post-traumatic fingertip amputation. Physical examinations are necessary to evaluate the functional and sensory capabilities of the damaged finger. Surgical intervention is necessary for severe cases, with primary closure or revision amputation being the preferred procedure. Full-thickness skin grafting is also used for fingertip amputations, preserving the structure of the recipient's fingers and addressing areas with insufficient skin. Flap repair is a method for managing fingertip amputations, using skin from another area or distant region. Local flaps are best for small covering areas, while regional flaps are used for extensive incisions. These flaps prevent prolonged immobilization and allow for a return of feeling in the fingertip. Post-amputation complications include delayed wound healing, nail abnormalities, heightened sensitivity, pain, intolerance to cold, scar retraction, limited finger movement, persistent ulcers, infection, and loss of tissue flaps. Inadequate management of fingertip amputations can lead to cosmetic flaws, reduced tolerance to cold, and increased skin sensitivity.

Evaluation of hexagonal flap for Syndactyly repair

Background and objective: Syndactyly is among the most commonly treated hand anomalies by plastic surgeons. Since the 1800s,over 46 corrective procedures have been described. These techniques involve using different flap designs and full-thickness skin graft or depending on graftless techniques to achieve the goals. Some articles concluded that graftless techniques have shorter operative times and fewer postoperative complications. The aim of the study is to evaluate the use of a local "hexagonal" dorsal advancement flap (HDAF) for syndactyly repair without using a skin graft. Methods: Between March 2021 and March 2022, we operated on 18 subjects (25 web spaces) in Rizgary and Hawler teaching hospitals in Erbil. Our study subjects were children and adults with different types of syndactyly (congenital, recurrent, and post-burn). We studied the early outcomes of using HDAF and straight-line incision for syndactyly repair. Results: The patients' ages ranged from 1.5 to 50 years, and the mean follow-up period was 6.3 months (1-13 months). The mean operation time was 98.5 minutes (40-160 minutes). Wounds were closed primarily without skin graft in 96% of the cases. We encountered neither a flap loss nor recurrences of syndactyly. The mean abduction angle achieved was 36.5º. All patients and their caregivers were satisfied with the aesthetic outcome. Conclusion: Syndactyly repair using a hexagonal dorsal advancement flap and straight-line separation of the fingers is a safe and straightforward technique regardless of age and syndactyly class or type. It results in a relatively short procedure with good-looking and well-functioning fingers.

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

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

Characterising the use of full and split thickness skin grafts amongst dermatologists: An international survey.

Abstract Background The use of full-thickness and split-thickness skin grafts (FTSG/STSG) among dermatologists has not been well characterized. Objectives To characterize the utilization of graft techniques, fixation methods and training needs pertaining to graft use among an international cohort of dermatologists. Methods An online questionnaire was developed iteratively, and subsequently distributed between July and August 2022 to dermatologists from the UK, European countries and New Zealand (NZ). Results In total, 150 responses were obtained from the UK, Ireland, NZ, Australia, Brazil, USA and eight European countries. Among the respondents, 23.3% (35 of 150) undertook both FTSG and STSG; 46.7% (70 of 150) performed only FTSG; and 30.0% (45 of 150) did not undertake skin grafts in their practice. Of the 67 Mohs surgeons, only 42% (28 of 67) undertook both FTSG and STSG. Overall, common donor sites for FTSG included the preauricular area (86 of 105; 81.9%) and clavicle (75 of 105; 71.4%), while the thigh was the most common donor site for STSG (30 of 35; 86%). Grafts were fixed mostly with sponge tie-over dressings and basting/quilting sutures. For STSG, most were harvested using an electric dermatome (18 of 35; 51%), freehand skin-graft knife (17 of 35; 49%) and flexible razor blade (5 of 35; 14%). Of the total, 48.0% (72 of 150) considered skin grafting an essential skill in dermatology training, and most respondents cited a lack of training opportunity and insufficient surgical cases as significant barriers. Conclusions Our survey reveals diverse practices among an international cohort of dermatologists in the use of FTSG/STSG and highlights the need for further training.