Graft Contraction Research Articles

A Comparative Review of Meshed Versus Unmeshed Grafts in Split-Thickness Skin Grafting: Clinical Implications and Outcomes.

Split-thickness skin grafting (STSG) is a cornerstone technique in reconstructive surgery, offering solutions for covering wounds, burns, and other skin defects. This review compares meshed versus unmeshed STSG, focusing on their clinical implications and outcomes. Meshed grafts, created by perforating the skin graft to form a mesh-like pattern, are frequently used for larger or irregularly shaped areas due to their ability to expand and conform to the underlying tissue. In contrast, unmeshed grafts are applied as whole sheets, making them suitable for smaller or cosmetically sensitive regions where appearance is paramount. This review examines various aspects of these graft types, including graft survival rates, aesthetic and functional results, healing times, and complications such as infection and graft contraction. This study aims to identify the relative advantages and drawbacks of meshed versus unmeshed grafts by analyzing data from clinical trials, meta-analyses, and systematic reviews. The findings highlight that while meshed grafts offer improved coverage and reduced risk of graft failure, unmeshed grafts are preferred for their superior cosmetic outcomes. Understanding these differences is crucial for optimizing surgical strategies and improving patient outcomes. The review also addresses patient-specific factors and recommends selecting the appropriate graft type based on clinical scenarios.

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.

Adipose-derived stem cells transplantation improves survival and alleviates contraction of skin grafts via promoting macrophages M2 polarization.

Full-thickness skin grafts are widely used in plastic and reconstructive surgery. The main limitation of skin grafting is the poor textural durability and associated contracture, which often needs further corrective surgery. Excessive inflammation is the main reason for skin graft contractions, which involve overactivation of myofibroblasts. These problems have prompted the development of new therapeutic approaches, including macrophage polarization modulation and stem cell-based therapies. Currently, adipose-derived stem cells (ASCs) have shown promise in promoting skin grafts survival and regulating macrophage phenotypes. However, the roles of ASCs on macrophages in decreasing skin grafts contraction remain unknown. Rat adipose-derived stem cells (rASCs) were isolated from rat inguinal adipose tissues. Full-thickness skin graft model was constructed on male rats divided into control group and rASCs treatment group. Skin graft was assessed for concentration, elasticity modulus and stiffness. Rat bone marrow-derived macrophages (rBMDMs) were isolated from rat femurs, and subsequent RT-qPCR and coculture assays were carried out to explore the cellular mechanisms. Immunohistochemical and immunofluorescence staining were used to verify mechanisms in vivo. In vivo results showed that after injection of ASCs, improved texture, increased survival and inhibited contraction of skin grafts were seen. Vascularization was also improved as illustrated by laser perfusion image and vascular endothelial growth factor (VEGF) concentration. Histological analysis revealed that ASCs injection significantly reduced expression of pro-inflammatory cytokines (TNF-a, IL-1β) and increased expression of anti-inflammatory (IL-10) and pro-healing cytokines (IGF-1). At cellular level, after co-culturing with rASCs, rat bone marrow derived macrophages (rBMDMs) favored M2 polarization even under inflammatory stimulus. ASCs treatment enhanced vascularization via angiogenic cytokines secretion and alleviated inflammatory environment in skin grafts by driving M2 macrophages polarization, which improved survival and decreased skin grafts contraction. Our work showed that ASCs transplantation can be harnessed to enhance therapeutic efficacy of skin grafting in cutaneous defects treatment.

(223) Using Aglan Flap in Peyronie`s Surgery

Abstract Introduction Surgical therapy is indicated if: 1- Deviation compromises or makes sex practice impossible. 2- Conservative treatment has failed. 3- Disease duration is at least 12 months. 4- The stable phase is at least 6 months. When deviation is greater than 60 degrees many centers prefer a grafting procedure to avoid penile shortening, grafting procedures leads to potential lengthening of the concave side of the deviation. The resulting tunical defect may be filled using an auto graft .e.g. detubulerized saphenous vein, fascia-lata, buccal mucosa, allograft e.g human pericardial tissues and human fibrinogen and thrombin coated onto equine collagen sponge, or xenografts e.g bovine pericardial and bovine intestinal submucosal tissues. Currently there is no consensus on the most suitable graft material for penile graft, many surgeons used synthetic grafts e.g self-adhesive collagen fleece, we were used the elastic wall of silicone caps with penile implants as a cover to the defects during implantation with peyronie`s previously. Synthetic grafts has the risk of infection, sensory loss, altered glans sensation, recurrent curvature due to graft contraction and length loss. So synthetic grafts should be avoided. Penile plication is simple and minimally invasive but invariably may results in penile length loss and may in fact worsen the existing hour-glass or hinge effect. Objective Presentation of new method to cover defects in peyronie`s diseases. Methods Methods two patients were operated, excision of the plaque was done, dissection of caval tissues in subtunical plane, elevation of Aglan caval flap, penile implantation (maliable), covering of the implant by the flap and suturing, second layer of the nearby tissues was added. The dissection could be done up to 360 degrees. Results Follow up for six months was done, both patients have no complications initial decrease in sensation was reported, improved within 3 months completely, the flap is safe, very vascular could be based at any point. It is natural, economic with minimal side effects if compared with synthetic grafts. Obvious nerves at area of excision should be retracted away if possible for maintenance of sensation. It could be used to cover defects with peyronie`s or other tunical defects with implantation. Conclusions Aglan flap is safe, economic, simple and effective method for covering tunical defects in peyronie`s disease. Disclosure No.

The efficacy and safety of continuous blanket suture for severe recurrent pterygium with symblepharon.

Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks. Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon. Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications. Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1-3) to 0.33 ± 0.53 (range 0-2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%). When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision.

Outcome of split-thickness skin graft (STSG) in complex orthopaedic trauma.

Objective: Complex orthopedics wounds are challenges to surgeon and patient in operative management. Road traffic accidents, the major cause of open fracture, represent a massive global health problem with high mortality and morbidity rates. Study Design: Retrospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: January 2021 to January 2022. Material &amp; Methods: Thirty eight patients with open fractures with skin loss, treated with graft, and wound where a flap was not possible were included in the study. The outcome was assessed in terms of the outcome of STSG in complex orthopaedic trauma. Results: A total of 38 patients were included who underwent STSG graft. Among these, more than half of cases, 33(86.8%), were males, while 5(13.2%) were female cases with a mean age of 25.82±13.09 ranging from (6-63) years. Graft loss was found in 4 cases (10.5%), graft contracture in 7 cases, altered sensation in three cases, skin pigmentation in 4 cases, episode infection in 8 cases, and skin breakdown in only one case observed. Average hospital stay ranged from 2-3 weeks in all cases. Conclusion: It is concluded that Acute complex orthopedics wounds present a unique challenge for surgeons. Good surgical technique, early appropriate surgical intervention, source control, early use of broad-spectrum antibiotic therapy, VAC dressing, and early tissue coverage prevent wound infection and decrease the chances of limb amputation.

Evaluating the effect of medical honey and stapler on skin graft fixation in burn wounds: A Randomized clinical Trial

Background One of the applications of honey is in wound healing. A stapler normally connects the skin graft to the underlying bed. Due to its high cost and lack of production in Iran, and causing physical damage to the tissue, an alternative method is needed. Objective This study aims to compare the effects of using medical honey and staplers for skin graft fixation in patients with burn wounds in the north of Iran. Methods In this clinical trial, 80 patients with deep second-degree and third-degree burns less than 40% of total body surface area were included and were randomly divided into two groups of honey (n=40) and stapler (n=40). Demographic information and the percentage of burns were extracted from patients’ medical files. The graft rejection, number of hospitalization days, grafted skin displacement, graft contracture, pain severity, existence of edema or hematoma, itching severity, and infection after grafting were investigated and recorded. Results Of 80 patients, 34 were male (42.5%) and 46 were female (57.5%). The mean age of the patients was 39.29±15.42 years. A significant difference was observed in the mean number of hospitalization days after grafting (P&lt;0.001), incidence of infection, hematoma, edema, and severity of pain and itching (P&lt;0.001), which were lower in the honey group. The graft contracture rate was lower in the stapler group (P&lt;0.001). Graft rejection was not observed in any groups. Conclusion The use of medical honey for skin graft fixation reduces the duration of hospitalization and adverse effects such as pain, itching, edema, hematoma, and infection compared to staplers. This method is as efficient as the routine treatment.

(089) Regional Vestibulectomy and Buccal Mucosal Graft Reconstruction for Refractory Neuroproliferative Vestibulodynia

Abstract Introduction Buccal mucosal grafts (BGM) are widely used in male urethral reconstruction and have more recently been reported for female urethral reconstruction. We report the first case of using a buccal mucosa graft (BMG) to cover the excised 12:00 vestibule in a 19 year old woman with lifelong persistent genital arousal disorder (PGAD) presumed secondary to congenital neuro-proliferative vestibulodynia. She presented to our clinic at 17 and underwent lysis of clitoral adhesions, excision of the core 12:00 region with primary closure, and complete vestibulectomy with vaginal advancement flap. Her vestibular specimen positively stained for CD117 and PGP9.5 consistent with excess mast cells and nerves, respectively. Post-operatively, there was marked reduction of vestibular pain in the 1:00 to 11:00 region posteriorly, however she had persistent PGAD and significant residual tenderness to cotton-tipped swab testing at the 12:00 region. Her PGAD was medically managed successfully with tramadol, clonazepam and low dose zolpidem. Desiring to eliminate the need for systemic medications, the patient returned to the clinic at age 19. Again, local anesthesia applied to the clitoris and 12:00 vestibule region resulted in clinically significant PGAD symptom reduction and 12:00 vestibulodynia. We discussed repeat clitoral lysis and re-excision of the 12:00 region with BMG reconstruction. Objective To report on a novel technique using BMG for 12:00 region vestibular reconstruction in one woman with distressing vestibulodynia and PGAD. Methods Pre-operative counseling included discussion of routine surgical risks, benefits, alternatives, with additional possible complications including failure of the procedure to relieve PGAD or vestibulodynia, graft contracture, buccal harvest site contracture, sexual dysfunction, and genital disfigurement. The patient gave consent for the procedure and underwent a repeat lysis of clitoral adhesions and 12:00 regional subepithelial vestibulectomy. The defect measured 2.5 cm x 2.5 cm. A non-tubularized onlay patch of buccal mucosa was harvested and used for vestibular reconstruction. The procedures were performed by a single surgeon. The patient was discharged the same day. Results The patient’s post-operative course was notable for acute urinary retention in the recovery room. She was discharged with a foley catheter and passed a voiding trial on post-op day 1. Her pain was well-controlled with non-opioid medications and she was able to resume a soft food diet immediately after surgery. At post-op week 5, the clitoral area, buccal harvest site, and graft site were healed without complication. The patient reports that her 12:00 pain to touch has resolved. Her PGAD has decreased slightly, although she has not yet attempted to discontinue oral medications. Conclusions For this patient, regional vestibulectomy with BMG to the 12:00 region of the vestibule appears to have been a safe and feasible technique for refractory neuroproliferative vestibulodynia. Given that the vestibule is of endodermal origin derived from the urogenital sinus, and neuroproliferation may represent a congenital anomaly, there is a rationale to replace urogenital sinus endoderm with a non-urogenital sinus endoderm such as buccal mucosa. Pre-operative counseling should include surgery specific adverse events like mouth opening restriction and genital disfigurement. Longer follow up and larger studies are needed. Disclosure No

Cyanoacrylate tissue adhesive vs. conventional sutures in free gingival grafts: a prospective clinical randomized study

Objective: The present prospective randomized clinical study compared the use of Dermabond® tissue adhesive as a substitute for sutures in free gingival graft fixation. Materials and Methods: Twenty individuals with absence of keratinized mucosa (KM) or KM height less than 1.0 mm in the buccal area of the mandibular incisors were selected to receive free gingival grafts. The patients were distributed into two groups: G1, composed of 8 patients with 10-mm grafts fixed with sutures; G2, composed of 10 patients with 10-mm grafts fixed with Dermabond®. All grafts had the same height (5mm) and thickness (1mm). Bleeding on probing, probing depth, gingival recession, keratinized mucosa height, attached keratinized mucosa height, and clinical attachment level were measured at 0, 15, 30, 45, 90, and 180 days. Results: ANOVA test showed significantly smaller graft contraction and significant increase in attached keratinized mucosa (p &lt; 0.05) in G2, compared to G1. Additionally, G2 exhibited significant clinical root coverage (p &lt; 0.05). Conclusions: The free gingival grafts fixed with Dermabond® tissue adhesive presented a faster clinical surgery, better dimensional stability, clinical root coverage, and did not alter the clinical healing process.

Xenogeneic collagen matrix versus free gingival graft for augmenting keratinized mucosa around posterior mandibular implants: a randomized clinical trial.

To assess the clinical efficacy of xenogeneic collagen matrix (XCM) plus apically positioned flap (APF) in augmenting the keratinized mucosa (KM) width (KMW) and thickness (KMT) around posterior mandibular implants and compare it with free gingival graft (FGG) plus APF. Thirty patients with KMW ≤ 2mm in the posterior mandibular implant site were randomly allocated to the FGG group (FGG plus APF) or the XCM group (XCM plus APF). Clinical assessments, including KMW and KMT, shrinkage rate of established KM, and peri-implant soft tissue health, were evaluated during a 6-month follow-up. Additionally, the esthetic outcomes and patient-reported postoperative morbidity were investigated. At 6months, the KMW measured 3.60 ± 0.79mm in the FGG group and 3.28 ± 0.96mm in the XCM group (p = 0.186). Both groups showed a tendency for graft contraction (FGG, 42.11%; XCM, 53.22%). The KMT measured 1.24 ± 0.34mm in the FGG group and 0.95 ± 0.29mm in the XCM group, with statistical difference (p = 0.002). No difference in the peri-implant soft tissue health was observed between the two groups (p > 0.05), but the esthetic outcomes were better in the XCM group (p < 0.05). XCM plus APF rendered a similar clinical efficacy in augmenting KMW as that with FGG plus APF, but with higher shrinkage. XCM plus APF was inferior with respect to FGG plus APF in augmenting KMT. The esthetic outcomes were better with XCM plus APF than FGG plus APF. Clinical relevance XCM plus APF graft was inferior with respect to FGG plus APF in augmenting KMT. Trial registration number: ChiCTR2200058027 and date: 03/27/2022.

Bionic artificial penile Tunica albuginea

Bionic artificial penile Tunica albuginea

Is "Initial Size of the Graft the Real Culprit behind Primary Contraction of Full-Thickness Skin Graft"? - A Cross-Sectional Study.

Background Primary contraction of full-thickness graft has been traditionally quoted to be 40%. There are lacunae in literature to elaborate on the factors influencing it ever since. Methods About 75 subjects who underwent full-thickness grafting procedures to resurface small defects were included in the study. The initial and final graft dimensions after primary contraction were traced on X-ray templates and the percentage of contraction was evaluated using the graphical method. This was further correlated with age, collagen, elastic matrix metalloproteinases-1 (MMP-1) and -2 content along with dermal thickness of the skin specimen sent from the graft. Results The primary contraction of the graft had a very significant correlation only with the initial size of graft harvested with a linear regression of 33.3% and a Spearman's correlation of 0.587 significant at a p -value of 0.001. Conclusion This study though preliminary tries to highlight an important factor that primary contraction of grafts is a physical phenomenon independent of its contents like collagen, elastin, or MMP-1 and -2 or age and dependent on its initial size of harvest instead.

Outstanding surgeon of the twentieth century, professor Natalya Ivanovna Butikova

The purpose of the study is to highlight the scientific, clinical, pedagogical and social activities of the outstanding maxillofacial and plastic surgeon, Doctor of Medical Sciences, Professor N.I. Butikova.&#x0D; Material and methods. Based on the analysis of domestic literature, as well as the life, professional activities and scientific works of Doctor of Medical Sciences, Professor N.I. Butikova to present her role in the formation and development of domestic maxillofacial and plastic surgery.&#x0D; Results. Information from the life of a well-known surgeon in our country, one of the patriarchs of Russian pediatric traumatology and maxillofacial surgery, Doctor of Medical Sciences, Professor Natalia Ivanovna Butikova, who turned 110 years old in 2020, is presented. The formation of N.I. Butikova as a doctor, researcher and teacher, her activities during the Great Patriotic War are noted. The main directions of her scientific activity in the development and improvement of methods for the treatment of gunshot injuries of organs and tissues of the maxillofacial region and neck, the rehabilitation of the wounded with defects in the jaws and tissues of the oral region using the methods of bone autoplasty and Filatov's stalk are highlighted. Natalya Ivanovna paid much attention to improving the treatment of face and neck burns and their consequences, as well as to surgical methods for eliminating mimic muscle paralysis. Its role in the development of oncostomatology, combustiology, pediatric traumatology and orthopedics is revealed. N.I. Butikova developed surgical methods for the treatment of syndactyly in children under the age of one year and the first years of life using zigzag incisions, improved the methods of free tissue grafting and plasty with split skin grafts, and proposed an apparatus for preventing secondary contraction of skin grafts during transplantation.&#x0D; Conclusions. It is emphasized that she was one of the pioneers of domestic maxillofacial surgery. N.I. Butikova, being one of the founders of domestic surgery, the creators of the school of pediatric traumatologists and orthopedists, as well as maxillofacial surgeons, is rightfully recognized as one of the patriarchs of national healthcare.

Specific Graft Treatment Solution Enhances Vascular Endothelial Function.

Saline is still the most widely used storage and rinsing solution for vessel grafts during cardiac surgery despite knowing evidence of its negative influence on the human endothelial cell function. Aim of this study was to assess the effect of DuraGraft©, an intraoperative graft treatment solution, on human saphenous vein segments and further elaborate the vasoprotective effect on rat aortic segments in comparison to saline. Human Saphenous vein (HSV) graft segments from patients undergoing aortocoronary bypass surgery (n = 15), were randomized to DuraGraft© (n = 15) or saline (n = 15) solution before intraoperative storage. Each segment was divided into two subsegmental parts for evaluation. These segments as well as rat aortic segments stored in DuraGraft© underwent assessment of vascular function in a multichamber isometric myograph system in comparison to Krebs-Henseleit solution (KHS), a physiologic organ buffer solution. Potassium-Chloride (KCL)-induced contraction depicted a tendency towards increase when treated with DuraGraft© compared to saline preservation of HSV segments (23.02 14.77 vs 14.44 9.13 mN, p = 0.0571). Vein segments preserved with DuraGraft© showed a significant improvement of endothelium-dependent vasorelaxation in response to cumulative concentrations of bradykinin compared to saline treated segments (p 0.05). Rat aortic segments stored in saline showed significantly impaired vasoconstriction (3.59 4.20, p 0.0001) and vasorelaxation when compared to KHS and DuraGraft© (p 0.0001). DuraGraft© demonstrated a favorable effect on graft relaxation and contraction indicating preservation of vascular endothelial function. NCT04614077.

Efficacy of split-thickness skin graft combined with novel sheet-type reprocessed micronized acellular dermal matrix

BackgroundAutologous split-thickness skin grafts (STSGs) remain the mainstay for treatment of large skin defects. Despite its many advantages, there exist critical disadvantages such as unfavorable scar and graft contracture. In addition, it cannot be used when structures such as tendons and bones are exposed. To overcome these limitations, acellular dermal matrix (ADM) is widely used with STSG. CGDerm Matrix®, which was recently developed, is a novel reprocessed micronized ADM (RMADM). In this study, outcomes of the combined application of RMADM and STSG on full-thickness wounds were analyzed.MethodsForty-one patients with full-thickness skin defects due to trauma, scar contracture release, and diabetic foot ulcers, who underwent STSGs, from January 2021 to July 2021, were retrospectively reviewed. The primary outcome of interest was skin loss rate, which was measured 14 days after surgery.ResultsThe most common cause of skin defect was trauma (36 patients), diabetic foot (2 patients), scar contracture release (2 patients), and malignancy (1 patient). The average defect size was 109.6 cm2 (range, 8–450 cm2). The average skin loss rate was 9.1%, showing a graft take rate of > 90%.ConclusionThe use of combined RMADM and STSG in full-thickness wound reconstruction provides stable and acceptable outcomes. The newly developed ADM can be a promising option in wound reconstruction.

Partial Tracheal Defects Closure using Glutaraldehyde-Treated Autologous Pericardium.

The usefulness of autologous pericardium treated with glutaraldehyde (GA) for tracheal defect closure is unknown. This study preliminarily evaluated whether a GA-treated autologous pericardial graft can effectively close tracheal defects in a beagle model. Defects of 10 mm × 10 mm were created on the trachea of 10 beagles and divided into a GA-treated group (n = 5), with tracheal reconstruction using GA-treated pericardium, and control group (n = 5), using fresh pericardium. Repair sites were evaluated through bronchoscopy and histology. Blood flows on graft were measured using laser Doppler technique on postoperative days (PODs) 0, 4, 7, 14, 28, and 56. Repair sites were histologically evaluated on POD 56. In addition, GA-treated pericardia of three other beagles were histologically evaluated 12 months postoperatively, for long-term follow-up. All animals survived; none developed anastomotic insufficiency. The mean suturing time and frequency of additional suture were significantly shorter and lower in the GA-treated group than in the control group (p = 0.002, 0.004). All animals in the control group exhibited graft contraction, whereas the GA-treated group healed with most graft residual and reepithelialization in the bronchoscopic and histological findings (p = 0.01, 0.004). Further, all long-term GA-treated pericardia of three beagles were confirmed as residual grafts with reepithelialization, without contraction, at 12 months postoperatively. Blood flows on graft using laser Doppler technique in the GA-treated group were detected at POD 14 or thereafter. GA-treated pericardium was easier to handle and provided favorable scaffolding, without graft contraction, compared with the nontreated pericardium at short- and long-term follow-up.

Buccal versus skin graft for two-stage repair of complex hypospadias: an Egyptian center experience

BackgroundUrethral reconstruction in complex hypospadias poses a significant challenge. We report our 10-year experience with buccal mucosa graft (BMG) in the two-stage repair of complex hypospadias and compare its results to the skin graft.MethodsWe retrieved the data of 15 patients with complex hypospadias who underwent two-stage repair using the BMG at our institution. The data were compared to 13 patients who underwent skin graft during the same period.ResultsThe median follow-up duration was 14 (12–17) months in the BMG group and 16 (13.5–22.5) months in the skin graft group. Patients in the BMG had a numerically lower incidence of the diverticulum, wound dehiscence, fistula, and infection than the skin graft group, however, without statistically significant difference (p > 0.05). On the other hand, the incidence of meatal stenosis and urethral stricture was significantly lower in the BMG group (0% each) compared to the skin graft group (30.8% each; p = 0.02). At the same time, there were no reported cases of graft contracture. The frequency of donor site morbidity was significantly higher in the skin graft group compared to the BMG group (p = 0.003). The BMG led to a lower incidence of postoperative straining than the skin graft (0% vs. 38.5%, p = 0.03). Only one patient needed revision surgery after skin graft, compared to no case in the BMG (p = 0.27).ConclusionThe present study demonstrates the feasibility and durable outcomes of the BMG in the setting of two-stage repair of complex hypospadias.

Sutureless full-thickness skin grafting using a dual drug-in-bioadhesive coacervate

Conventional skin grafting procedures such as suturing and stapling are accompanied by pathologic scarring with functional and psychological sequelae; severe scars need a prolonged recovery period, increasing the chance of wound infections or graft contraction. The present study develops a novel bioadhesive delivering dual drugs to minimize scar formation and accelerate wound healing during full-thickness skin grafting. The bioadhesive is prepared via coacervation of a mussel protein and shows high adhesive strength in both porcine skin and in vivo rodent models; furthermore, it sustainably releases dual drugs (allantoin and epithelial growth factor) to enhance re-epithelialization and collagen deposition while simultaneously reducing scar formation. The proposed dual-drug-in-bioadhesive coacervate may ideally meet the requirements of the wound healing process and is a promising candidate for sutureless full-thickness skin grafting.

Abdominoplasty Panniculus as a Source for Human Acellular Dermis: A Preliminary Report.

In extensive deep dermal burn injuries, split-thickness skin graft (STSG) has been the most preferred treatment option for resurfacing burn wounds. A thick split-thickness skin graft is ideal for preventing graft contracture but is associated with delayed donor healing and the lack of adequate donor skin. When applied with STSG, the dermal substitutes offer better-reconstructed skin than STSG alone. Human-derived acellular dermal matrix (HADM) obtained from cadaver skin is a dermal equivalent with good clinical outcomes. However, high cost and limited cadaver donor skin availability limit its clinical utility. Developing a low-cost preparation method and finding an alternate source of human donated skin can help reduce the cost. The objective of this study was to explore the feasibility of making HADM from abdominoplasty panniculus skin. Skin samples were collected from the abdominoplasty panniculus of ten eligible donors with their informed consent. A combination of low-cost reagents-sodium chloride and hypotonic solution (water for injection) was used for decellularizing the skin. Characterization of the prepared Acellular Dermis Matrix prototype was done. The skin was deepidermized with one molar NaCl treatment at 37°C for 24h. The deepidermized dermis became acellular with hypotonic solution treatment at 4°C for two weeks. The hematoxylin and eosin staining and cytotoxicity test confirmed the acellularity and non-cytotoxicity of the prepared HADM prototype. The HADM prototype also facilitated the formation of neo-epithelium in the 3D cell co-culture model. This study confirms that abdominoplasty panniculus can be a viable alternative for HADM preparation. Further characterization studies are required to prove the concept.

597 Reconstruction of Lop Ear Deformities After Severe Burn Injury in Pediatric Patients: An 11-year Experience

IntroductionThe ear is one of the most highly visible structures on the face. One or both ears are frequently involved in panfacial burns. Because they are bilateral structures, asymmetries are clearly visible. Reconstruction of burned ear deformity often requires replacement or modification of skin and/or cartilage. Even these are successfully replaced, scar contractile forces can cause deformation of the ear. One of these deformities is lop or cup ear, in which the helical rim is either folded over, wrinkled or tight. We describe the necessity of applying otoplasty techniques to address this problem.MethodsA retrospective chart review analysis was performed to assess demographic variables, procedural indications and procedural outcomes in pediatric patients treated at our hospital for complex ear reconstruction for ear deformities after her surgery. Inclusion criteria were pediatric patients aged 0 to 21 years admitted to Shriners Hospital for Children-Boston from January 1, 2010 to January 1, 2021 for burn injury, who subsequently required follow-up complex ear reconstruction for ear deformities after burn injury. Of these patients, those with lop ear deformities who required construction were examined. Using the Trauma Registry of the American College of Surgeons (TRACS) and Shriners Hospital for Children Information Source (SHCIS) databases, we identified 12 eligible patients. Surgical procedure data was obtained from the SHCIS electronic medical records. Surgical photographs were obtained with patient informed consent. Those patients who required Medpor or cartilage frame reconstructions were excluded.Results12 patients required an otoplasty-type procedure to obtain desired results or symmetry with the contralateral ear. This technique involved a posterior incision in the auriculomastoidmastoid sulcus, are you a year and cartilage modification with sutures to to re-create the antihelical fold an superior crus as well as conchal setback sutures.ConclusionsBecause ears are bilateral structures, symmetry is extremely poor. Because of multiple contractile forces on the external ear from secondary healing or contraction of skin grafts, the ear is often displaced anteriorly and the upper portions become folded. Treatment requires reconstruction of the natural folds of the ear and shortening of the helical rim to mastoid distance. this requires an otoplasty approach with a posterior incision,, exposure of the cartilaginous framework and modification of the cartilage with incisions and sutures. This technique however requires adequate soft tissue coverage of the ear.