Partial Thickness Skin Graft Research Articles

Customized Negative Pressure Wound Therapy: Innovative Design in Polyurethane Foam for Complex Burn Reconstruction.

The use of negative pressure wound therapy (NPWT) throughout the entire treatment of a burn patient boosts wound healing and recovery. Hand burns require specialized management that enhances wound healing and facilitates early physical rehabilitation. Thus, this article showcases a novel idea of NPWT foam customization that boosts recovery and rehabilitation in patients with hand burns. We present two patients with hand burns treated with NPWT using a customized foam design that allowed for early rehabilitation while providing and optimized recovery. In the two cases presented, the patients required two surgical stages; in the first surgery, debridement of the burns was performed and customized NPWT with instillation was applied, and in the second surgical stage, the bed was reconstructed with partial-thickness skin grafts, which were bolstered with customized conventional NPWT. The management, reconstruction, and rehabilitation were accomplished in under 2 weeks, achieving a remarkable 100% success rate in graft integration during the acute phase on the first attempt. This highlights the effectiveness of incorporating NPWT across all burn treatment phases, expediting recovery and ensuring optimal functional outcomes for patients. Surgeons can customize different NPWT foam shapes that facilitate its use on difficult-to-treat areas, allowing for a faster recovery and better rehabilitation outcomes.

The Value of Low-Level Laser Therapy on The Healing Process of Donor Site after Partial Thickness Skin Graft Surgery

The Value of Low-Level Laser Therapy on The Healing Process of Donor Site after Partial Thickness Skin Graft Surgery

Vezani muskulokutani režanj trapeziusa u rekonstrukciji defekta u regiji ramena nakon resekcije mekotkivnog sarkoma - prikaz slučaja i pregled literature

Introduction: Soft tissue sarcomas (STS) in the extremities require complex treatment involving limb-sparing surgery with adjuvant therapy. The treatment involves tumor resection with wide margins along with additional radiation and/ or chemotherapy. In addition to tumor resection, an important aspect is the reconstruction of the resulting soft tissue defect. For extensive reconstructive procedures in the upper extremities, literature suggests the use of free or pedicled flaps. In the shoulder region, due to its complex regional anatomy, selecting an appropriate flap is the surgical imperative. Recently, there has been significant interest in the use of the pedicled trapezius musculocutaneous flap, which offers certain advantages over other flaps. Case report: A female patient (31 years old) with STS in the left shoulder region, was surgically treated three times. The first surgery involved an intralesional procedure - R2 resection when a pleomorphic dermal sarcoma was diagnosed. After five months, a recurrence of the disease was detected based on magnetic resonance imaging (MRI) findings at the site of the surgical scar. Tumor resection was performed, and the soft tissue defect was covered with a free Thiersch partial-thickness skin graft. Histopathological analysis revealed a high-grade leiomyosarcoma. Two months after the second surgery, MRI findings confirmed a recurrence of the disease. Wide tumor resection was conducted, and the soft tissue defect was covered with a pedicled lower trapezius musculocutaneous flap. Conclusion: The literature lacks studies describing the outcomes of the use of trapezius flaps in the reconstruction of defects in the shoulder region following STS resection. Additionally, there is no unanimous official opinion on the resection margin width that is considered safe. The treatment outcome of our patient indicates the significant potential and advantages of the trapezius flap, as compared to other flaps of that region.

Forearm injury reconstruction with split-thickness skin graft: a case report

Nowadays, automobile accidents have become one of the leading causes of death and functional, as well as aesthetic, repercussions in the young population. These accidents often result in a significant loss of skin surface, posing a challenge for reconstructive surgeons to cover the wounds. As a result, in the last few decades, various techniques such as negative pressure therapy, partial and full-thickness skin grafts, and the use of different flaps have been implemented. This article aims to discuss the use of skin grafts for wound coverage and the differences between the two types of grafts. It will also present a case study of a 43-year-old patient who suffered trauma while driving his vehicle, resulting in an injury to his left forearm's posterior region from the level of the elbow joint to 6 cm proximal to the radiocarpal joint. The wound was covered with a partial-thickness skin graft, which showed good evolution and excellent aesthetic results.

The Effects of Zataria multiflora Cream on Split-Thickness Skin Graft Donor-Site Management: A Randomized, Blinded, Placebo-Controlled Study.

Purpose: The wound healing process involves a complex series of biological events. Skin grafts have several uses as a reconstructive method. There are several dressings for the skin graft donor site, but the optimum dressing agents that provide all the requirements at the same time are unclear. This prospective, randomized, placebo-controlled clinical trial aimed to evaluate the therapeutic effect of Zataria multiflora cream in the wound healing process of partial-thickness skin graft donor sites and compared it with a placebo. Materials and Methods: This clinical trial study was performed on patients who underwent split-thickness skin grafts. Enrolled patients applied Z. multiflora cream and placebo controlled (petrolatum ointment) twice a day, from the day of intervention at the skin graft donor sites in two parts, separately. On 7, 14, 21, and 28 days after surgery, the wound healing process was evaluated, photographed, and scored according to the Bates-Jensen assessment tool. Evidence of infection was evaluated. The main agent and placebo were compared during the wound healing process. Results: Decreases in wound surface area and total score were significantly greater in the Z. multiflora group (p < 0.05). The wounds of 30% of patients in the second week and 90% of patients in the third week were completely epithelialized in the Z. multiflora group. These values were 3.3% and 36.7% for the control group, respectively, and so, the healing rate was ∼9-fold in the second week and 2.45-fold in the third week in the Z. multiflora group compared with the control group (p < 0.05). Conclusion: Wound healing and reepithelialization accelerated significantly in the first, second, third, and fourth week after intervention in the Z. multiflora treatment group, due to modulating the inflammatory phase and improving the proliferative phase. Clinical Trial Registration Number: IRCT20210624051695N1.

Evaluation of Bacterial Cellulose Dressing versus Vaseline Gauze in Partial Thickness Burn Wounds and Skin Graft Donor Sites: A Two-Center Randomized Controlled Clinical Study.

Objective Bacterial cellulose (BC) dressing, which can maintain a moist environment and prevent the invasion of pathogens, has become a competitive dressing material for burn wound treatment. This study was conducted to evaluate the treatment efficacy of a novel China-made BC dressing for the treatment of second-degree burn wounds and skin graft donor sites. Methods 212 patients with second-degree burn wounds or skin graft donor sites were enrolled from two research centers. They were randomly assigned to the BC dressing group (study group) or the Vaseline gauze (VG) dressing group (control group). Wound conditions were assessed before and after treatment. Dressings were changed according to the condition of the wound bed. Healing rate and healing time were recorded as primary endpoints to evaluate the efficacy of BC dressing against VG dressing. Erythema, swelling, exudation, bleeding, subeschar purulence, and pain were assessed as secondary endpoints. Results 207 participants completed the trial and their wounds all healed within 28 days. The average healing times for superficial and deep secondary burn wounds and skin graft donor sites in the BC group were 8.12, 15.77, and 10.55 days, respectively. In the VG group, the average healing times for superficial and deep secondary burn wounds and skin graft donor sites were 9.30, 15.27, and 11.19 days, respectively. The healing time of superficial burn wounds in the BC group was statistically shorter than that in the VG group. There was no difference in the frequency of dressing changing between two groups. The BC dressing showed equal efficacy with the VG dressing at all secondary endpoints. Conclusion The novel BC dressing could be used for the management of second-degree burn wounds and skin graft donor sites. With a shorter healing time in superficial secondary burn wound than that of the VG dressing, the BC dressing showed noninferiority in the treatment of superficial and deep secondary burn wounds and skin graft donor sites versus the VG dressing. This study is registered with the Chinese Clinical Trial Registry (registry number: ChiCTR1800014377 (http://www.chictr.org.cn)).

Second-Layer Palmar Graft for Fingertip Reconstruction: An Analysis of Aesthetic and Functional Outcomes.

Background: Fingertip injuries are very common and require a stable and durable cover. The end result after reconstruction must be a painless finger with good aesthetic appearance. Skin loss in fingertip, with or without partial loss of pulp fat, is often managed with a split-thickness skin graft, which causes a poor aesthetic result due to color mismatch of the grafted skin in the glabrous volar skin of fingertip. The full-thickness and partial-thickness skin graft harvested from palmar skin provide color match but may cause donor site morbidity in the form of painful scar or contour deformity. Harvest of the second layer from the palm (intermediate part of dermis) allowed the first layer (epidermis with superficial part of dermis) to be reposed over the remaining dermis in palm, thus allowing closure of donor defect without any tension. This technique provides a good color match for the primary defect, along with reduced donor site morbidity.Aim: The study aims to analyze the outcomes of second-layer palmar graft (SLPG) in patients with fingertip injuries.Materials and methods: The retrospective study was conducted in January 2012 on 40 patients who underwent SLPG.Result: The graft take was 100% in 36 patients with an average static two-point discrimination (2PD) of 6 mm. The average cosmetic visual analog score for the donor area was 100 and recipient site was 80.Conclusion: The SLPG is a good surgical procedure for reconstructing fingertip defects, providing excellent aesthetic appearance and optimal function.

A simple technique for definite closure of full thickness abdominal wall defect in open abdomen after temporary applied split thickness graft

Open abdomen (OA) has gained a wide acceptance in the management of abdominal surgical catastrophes. Definite reconstruction of OA is an operative challenge as various methods are used. Dynamic techniques are preferred for the closure of OA. If other methods fail to close the OA, then temporary split thickness skin graft can be applied and refer the definite closure for later. We used a modification of an existing technique, in a 47-year-old female patient with a big midline incisional hernia due to temporary closure of OA with partial-thickness skin graft, who was operated for permanent closure of the defect. In order to avoid complications from extensive dissection, we invaginated the grafted area and realigned the recti muscles with on lay mesh reinforcement with excellent outcome. This technique of inverting the previous grafted area when it can be applied is an easy and safe method with rewarding results.

Soft Tissue Management and Tibialis Posterior Tendon Transfer in Acute Correction for Neglected Drop Foot Deformity

Acute correction of rigid drop foot deformity can be problematic due to the skin defect that may occur in the medial part of the ankle. The purpose of this study is to present an innovative solution for this problem. We hypothesized that acute correction for rigid ankle contractures without arthrosis might be possible if the medial skin defect could be closed. Therefore, we described a surgical technique for acute functional correction of rigid drop foot deformities. The closure of the medial defect was performed by applying a flap and partial-thickness skin graft. We have retrospectively evaluated the results of 18 patients who were treated between 2010 and 2016 with this technique. The mean age of the patients was 37 ± 9.5 (22-56) years. Foot drop etiology was firearm-related nerve injury. Corrections were performed after 14.6 ± 7.9 (8-38) months following the injury. At the end of an average follow-up period of 44.4 ± 6.2 (37-60) months, 14 of 18 patients (78%) recovered without complications, 3 patients experienced partial loss in the medial skin graft region, and 1 patient developed a superficial infection. None of the patients have developed pes planus. We observed that the ankle flexion contracture, which was 34° ± 9.2° (20°-50°) preoperatively, could reach an average of 2.2° ± 2.5° (0°-6°) dorsiflexion after surgery. We suggest that acute correction and tibialis posterior tendon transfer in the treatment of rigid foot drop deformity can be performed with an effective skin closure with low soft tissue complications.

Outcome of Comparison between Partial Thickness Skin Graft Harvesting from Scalp and Lower Limb for Scalp Defect: A Clinical Trial Study.

BACKGROUNDPartial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb.METHODSThis clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. RESULTSOverall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale.CONCLUSIONScalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.

Abstract Introduction In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application. Methods Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up. Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay. Results Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing. Conclusions The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.

Outcome of Comparison between Partial Thickness Skin Graft Harvesting from Scalp and Lower Limb for Scalp Defect: A Clinical Trial Study

Outcome of Comparison between Partial Thickness Skin Graft Harvesting from Scalp and Lower Limb for Scalp Defect: A Clinical Trial Study

SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

Fournier's gangrene: its management remains a challenge.

Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (HBOT). The vaccum assisted closure (VAC) therapy is also used, which is a non-invasive system that promotes open wound healing. Healing techniques can be once the septic risk is controlled. Dressings topical treatments, such as fatty substances or calcium alginate, in addition to skin grafts, musculo-neurotic or musculo-cutaneous cover flaps can be used. During the follow-up period, no reccurrence occurred in 14 out of the 18 cases (2 patients were lost to follow-up and 2 patients died). A colostomy was closed in 10 out of 11 cases with simple follow-ups. Restorative surgery (partial thickness skin graft) at the perineal level was performed in only one case. Despite the better understanding of its etiopathogenesis, the advent of targeted antibiotic therapy, the establishment of a better codification of surgical procedures, the contribution of hyperbaric oxygenation and reconstruction techniques, mortality rates are still high and FG remains a real health threat, thus constituting a real medical and surgical emergency.

Apert Hand Reconstruction: Do Partial-Thickness Skin Grafts Result in Flexion Scar Contracture?

Hand reconstruction for patients with Apert syndrome is a critical step in comprehensive care and enables this population to gain significant hand function. Digit separation for Apert syndrome, as described in most algorithms, is finalized using local flaps and full-thickness skin grafts. The objective of this study is to report our experience using local flaps and partial-thickness skin grafts after digit separation for Apert hand reconstruction. An observational retrospective study was performed with Apert patients whose hands were reconstructed between January 2007 and July 2019 using local flaps and partial-thickness skin grafts after digit separation. Demographic data and outcome data were verified and recorded. Out of a total of 75 Apert patients who underwent hand reconstruction, 12 underwent hand reconstruction utilizing local flaps and partial-thickness skin grafts. The average patient age at the time of the first procedure was 1.9 years. These 12 patients were stratified according to Upton hand severity, 3 being type I (25%), 3 being type II (25%) and 6 being type III (50%). Mean follow up provided to all patients in this study was 1.8 years and donor site-related complications were seen in 2 patients (16.6%). No flexion scar contracture was observed in any of the patients who received partial-thickness skin grafts. The use of local flaps along with partial-thickness skin grafts to finalize digit separation for patients with Apert syndrome is an effective technique that reduces donor site morbidity and does not result in flexion scar contracture.

Surgical management of Fournier gangrene

Background: Fournier's gangrene (FG) is a debilitating type of infective necrotizing fascitis of the perineal, genital, or perianal regions. Despite the rarity of this disease, unfavorable ­prognosis related to this disease depends much on the timing of medical care. Hence; the present study was undertaken for assessing and summarizing data of surgical management of 30 patients of Fournier gangrene. Materials & methods: Thirty patients who presented with clinical signs and symptoms suggestive of FG were enrolled. Emergency debridement of all the patients was carried out under the cover of broad spectrum antibiotics. Tissue samples were subjected to analysis for culture and antibiotic sensitivity testing. At the time of first debridement, hydrogen peroxide was used, followed by Eusol dressings until slough had separated. This was followed by Povidone Iodine dressings until the wound was healthy and ready for graft. Fournier’s Gangrene Severity Index (FGSI) was assessed. Surgical management procedures employed were recorded separately and follow-up was done. Results: Mean age of the patients was 58.4 years. Diabetes was found to be present in 66.67 percent of the patients. Mean FGSI score was found to be 3.96. Mean number of debridements was found to b 4.69. Fever, scrotal pain and headache were the most common symptoms encountered in the present study. Mean duration of hospital stay was 30.1 days. Partial thickness skin grafting was done in 36.67 percent of the cases while thigh pouch reconstruction was done in 20 percent of the cases. Secondary suturing was done in 53.33 percent of the cases. Multiple additional incisions on inguinal region and psoas for draining abscess were done in 12 patients. Mortality was nil in the present study. Conclusion: Adequate debridement along with surgical therapy results in significant favorable outcome in FG patients. Also, mortality can be significantly reduced by achieving with rapid diagnosis and carrying out urgent surgical debridement of all necrotic tissues under cover of adequate antimicrobial therapy.

Penoplasty and vacuum-assisted closure in children with Fournier’s gangrene of the penis

Fournier’s gangrene (FG) of the penis rarely occurs in boys. Initial treatment consists of debridement and infection control. Penoplasty, a complex procedure burdened with complications, should ensure good erectile function and aesthetic outcome. This article presents the vacuum-assisted penoplasty procedure that was undertaken in three children with FG of the penis from 2000 to 2017 in University Hospital Centre Zagreb. FG started at the prepuce, penile skin or scrotum due to immunosuppression caused by chemotherapy for acute lymphatic leukaemia. Necrectomy of the whole penile shaft was performed in general anaesthesia, and urinary catheter was placed and fixated to the glans. A partial thickness skin graft (0.5 6 mm) was harvested from the lateral thigh, placed on the penile shaft while artificial erection was maintained (to ensure sufficient skin for later erections) and fixated with quilting sutures. The skin graft was covered by Vaseline gauzeVaseline® Petrolatum gauze, circular 20 mm thick VAC (Vacuum Assisted Closure ) sponge and adhesive film. Negative pressure was maintained at 75 mm Hg and the penis was kept in erected state. Glans capillary refill was regularly checked. Vacuum therapy was removed on the seventh postoperative day. There were no postoperative complications and full re-epithelisation occurred on postoperative day 10. The 15-year-old patient reported painless postoperative erections and achieved ejaculation with masturbation. Thicker than usual grafts were used to minimize graft contraction. Negative pressure of 75 mm Hg and complete adherence of the sponge were achieved despite the cylindrical shape of the wound bed. The function of the vacuum system was not only to fixate the graft, but to maintain the penile shaft in the state of permanent artificial erection. The pressure of 75 mm Hg was chosen because the reports in which higher pressures were used reported a higher postoperative pain levels as well. Good functional and aesthetic outcome with no complications make this procedure the method of choice for the reconstruction of penile shaft skin defects after Fournier’s gangrene in children.

Utilization of a Dermal Substitute (Hyalomatrix) in Pediatric Upper Extremity Procedures

Introduction Hyalomatrix is a skin graft substitute that may be able to be utilized as an alternative to partial or full thickness skin grafts in a variety of procedures involving the pediatric upper extremity. Composed of an esterified Hyaluronic Acid layer and a silicone layer, Hyalomatrix provides a matrix for dermal induction while protecting the wound from the external environment. The use of this skin graft substitute can potentially decrease the overall …

“POMELO PROJECT” - a simple and low cost simulator for harvesting skin graft by plastic surgery residents

BackgroundHarvesting partial thickness skin grafts is an important technical skill the training plastic surgeon is required to hone. Historically accomplished via manual dermatome (Humby's knife) or the modern day electric dermatome. ObjectivePresenting a means of practicing the use of Humby’s knife for novice surgeons. Methods15 plastic surgeons comprising 8 seniors and 7 residents, in a single tertiary center participated. Each utilised a Humby knife to harvest 4 skin grafts from a Pomelo. The graft areas were measured via computerised image processing, comparing measures of graft harvest consistency across groups of surgeons. ResultsIn the resident surgeon group, the average relative difference between exact graft area and encompassing area was 0.45, as compared with 0.15 in the Senior surgeon group, indicating a greater degree of inconsistency in graft harvest. Comparisons across groups yielded significant differences per each of the 4 grafts harvested (p <=0.005). Limitationssingle center and small cohort (inherent to the sparsity of plastic surgeons), marginal statistical evidence. ConclusionsCitrus Maxima (Pomelo) is a useful substrate to instruct and practice the use of Humby knife effectively, allowing novice surgeons to practice the manual manoeuvres required therefore as well as increase confidence in its subsequent operative use.

Experiences with Surgical Reconstruction of Penoscrotal Extramammary Paget's Disease: A review of 21 cases

Penoscrotal extramammary Paget's disease is a rarely found intraepithelial adenocarcinoma in older male patients. The challenge for surgeons to perform high-quality post-surgery reconstruction is mostly case-dependent. Here, we present a review of post-surgical reconstruction practice in 21 cases using various scrotal skin flaps. During the 10-year study period (from 2008 to 2018), all 21 male patients diagnosed with penoscrotal extramammary Paget's diseases at Sun Yat-sen memorial hospital were enrolled in this study. All patients underwent expanding resections guided by frozen sections and penoscrotal reconstructions using various scrotal skin flaps alone or combined with pubic skin flaps and partial thickness skin graft depending on individual defects. The patient's clinical data, specifically the diagnosis, surgical outcome, and follow-up evaluation were retrospectively analyzed. The size of skin lesions ranged from 4 × 5 cm to 16 × 18 cm approximately. Out of 21 total cases, 13 patients received combined scrotal and pubic flaps, three patients received single scrotal flaps, and five patients received scrotal flaps and partial thickness skin grafts. Limited flap tip necrosis (two cases) and wound dehiscence (one case) were observed, and secondary resections were performed in four cases with positive post-operative pathological results. All patients experienced complete wound healing and had well-maintained penile morphology and function. Various scrotal skin flaps alone or combined with pubic skin flaps designed for individual lesion conditions in patients with penoscrotal extramammary Paget's disease are efficient for scrotal reconstruction. A good match of the local skin texture helps to maintain the morphology and function of the penis and scrotum.