Reconstruction Of Skin Defects Research Articles

Advancement Flap in Paralateronasal Defect Reconstruction.

Various techniques for local flap reconstructions of the facial region have been documented in the literature, including the advancement flap. This flap is one of the most versatile options for reconstructing various skin defects across different areas of the body. The purpose of this study is to demonstrate the safety and effectiveness of the advancement flap for reconstructing the paralateronasal region after the excision of skin cancer. The following article presents a retrospective case series of 6 patients in whom the advancement flap was used to reconstruct skin defects resulting from malignant tumor resections in the paralateronasal region. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano, and the study was conducted in collaboration with Sapienza University of Rome, from February 2023 to February 2024. All the flaps settled with no complications, and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the advancement flap turns out to be a rapid and reliable option that could be easily applied for cutaneous defects of the face even for the oldest and/or emaciated patient.

Reconstruction of penile skin defect using negative pressure therapy, spiraling full-thickness skin grafts, and nanofat grafting: a case report

Abstract The penis is a structure that requires both anatomical and functional reconstruction. Being a three-dimensional structure that changes in volume, it presents a reconstructive challenge for the plastic surgeon. Currently, various alternatives are available for covering these complex defects, such as grafts, flaps, and dermal matrices. The objective of this study is to present a case report describing a complex post-traumatic penile defect in which three combined strategies were implemented for the first time (spiral full-thickness grafts, nanolipoinjection, and negative pressure therapy). These strategies have been described in the literature for defect coverage, achieving satisfactory anatomical and functional results.

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.

Challenging frontiers in neuroplastic cranial reconstruction: addressing neurosurgical wound healing complications through interdisciplinary collaboration – an observational study

Background and objectivesAlthough rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.MethodsA retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.ResultsA cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.ConclusionsOur study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.

Limberg Flap for Lateral Midface Reconstruction.

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2cm) and medium-sized (size around 2-4cm) cutaneous defects of the face even for the oldest and/or emaciated patients.

Composite skin substitutes, 3D skin bioprinting and the “BioMask” concept in regenerating skin defects - review

The treatment of skin trauma, especially facial skin trauma, is a major challenge due to its complex structure, the presence of appendages, color, texture, and the large area to be reconstructed in extensive trauma. “The gold standard” for treating trauma is autologous intermediate thickness skin grafting. An alternative solution is the usage of bioengineered skin substitutes. Tissue engineering is intended to provide patients with better treatment options and more effective pain reduction. Unique skin lesions are those related to the face. To fulfill the need to improve the results of facial skin reconstruction, the “Biomask” concept was introduced for the treatment of facial wounds. The purpose of this review is to analyze composite dermal-epidermal substitutes already on the market for clinical use, as well as briefly discussing materials in the testing phase, focusing on 3D skin bioprinting and facial trauma regeneration using “BioMask”. PubMed and Google Scholar databases were searched for relevant sources. Search terms included “skin substitutes”, “synthetic skin substitutes”, “bioengineered skin”, “composite skin substitutes” and additionally each analyzed unit of composite skin substitutes was searched. Bioengineered skin substitutes effectively fulfill the role of dressings during the reconstruction of skin injuries. The development of 3D skin bioprinting is enabling the increasing and effective use of these materials. The high requirements in the treatment of facial skin injuries are the trigger for the development of new materials such as "BioMask". The synergy of new technologies makes it possible to create improved methods of wound dressing and reconstruction of skin defects.

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.

Versatility of the supraclavicular artery island flap for head and neck reconstruction.

To present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction. We performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes. Thirty-three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti-infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed. The SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity. 4.

The kite flap for the reconstruction of Face Skin Defects: a retrospective study

The kite flap for the reconstruction of Face Skin Defects: a retrospective study

Application of negative wound pressure therapy to skin grafts after coverage of uncertain granular sites: a case series

The split thickness skin graft (STSG) is one of the most popular tools used in reconstructive surgery. Developed for the first time by Olier in 1872, with perpetually improving techniques, this graft has since facilitated the reconstruction of skin defects. Negative wound pressure therapy (NPWT) is a therapeutic procedure that has been widely used for decades; it stabilizes the wound environment, improves tissue perfusion by stimulating granulation and angiogenesis, and reduces bacterial load and, consequently, wound edema. This case series of 3 patients aimed to show the advantages of applying NPWT over STSGs after the coverage of uncertain granular sites. The intake rate was 95% on average, with rapid wound healing, no hematoma formation, no need for regrafting, and no pain or signs of infection.

Visor flap: A solution for the reconstruction of large skin defects on the frontal and parietal parts of the skull.

Reconstruction of skin defects after oncological surgery for a cutaneous squamous cell carcinoma is often mandatory to facilitate adjuvant treatment and/or to prevent chronic wound problems. Some of the most challenging regions to reconstruct after resection of a skin tumor are the frontal and parietal parts of the skull. This article describes three patients with large skin defects after oncological surgery that were reconstructed with the use of a (hemi) visor flap. The (hemi) visor flap is easy to harvest, resulting in a concise procedure and short hospitalization with maximum wound control. The (hemi) visor flap is a safe and reliable option for the closure of large skin defects on the skull. Especially in the older and frail patient group.

Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects.

This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm2. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

Skin graft on a collagen and elastin matrix fixed with negative pressure in a complicated pediatric dog bite: case report

Animal bites represent a significant source of morbidity in the pediatric population, with dogs being the primary cause. Highlighting the need for innovative solutions to effectively tackle the issue and enhance both functional and aesthetic outcomes. Dog bites, marked by a heightened morbidity rate, present an inherent infection risk owing to the considerable bacterial load present in saliva. The fundamental approach to treatment revolves around preventing infection through meticulous washing, debridement, and the timely implementation of early primary closure. We detail the management of a pediatric patient with a dog bite on the pelvic limb, resulting in a challenging-to-manage wound. This case was successfully treated with a skin graft on a bed of collagen matrix, secured with negative pressure therapy. The choice of the appropriate technique for reconstructing skin defects depends on their depth and size. Consequently, combining these three techniques yielded a favorable functional and aesthetic outcome for the patient. This case report emphasizes the relevance of employing different techniques in managing complicated dog bites.

Reconstruction of perianal skin defect using modified keystone flap after perianal tumor resection

PurposeThe large resection area of perianal tumor makes the skin defect hard to reconstruct. The keystone flap has demonstrated a growing application in skin defects. Herein, we aimed to explore the efficacy of keystone flap in the repair of skin defect after perianal tumor resection. MethodsThis study is a retrospective review of patients diagnosed with perianal tumor from January 2010 to November 2021. A standardized data collection template was used to collect variables. The detailed process of the reconstructive surgery is carefully described in this article. After surgery, the healing process was closely observed. ResultsTwenty patients underwent keystone flap repair. The average wound size before closure measured 3.5 × 4.9 cm2. Primary wound healing was achieved, and the flap survived during the follow up period, which ranged from 6 to 24 months. No severe complications occurred; slight edema was noticed in one patient. ConclusionThe application of keystone flap is a promising way to repair skin defect after tumor removal, and the complications rate was low after surgery. It can be concluded that this method is an effective and reliable way to repair perianal skin defect.

Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study.

The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT. The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days. Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft. This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.

Application of maple leaf‐shaped flap combined with negative pressure wound therapy in the perianal circular skin defect reconstruction

AbstractWe aimed to explore the efficacy of maple leaf‐shaped flap in the repair of perianal circular skin defect. This study is a retrospective review of patients with perianal circular skin defect after skin tumour resection and repaired with maple leaf‐shaped flap. Patients included in this study were admitted in our department between January 2010 and January 2023. A standardized data collection template was used to collect related variables. The design and surgical procedures of maple leaf‐shaped flap are carefully described in this study. Negative pressure wound therapy (NPWT) was applied to assist wound healing postoperatively. Twenty‐seven patients were included in this study. The average wound size after tumour resection measured 4 × 5 cm2–10 × 10 cm2. The circular skin defect was repaired by maple leaf‐shaped flap, and NPWT was used after surgery. Twenty‐five patients achieved primary wound healing and flaps were well‐survived. Slight infection occurred in two patients, and both were cured after dressing change. During the follow‐up period of 6–24 months, no tumour recurrence occurred. The perianal morphology can be well‐restored by maple leaf‐shaped flap, and the defecation control function of anus was not impaired. The application of maple leaf‐shaped flap and NPWT is a promising way in the repair of perianal circular skin defect with little complication and satisfying outcomes.

Reconstruction of Skin Defects in the Medial Canthal Region Using the Novel Hug Flap.

Various methods of reconstructing skin defects in the medial canthal region have been reported. We report 2 skin flaps for the upper and lower eyelids designed to reconstruct soft tissue defects in the medial canthal region based on the approach used for the orbit during surgeries for facial bone fractures. The skin flap was elevated without tension until it reached the defect. The skin flaps of the upper and lower eyelids were moved around the defect as rotational flaps and sutured. Two patients with skin defects in the medial canthal region after basal cell carcinoma resection were treated with this technique. No complications occurred, and good cosmetic and functional outcomes were obtained. This method can be used to reconstruct the eyelid with an elevated skin flap and is considered useful for repairing defects in the medial canthal region.

Autologous Skin Cell Suspension for Full-Thickness Skin Defect Reconstruction: Current Evidence and Health Economic Expectations.

Despite differing etiologies, acute thermal burn injuries and full-thickness (FT) skin defects are associated with similar therapeutic challenges. When not amenable to primary or secondary closure, the conventional standard of care (SoC) treatment for these wound types is split-thickness skin grafting (STSG). This invasive procedure requires adequate availability of donor skin and is associated with donor site morbidity, high healthcare resource use (HCRU), and costs related to prolonged hospitalization. As such, treatment options that can facilitate effective healing and donor skin sparing have been highly anticipated. The RECELL® Autologous Cell Harvesting Device facilitates preparation of an autologous skin cell suspension (ASCS) for the treatment of acute thermal burns and FT skin defects. In initial clinical trials, the approach showed superior donor skin-sparing benefits and comparable wound healing to SoC STSG among patients with acute thermal burn injuries. These findings led to approval of RECELL for this indication by the US Food and Drug Administration (FDA) in 2018. Subsequent clinical evaluation in non-thermal FT skin wounds showed that RECELL, when used in combination with widely meshed STSG, provides donor skin-sparing advantages and comparable healing outcomes compared with SoC STSG. As a result, the device received FDA approval in June of 2023 for treatment of FT skin defects caused by traumatic avulsion or surgical excision or resection. Given that health economic advantages have been demonstrated for RECELL ± STSG versus STSG alone when used for burn therapy, it is prudent to examine similarities in the burn and FT skin defect treatment pathways to forecast the potential health economic advantages for RECELL when used in FT skin defects. This article discusses the parallels between the two indications, the clinical outcomes reported for RECELL, and the HCRU and cost benefits that may be anticipated with use of the device for non-thermal FT skin defects.

Reconstruction of Achilles Tendon Skin Defect Using Single-Stage Reverse Sural Artery Island Flap

Wound complications following open repair of a ruptured Achilles tendon are common and require immediate skin cover. This study analyses the use of a reverse sural artery island flap to cover skin defects over an exposed intact Achilles tendon. Thirteen patients with postoperative wound complications over the tendoachilles were operated upon. All wounds were debrided and reconstructed with a single-stage reverse sural artery island flap. Within 5 weeks of flap cover, 12 wounds healed completely, while 1 flap had superficial necrosis at the margin in a diabetic patient. This eventually healed and did not compromise the final result. None of the flaps had venous congestion. In our hands, reconstructing skin defects following wound complications after Achilles tendon repair with islanded reverse sural artery flap is a reliable and safe option. Level of Evidence: Level IV.