Skin Coverage Research Articles

Use of Cultured Epithelial Autograft in Conjunction with Biodegradable Temporizing Matrix in Massive Burns: A Case Series.

Intensive care for massively burn patients has increased survival and highlights the need for a solution to the problem of insufficient donor sites for autologous skin coverage. In this case series we present ten patients with average burn size of 81% TBSA and mean age of 24 years old, who underwent burn excision followed by either immediate or delayed biodegradable temporizing matrix (BTM) placement. After an integration period, the BTM was delaminated either the day before or immediately prior to placement of cultured epithelial autografts (CEA) over a widely meshed (4:1 or 6:1) split thickness skin graft (STSG). One patient had CEA alone, without STSG, placed on integrated BTM and had successful take. Seven patients survived to discharge and had average 95% wound closure at 135±35 days. The patients had on average 10.4 total operations and 8.7 excision and grafting operations. Five patients had complications related to the BTM requiring removal or replacement including three fungal infections, one bacterial infection and one with bleeding and a large clot burden. In conclusion, this surgical strategy is a viable option for patients with massive burns and insufficient donor for autologous skin grafting.

78 Improvement of Cell Viability in Temporary Storage of Split Thickness Skin Grafts

Abstract Introduction Autologous split thickness skin grafts (STSGs) are the preferred donor tissue for restoration of large tissue deficits. Although grafting should be done at the time of donor harvest, various factors necessitate tissue storage, traditionally in saline solution (SS) at 4oC. However, STSGs often expire before grafting in these conditions. Patients then require further excision procedures or die due to inadequate skin coverage. For patients’ wellbeing, establishing a new storage protocol is imperative. This study sought to determine an effective storage media for prolongation of graft viability for subsequent incorporation into excision and grafting practice. Methods Following patient consent, excess tissue >1cm2 was collected after grafting procedures. Tissue was stored at 4oC in RPMI, DMEM, and SS with penicillin/streptomycin. Samples were evaluated at 2, 5, 7, and 14 days. Cell viability was measured by Trypan blue dye exclusion test in an automated cell counter yielding percentage of viable keratinocytes (PVK). An unbiased pathologist assessed tissue integrity by epidermal-dermal junction, perinuclear keratinocyte halos, and collagen organization with higher scores denoting deterioration. Data were evaluated by ANOVA and Effect size. Results A total of 155 sets of two specimens each were collected from 13 patients. Mean PVK values at day 2, 5, 7, and 14: SS (57.38, 36.96, 38.38, 27.50), RPMI (69.46, 69.92, 70.33, 62.67), DMEM (63.17, 53.50, 54.83, 37.92). By pairwise comparison, RPMI preserved PVK better than SS at days 5, 7, and 14 (p = 0.001 for each day). DMEM preserved PVK better than SS when comparing all days (p = 0.011) but failed to produce a statistically significant difference at any specific day. RPMI preserved PVK greater than DMEM each day. However, statistically significant differences were only revealed at day 14 (p = 0.017) and when comparing all days (p < 0.001). Effect size was large for overall group differences of PVK at day 5, 7, and 14 (Cohen’s f = 0.72, 0.73, and 0.75). Tissue integrity scores at day 2, 5, 7, and 14: SS (0.69, 1.0, 1.38, 2.0), RPMI (0.54, 0.92, 0.85, 1.54), DMEM (0.77, 0.92, 0.77, 1.15). Although culture media preserved tissue integrity greater than SS, no statistically significant differences were found. Conclusions RPMI preserved cell viability better than DMEM and SS. This suggests that STSGs stored in RPMI may prolong the time of which tissue could be stored and successfully amalgamated with skin. Applicability of Research to Practice Storing tissue in RPMI could benefit burn patients by decreasing tissue disposal therefore reducing future donor site area or eliminating repetitious excision procedures entirely. These effects decrease inpatient days and healthcare costs. Most importantly, successful tissue storage will save patients’ lives, especially those of large surface area burns who lack sufficient donor sites.

562 Therapy Resources for Management of Large TBSA Burns: A Case Study

Abstract Introduction Therapy studies involving large percent TBSA burns ( >50% TBSA) are not well described. Studies show the highest predictor of preventing burn scar contracture is the amount of burn rehabilitation time received per cutaneous functional units involved, but what does “more therapy time” mean for larger burns in terms of therapy resources for burn centers? Methods A case study was completed on a 20-year-old male admitted after sustaining 85% TBSA full thickness flame burns to his face, neck, arms, legs, and trunk, along with an inhalation injury. He was admitted to the inpatient burn ICU for 113 days, undergoing 16 surgeries to achieve skin coverage prior to discharge to acute rehab. Therapy was initiated < 24 hours after admission to the Burn ICU. Direct therapy contact minutes were tracked during all session and divided into therapy treatment domains. (resource). If co-treating occurred, a single unit of time was used for the time of the session to avoid doubling the units provided. Results Therapy occurred on 106/113 days of admission, receiving 238 therapy sessions (113 PT, 125 OT). He received 21,027 minutes of direct therapy, averaging 196.5 min/rehab days. The highest number of therapy minutes were spent on ROM (9,032 min). Other domains of care included Mobilization (3,171 min), Positioning (2,298 min), Orthotic management (1,326 min), etc. (Table 1). Despite focus on ROM and positioning, he discharged with 7 moderate (left wrist extension, bilateral hip abduction, bilateral ankle dorsiflexion, left neck rotation, and left forearm supination) and 4 severe contractures (right wrist extension, bilateral hip extension, neck extension). He was able to transfer with moderate assistance and walk 150 ft with a platform walker at discharge. Conclusions Therapy interventions in the literature are often described in isolated “domains” of practice, however guidelines on a global approach to management of those with catastrophic injuries does not exist. Prioritization between domains with limited therapy resources when facing patients with extensive deficits is challenging. A dedicated burn therapy staff with availability to secure additional resources was required to ensure optimal outcomes in the management of this patient Applicability of Research to Practice This case study demonstrates the comprehensive burden of care and need for additional therapy resources in the management large TBSA burns.

Multifidelity Design of Structurally Embedded Waveguides

Slotted waveguides embedded in aircraft skin panels may not support a buckling load without failure in the copper waveguide due to stress concentrations created by the corners of the slots. To create designs strong enough to avoid compressive failure before buckling instability, an initial offset in the copper waveguide may be added so that the supporting skin cover and backplane take additional load to prevent failure at the waveguide slot corners. A structural model is developed to include a gap in the eigenvalue analysis through a prestress term, and subsequently to account for the gap in an optimization procedure. Additionally, a curve fit is used to account for local buckling modes that reduce the plate buckling mode of the final panel design. These factors combine to allow for a low-fidelity model to account for the gap and local buckling without the need for a high-fidelity model using plate or contact modeling. This low-fidelity model is then run through an optimizer, producing designs that are stronger and/or lighter for a fraction of the computational cost of prior high-fidelity models.

Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap.

Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect. A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups. A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups (p < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF (p < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups (p < 0.05). The overall rate of complications was comparable between groups (24%, p = 0.129). The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.

MODIFIED VACUUM-ASSISTED CLOSURE (MVAC): A SIX-MONTH CASE SERIES ON THE METHODS AND OUTCOMES OF USING MODIFIED NEGATIVE PRESSURE WOUND THERAPY AMONG PATIENTS WITH INADEQUATE SOFT-TISSUE COVERAGE AT PHILIPPINE ORTHOPEDIC CENTER (POC)

To describe clinical situations for use of modified VAC in POC based on: diagnosis, comorbidities, BMI, wound size in cm, days following trauma when VAC was first applied, total duration of uninterrupted use, frequency of change, settings, bacterial growth, outcomesTo report the outcomes of mVAC use in POC within 6 months to help improve and standardize its application in the institutionThis study involves data gathering from inpatients handled by orthopedic surgeons in training and subspecialty rotations in POC. The data collected are highly dependent on the doctors-in-charge's complete charting, thorough reporting and accurate documentation. Modified Vacuum Assisted Closure (mVAC) is used frequently in this study and is defined as a form of revised, adapted and reformed use of VAC based on available materials in the involved institution. The materials that are included are, but not limited to the following: sterile Uratex™ blue foam, nasogastric or suction tubing, phlegm suction machine, Bactigras™ and Opsite™ or Ioban™.A total of 58 patients were included in the study. The average age of the population was 35 and are predominantly male. The most common mechanism of injury was motorcycle accident and 37 of the patients were diagnosed with an open fracture of the lower extremity with open tibia fractures (22) being the most common. Average wound area measured was 24.12 cm3. All patients yield a bacteria growth with e. coli being the most frequent. Average during of uninterrupted use was 39 days. Of the 58 included in the study, 8 patients underwent STSG, 2 had a flap coverage surgery, 4 patients eventually underwent amputation and 33 with complete resolution of soft tissue defect after conversion to biologic dressing post-mVAC. The rest of the population were still ongoing mVAC at the end of the study.mVAC is an alternative temporary medium for soft tissue coverage for cases with or without concomitant fractures. mVAC promotes removal of exudate from the wound, supports wound apposition and granulation bed proliferation. Usage mVAC helps prepare for skin coverage procedure and on some cases leads to full resolution of defect.

OS EFEITOS DA CAPACITAÇÃO DA EQUIPE DE ENFERMAGEM SOBRE A AVALIAÇÃO E CUIDADOS DE PACIENTES COM FERIDAS

Pressure ulcer is an injury located in the skin and/or deep sensitive coverings that commonly appears over the bony protuberance and may be associated with the use of a medical device or other artifice. The nurse's autonomy begins in the development of the decisions to be taken that make the dressing or a better therapy. This study aims to present, through a literature review, the effects of nursing team training on the assessment and care of patients with wounds. Nursing develops indispensable interventions to prevent, promote and treat PIs, and direct action by nurses is essential for the efficiency of preventive therapy, outlining care according to integral and individual factors. Several mechanisms can be used to optimize the level of knowledge of professionals; however, it is essential to recognize the personal and institutional barriers that hinder the fulfillment of this goal. This is a literature review based on scientific knowledge produced by the effects of nursing team training on the assessment and care of patients with wounds. By qualifying, the nursing professional improves and qualifies the work team, keeping up-todate, expanding their knowledge, satisfying themselves as professionals and patients, the demands assigned to them to demonstrate scientific and practical knowledge, in addition to decision-making. Inaddition to expanding knowledge, professional qualifications provide the nursing professional, whether technical or graduate, with the achievement of autonomy in the space in which he works as a professional.

A Unique Case of Modifying an Old Extended Spreader Costal Graft into a Supportive Structure in a Nasal Alar Reconstructive Surgery – A Case Report

A ten-year-old reconstruction surgery of a total nasal dorsum defect on the right nose involves a medial arm flap and self-rib cartilage, complicated into fibrous tissue retraction, which caused nostril narrowing and asymmetry. This complication was corrected using a combination of a nasolabial flap for a skin coverage and a modified, old rib cartilage graft to create a supportive rim for the newly reconstructive right nasal ala. There is controversy about the advantage of auricular cartilage versus costal cartilage with a gap in academic studies. However, in this case, costal cartilage has shown significant benefits that helped patients to gain the best functional and aesthetic results. In addition, the modification of an old nasal graft for another function is a unique spotlight in our case. Therefore, we report a case about using an old nasal graft for an alternative function, as well as the observed results from the first-stage of this procedure.

The Role of Tissue Expanders in the Reconstruction of Proximal Hypospadias

OBJECTIVETo report the technique and outcomes of tissue expansion (TE) for generating additional penile skin for urethroplasty and/or skin coverage during primary or redo hypospadias repair in penoscrotal transposition (PST) patients with a proximal hypospadias. METHODSProximal hypospadias and PST patients with a lack of penile skin, congenitally or after failed repair, who underwent TE assisted reconstruction were reviewed. TE were placed under the penile shaft and expanded skin was used for tubularized incised plate repair. Success was defined as urethral advancement to the corona or more distal with tension free skin coverage. RESULTSA total of 24 patients underwent reconstruction including 16 as part of primary repair and for redo repairs in 8. Nine patients experienced expander extrusion and posturethroplasty complications occurred in 43.8% of primary repairs and 75.0% of redo repairs; a urethrocutaneous fistula was most common (n = 8). Overall, success was achieved in 87.5% of patients with postoperative meatal locations almost all coronal (45.8%) or glanular (50.0%). CONCLUSIONProximal hypospadias reconstruction is challenging, and complications are not infrequent. TE is a useful alternative for complex patients with a skin paucity such that cutaneous coverage would be difficult following urethroplasty. Although the complication rate was 43.8% for primary repair, TE generated sufficient residual skin for success after additional reconstruction. For redo repair early use is most beneficial as there is more expandable skin. The pseudocapsules provide vascularized coverage to reinforce the urethra while there is sufficient skin to minimize the need for a skin graft for penile coverage.

THE ROLE OF GASTROCNEMIUS MYOCUTANEOUS FLAP IN COVERING DEFECTS OF PROXIMAL AND MIDDLE THIRD OF LEG

BACKGROUND: The treatment of a large soft tissue defect affecting the upper and middle portion of the leg remains a problem. The purpose of this study was to determine the efficacy and adaptability of a gastrocnemius myocutaneous flap cover for a post-traumatic major defect of the upper and middle third of the leg. METHODS: This prospective study was undertaken from January 2021 to December 2022 on 27 consecutive cases with post-traumatic upper and middle third leg defect treated with gastrocnemius myocutaneous flap, and the functional and aesthetic outcomes were assessed. RESULTS: There were no reports of full flap failure. In two individuals (7.4%), there was partial cutaneous necrosis and infection noted in one individual (3.7%) There was no postoperative hematoma. In terms of donor site morbidity, no functional deformity was seen during the follow-up period. The process was proven to be dependable, technically simple, and visually pleasing. CONCLUSION: Post-traumatic extensive leg defects extending in the upper and middle thirds were easily covered with a regional gastrocnemius myocutaneous flap, resulting in a great outcome and cosmetically acceptable skin coverage without substantial problems or long-term morbidity and can be performed by an orthopedic surgeon without the assistance of plastic surgeon

Occipital artery based myocutaneous flap repair for cochlear implant extrusion- How I do it

Introduction: Cochlear implant extrusion is a challenging complication to manage. It needs meticulous planning, antibiotic cover and a good vascularized tissue covering. Occipital artery based myocutaneous flap is used to cover tissue defects in neurosurgery and oncosurgery practice and the results are widely accepted. In ENT practice we can safely utilize this versatile and reliable flap to achieve good tissue cover over an extruded cochlear implant. Objective: To improve confidence and share experience to achieve better outcomes when dealing with complications after cochlear implantation. Method: Occipital artery based flap is used to cover the tissue defects as an axial flap over the exposed implant after antibiotic cover, with the Consultant microbiologist’s guidance to overcome biofilm resistance and a through wound debridement. Results: Good healing achieved with a thick scalp skin cover. Conclusion: In ENT practice we can safely utilize this versatile and reliable flap to achieve good tissue cover over an extruded cochlear implant.

High Expansion Auxetic Skin Graft Simulants for Severe Burn Injury Mitigation.

Burn injuries are commonly treated with split-thickness skin grafting. However, low expansions offered by spilt-thickness skin grafting inhibit the treatment of large and severe burn injuries when limited donor skin is available. To overcome this gap, in this work, it was attempted to study the expansion potential of skin grafts with novel auxetic incisions with rotating rectangle (RR), honeycomb (HC), alternating slit (AS), H-shaped (HS), Y-shaped (YS), and I-shaped (IS) unit cells, through development of skin graft simulants. Clinically relevant biaxial load testing was conducted to estimate the stress-strain response, void area, and meshing ratio. Moreover, hyperelastic constitutive models were employed to characterize the non-linear biomechanical behavior of the skin graft simulants. The maximum void area increase was observed in the HS skin graft simulant, indicating low skin cover. Overall, the IS auxetic skin graft design exhibited meshing ratio higher than traditional grafts (>3:1), low void area and stresses, which can be beneficial for large skin cover and burn wound healing. With further optimization and clinical tests, the auxetic skin graft designs may find a place with the graft manufacturers for fabrication of grafts with better surgical outcomes for severe burn injuries.

Skin and soft-tissue coverage for limb salvage in extensive diabetic foot ulcers: An institutional experience

Background: Extensive diabetic foot ulcers (DFUs) with skin and soft-tissue defects need prompt coverage of the defect using plastic surgical means. The indication, timing, and techniques of wound coverage in DFUs are not adequately understood by all. Hence, an institutional experience of providing skin and soft-tissue coverage to extensive DFUs is reported. Aims and Objectives: The aims of this study were to study the various types of DFU that needs surgical wound coverage and to understand the types of wound coverage surgeries, their timings, success rates, and final outcomes. Materials and Methods: A retrospective-prospective study of all the DFUs managed using skin and soft-tissue coverage was conducted. Surgical and medical management and their outcomes were studied. Results: Sixteen patients underwent skin graft or flap surgery for their DFU. All the limbs were salvaged and all wounds were covered with two reports of ulcer recurrences. Conclusion: For optimal care of DFUs, the possible need for wound coverage, it’s timing, and aftercare are to be understood by all involved.

Strategies of Total Auricular Reconstruction for Patients With Poor Skin Coverage at the Mastoid Area.

Burns and injuries can lead to massive defects in the mastoid tissues, which increase the difficulty of ear reconstruction. It is crucial to choose an appropriate surgical method for these patients. Here, we introduce strategies for auricular reconstruction in patients without satisfactory mastoid tissues. From April 2020 to July 2021, 12 men and 4 women were admitted to our institution. Twelve patients were severely burned, 3 patients experienced car accidents, and 1 patient had a tumor on his ear. The temporoparietal fascia was used for ear reconstruction in 10 cases, and the upper arm flap was used in 6 cases. All of the ear frameworks were made of costal cartilage. The location, size, and shape of both sides of the auricles were generally the same. Two patients needed further surgical repair because of cartilage exposure at the helix. All of the patients were satisfied with the outcome of the reconstructed ear. For patients with ear deformity and poor skin coverage in the mastoid area, we can choose the temporoparietal fascia if the patient's available superficial temporal artery is longer than 10cm. If not, we can choose the upper arm flap. The latter needs a five-stage operation, which is more time consuming and difficult than the former. Moreover, the expanded upper arm flap is thinner and has better elasticity than the temporoparietal fascia, so the shape of the reconstructed ear is better. We need to evaluate the condition of the affected tissue and choose the appropriate surgical method to achieve a good result.

Кожно-шерстный покров овец при пастбищном и круглогодовом стойловом содержании животных

The positive influence of year-round stabling (in comparison with stabling-pasture) on the formation of skin and wool cover: the total thickness of skin and its separate layers, the density of hair follicles, physical and technical properties and wool shearing has been established in sheep of the Prekos breed. The studied technology in growing of repair young sheep is acceptable in conditions of sheep breeding farms of the Central Black Earth zone.

Outcome of vacuum assisted dressing in open comminuted tibial fracture with primary fixation

Background/Aim: Wound management of the compound open tibia (Gustilo-Anderson grade 2, 3a, 3b) is complicated by a higher infection and the problem of adequate soft tissue coverage is significant. Primary wound closure is not easily advisable in these types of compound open tibial fractures. Early tissue flap or graft procedure might increase the complication rate due to temporary graft rejection and wound infections. The aim of this study was to analyse the duration required for formation of healthy granulation tissue, duration required for making wound fit for skin cover procedure and duration of hospital stay in compound open tibia fracture treated with vacuum assisted closure (VAC). Methods: A prospective interventional study of 22 patients aged 18 to 60 years was done. After assessing the size of the wound, primary bone fixation and wound debridement were carried out as soon as possible and then VAC was applied. Assessment of VAC therapy was based on mean decreases in wound size and "modified Johner and Wruh's criteria", used for assessment of the functional outcome of tibial shaft fracture was recorded during each follow-up. Results: Twenty two patients suffered comminuted open fractures of tibia-fibula. Primary fixation of bone were done with vacuum dressing. During follow-up, the good decrease in wound size considering vacuum dressing remedy was once 18.75 ± 18.36 cm2 (p = 0.001). Six patients achieved excellent results according to "modified Johner and Wruh's criteria" of tibial shaft fracture. Conclusion: This technique effectively reduced wound size, accelerated the formation of healthy granulation tissue of wound with open fracture bone and provided a better functional outcome. The VAC treatment had suggestively increased wound closure rate, decreased morbidity and costs for patients.

Three-Year Experience With Combined Complex Skin Repair in Patients With Extensive Burns: A Retrospective Study

Introduction. The Meek micrografting technique used in STSG expansion is effective in achieving wide and rapid coverage of burn wounds. Certain growth factors have also been shown to modulate or mediate wound healing. Objective. In this study, a combined treatment approach for severe burns involving the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF was evaluated. Materials and Methods. A retrospective study was conducted of 7 extensively burned patients who were treated with the Meek technique, systemic application of rhGH, and topical application of rhEGF between January 2017 and December 2019. Results. The mean percent TBSA burned was 89%. An average of 9.5 surgical procedures were performed to obtain skin cover, with an average of 5.8 Meek micrograft procedures performed in the 6 surviving patients. Complete wound healing was achieved at an average of 120 days in the 6 surviving patients. The mean graft take rate was 81%. Infection was the main reason for graft failure. Donor sites were used for up to 5 re-harvestings without additional morbidity. Conclusions. A multipronged treatment approach that combines the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF is a promising tool for the management of severe and extensive burns.

Medial Plantar Artery Flap for Reconstruction of Weight-bearing Sole Defect- A Series of Ten Cases

Weight-bearing areas of feet are at risk of developing ulcers due to various reasons like a neuropathic foot in diabetes mellitus, acute trauma, post-tumour excision etc., Various reconstructive options have been described in literature from split-thickness skin graft to free flap. This case series reports 10 patients with sole defects. Out of 10 patients, seven patients had heel defect and three patients had the plantar aspect of the forefoot defect. For patients with heel defect, authors used a proximally based medial plantar flap as a reconstructive tool while for forefoot sole defect distally based (reverse) Medial Plantar Artery (MPA) flap was used. The most common cause of heel defect was postdebridement defect in diabetic foot in five cases, postmelanoma excision defect in three cases, postsquamous cell carcinoma excision defect in one case and postelectric burn defect in one case. Flap size ranged from 5x5 cm to 10×7 cm. All flaps offered stable, durable, and cosmetically acceptable skin cover. No patient had a recurrent ulcer during follow-up period. Partial flap necrosis in one case was managed conservatively. The MPA flap offers excellent cover which is a sturdy, durable, cosmetically acceptable cover for medium size defect over the sole i.e., the weight-bearing part of forefoot and heel.

A Prospective Study of Reconstructive Procedures For Post Burn Hand Contractures

Objective: The hand is among the most frequent sites of burns contracture deformity. It represents a common problem and a difficult challenge for many reconstructive surgeons. It is important to restore length, function, and provide good quality skin cover. Our aim is to evaluate the different surgical procedures for resurfacing after release of post burn hand contractures in terms of functional recovery and aesthetic outcome. Methods: Totally 30 cases of post burn hand contractures were reconstructed between May 2018 and November 2019 according to site and type of contracture with individualization for each case. All cases were followed up with physiotherapy and splinting devices, functional and aesthetic outcome for each procedure. Results were analyzed as per successful reconstruction, type of procedure, complications, functional and aesthetic outcome. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z- plasties with proper planning gives maximum length gain with no donor morbidity as other procedures and acceptable appearance. Conclusion: Postoperative physiotherapy and splinting are must for better outcome in all cases.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand