Skin Coverage Research Articles

Skin oncoplasties: O-to-Z technique a technique of choice in situation of limited resources? Case of Burkina Faso

BackgroundIn developing countries, the long delays in consultation lead to a delay in diagnosis and management of the skin tumors. The lesions are often large and bring the problem of skin coverage after their resections. Several reconstruction techniques allow skin coverage. The objective of this study is to describe the place of O-to-Z technique in the surgical treatment of skin cancers in Ouagadougou. We hypothesized that O-to-Z technique reduces healing times and the number of dressings compared with directed wound healing.Patients and methodsIt was a two-center, retrospective, descriptive study on O-to-Z technique in skin cancers. It included patients who underwent surgery between January 1st, 2013 and March 30th, 2021 in Ouagadougou. Scar quality and healing time in Z-plasty were compared with those of secondary healing. We used the Student’s t test.ResultsIn 8 years and 3 months, 171 skin cancers were identified. The mean time to consultation was 13.6 months. The average size of the tumors was 9 cm. An O-to-Z technique was performed in 42 cases, being 58.3% of the patients operated on. The average healing time was 15 days. It was four and a half times shorter in O-to-Z technique than in secondary healing. Ischemic necrosis of the Z-corner was noted in 7 cases. The recurrence rate in O-to-Z technique and secondary healing was 7.1% and 9.1% respectively. Hypertrophic or keloidal scars were noticed in 7 cases and hypochromia in 2 cases.ConclusionO-to-Z technique is a technique of choice for skin coverage after large resections in surgical oncology. It reduces the healing time and the cost of postoperative care without increasing the risk of tumor recurrence.

The pericranial flap for inner lining of full-thickness nasal defects: a retrospective cohort study

Effective nasal reconstruction requires skin and soft tissue cover, cartilage or bone structure, and mucosal lining. Ideal lining is thin, pliable and vascularised, making reconstruction challenging. This paper presents the first case series with long-term outcomes of pericranial flaps used as inner lining for nasal reconstruction. Patients undergoing paramedial forehead flaps from 2007 to 2019 were identified using second-stage nasal reconstruction billing codes. Patients with pericranial flaps for lining, for whom there were data on resulting outcomes and complications, were identified. Sixty-six patients underwent second-stage nasal reconstruction. Eighteen patients had paramedian forehead and pericranial flaps for inner lining reconstruction. The flap lining had no immediate post-operative complications. Three patients suffered partial to major reconstructive failure post radiotherapy. Other complications included nasal stenosis and orocutaneous fistula. Combined with paramedian forehead flaps, the pericranial flap is reliable as inner lining for nasal reconstruction. It is easily accessible and useful in resections with limited mucosal options.

Rotation Advancement Keystone Flap for Closure of Large Myelomeningocele Defects.

Myelomeningocele is the most common form of neural tube anomalies. Early reliable skin coverage should be achieved to reduce central nervous system infections. The keystone flaps are gaining popularity for myelomeningocele defect reconstruction. However, the use of a traditional keystone flap is limited in very wide or transversely oriented myleomeningocele defects with inadequate lateral tissue laxity. In this study, we present our successful experience using modified rotation advancement keystone flaps for closure of the transversely oriented myelomeningocele defects. Between April 2019 and April 2020, the modified rotation advancement keystone flap was used for reconstruction of transversely oriented myelomeningocele defect in 7 patients (5 males and 2 females) with average age of 14 days. The localization of the lesions was lumbosacral in 5 patients and thoracolumbar in 2 patient. The average myelomeningocele defect width was 6.4 cm, whereas the average defect length was 5.7 cm. The following information was evaluated: the flap dimensions, operative time, and postoperative complications. All patients had uneventful operations, except for 1 case of superficial epidermolysis over flap tip, which settled with conservative wound management. Immediate venous congestion was detected in 2 patients that completely resolved. Otherwise, all wounds healed without any evidence of complications. The mean follow-up was 4 months. Although the conventional keystone flap seems to have geometric constraints to close a transversally oriented myelomeningocele defect, the modified rotation advancement keystone flap serves as a superior alternative and effective option for closure transversally oriented defect.

Koyanagi urethroplasty for proximal hypospadias: A stage procedure?

To report experience and technical refinements with the Koyanagi urethroplasty for proximal hypospadias. A retrospective study was conducted between 2004 and 2017. Medical records of patients treated by the Koyanagi technique were investigated. The penile ventral skin was closed either with a Byars flap or using an "Ombredanne's chasuble" (OC). The cohort was divided chronologically into two groups of the same number of patients (early -E- and late experience group-LEG-). Demographics, anatomical findings and surgical outcomes were compared between groups using univariate analysis. A logistic regression was performed to assess factors associated with the occurrence of a postoperative urethrocutaneous fistula or urethroplasty dehiscence (UD). The Koyanagi urethroplasty was performed in 67 patients, 33 in the EEG and 34 in the LEG. The overall surgical complication rate was 64.2% (n=43), including 42 fistula or UD, higher in the EEG (81.8%) than in the LEG (44.1%, P<0.01). However, in the LEG, patients underwent the surgery older and the use of OC more frequent. After multivariate analyses, factors associated with a postoperative fistula or UD were the year of surgery (OR=0.71 [0.53-0.96] P=0.02), the age at surgery (OR=1.11 [1.01-1.22], P=0.03); contrary to the skin coverage method or the stenting duration (P>0.05). An urethral stenosis occurred in 1 patient (1.5%). At last follow-up, 64.2% of patients required a further procedure and 80.6% of urethral meatus were glandular. In this study the complication rate, particularly the urethrocutaneous fistula, remained high. Urethral stenosis, were rare but the follow-up was too short to clearly identified them. Considering as a 2 stage procedure koyanagi uretroplasty allows to obtain finally good results. III.

804 Catastrophic Burn Management: A case series using autologous skin cell suspension

IntroductionCatastrophic thermal injury treatment is complex due to the lack of autologous donor site, which is imperative for permanent wound closure. Historically, our burn unit has relied on application of cultured epithelial autografts for wound closure in this patient population. Lab grown skin requires a significant time investment. Therefore, in our most recent subset of large burn injuries, we have transitioned to the use of autologous skin cell suspension over widely meshed autograft utilization almost exclusively.MethodsA case series of four thermally injured patients with injuries greater than 75% TBSA was reviewed. Patient length of stay, operative interventions, skin coverage, mortality and cost were examined.ResultsBurn size ranged from 75-85% TBSA in four patients. Early excision was implemented for all four patients in the case study. One of the four patients was treated with a combination of lab grown skin and autologous skin cell suspension. The three other patients were treated exclusively with autologous skin cell suspension for wound coverage. All patients underwent widely meshed autograft with the autologous cell suspension for wound coverage. All four patients survived to discharge and their initial follow up. Cost of operative interventions were less expensive for autologous skin cell suspension than for cultured epithelial autografts. Length of stay varied from 66-179 days. Discharge location varied from acute rehabilitation, to a homeless shelter, to another burn facility with inpatient psychiatric services.ConclusionsAutologous skin cell suspension is a safe and efficient treatment modality to obtain permanent wound closure in catastrophic thermal injuries.

794 Use of Cultured Epithelial Autografts After Biodegradable Temporizing Matrix in Massive Burns

IntroductionAs burn care advances, patients are surviving with larger burn injuries, that previously would have been fatal. However, the need for autologous skin coverage continues to be an unmet need for massive burn injuries. Several attempts have been made to address this with various dermal substitutes, temporary coverage, and skin substitutes. For 25 years, Cultured Epithelial Autografts (CEA) have been used to treat large burn injuries, but this was met with variable success and has a mandatory pre-requisite lab time before it is ready for use. In 2018, Biodegradable Temporizing Matrix (BTM) that can be placed immediately on excised burns was first studied in burn patients, which has led to its increased use in subsequent years. This case series seeks to examine our experience using CEA following the application and ingrafting of BTM on large burns.MethodsA retrospective review was conducted from 2017-2020 of adult burn patients admitted to an ABA verified burn center who underwent placement of both BTM and CEA. Demographics, mechanism of injury, burn characteristics, surgeries, and outcome data were collected. Surgical technique was early excision, BTM placement, a BTM integration period, repeat superficial excision, fibrin/thrombin spray, split thickness skin grafting with usually 6:1 mesh autograft, and finally CEA application. CEA was managed per manufacturer protocols. Descriptive statistics and univariate analyses were performed with Microsoft Excel.ResultsEight patients met inclusion criteria. The average age was 29.3±5.3 years, 2nd degree TBSA 22.5±22.6%, 3rd degree TBSA 55.8±21%, and total TBSA was 78.3±4.4%. Four patients died during their hospital course and four survived to discharge. For survivors, the age length of stay was 135±23.6 days and they underwent an average of 8.5±1.5 total excision and/or grafting procedures. All patients had severe complications including severe sepsis/septic shock (n=8), gastrointestinal bleeds (n=2), acute respiratory distress syndrome (n=3), acute kidney injury or renal failure (n=4), pulmonary embolism (n=1) and myocardial infarction (n=1). The average time to 95% wound closure was 5 (79-147) days for survivors.ConclusionsThere continues to be an unmet need for autologous skin coverage in massive burn injuries when there is insufficient donor skin. In this series, we describe eight patients with massive burn injuries who underwent initial BTM placement, followed by 6:1 meshed autograft and CEA application. Although four patients died during their treatment course, the four surviving patients had acceptable wound closure rates and length of stay for their burn size.

Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study.

IntroductionTreatment of distal tibial fractures may be problematic due to their close proximity to the ankle joint and poor skin coverage, resulting in skin problems, deep infection, and malunion. To address these problems, minimally invasive plating methods have been described. In this study, we aimed to compare the clinical findings, radiological findings, and complication rates of patients treated with open reduction or minimally invasive plating.MethodsA total of 44 patients with distal tibial fractures with a mean follow-up period of 20.73 (12-50) months were included in this study retrospectively. The patients were divided into two groups, those who underwent open reduction and internal fixation and those treated with minimally invasive plates. The two groups were statistically compared in terms of radiological and clinical scores and complication rates (p=0.05). Comparative analysis was also performed for three fracture types in both groups.ResultsTwenty patients were treated with a minimally invasive approach and 24 patients were treated with the open reduction method. Age, gender, fracture type, and follow-up times were similar between the two groups (p>0.05). There was no statistically significant difference between postop American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), anterior distal tibial angle (ADTA), or lateral distal tibial angle (LDTA) values between both groups. There was also no difference in union times or nonunion rates (p>0.05). There was no statistically significant difference in rates of superficial skin problems or deep infections between the two groups (p>0.05). In comparison regarding fracture types, patients with type C fractures seemed to have better outcomes with minimal invasive plating.ConclusionMinimally invasive plating is a good approach in the treatment of distal tibial fractures. The technique seems to be advisable, especially for patients with type C fractures. However, the rates of skin problems and deep infections are similar to those seen with the open reduction method.

A Two-Stage Training Program for Auricular Framework Fabrication Practicing Using Three-Dimensional Printing Silicone Ribs and Porcine Costal Cartilage.

Background:The manufacture of cartilage framework is a key element in the success of total ear reconstruction. Appropriate training can improve cartilage curving and fabricating skills, which is especially helpful for the novice clinicians. Based on threedimensional printing silicone model and porcine rib cartilage, the authors have designed a 2-stage training program to improve skills and cosmetic cognition for ear reconstruction.Methods:The training program includes 2 successive stages. In the first stage, trainees completed observation of framework fabrication, design and sculpturing practice on silicone rib models. Porcine costal cartilages are used for fabrication in the second stage. After that, the framework was put in a latex glove connected with a suction to simulate the skin cover procedure in operation.Results:At the end of the training program, all trainees could fabricate an ear-shaped cartilage framework successfully. Their cosmetic cognitions of the ear have also improved.Conclusions:Based on three-dimensional printing silicone model and porcine rib cartilage, the authors have designed a 2-stage training program to improve trainee’s carving techniques and cosmetic cognition for ear reconstruction. The authors believe that this training program is helpful in training, practicing and teaching activities of framework fabrication in total ear reconstruction.

Expansion potential of skin grafts with alternating slit based auxetic incisions

Due to a dearth of skin substitutes, severe burn injuries result in millions of deaths every year. Split thickness skin grafting, which involves the projection of a parallel incision pattern on a small section of excised healthy skin, is commonly used to improve the expansion and cover a large burn site. The true expansion capacity of such grafts is currently limited to less than three times, which is insufficient for treating severe burn damage. In this work, we investigated the expansion potential of skin grafts using alternating slit based auxetic incision designs, with the hypothesis that this would lead to greater expansion than standard graft models. Nine two-layer skin graft models were developed with varying slit lengths and spacing, and the Poisson's ratio, meshing ratios, and induced stresses were estimated under uniaxial and biaxial load tests. For up to 100% applied strains, the Poisson's ratio increased with increase in the unit cell spacing. For the biaxial tests, equal lengths of the slits of the pattern, with a high unit cell spacing, was found to lead to a greater skin cover and lower stress localization in the graft models. However, when the graft models were tested up to the ultimate tensile strength of skin, a low unit cell spacing was found to be more desirable. Maximum uniaxial and biaxial meshing ratios, approximately 13 and 5 times higher than that of traditional grafts respectively, were quantified. Such expansion potentials and stress estimations with skin grafts have not been reported previously and would be indispensable for ground breaking advances in burn surgery research.

Реконструкция мягких тканей при обширных раневых дефектах стопы лоскутами с осевым типом кровоснабжения (обзор литературы)

peculiarity of the skin cover of the supporting zones is that the elastic fibers of the soft tissues of the plantar foot fix the skin to the deep fascia and the bone skeleton, resulting in minimizing of the supportive tissue mobility and increasing pressure stability without circulation disorder in areas of increased weight-bearing. Therefore, the requirements to the plastic properties of the selected material for the reconstruction of the soft tissues of the foot increase. Purpose is to review the various methods and techniques of surgical treatment for extensive soft tissue defects of the foot using flaps with an axial type of circulation. Material and methods The search of materials was performed from 2015 through 2020 in the following sources of information: eLibrary.ru; bibliographic bases (Scopus,; Web of Science); electronic library of dissertations of the Russian State Library (http://diss.rsl.ru) and sites of Dissertation Boards. The review of 72 publications of national and foreign authors related to this topic is presented. The depth of source selection was 16 years, starting from 2004. In the last 5 years, 45 studies data have been published. The literature related to surgical treatment of extensive defects in the foot soft tissues using complex flaps with an axial type of circulation supply was analyzed. Results Basing on the analysis of publications from various sources, the disadvantages and advantages of various methods and techniques of reconstructive plastic surgery are presented and various approaches and criteria for choosing the techniques of surgical soft tissues reconstruction are described. Conclusion In the treatment of patients with extensive soft tissue defects of the foot at the current stage of the reconstructive plastic surgery development, the doctrines based on microsurgical technologies of autografts of tissue complexes with an axial type of circulation became the most acceptable ways and techniques for lost skin restoration.

Rhinopoièses esthétiques triplan de l’unité de l’aile après ablation de lésions basocellulaires évoluées. À propos de 26 cas

The aesthetic reconstruction of full thickness defects of the entire ala is difficult because of its complex tridimensional anatomy. The triplan reconstruction of this unit which includes: -a lining with a mucosal flap, -a sculptured cartilage framework imitating the anatomy of the opposite ala -and a skin coverage by an immediate defatted forehead flap, gives regularly a very good aesthetic results, superior to the ones obtained by other techniques. From may 2008 to December 2020, 26 patients aged between 49 and 78 years old have benefited from this triplan aesthetic reconstruction after an excision of evolved basal cell carcinomas interesting the ala unit. The defects resulting were located in the entire ala with slight extension to the adjacent units. In all cases, the lining was reconstructed by the BURGET'S homolateral septal mucosal flap. The shape of the ala was obtained by a precise sculpture of conqual cartilage, taking the opposite ala as the model. The cutaneous coverage was provided by a paramedian forehead flap tailored exactly to the defect's size and immediately defatted. With a mean follow up of 8 years, all the reconstructed ala were quasi symmetrical to the opposite ones with a very good shape of the new nostrils. No complications and no tumoral recurrence are reported. This triplan reconstruction of the entire ala's defects is really aesthetic and gives a natural look for the lower third of the nose.

Effects of mesenchymal stem cell culture on radio sterilized human amnion or radio sterilized pig skin in burn wound healing.

Deep second and third degree burns treatment requires fibroblasts, keratinocytes and other skin cells in order to grow new dermis and epidermis. Cells can proliferate, secrete growth factors and extracellular matrix required to repair the damaged tissue. Radiosterilized human amnion and radiosterilized pig skin have been used as natural origin skin dressings for burned patients. Adipose-derived mesenchymal stem cells can differentiate into fibroblasts and keratinocytes and improve wound-healing progress. These cells can stimulate vascular tissue formation, release growth factors, synthetize new extracellular matrix and immunoregulate other cells. In this study, we developed mesenchymal stem cells-cellularized skin substitutes based from radiosterilized human amnion or pig skin. Third-degree burns were induced in mice animal models to evaluate the effect of cellularized skin substitutes on burn wound healing. Mesenchymal phenotype was immunophenotypically confirmed by flow cytometry and cell viability was close to 100%. Skin recovery was evaluated in burned mice after seven and fourteen days post-coverage with cellularized and non-cellularized sustitutes. Histological techniques and immunofluorescence were used to evaluate re-epithelization and type I collagen deposition. We determined that cellularized-human amnion or cellularized-pig skin in combination with mesenchymal stem cells improve extracellular matrix deposition. Both cellularized constructs increase detection of type I collagen in newly formed mouse skin and can be potentially used as skin coverage for further clinical treatment of burned patients.

¿Son los colgajos toracoabdominales una herramienta útil en el tratamiento del carcinoma de mama avanzado?

Despite advances in the treatment of breast cancer, there are cases in which the disease occurs in advanced stages and requires aggressive surgical treatments that cause large defects in the chest wall. Within the different techniques included in oncoplastic surgery, the thoracoabdominal flaps, included in the group of rotation flaps, have been postulated as an attractive technique to cover the wide defects resulting from these extensive surgeries, in order to start adjuvant treatment earlier and improve survival without increasing morbidity. It is important to establish a correct indication and an exhaustive knowledge of the anatomy in order to achieve a simple closure of the defect with good skin coverage.

3D Porous Graphene Films with Large‐Area In‐Plane Exterior Skins

AbstractConstruction of macroscopic 3D architectures of graphene is crucial to harness the advantageous properties of planar 2D graphene and to enable integration to many conventional and novel applications. Ideally, the 3D structure of graphene should be free of defects, covalently interconnected, and can be produced at large‐scale. Among various assembly techniques, fabrication using chemical vapor deposition (CVD) enables the production of high‐quality graphene where selection of template is the key that determines its consequent crystalline quality and structural morphology. Herein, a new method is presented to synthesize high‐quality porous graphene film by incorporating an in situ reduction–oxidation cycling treatment to generate micrometer‐sized pores on commercial Ni foil using an all‐CVD process route. Owing to the unique morphological features of the modified Ni template, the graphene film exhibits a holey surface with large‐area exterior skin coverage of &gt;94% and many interconnected ligaments within its porous interior. This extraordinary configuration gives rise to superior in‐plane electrical conductivity despite its low density. In comparison to state‐of‐the‐art materials for electromagnetic interference shielding, this porous graphene film is among the best performing materials with a specific shielding effectiveness of &gt;550 dB cm3 g−1 and absolute effectiveness of &gt;220 000 dB cm2 g−1.

Treatment of severe extravasation injury in a newborn by using tilapia fish skin: A case report.

Introduction and importancePeripheral venous catheterizations in newborns are associated with complications such as infections, phlebitis, vessel rupture and drug leaks or serum. Extravasation injury refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues, skin necrosis, and sometimes amputation. Using tilapia fish skin (TFS) is one of the new strategies that have been used in wound management.Case presentationThis case is a 36-week- and 4-day-old male fetus with a birth weight of 1600 g, height of 40 cm, and head circumference of 31 cm who was born to a 25-year-old mother by cesarean section at Mahzad Obstetrics and Gynecology Hospital, Urmia, Iran. On the third day of hospitalization at neonatal intensive care unit (NICU), an extravasation injury occurred in the infant's left hand in size approximately 1 × 1 cm by peripheral catheter. Despite extensive intravenous antibiotic therapy and rinsing with normal saline, wound healing was not achieved. The necrotic area was bandaged by using of the tilapia skin. For this purpose, the area was first washed with normal saline for 5 min and then the tilapia skin was placed on the damaged skin for 10 days. After a month, the newborn's wound had completely healed.Clinical discussionInfants are more prone to extravasation injury than adults due to being more sensitive and thinner peripheral vessel walls.ConclusionThis case illustrates that tilapia fish skin may be a suitable alternative to other temporary skin cover dressings in premature newborns suffering from extravasation injury.

Tunneled tubularized bladder mucosal grfaft for long urethral reconstruction: is it a reliable option in selected complex cases in children and adolescents?

Aim: We analyzed the use of tubularized tunneled bladder mucosa graft (TBMG) and its application as a salvage procedure or as primary surgery for long urethroplasty in children and adolescents. Specific attention was given to a new method to harvest a long bladder mucosa graft through a minimal detrusotomy. Methods: We analyzed the files of 10 patients who underwent TBMG urethroplasty at median age of 105 months (range 20-195 months). The indications were perineal hypospadias cripple in two, masculinizing genitoplasty for ovotesticular Ovotesticular Disorder of Sex Development (DSD) in two, perineal hypospadias in four, duplicated urethra in one, and complications of circumcision in one. Staged reconstruction was performed in all patients. The first stage was removal of all fibrous tissues and efficient treatment of curvature and skin coverage. After a minimal delay of one year, a free bladder mucosa graft was harvested through a minimal detrusotomy and tubularized. Tunneling of the graft was proceeded from the perineal urethrostomy to the glans. Results: The graft was successfully harvested through the minimal detrusotomy approach for variable lengths of urethroplasty; the median length was 10.5 cm (range 8-16 cm). The median follow up was 61.7 months (range 18-160 months). TBMG was the last surgery with no redo in five cases (50%). Long stricture occurred in one case of primary perineal hypospadias and needed a redo staged surgery. Two patients performed self-dilatation for distal stenosis. Conclusion: The tunneled bladder mucosa tube graft technique represents a good alternative for a long urethroplasty in patients with a paucity of healthy skin. The minimal detrusotomy technique for graft retrieval may reduce graft harvesting morbidity.

Prevenção de lesão por pressão no paciente com COVID-19 em posição prona: revisão de escopo

The aim was to map preventive measures of PI in the patient with COVID-19 in the prone position. This is a study developed through a scope review based on the Joanne Briggs Institute guidelines and the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Review checklist. The guiding question was elaborated based on the PCC's strategy. The search took place during the month of December 2021 in 5 databases. Fifteen articles were included. The PI preventive measures for the patient with COVID-19 in prone position include risk assessment activities, skin assessment, early repositioning and mobilization of support surfaces, PI classification, PI assessment and healing monitoring health professional education, preventive skin care, dressings and coverings and PI related to medical devices. Mapping and understanding the unfolding of PI in the prognosis of the COVID-19 patient allows for the elaboration of real preventive strategies based on the patient's needs.

Chopart Fractures and Dislocations: Case Series and New Algorithm of Treatment

Category:TraumaIntroduction/Purpose:Chopart fractures and dislocations are one of the most commonly overlooked injuries of the foot. These injuries are still challenging in both diagnosis and treatment and result in a high degree of long-term disability. Recent studies have shown that around 30 to 40% of these injuries are not adequately diagnosed on first consultation, mainly because of their low incidence and high clinical variability/spectrum of injuries. Anatomical reduction of Chopart injuries seems to be the most important prognostic factor of functional outcomes. However, there is still no consensus or clear evidence-based guidelines on the management of these types of injuries. We report the result of our current management protocol and propose a new algorithm of management of Chopart Injuries.Methods:We present a case series of patients with Chopart fractures and fracture-dislocations admitted to a Level 1 Trauma center between March 2015 and April 2020. Demographic data, mechanism of injury, treatment and complications were obtained from clinical records. Classification of injuries according to Zwipp was performed. Standardized surgical management was performed in 1 or 2 stages, according to soft tissue status. Open reduction and internal fixation of associated fractures of the talus, navicular, calcaneus and cuboid was performed. In cases of severe articular comminution or presence of medial and/or lateral instability, transarticular bridge plating was indicated. Postoperative radiological assessment was performed with X-rays and CT scan. Outcomes were determined using the American Orthopaedic Foot & Ankle Society midfoot score (AOFAS), visual analogue scale (VAS), foot and ankle ability measure (FAAM) and the 12-item Short Form Survey (SF-12).Results:Thirty four patients (12 women) were included in this study with a mean age of 37 years. Mechanisms of injury were: motor vehicle accidents (n=12), low energy midfoot torsion (n=12), crushing injuries (n=7), fall from height (n=2) and firearm injury (n=1). Mean follow up was 39 months (ranging from 8 to 71 months). The mean AOFAS score 84.8 (SD 12.9), mean FAAM of 84.4% (SD 15.4) and mean VAS score was 3/10. In terms of quality of life, the SF-12 physical component score was 43.59 (SD 9.3), with a mental component score of 51.98 (SD 12.1). Secondary procedures included: hardware removal (n=23), midfoot fusion (n=3) and skin coverage procedures by plastic surgery (n=5).Conclusion:In this case series, a standardized strategy for the treatment of Chopart injuries including the use of external fixation, ORIF and transarticular plating is presented. Reestablishment of joint alignment of both columns (medial and lateral) is crucial to obtain acceptable functional outcomes. Transarticular fixation is a useful alternative to post-reduction residual instability and bridging of fractures with periarticular comminution. Functional and quality of life results on this series were acceptable and comparable to previous reports at minimum one year follow up. Long-term follow up is needed to further validate the proposed algorithm.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study.

nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

Total reconstruction of the skin coverage of the penis with myocutaneous flap: case report

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.