Skin Edges Research Articles

En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint.

ObjectiveTo observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction.MethodsFrom January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw‐rod system combined with bone grafting.ResultsThe operation time was 155–310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400–8500 ml, with an average of 3111 ± 2189 ml. Follow‐up ranged from 5 to 108 months, with a median follow‐up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3‐year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months. Complications: one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%.ConclusionThe tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.

Sistemas de relajación de la piel para el cierre de grandes defectos mamarios

In mammary tumors that are large relative to breast-size, complex reconstructive methods are required. We describe an alternative system of closure. In circumstances such as this, primary closure of this skin defect may be enabled by stress relaxation of the skin and the use of a tension-relief system. Tension-relief systems secures immediate primary closure of large skin defects in patients with large for breast-size tumors by placing the tension away from the skin edges. This enables early skin closure and rapid mobilization with good functionality. Optimal healing facilitates postoperative radiotherapy on time without reconstruction failure.

A simple technique for neoumbilical reconstruction for congenital hernia associated proboscis deformity

IntroductionUmbilical reconstruction in pediatric patients who have developed a large proboscoid redundancy can be challenging after standard umbilical repair. We present a simple and unique surgical technique that results in a cosmetically appealing reconstruction. Operative techniqueThe operation is initiated with circumferential redundant skin excision and isolation of the hernia sac. Primary fascial repair is performed. Reconstruction utilizes the cut dermal/epidermal edge by approximating it to the exposed fascia just below the skin edge outside of the fascial repair in a purse string fashion for the creation of a neoumbilicus. ConclusionThis simple technique is unique from any currently published methods and results in a cosmetically pleasing reconstruction without evidence of any incision. Level of evidenceLevel V: Expert Opinion.

Next-generation sequencing for diagnosis of infection: is more sensitive really better?

The utility of next-generation sequencing (NGS) in differentiating between active infection and contaminant or baseline flora remains unclear. The purpose of this study is to compare NGS with culture-based methods in primary shoulder arthroplasty. A prospective series of primary shoulder arthroplasty patients with no history of infection or antibiotic use within 60 days of surgery was enrolled. All patients received standard perioperative antibiotics. After skin incision, a 10 × 3-mm sample of the medial skin edge was excised. A 2 × 2-cm synovial tissue biopsy was taken from the rotator interval after subscapularis takedown. Each sample set was halved and sent for NGS and standard cultures. Samples from 25 patients were analyzed. Standard aerobic/anaerobic cultures were positivein 10 skin samples (40%, 95% confidence interval [CI] 20%-60%) and 3 deep tissue samples(12%, 90% CI1%-23%]). NGS detected ≥1 bacterial species in 17 of the skin samples (68%,95% CI49%-87%) and 7 deep tissue samples (28%, 95% CI9%-47%). There was a significantdifference (P < .03) in the mean number of bacterial species detected with NGS betweenthe positive standard culture (1.6 species) and the negative standard culture groups (5.7 species). NGS identified bacteria at higher rates in skin and deep tissue samples than standard culture did in native, uninfected patients undergoing primary procedures. Further research is needed to determine which NGS results are clinically relevant and which are false positives before NGS can be reliably used in orthopedic cases.

Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants.

IntroductionIn cases of explantation and delayed reimplantation of an infected penile prosthesis, the scarring that afflicts the corporal bodies renders reimplantation difficult and risky, with potential loss in penile size.AimMitomycin C is an antitumor, antibiotic agent with a potent antifibrotic action that can be used to limit corporal scarring following explantation with the aim of achieving easy and safe subsequent reimplantation, in addition to preserving penile size.MethodsThis was a prospective study involving 5 patients with infected penile prostheses who were referred to our tertiary implantation center. The infected prostheses were explanted, followed by corporal washout with antiseptics and antibiotics. Patients were rescrubbed and redraped. Mitomycin C, 10 mg in 250 cc saline, was instilled into the corpora cavernosa (125 cc each), avoiding extracavernous spilling and contact with corporotomy and skin edges. Corporotomy and skin edges were freshened and closed. Reimplantation was performed 10 to 12 weeks later.Main Outcome MeasureWe evaluated the ease of blunt dilatation upon reimplantation and success in implanting cylinders the same size as the ones explanted.ResultsWe were able to dilate the corporal bodies with ease in all cases using blunt Hegar dilators. All cases received the same size implant as the one explanted, in terms of length and girth, with the exception of a case where the length was only 1 cm shorter.ConclusionsIrrigation of the cavernous spaces with mitomycin C upon explantation of an infected penile prosthesis appears to ameliorate corporal scarring and keep the cavernous spaces open. On a larger scale, this approach could render the most feared complication of penile prosthesis implantation surgery much more manageable.Shaeer O, Abdel Rahman IFS, Shaeer K. Shaeer’s Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants. Sex Med 2019; 7:357–360.

Percutaneous Pedicle Screws in the Obese: Should the Skin Incision Be More Lateral?

Objective: To determine if the skin incision for lumbar percutaneous pedicle screws should be more lateral in the obese patient.Methods: This was a retrospective radiographic analysis of 30 obese and non-obese lumbar spine computed tomography (CT) radiographs comparing the depth of soft tissue along the anatomic axis of the pedicle at L4 and L5.Results: The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L4 was 1.4 cm and 3.8 cm in the non-obese and obese groups, respectively. The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L5 was 2.1 cm and 4.3 cm in the non-obese and obese groups, respectively; both these differences reached statistical significance, p <0.05.Conclusions: This radiographic study supports a more lateral start point for percutaneous pedicle screws in obese patients to maintain an anatomic trajectory when inserting percutaneous pedicle screws into the lumbar spine at L4 and L5. If a skin incision is made at only 1 cm lateral to the pedicle in the obese patient, the surgeon often has to place significant traction on the skin edge to lateralize their instrumentation to achieve an appropriate angle of insertion. By making a more lateral skin incision, less manipulation of the skin and soft tissues is needed to maintain an anatomic trajectory of the pedicle screw. Decreasing soft tissue manipulation may decrease wound and instrumentation complications in this at-risk population.

A qualitative study to identify indicators of the quality of wound closure

Background: Wound healing after surgery may be complicated by surgical site infection (SSI). SSI development may be influenced by surgical techniques surrounding primary wound closure; for example, the standard to which surgical wounds are closed at the end of an operation. Aim: This study aimed to identify indicators of the quality of wound closure, and factors affecting this, to enable the future development of a tool to measure the quality of wound closure in the context of abdominal surgery. Methods: This study was undertaken within the context of an ongoing feasibility study comparing dressing strategies for patients undergoing abdominal surgery. Content analysis of published literature, non-participant observations of wound closure in the operating theatre, and semi-structured interviews with clinicians were used to identify indicators of the quality of wound closure. Results: A long list ( n = 38 domains) was categorized into visible markers indicating the quality of wound closure (e.g. suture visibility, apposition of wound edges, evidence of gaps in the wound or tethering of the skin edges), factors that might influence this (e.g. surgeon’s expertise, time taken to closure the wounds) and patient factors (e.g. obesity, skin conditions). Conclusions: This is the first study to investigate what is meant by ‘good wound closure’ and factors that might influence it. Findings will result in the development of a tool to assess quality of primary wound closure.

Use of a novel suture retention device to protect skin edges while using pulley suture technique for high-tension wound closure

Use of a novel suture retention device to protect skin edges while using pulley suture technique for high-tension wound closure

Comparison of incisional delay patterns on a rat random flap model

One of the simplest form of surgical delay can be performed by placing an incision around the flap without undermining, prior to flap elevation. In this study, we have compared the efficiency of different patterns of skin incision to improve flap survival. Twenty-eight animals were used in four groups. Incisional delay was performed prior to flap elevation in the three experiment groups. Complete incision of the three flap edges was performed in the all experiment groups with the exception of an intact skin section on the middle 1/3rd of the bilateral edges in group 1 (bilateral skin edge preserved delay: BSEPD), of a unilateral edge in group 2 (unilateral skin edge preserved delay: USEPD) and of the superior edge in group 3 (superior skin edge preserved delay: SSEPD) without any undermining. Two weeks following the delay procedure, dorsal skin flaps were raised and reinserted back to their place. The results were evaluated with the measurement of necrotic flap area, microangiographic imaging and histological evaluation. The mean percentage of necrotic flap area to whole flap area was 16.94%, 7.54%, 23.34% and 50.6% in the BSEPD, USEPD, SSEPD and control groups, respectively. In selected microangiographic images, vessels were more prominent in the delay groups. The results of the study indicate that three sided incision with an intact skin on the superior edge is not effective in providing a sufficient delay and flap survival improvement when compared to incisions with intact skin on the unilateral and bilateral edges.

Coacervate-mediated exogenous growth factor delivery for scarless skin regeneration

Although there are numerous medical applications to recover damaged skin tissue, scarless wound healing is being extensively investigated to provide a better therapeutic outcome. The exogenous delivery of therapeutic growth factors (GFs) is one of the engineering strategies for skin regeneration. This study presents an exogenous GF delivery platform developed using coacervates (Coa), a tertiary complex of poly(ethylene argininyl aspartate diglyceride) (PEAD) polycation, heparin, and cargo GFs (i.e., transforming growth factor beta 3 (TGF-β3) and interleukin 10 (IL-10)). Coa encompasses the advantage of high biocompatibility, facile preparation, protection of cargo GFs, and sustained GF release. We therefore speculated that coacervate-mediated dual delivery of TGF-β3/IL-10 would exhibit synergistic effects for the reduction of scar formation during physiological wound healing. Our results indicate that the exogenous administration of dual GF via Coa enhances the proliferation and migration of skin-related cells. Gene expression profiles using RT-PCR revealed up-regulation of ECM formation at early stage of wound healing and down-regulation of scar-related genes at later stages. Furthermore, direct injection of the dual GF Coa into the edges of damaged skin in a rat skin wound defect model demonstrated accelerated wound closure and skin regeneration after 3 weeks. Histological evaluation and immunohistochemical staining also revealed enhanced formation of the epidermal layer along with facilitated angiogenesis following dual GF Coa delivery. Based on these results, we conclude that polycation-mediated Coa fabrication and exogenous dual GF delivery via the Coa platform effectively augments both the quantity and quality of regenerated skin tissues without scar formation. Statement of SignificanceThis study was conducted to develop a simple administration platform for scarless skin regeneration using polycation-based coacervates with dual GFs. Both in vitro and in vivo studies were performed to confirm the therapeutic efficacy of this platform toward scarless wound healing. Our results demonstrate that the platform developed by us enhances the proliferation and migration of skin-related cells. Sequential modulation in various gene expression profiles suggests a balanced collagen-remodeling process by dual GFs. Furthermore, in vivo histological evaluation demonstrates that our technique enhances clear epidermis formation with less scab and thicker woven structure of collagen bundle, similar to that of a normal tissue. We propose that simple administration of dual GFs with Coa has the potential to be applied as a clinical approach for fundamental scarless skin regeneration.

Research on a Face Real-time Tracking Algorithm Based on Particle Filter Multi-Feature Fusion

With the revolutionary development of cloud computing and internet of things, the integration and utilization of “big data” resources is a hot topic of the artificial intelligence research. Face recognition technology information has the advantages of being non-replicable, non-stealing, simple and intuitive. Video face tracking in the context of big data has become an important research hotspot in the field of information security. In this paper, a multi-feature fusion adaptive adjustment target tracking window and an adaptive update template particle filter tracking framework algorithm are proposed. Firstly, the skin color and edge features of the face are extracted in the video sequence. The weighted color histogram are extracted which describes the face features. Then we use the integral histogram method to simplify the histogram calculation of the particles. Finally, according to the change of the average distance, the tracking window is adjusted to accurately track the tracking object. At the same time, the algorithm can adaptively update the tracking template which improves the accuracy and accuracy of the tracking. The experimental results show that the proposed method improves the tracking effect and has strong robustness in complex backgrounds such as skin color, illumination changes and face occlusion.

Comparison of Constrained Parameterisation Strategies for Aerodynamic Optimisation of Morphing Leading Edge Airfoil

In the context of ambitious targets for reducing environmental impact in the aviation sector, dictated by international institutions, morphing aircraft are expected to have potential for achieving the required efficiency increases. However, there are still open issues related to the design and implementation of deformable structures. In this paper, we compare three constrained parameterisation strategies for the aerodynamic design of a morphing leading edge, representing a potential substitute for traditional high-lift systems. In order to facilitate the structural design and promote the feasibility of solutions, we solve a multi-objective optimisation problem, including constraints on axial and bending strain introduced by morphing. A parameterisation method, inherently producing constant arc length curves, is employed in three variants, representing different morphing strategies which provide an increasing level of deformability, by allowing the lower edge of the flexible skin to slide and the gap formed with the fixed spar to be closed by a hatch. The results for the optimisation of a baseline airfoil show that the geometric constraints are effectively handled in the optimisation and the solutions are smooth, with a continuous variation along the Pareto frontier. The larger shape modification allowed by more flexible parameterisation variants enables an increase of the maximum lift coefficient up to 8.35%, and efficiency at 70% of stall incidence up to 4.26%.

Isoamyl-2-cyanoacrylate with subcuticular polyamide suture for skin closure in elective surgical procedures: Comparison of cosmetic outcome

The history of wound suturing reflects that of surgery itself. Wound treatment includes the technique of suturing as well as suturing materials. Of the above mentioned two, wound suturing plays a prominent role. Though the technique of suturing to close the dead space, to support and strengthen wounds until healing increases the tensile strength, to approximate skin edges for an aesthetically pleasing and functional result, and to minimize the risks of bleeding and infection, have remained the same. 50 patients (25 in each group) undergoing clean elective surgery with no focus of infection on the body admitted in the department of general surgery. This was a comparative study in which patients were studied in two groups. The mean cosmesis score at the end of one month was 5.92 for the adhesive glue group and 5.68 for the skin suturing group. Compared to the 7th day scores the difference between the two groups is further widened and infers a cosmetically better outcome for the adhesive glue group.

Conversion total knee arthroplasty after arthrodesis using rotatory hinge revision system

Objective Patients with knee arthrodesis experience many daily activities and limitations affecting their life quality. The purpose of this study was to report and discuss the outcome of our cases of knee arthrodesis converted to total knee arthroplasty. Patients and methods In the period from August 2015 to December 2017, the authors conducted a prospective study that included six patients (one female and five males) with sound knee arthrodesis. All patients underwent conversion total knee arthroplasty using rotatory hinge revision system. Patients’ ages ranged from 35 to 66 years. Patients were evaluated using Knee Society Clinical Score and Knee Injury and Osteoarthritis Outcome Score. Results The average follow-up period was 24.5 months (18–36 months). At the final follow-up, average knee flexion was 87.5° (70°–100°). Knee Society Clinical Score and Knee Injury and Osteoarthritis Outcome Score score increased form an average of 31.8 (28.4–34.8) preoperatively to 66.6 (58.6–74.4) at the final follow-up. The authors had an average final Knee society score of 67.6, ranging from 53 to 78. Three cases experienced postoperative complications, representing 50% of the study group, two cases had superficial wound infection, and a case had skin edge necrosis; all were successfully managed, with no long-term complications. Conclusion Conversion total knee arthroplasty is a hope for patients who cannot tolerate the effect of knee arthrodesis in their lives. Awareness of the risks, proper patient selection, good preoperative planning, and adequate management of complications can help the patients to have satisfactory results.

Operative treatment of pressure ulcers using pedicled flaps

Purpose: To present the results of surgical treatment concerning pressure ulcers. Materials and methods: All patients underwent surgical treatment at the Orthopedics and Traumatology Clinic from 1997 to 2016. One operator performed the procedures. A total of 28 pressure ulcers were operated (25 patients). The clinical material consisted of 15 pressure ulcers located in the lower back area, six pressure ulcers located in the ischial area, three pressure ulcers located in the trochanteric area and four pressure ulcers located in the heel area. Results: One conducted the result evaluation based on the criteria of complications proposed by Seiler. In case of all surgically treated patients, pressure ulcers appeared after 2-5 weeks after the surgery. One patient experienced hematoma below the slide piece. One could observe seroma in case of 5 patients. In this situation, it was required to apply a local postoperative puncture. Four patients experienced marginal skin necrosis (2 of them required resection of dead skin edges in operating block conditions which were later re-stitched using “side to side” technique). During the 3-year follow-up, there was no recurrence of operated pressure ulcers. Conclusions: Deep septic pressure ulcers, according to the division introduced by Seiler, connected with bone infection require the application of muscular-skin pieces. This procedure is aimed at improving local tissue blood supply. Proper preoperative preparation of the patient, careful planning of the surgery and suitable postoperative treatment of the patient are as significant as the surgery itself.

Experience of local using of platelet-rich plasma in 25 patients with diabetic foot

The aim of the study was to evaluate the effectiveness of local using of autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2. The study included 25 patients with a diagnosis of diabetic foot in stage 2. At the time of inclusion in the study, all patients had a defect of 3–7 cm2 of the skin and subcutaneous adipose tissue in the plantar part of the foot. In addition to the standard treatment, it was decided to perform the local administration of autologous platelet-rich plasma in all patients. The entire platelet-rich plasma volume obtained was injected in the edge of skin around the wound using 30-gauge needles. Repeated injections were performed every 5–7 days until complete healing of the soft tissue defect. To evaluate the effectiveness of the treatment, the area of the ulcerative defect was measured before the manipulation, as well as at an interval of 14 days until the ulcer was completely healed. The following results are obtained: prior to the manipulation, the area of ulcerative defects in the examined population was 511.9±120.3 mm2. On the 14th day, this indicator was already 353.6±112.5 mm2 and was significantly different from the area of the ulcerative defects before manipulation (p&lt;0.01). On the 28th day, complete healing of diabetic ulcers was observed in 11 (44%) patients, and the area of the skin defect in the study population was 22.4±24.3 mm2 and was significantly different from those in all previous study dates (p&lt;0.01). On day 42, we noted the complete healing of ulcers in absolutely all patients. Thus, local injection of an autologous platelet-rich plasma improves the local regenerative process and leads to complete healing of stage 2 diabetic ulcers with an area of 3–7 cm2 for 6 weeks.

Fucoidans inhibit the formation of post-operative abdominal adhesions in a rat model.

PurposeFibrin clot is essential for post-operative abdominal adhesion formation. Fucoidans, sulfated polysaccharides, inhibit fibrin clot formation. In addition, they inhibit inflammation and fibrosis, which also play important roles in adhesion formation. The purpose of this study was to evaluate fucoidans’ potential for inhibiting post-operative abdominal adhesions and measure their effects on systemic coagulation parameters when administered intraperitoneally (IP).Methods and materialsFemale Sprague Dawley rats were studied. A 2.5x2.5cm full thickness segment of abdominal wall was excised. The skin edges were approximated. This model induces extensive adhesions and allows objective quantitation. Three fucoidans were evaluated- Sigma Fucoidan Crude (SFC), Fucus vesiculosis 95% (Sigma) and, Peridan. One protocol involved continuous infusion into the abdomen from a subcutaneous osmotic pump. Alternatively, boluses of the solutions were injected IP at the end of the operation. Rats were sacrificed a week later. Adhesion extent was scored. Systemic coagulation effects of fucoidans were also evaluated. INR and aPTT were measured following IP injection of the fucoidan solutions and after 7 days of continuous infusion.ResultsAnimals given a continuous infusion of either SFC or Peridan yielded adhesion reduction of 80 to 90% from control. Bolus Peridan had no discernable influence on adhesion formation, but a single bolus of SFC caused significant adhesion reductions. Peridan resulted in prompt aPTT elevations which fell to nearly normal by 5 hours. The maximum peak value after SFC injection was seen in 15 hours. The maximal INR elevations were around 2. Measurement of INR and aPTT after a week of continuous infusion of either Peridan or SFC, were always in the normal control range. The third agent, Sigma, frequently yielded intraperitoneal infection found at autopsy.ConclusionsThese findings indicate that selected fucoidans infused intraperitoneally for a week after abdominal operations reduce adhesion extent by up to 90%.

Unilateral Cleft Lip Repair: Assessment of Outcome of Olokun-Olaitan Vermillion Flap Approach.

This study aimed to assess the outcome of our novel free-hand approach. Numerous cleft lip repair techniques exist, all of which involve incisions on skin and excision of tissue. Unilateral cleft lip is the result of failure of migration of orofacial tissues in-utero. Cleft lip repair should ideally involve an approach that simulates nature by avoiding skin incision and tissue excision, as these are not known to occur in the normal natural sequence of events.Without incising skin or excising any tissue, vermillion flaps were raised exposing the muscular layer and edges of skin and mucosa. Similar tissue types were advanced and sutured across the cleft, replicating what should have occurred normally.All 28 patients (100%) treated using our technique had competent lips. Acceptable symmetry of the vermillion was achieved in 24 (85.7%) of the patients. Lip symmetry was judged to be acceptable in 22 (78.6%). Symmetry of the nose was acceptable in 18 (64.3%) of patients.The Olokun-Olaitan vermillion flap approach proved effective in the repair of unilateral cleft lip, as it compared very favorably with results obtained using Millard's technique.

In vivo measurement of the effective atomic number of breast skin using spectral mammography

X-ray characteristics of body tissues are of crucial importance for developing and optimizing x-ray imaging techniques, in particular for dosimetry and spectral imaging applications. For breast imaging, the most important tissues are fibro-glandular, adipose and skin tissue. Some work has and is being done to better characterize these tissue types, in particular fibro-glandular and adipose tissue. In the case of breast skin, several recent studies have been published on the average skin thickness, but with regards to x-ray attenuation, the only published data, to the knowledge of the authors, is the elemental composition analysis of Hammerstein et al (1979 Radiology 130 485–91).This work presents an overview of breast skin thickness studies and a measurement of the effective atomic number () of breast skin using spectral mammography. , which together with the density forms the attenuation, is used to validate the work by Hammerstein et al, and the dependence of clinical parameters on is explored. Measurements were conducted on the skin edge of spectral mammograms using clinical data from a screening population (n = 709).The weighted average of breast skin thickness reported in studies between 1997 and 2013 was found to be mm. Mean was found to be 7.365 (95% CI: 7.364,7.366) for normal breast skin and 7.441 (95% CI: 7.440,7.442) for the nipple and areola. of normal breast skin is in agreement with Hammerstein et al, despite the different methods and larger sample size used. A small but significant increase in was found with age, but the increase is too small to be relevant for most applications.We conclude that normal breast skin is well described by a 1.56 mm skin layer and the elemental composition presented by Hammerstein et al (1979 Radiology 130 485–91) and recommend using these characteristics when modelling breast skin.

Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute.

We have described previously our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. Here we describe a modification of our standard technique using a bilaminar skin substitute to allow closure of large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large OSB defects. Surgery was performed between 24.0 and 28.9 gestational weeks with the woman under general anesthesia, using an entirely percutaneous fetoscopic approach with partial carbon dioxide insufflation of the uterine cavity, as described previously. If there was enough skin to be sutured in the midline, only a biocellulose patch was placed over the placode (single-patch group). In cases in which skin approximation was not possible, a bilaminar skin substitute (two layers: one silicone and one dermal matrix) was placed over the biocellulose patch and sutured to the skin edges (two-patch group). The surgical site was assessed at birth, and long-term follow-up was carried out. Percutaneous fetoscopic OSB repair was attempted in 47 consecutive fetuses, but surgery could not be completed in two. Preterm prelabor rupture of membranes (PPROM) occurred in 36 of the 45 (80%) cases which formed the study group, and the mean gestational age at delivery was 32.8 ± 2.5 weeks. A bilaminar skin substitute was required in 13/45 (29%) cases; in the remaining 32 cases, direct skin-to-skin suture was feasible. There were 12 cases of myeloschisis, of which 10 were in the two-patch group. In all cases, the skin substitute was located at the surgical site at birth. In five of the 13 (38.5%) cases in the two-patch group, additional postnatal repair was needed. In the remaining cases, the silicone layer detached spontaneously from the dermal matrix (on average, 25 days after birth), and the lesion healed by secondary intention. The mean operating time was 193 (range, 83-450) min; it was significantly longer in cases requiring the bilaminar skin substitute (additional 42 min on average), although the two-patch group had similar PPROM rate and gestational age at delivery compared with the single-patch group. Complete reversal of hindbrain herniation occurred in 68% of the 28 single-patch cases and 33% of the 12 two-patch cases with this information available (P < 0.05). In four cases there was no reversal; half of these occurred in myeloschisis cases. Large OSB defects may be treated successfully in utero using a bilaminar skin substitute over a biocellulose patch through an entirely percutaneous approach. Although the operating time is longer, surgical outcome is similar to that in cases closed primarily. Cases with myeloschisis seem to have a worse prognosis than do those with myelomeningocele. PPROM and preterm birth continue to be a challenge. Further experience is needed to assess the risks and benefits of this technique for the management of large OSB defects. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.