Skin Graft Research Articles

Post-Dural Puncture Headache: A Case Report

The purpose of the study is to present a complicated case who present an unwanted severe headache which occur in a patient receiving a spinal or epidural injection. We report the case of a 64-year-old male patient who underwent skin transplantation, namely split-thickness skin graft (STSG) on the right instep using a 26 G Quincke spinal needle. After successful plastic surgery which lasts 90 minutes using spinal anesthesia, postoperatively, the patient was admitted to the recovery room and instructed to rest in bed for 12 hours, and also not to sit and lift the head. After the motoric strength of both legs is normal (Bromage scale 0) the patient may tilt left-right, given RL infusion 30 tpm, and ketorolac analgesic injection 30 mg IV. In the recovery room the patient allowed to drink and eat as usual. But just after four hours, the patient goes to the bathroom to urinate, and at that moment the patient felt a sudden severe headache. The patient had to be helped by his family to get back to bed and lie down and after 15 minutes, the complaints subsided. The doctor on duty who was reported by the nurse about this incident asked the patient to rest in bed for 24 hours until the complaint completely disappears. In the following day, the patient discharged from the hospital in good condition. Despite its frequency and impact, PDPH remains poorly understood, and further research is needed to elucidate its actual scope of the problem, its pathophysiology and optimal management.

Reconstruction after Nasal Skin Cancer Resection: Nasal Obstruction and Associated Factors.

Background: Equal attention must be given to nasal aesthetics and function when reconstructing nasal defects after skin cancer resection. Little data exist on functional nasal outcomes following nasal reconstruction. Learning/Study Objective: Describe and analyze factors contributing to functional outcomes following nasal skin cancer defect reconstruction. Design Type: Retrospective review. Methods: Patients who underwent reconstruction of Mohs nasal defects were included. Reconstruction methods included primary closure, skin grafts, and local and interpolated flaps. Both subjective reports and physician-noted exam findings suggestive of nasal obstruction were noted. The obstructive domain of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) was administered preoperatively and at follow-up intervals. Results: In total, 193 patients met the inclusion criteria. Female sex, medial or lateral ala primary defect subunit, and auricular cartilage use were associated with increased risk of postoperative nasal obstruction within the first year on multivariate analysis, while reconstruction with a skin/composite graft was associated with lower risk of obstruction. Average time from reconstructive surgery to first report of obstruction was 116 days, and time to reported resolution was 235 days. Conclusion: The incidence of nasal obstruction following nasal defect reconstruction is low. Female sex, ala involvement, and auricular cartilage may increase the risk of nasal obstruction postoperatively.

Single-stage reconstruction of congenital multi-finger syndactyly with contiguous cross-shaped advancement flaps.

The purpose of this paper is to report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of the three- or four-finger syndactyly in a single-stage operation for congenital syndactyly. Thirty-five patients with multiple-finger syndactyly for web-space reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients were treated between January 2019 and October 2022. There were 20 patients with Poland syndrome, nine with constriction ring sequence, and six with synpolydactyly. One patient had bilateral hands involved. Twenty-three hands had three-finger syndactyly, and 13 hands had four-finger syndactyly. The patients' ages ranged from 5 to 96 months, with an average age of 29.6 months. The contiguous dorsal cross-shaped flaps were advanced to reconstruct both web space and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep of each reconstructed web. Scar hyperplasia was assessed using the Vancouver Scar Scale (VSS). Visual Analogue Scale (VAS) of 0 to 10 was applied to evaluate the subjective satisfaction of the parents with the overall appearance and function. In all cases the syndactyly was successfully released in a single operation. There were no perioperative complications such as finger necrosis, incision infection, or skin graft failure in this group. During a 12-to-58-month follow-up period, all the reconstructed web spaces exhibited satisfactory appearance, and there was no obvious web creep. The scars on the dorsal side of the hand were acceptable. Revision surgery was not needed in any patients. Web creep averaged 0.45, and the VSS score averaged 1.6. The average VAS score of appearance was 1.2, and that of function was 2.5. Multiple syndactyly release in one stage is feasible and safe. The contiguous cross-shaped flaps can be used to reconstruct two or more web spaces simultaneously after releasing.

Mussel Goo as Glue

Abstract Skin grafting is a critical component for healing damaged skin when the damage is extensive. Engraftment requires adhering replacement tissue over the damaged area. Traditional adherence methods, such as stapling or suturing the replacement in place, can produce additional damage and complicate healing. Researchers at Pohang University of Science and Technology have developed an adhesive mixture with superior properties for attaching skin grafts and promoting wound healing. The mixture is based on polymers derived from mussels.

The Impact of Vegan and Vegetarian Diets on Wound Healing: A Scoping Review.

Globally, vegan and vegetarian diets have grown in popularity. At the same time, it is well-known that nutrition plays a critical role in postoperative outcomes, including wound healing. The present investigation undertakes a systematic scoping review of the current literature that explores the impact of vegan or vegetarian diets on wound healing. The protocol followed PRISMA-ScR guidelines. PubMed, Web of Science, and Cochrane Library were used to identify articles published until 2024. Studies comparing any wound healing outcome between vegan or vegetarian patients and omnivorous patients were considered eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome-any wound healing outcome-and secondary outcomes, which included study general information, laboratory values, limitations, and future perspectives. Eight studies were included in this review. The majority of publications (87.5%) were prospective studies. Papers reported diverse wound healing outcomes after the following interventions: fractional microneedle radiofrequency, laser surgery, microfocused ultrasound, narrow-band ultraviolet B phototherapy, ultrapulsed CO2 resurfacing, excisional biopsy, skin graft, and photodynamic therapy. In almost all studies (87.5%) wound healing outcomes were statistically inferior in vegan or vegetarian patients compared to omnivorous patients. Our results suggest that wound healing outcomes may be suboptimal in patients adhering to vegan or vegetarian diets, indicating that these dietary patterns might contribute adversely to the wound healing process. Future research is needed to understand better the underlying mechanisms and the potential implications in the preoperative assessment and postoperative course of these patients. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Pelvic Exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) in Greece: A national snapshot survey of current practice

Background: Surgical treatment of locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) relies on Pelvic Exenteration, a complex procedure with high morbidity and mortality rates and great disparities in practice across different centers internationally. The aim of this survey is to review the current perioperative management of LARC and LRRC in Greece. Material and Methods: National Snapshot Survey disseminated online by the Hellenic Surgical Society and Greek Society of Coloproctology. Results: Most respondents were surgeons, 22% of whom had received fellowships in pelvic exenteration surgery. 83% of the participants reported holding multidisciplinary team meetings, and typically fewer than 10 pelvic exenteration procedures are conducted annually. A total of 28% of the participants employ a validated classification system to describe the operative approach (Pelvic Exenteration Lexicon). Considering outcomes, surgical factors like length of stay (78%), ICU duration (72%), blood loss (70%) and number of blood transfusions (64%) were prioritised, whereas patient-reported outcomes focused on physical functioning (77%), quality of life (75%), and urinary function (75%). For urological reconstructions, percutaneous nephrostomy (87%), cutaneous ureterostomy (75%) and urinary diversion using an ileal conduit (73%) were utilised the most, while plastic reconstructions involved mainly mesh placement (72%), omental flap with/without a skin graft (70%) and pedicled flaps (58%). Most prevalent complications were perineal wound dehiscence, abdominal wall hernia, postoperative ileus, urinary infection and VTE. Conclusion: Due to its complexity and low volume, experience in LARC/ LRRC is dispersed and differs among individuals. There is a need for structured, validated national guidelines to standardise methods and ensure that patients receive the highest standard of care.

Bioprinting-By-Design of Hydrogel-Based Biomaterials for In Situ Skin Tissue Engineering

Burns are one of the most common trauma injuries worldwide and have detrimental effects on the entire body. However, the current standard of care is autologous split thickness skin grafts (STSGs), which induces additional injuries to the patient. Therefore, the development of alternative treatments to replace traditional STSGs is critical, and bioprinting could be the future of burn care. Specifically, in situ bioprinting offers several advantages in clinical applications compared to conventional in vitro bioprinting, primarily due to its ability to deposit bioink directly onto the wound. This review provides an in-depth discussion of the aspects involved in in situ bioprinting for skin regeneration, including crosslinking mechanisms, properties of natural and synthetic hydrogel-based bioinks, various in situ bioprinting methods, and the clinical translation of in situ bioprinting. The current limitations of in situ bioprinting is the ideal combination of bioink and printing mechanism to allow multi-material dispensing or to produce well-orchestrated constructs in a timely manner in clinical settings. However, extensive ongoing research is focused on addressing these challenges, and they do not diminish the significant potential of in situ bioprinting for skin regeneration.

Advanced Reconstructive Techniques Following Orbital Exenteration: The Role of LCFA Free Flaps

BackgroundOrbital exenteration is a severe and disabling surgical procedure that involves the removal of all orbital contents. Effective reconstruction is crucial to managing the resulting defects. This study aims to propose a reconstructive algorithm utilizing free flaps derived from the lateral circumflex femoral artery (LCFA) system for orbital exenteration defects, based on our clinical experience. Patients and MethodsBetween January 2013 and January 2022, patients who underwent orbital exenteration and subsequent reconstruction using LCFA-based free flaps were included in this study. ResultsA total of 44 patients underwent orbital exenteration followed by LCFA free flap reconstruction. The choice of reconstructive technique varied according to defect type and dura mater exposure, adhering to the proposed algorithm. The procedures included 20 standard ALT flaps, 13 chimeric ALT flaps, 1 SALT chimeric flap with skin grafting, 7 SALT flaps with skin grafting, and 3 buried SALT flaps. Complications were recorded in 10 cases at the recipient site and in 2 cases at the donor site. ConclusionOrbital exenteration presents significant challenges both surgically and reconstructively, with a high risk of local recurrence and postoperative mortality. The reconstruction algorithm using LCFA-based free flaps, as proposed in this study, may guide surgeons in selecting the most appropriate technique, tailored to the specific defect and considering postoperative treatments such as adjuvant radiotherapy.

The Causes, Characteristics and Outcomes of Paediatric Farm Burns in Australia and New Zealand.

Burn injuries on farms are under-recognised in Australia and New Zealand. Previous studies suggested children are at risk of burn injury, focusing on risk factors including unmodified farm work, risk-taking behaviours, lack of supervision, and limited safety regulations. This study investigated the causes, characteristics, and outcomes of paediatric farm burns. Registry-based retrospective cohort study. Observational. Burns Registry of Australia and New Zealand (BRANZ). Paediatrics aged < 16 years and registered to the BRANZ between 2009 and 2021. The demographics, causes of burn injuries, pre- and in-hospital management, severity, and outcomes. Out of 10 936 paediatric burns, 186 were farm-related (1.7%). Children sustaining farm-related burns were older than those in non-farm environments, with 78.8% aged ≥ 5 years. Most farm burns occurred during leisure (72.5%). Predominant causes were found to be contact (62.4%), followed by flame (19.9%) and friction (10.8%). Only 56.9% received gold-standard first aid compared to 74.0% in non-farm environments. Farm-related burns were smaller but a greater proportion were full-thickness injuries, requiring surgical management with skin grafts. The majority of farm-related burns were discharged home (97.3%) with zero deaths. Farm-related burns in children are distinct from burns in non-farm environments. Despite children being well-recognised participants in farm work, work-related burns were relatively uncommon, and the occurrence of burns during leisure may explain low rates of recommended first aid. These insights can inform burn prevention and first aid strategies targeted at farm communities.

Bifocal metachronous dermato fibrosarcoma protuberans in children: A case report.

Dermato fibrosarcoma protuberans presents challenges in diagnosis and treatment, especially in children. Awareness of its aggressive local recurrence and its potential for multifocal presentation is crucial. Wide surgical resection with adequate margins remains the basis of management, in association with regular follow-up of affected patients. Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma, particularly uncommon in children. We report the case of a 13-year-old boy who initially presented with a firm mass on the left foot, later diagnosed as DFSP following histological and immunohistochemical analysis. The tumor was surgically excised with a wide margin, and a skin graft was used for coverage. Despite an initial favorable outcome, a new DFSP lesion developed at the proximal left thigh 1 year later, requiring further wide surgical excision and coverage with a tensor fascia lata flap. Both sites remained free of recurrence at one-year follow-up. This case underscores the importance of long-term vigilance in managing DFSP due to the potential risk of recurrence and multifocal involvement.

Implant-based Cryopreserved Autologous Free Nipple Grafting for Breast Reconstruction: The ICEBERG Technique.

Nipple creation is generally the final step of breast reconstruction. However, patients many times forego this procedure due to reconstructive fatigue. Herein, we describe a technique of harvesting the nipple-areola complex as a full-thickness skin graft during the initial mastectomy with direct-to-implant reconstruction, storing the harvested nipple tissue at -80°C, and then placing the nipple as a skin graft 2 weeks after the initial mastectomy. This method, termed the implant-based cryopreserved autologous free nipple grafting for breast reconstruction technique, serves as a feasible and shorter alternative to traditional procedures. The implant-based cryopreserved autologous free nipple grafting for breast reconstruction technique can, therefore, reduce the longevity of the reconstructive journey for patients.

Reconstruction of the anterior abdominal wall using a myocutaneous flap from the tensor fasciae latae muscle in a patient with squamous cell carcinoma of the skin

The present study reports the case of a 59-year-old female patient admitted to the department due to advanced skin cancer in the lower abdominal region extending to the peritoneum. The patient was qualified for tumor resection with simultaneous reconstruction using flap surgery techniques, employing a tensor fasciae latae muscle flap. The intervention involved wide tumor resection aimed at maximizing the likelihood of achieving oncological radicality. Reconstruction was carried out using a propeller flap from the tensor fasciae latae muscle and a rotational musculocutaneous flap based on the external oblique muscle. The procedure concluded with a skin graft from the thigh, which covered the remaining tissue defect after flap harvesting. The described reconstruction technique was carefully planned, considering the defect's characteristics and the patient’s condition, highlighting the importance of individualized approaches in plastic surgery. This case illustrates the complexity of surgical procedures in cancer patients and the significance of avoiding foreign materials in the context of chronic infections.

The impact of skin grafts on the management of deep burns: Approaches and results in the treatment of third-degree burns

Deep burns are serious and complex injuries, leading to complete destruction of the skin and subjacent tissues, with risks of major complications. Treatment requires a multidisciplinary approach, with skin grafting playing a key role in restoring skin integrity and promoting healing. The aim of this study is to demonstrate the efficiency of skin grafting in the treatment of deep burns, and its impact on improving the management of burn patients. A retrospective study of 50 patients admitted for the management of deep burns, hospitalized in the plastic, reconstructive and burns surgery department of CHU Tanger-Tetouan-Al Hoceima, over a 12-month period. Patients were divided into two groups: 15 patients treated with skin grafting (30%) and 35 patients treated with directed wound healing (70%). The average age of the patients was 29 years. Men accounted for 60% of patients, with a predominance also in the graft group. Patient comorbidities included arterial hypertension (14%), psychiatric disorders (10%), diabetes (8%) and epilepsy (6%). In terms of burns, 56% were thermal by flame, 32% by liquid contact and 12% electrical burns. Burns mainly affected the upper limbs (60%) and trunk (46%). Concerning the burn extent, 62% of patients had a BSI ≥ 20%. Skin grafts were mainly performed after 21 days, with a majority of thin skin grafts (87%). Graft uptake was optimal in the majority of cases, and we observed a minimal rate of post-operative complications consisting of partial graft lysis and one case of infection. Finally, major complications were more frequent in the directed healing group, including retractile bridles (14%) and hypertrophic scars (20%), whereas grafted patients mainly presented dysesthesia (8%) and hypertrophic scars (6%). Skin grafting has an important role to play in restoring skin integrity and preventing complications, improving healing and having a significant functional and aesthetic impact.

Rare Prevotella bivia infection after liposuction and fat graft: two case reports

Liposuction and fat grafting are commonly employed to improve body contouring. While postoperative infections are infrequent, severe complications like necrotizing fasciitis can arise, potentially destroying the aesthetic results. &lt;i&gt;Prevotella bivia&lt;/i&gt; is an anaerobic, Gram-negative rod bacterium commonly found in the vaginal mucosa, with increased prevalence in cases of bacterial vaginosis. Infections caused by this species can lead to necrotizing fasciitis or extensive tissue necrosis, necessitating prompt diagnosis during the acute phase. This report presents two severe cases of infection caused by &lt;i&gt;P. bivia&lt;/i&gt; following fat harvesting and grafting procedures. These cases required multiple debridements, skin grafts, and fasciotomies for management.

Brief Ectopic Banking and Immediate Plate Fixation With Free Omental Flap Addresses Multiple Fundamental Problems for Single-Stage Replant of Transhumeral Amputation.

High-velocity traumatic amputations of the proximal upper extremity are devastating to the patient and represent an extreme surgical challenge to the treatment team. The hand surgeon must simultaneously battle devascularization with timely microvascular anastomosis, gross contamination with meticulous debridement, and amputation with stable fixation. In restoring a functional extremity, many of these goals are in contention with each other. This case describes a novel management strategy for a left transhumeral amputation sustained by a 23-year-old man in a motorcycle accident. The amputated arm was temporized by ectopic banking via the lateral circumflex femoral artery to allow for thorough debridement and immediate open reduction internal plate fixation with coverage provided by a free omental flap and subsequent split-thickness skin graft. This strategy allows for a single-stage treatment of upper arm amputations with immediate microvascular anastomosis, stable internal fixation, and soft tissue coverage by the omentum providing immunogenic and lymphangiogenic properties to combat infection, lymphedema, and swelling. Functional reconstruction was then performed in a staged fashion with a free functional muscle transfer using the contralateral gracilis.

P-367. Containment of an Outbreak of Carbapenem-Resistant Acinetobacter baumanii in a Burn Intensive Care Unit

Abstract Background Acinetobacter baumanii is a cause of serious infections in hospital settings. Carbapenem-resistant Acinetobacter baumanii (CRAB) is especially difficult to treat. Patients in a burn unit are particularly vulnerable to colonization and infection with few reports describing CRAB outbreaks in a burn intensive care unit and measures required for containment. This study highlights the infection control measures successful in controlling an outbreak. Methods After detection of a patient with CRAB in an urban burn unit in January 2023, all patients in the burn unit were screened for carbapenem resistant organisms. Six patients with CRAB were identified between January 2023 and May 2023. Whole genomic sequencing was used for confirmation of clonal relatedness. All patients with a positive CRAB culture of sterile or non-sterile sites are included in this retrospective study. Results Six patients ages 29-53 tested positive for CRAB between January 2023 and May 2023. Case 1 was admitted from a long term acute care facility, with sputum culture positive for CRAB. One had CRAB from a blood culture, and four in wound cultures. Longer length of stay, 80 days vs 13 days was seen with CRAB positive patients because of partial skin graft failure, slower to heal wounds, and barriers to placement. After judicious use of antibiotics, following infection control practices were implemented: 1. Screening for carbapenem resistant organisms (CPOs) on admission, weekly, and on discharge. 2. Fluorescent markers added to adenosine triphosphate (ATP) testing of environmental surfaces and equipment. 3. Double terminal cleaning of rooms with CRAB. 4. A cleaning process for every piece of equipment. 5. Hand hygiene education and proper use of personal protective equipment. With the above measures, no cases of CRAB were seen after May 2023. Conclusion The CRAB outbreak was associated with patients with burn wounds, antibiotic use, similarities in age and demographics, slower wound healing, partial skin graft loss, and longer length of stay. The control measures listed were successful in controlling the outbreak. Disclosures All Authors: No reported disclosures

Reconstruction full-thickness defect of calcaneus post trauma using sural fascio-cutaneous flap: a case report

Traffic accidents often cause degloving injuries to the extremities that can cause an avulsion of the skin. Injuries of the feet and lower legs require special management, specifically the calcaneus region, which is an anatomical challenge for reconstructive surgery. The sural flap is often used for calcaneus defect reconstruction. This method provides more volume compared to skin graft methods. We report the case of a 33-year-old woman who was injured in a motorcycle accident. The patient had a wound on the calcaneus about 8 cm×3 cm long, just below the medial malleolus. The wound is circular, leaving intact tissue as a pedicle with a plantar pedis measuring 3 cm×2×cm×1 cm. The patient underwent debridement with a sural flap. Follow-up post-surgery, the flap was viable, but other procedures (casting, in setting flap, and refinement flap) are still needed to achieve better outcomes and physiotherapy to restore function. Degloving injuries generally cause devascularization. In cases like this, debridement is used as the initial therapy to preserve the surrounding soft tissue and skin. The second treatment is to prevent contractures. Most surgeons recommend a skin graft in the first stage. We performed a flap that has a rapid reconstruction process and can prevent the risk of skin necrosis as a weight-bearing area. Due to the existence of a long, retractable vascular pedicle, the sural flap is a helpful treatment in the reconstruction of skin defects in the distal area of the lower extremity. Reconstruction using fasciocutaneous flap procedure, for the patient's lower extremity defect (calcaneal defect) was successful. In trauma cases that cause damage full full-thickness skin and soft tissue, it is advisable to perform a flap as one of the reconstructive surgery procedures to restore the best function and shape of the involved lower extremity.

Clinical Outcomes and Complications in Complex Closures Under Local Anaesthesia Post-Mohs Surgery.

Mohs micrographic surgery offers high cure rates of cutaneous malignancies, but surgeons are often faced with large and complicated defects after tumour removal. To assess the safety and complication rates of large flaps and grafts (measuring ≥30 cm2) and larger complex linear closures (CLC, ≥12.5 cm, as defined by the American Medical Association Current Procedural Terminology code set), when performed under local anaesthesia. A retrospective analysis was conducted on a cohort of patients who underwent skin cancer treatment by Mohs at an academic institution (UCSD) from January 1, 2010, to December 31, 2022, and whose defects were repaired with CLC, flap, or skin graft. Demographic, surgical, and complication data were collected and analyzed. Of the 436 patients who met inclusion criteria, 39 underwent CLC, 344 underwent flap reconstruction, and 53 underwent grafting. Adverse effects to local anaesthesia were notably absent in all treatment methods. Overall complication rate was noted to be 16.1% (70/436). Complications varied across treatment methods, encompassing infection (6.0%, 26/436), bleeding (3.2%, 14/436), hematoma (5.0%, 22/436), seroma (0.2%, 1/436), and flap/graft necrosis (6.5%, 26/397). Our data suggest that large CLC, flaps, and grafts can be safely performed under local anaesthesia, but have higher complication rates compared to smaller reconstructions.

A Review on Autologous Platelet-Rich Plasma (Prp) Associated with Split Thickness Skin Grafting (Stsg) in the Treatment of Chronic Non-Healing Ulcers

Chronic non-healing ulcers present a significant clinical challenge due to their prolonged healing times and resistance to conventional treatments. Recent advances in regenerative medicine have introduced autologous platelet-rich plasma (PRP) as a promising therapeutic option. PRP, known for its high concentration of growth factors, has been shown to accelerate wound healing by enhancing tissue regeneration and angiogenesis. When combined with split-thickness skin grafting (STSG), PRP offers a synergistic approach to the management of chronic ulcers. This review evaluates the efficacy of PRP in conjunction with STSG in the treatment of chronic non-healing ulcers, drawing on recent clinical studies, case reports, and trials. The review highlights the biological mechanisms of PRP in wound healing, the procedural considerations in integrating PRP with STSG, and the clinical outcomes associated with this combined approach. Findings suggest that the use of autologous PRP alongside STSG significantly improves graft acceptance, reduces healing time, and promotes faster epithelialization, ultimately leading to better wound closure and patient recovery. However, the need for standardized protocols and further large-scale studies is emphasized to establish consistent guidelines for its use in clinical practice. This review aims to provide healthcare professionals with an updated perspective on this evolving treatment modality for chronic non-healing ulcers. KEY WORDS: Chronic ulcers, Platelet-rich plasma, Split-thickness skin grafting, Regenerative medicine, Wound healing, Tissue regeneration.

Conservative Reconstruction of the Lower Limb with a Bilayer Porous Collagen Matrix after a Spider Bite.

Brown recluse spider bites may cause symptoms ranging from local cutaneous reactions to systemic visceral loxoscelism. Most bites are self-limiting, but some can lead to necrotic ulcerations with severe complications and soft tissue defects. Necrotizing ulcers are uncommon and have various clinical presentations, so no standard treatment exists. A 68-year-old man required medical attention after getting a spider bite while traveling in Tanzania. After returning to Italy, the patient presented with a posterior lower limb black papule, local edema, and fever. The lesion quickly ulcerated with an eschar. Medical history and symptoms suggested a brown recluse spider bite. Ulcer management was conservative, with careful surgical debridement and a two-step reconstruction using a split-thickness skin graft and a bilayer porous collagen matrix. Treatment resulted in functional recovery and acceptable aesthetics.