Skin Harvesting Research Articles

Treatment of congenital syndactyly

Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.

656 Inter- and Intra-user Reliability of Skin Graft Thickness as a Function of Instrument

Abstract Introduction The most popular powered dermatomes (both electric and pneumatic) have a linear blade which oscillates at high speeds. Though the thickness of skin graft being elevated can be controlled by the depth-adjustment dial on the side of the instrument, factors, such as applied pressure, angle between the instrument and the surface, and curvature of the harvest site, can cause deviations from the target depth. As a result, the same depth setting can result in significantly different thicknesses of excised tissue among operators. A newer, powered dermatome has been developed which pneumatically rotates a circular blade at a fixed angle to the surface of the skin and does not require additional downward pressure. The goal of this study was to assess inter- and intra-user uniformity of graft thickness using conventional and newly designed dermatomes and assess the accuracy of the excised thickness. Methods Split thickness skin grafts were collected from the dorsum of Yorkshire pigs using a conventional dermatome and a newly designed test dermatome. Three different users collected three 2-inch wide by 4-inch long strips of skin using both instruments. Skin thickness at the center and edges of each strip were measured using a digital micrometer. Additionally, grafts were laser scanned to create a map of thickness for the entire piece of tissue. Reliability of the harvest was assessed using inter- and intra-class correlation coefficient. Results Both instruments were set to collect grafts 0.012” thick. Grafts harvested using the conventional dermatome ranged from 0.020–0.038” thick while grafts harvested with the test instrument ranged from 0.008–0.016” thick. On average, the conventional dermatome harvested grafts that were 2.16-fold thicker than the instrument setting while the test instrument collected grafts 0.91-fold the target thickness. Intra-user reliability was similar between instruments with greater reliability observed when users has substantial prior experience. Additionally, inter-user reliability was significantly increased with the test instrument. Conclusions Many factors control the uniformity and overall thickness of a skin graft including applied pressure and angle of attack, and how much tension is applied to the elevated graft. Using a conventional dermatome, variability in thickness was observed with greater average measured thickness versus depth setting. Grafts harvested using the newly designed instrument were on average closer to the desired thickness and more reproducible among users. Applicability of Research to Practice New instruments for skin harvesting may enhance uniformity of skin grafts.

540 Healthcare Resource Utilization and Costs of Care Among Pediatric Patients with Thermal Burns Undergoing Inpatient Autografting in a Managed Care Population

Abstract Introduction Autograft is considered the standard of care for severe burns; however, data on the economic outcomes in the pediatric population are sparse. This study assessed the healthcare resource utilization (HCRU) and costs of care among pediatric patients undergoing autografting for thermal burns. Methods The HealthCore Integrated Research Database was used to identify patients < 18 years old with thermal burns receiving the first inpatient autograft between 1/1/2011 and 6/30/2016. The first admission date was assigned as the index date; 12-month pre- and 24-month post-index-date continuous enrollment were required. Patient demographics, clinical characteristics, HCRU, and total costs were assessed. Results Of 65 identified patients, mean age was 7.2 years (standard deviation, SD=5.19), 46.2% were < 6 years old, and 69.2% were male. The majority of burn sites were in upper limbs (64.6%) and lower limbs (52.3%), followed by trunk (41.5%) and eye, face, head, and neck (24.6%). Over 80.0% of patients had third or deep third degree burns; 60% had total body surface area (TBSA) < 10% of any degree burn, and only a few patients (≤ 10) had TBSA ≥ 30%. The mean total all-cause cost in the one-year pre-index period was $14,359 (SD=$27,393), and $9,274 (SD=$25,694) of that cost were burn-related. The average length of stay of the index hospitalization was 10.9 days (SD=10.72), with mean total cost of $94,652 (SD=$162,176). The first-year post-index mean total cost was $111,536 (SD=$174,616) and 93.5% (including index hospitalization) were burn-related. On average, the index hospitalization accounted for 84.9% of the first-year costs. The second-year mean total cost was $10,734 (SD=$40,185), with 5.9% burn-related. Very few (≤ 10) patients had a burn-related hospitalization in the first year after discharge from the index hospitalization, and none had any burn-related inpatient stay in the second year. Conclusions The first-year economic burden after burn injury in this pediatric population was substantial, driven by the initial hospitalization for those undergoing autografting. Burn-related HCRU and cost reduced considerably in the second year post-index. Applicability of Research to Practice This study provided insights on the economic burden of pediatric patients with thermal burns who underwent inpatient autografting. Although autograft is part of the standard of care for severe burns, healthy skin availability and morbidity associated with skin harvest for autograft are major concerns among this vulnerable population. Innovations in burn care are warranted to ensure improved clinical and economic outcomes among patients with thermal burns.

Split-thickness Skin Harvest Site Incision or Inverted Folding-in with Dermostitches and Grafting Back to the Donor Site Using an Electronic Dermatome

Split-thickness Skin Harvest Site Incision or Inverted Folding-in with Dermostitches and Grafting Back to the Donor Site Using an Electronic Dermatome

Reduced Bacterial Burden of the Skin Surrounding the Shoulder Joint Following Topical Protocatechuic Acid Application: Results of a Pilot Study.

Background:Reducing the rising health-care burden associated with shoulder surgical site infection (SSI) is of paramount importance. The purpose of this study was to investigate the antimicrobial efficacy of protocatechuic acid (PCA) as a topical reagent for surgical skin antisepsis surrounding the shoulder joint.Methods:This was a 2-phase skin-disinfection trial involving the human shoulder. The shoulders of healthy volunteers were randomized to topical treatment with PCA (a 10% concentration of PCA in Phase I [11 subjects] and a 17% concentration in Phase II [12 subjects]), with a control of isopropyl alcohol (IPA) applied to the contralateral shoulder. Mechanical scraping was performed for skin harvest following reagent application, and samples were sent for aerobic and anaerobic culture. Sterilization rates and bacterial counts were determined for each treatment group, and the proportion of subjects with persistent Cutibacterium acnes colonization following topical application of PCA was determined using DNA sequencing analysis.Results:The topical application of 10% PCA was associated with significantly higher aerobic and anaerobic sterilization rates (90.9% and 81.8%, respectively) compared with treatment with IPA (p = 0.0143 and p = 0.0253, respectively). The topical application of 17% PCA was associated with a significantly higher anaerobic sterilization rate (83.3%) and trended toward a significantly higher aerobic sterilization rate (91.7%) compared with treatment with IPA (p = 0.0143 and p = 0.083, respectively). C. acnes was identified in 18.2% and 0% of subjects following treatment with 10% and 17% PCA, respectively.Conclusions:The topical application of PCA was associated with a reduction in the bacterial burden of human shoulder skin and demonstrated dose-dependent antimicrobial activity against C. acnes in young, healthy subjects. Clinical studies in a shoulder surgical population are warranted to determine the potential for application in surgical skin antisepsis to reduce shoulder SSI.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

RECELL® System Combined With Meshed Autograft for Reduction of Donor Skin Harvesting in Soft Tissue Reconstruction

RECELL® System Combined With Meshed Autograft for Reduction of Donor Skin Harvesting in Soft Tissue Reconstruction

Dermatome-Induced Lacerations: An Unspoken Problem in Burn Surgery

BackgroundDermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm. MethodsAn 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results. ResultsFifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). ConclusionsOur study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.

45-LB: Results of a Pilot Evaluation of a Novel Autologous Homologous Skin Construct Treatment of Diabetic Foot Wounds Refractory to Conventional Treatments

Background: An autologous homologous skin construct (AHSC) has been developed to treat complex cutaneous wounds (burns, chronic defects, and acute trauma) and was evaluated for treating diabetic foot ulcers (DFUs). Methods: AHSC was manufactured from 1.5cm2 healthy full-thickness skin harvest. All of the tissue is utilized and the endogenous regenerative populations are activated during processing. It is spread evenly across the wound bed and dressed similar to an autologous skin graft. Eleven Wagner 1 and Wagner 2 DFUs refractory to conventional therapies including advanced wound care products were treated with a single application of AHSC. Results: All harvests and deployments were performed in the outpatient setting. Wounds were dressed with silicone, compression bolster, and off-loading for the first 3 weeks followed by standard of care until closure. All harvest sites were primarily closed with no complications. All 11 wounds demonstrated complete graft take with one application. One patient with prior lower extremity hardware developed an infection separate from the AHSC-treated wound requiring extensive debridement including the treated wound. The remaining 10/11 wounds were closed by 10 weeks with a median of 5.8 weeks. Wounds remained closed at 2-week post-closure follow-up. There were no adverse events related to the AHSC treatments. Conclusions: AHSC was able to close DFUs refractory to standard of care with one treatment utilizing normal clinic work flow and requiring only one application. Further evaluation with randomized controlled trials are warranted. Disclosure C. Zelen: Research Support; Self; Musculoskelatal Transplant Foundation, Polarity TE. D.G. Armstrong: None.

Tumescent non-tumescent technique for split thickness skin graft harvesting

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.

Bold to do — bald to be? Outcomes decades after harvesting the scalp in burned children

BackgroundThe scalp is the only hidden donor site for split thickness skin grafts. Nevertheless, it is underappreciated due to fear of iatrogenic scarring alopecia. Long-term data showing whether androgenetic hair loss can reveal previously hidden scarring alopecia is unavailable. We aimed to evaluate results and patient satisfaction up to 30years after skin harvest from the scalp. MethodsBurn patients, hospitalized between 1977 and 1987 at the University Children’s Hospital Zurich with scalp skin harvest and currently over 30years old, were studied. Medical records and patient satisfaction were analyzed, and a clinical scalp examination was performed. ResultsThirty-two patients (18 males, 14 females) with a current age of 34.13±3.42years participated. Mean follow-up time was 27.09±3.04years. Fifty-four scalp harvests were performed with 1.69±0.96 sequential harvests. Hair growth was considered normal in 97% patients. Androgenetic alopecia (AGA) type Norwood II–VI was seen in 11 patients. Scalp examination revealed 11 unknown likely harvest-related alopecias with a mean size of 0.7cm2. ConclusionsLong-term morbidity of scalp skin harvest and the risk of clinically significant alopecia is very low while patient satisfaction is high. AGA is unlikely to reveal harvest damage previously hidden by regrown hair.

Autologous bilayered self-assembled skin substitutes (SASSs) as permanent grafts: a case series of 14 severely burned patients indicating clinical effectiveness.

Split-thickness skin autografts (AGs) are the standard surgical treatment for severe burn injuries. However, the treatment of patients with substantial skin loss is limited by the availability of donor sites for skin harvesting. As an alternative to skin autografts, our research group developed autologous self-assembled skin substitutes (SASSs), allowing the replacement of both dermis and epidermis in a single surgical procedure. The aim of the study was to assess the clinical outcome of the SASSs as a permanent coverage for full-thickness burn wounds. Patients were recruited through the Health Canada's Special Access Program. SASSs were grafted on debrided full-thickness wounds according to similar protocols used for AGs. The graft-take and the persistence of the SASS epithelium over time were evaluated. 14 patients received surgical care with SASSs. The mean percentage of the SASS graft-take was 98 % (standard deviation = 5) at 5 to 7 d after surgery. SASS integrity persisted over time (average follow-up time: 3.2 years), without noticeable deficiency in epidermal regeneration. Assessment of scar quality (skin elasticity, erythema, thickness) was performed on a subset of patients. Non-homogeneous pigmentation was noticed in several patients. These results indicated that the SASS allowed the successful coverage of full-thickness burns given its high graft-take, aesthetic outcome equivalent to autografting and the promotion of long-term tissue regeneration. When skin donor sites are in short supply, SASSs could be a valuable alternative to treat patients with full-thickness burns covering more than 50 % of their total body surface area.

Tumescent versus non-tumescent technique in skin graft healing: a cross-sectional study

Background: Skin grafting, especially burn surgery, is associated with great blood loss. Tumescent technique is the subdermal injection of fluid containing a vasoconstrictor prior to burn wound surgery to reduce blood loss. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. Although adrenaline is widely used, its local and systemic effects vary from patient to patient. The object of the present study was to observe the efficacy of tumescent technique, using adrenaline, versus non-tumescent technique in the healing of split thickness skin graft donor day 10.Methods: Two treatment groups of patients, tumescent (group A, n = 45) and non-tumescent technique (group B, n = 45), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of 1 mg (1:1000) adrenaline in 500 mL of saline. No prior administration of agent was performed in non-tumescent technique. Split-thickness skin grafting was carried out followed by regular inspection of the donor site. Healing rate was recorded at the postoperative day 10 by performing wound tracing technique and evaluated by performing unpaired t-test. P <0.05 was considered as statistically significant. Results: The mean age of patients was 29.98±12.6 years in group A and 45.36±10.23 years in group B. Age distribution was concentrated between 18 and 38 years. On postoperative day 10, complete epithelialization was observed in 15.56 % and 6.66% of patients in group A and B, respectively. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher healing rate (>80%, p=0.0134). Evidence of infection in the donor site was absent in both the groups.Conclusions: Tumescent technique by using adrenaline is more effective than non-tumescent technique in the healing of donor site and can be implemented preoperatively in split-thickness skin grafting.

313 Dermatome-Induced Lacerations: Incidence, Management, and Preventive Measures

Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors in order to develop a preventive algorithm. An 18-question survey was sent to all U.S. and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results and the current manufacturers’ guidelines. Fifty-six responses (42% response rate) were received from the burn unit directors. They reported 133 lacerations over the past 5 years. The overall incidence of dermatome-induced lacerations was 0.1% per year (1.3 per 1,000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010-0.015-inch thickness (78.4%), and 30–45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech/nurse (48.6%), while the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes. This study provides the only evidence on the incidence, etiology and risk factors of dermatome-induced lacerations. The development of an algorithm will help to increase the safety of skin grafting, the most commonly performed procedure in burn surgery.

A Genome-Wide Association Study of Apple Quality and Scab Resistance.

The apple ( × Borkh.) is an economically and culturally important crop grown worldwide. Growers of this long-lived perennial must produce fruit of adequate quality while also combatting abiotic and biotic stress. Traditional apple breeding can take up to 20 yr from initial cross to commercial release, but genomics-assisted breeding can help accelerate this process. To advance genomics-assisted breeding in apple, we performed genome-wide association studies (GWAS) and genomic prediction in a collection of 172 apple accessions by linking over 55,000 single nucleotide polymorphisms (SNPs) with 10 phenotypes collected over 2 yr. Genome-wide association studies revealed several known loci for skin color, harvest date and firmness at harvest. Several significant GWAS associations were detected for resistance to a major fungal pathogen, apple scab ( [Cke.] Wint.), but we demonstrate that these hits likely represent a single ancestral source. Using genomic prediction, we show that most phenotypes are sufficiently predictable using genome-wide SNPs to be candidates for genomic selection. Finally, we detect a signal for firmness retention after storage on chromosome 10 and show that it may not stem from variation in , a gene repeatedly identified in bi-parental mapping studies and widely believed to underlie a major QTL for firmness on chromosome 10. We provide evidence that this major QTL is more likely due to variation in a neighboring ethylene response factor (ERF) gene. The present study showcases the superior mapping resolution of GWAS compared to bi-parental linkage mapping by identifying a novel candidate gene underlying a well-studied, major QTL involved in apple firmness.

Reconstitution of full-thickness skin by microcolumn grafting.

In addition to providing a physical barrier, skin also serves a diverse range of physiological functions through different specialized resident cell types/structures, including melanocytes (pigmentation and protection against ultraviolet radiation), Langerhans cells (adaptive immunity), fibroblasts (maintaining extracellular matrix, paracrine regulation of keratinocytes), sweat glands (thermoregulation) and hair follicles (hair growth, sensation and a stem cell reservoir). Restoration of these functional elements has been a long‐standing challenge in efforts to engineer skin tissue, while autologous skin grafting is limited by the scarcity of donor site skin and morbidity caused by skin harvesting. We demonstrate an alternative approach of harvesting and then implanting μm‐scale, full‐thickness columns of human skin tissue, which can be removed from a donor site with minimal morbidity and no scarring. Fresh human skin microcolumns were used to reconstitute skin in wounds on immunodeficient mice. The restored skin recapitulated many key features of normal human skin tissue, including epidermal architecture, diverse skin cell populations, adnexal structures and sweat production in response to cholinergic stimulation. These promising preclinical results suggest that harvesting and grafting of microcolumns may be useful for reconstituting fully functional skin in human wounds, without donor site morbidity. © 2016 The Authors Journal of Tissue Engineering and Regenerative Medicine Published by John Wiley & Sons Ltd.

Simplifying the defatting of full-thickness skin using “razor strop” method

Defatting is usually required when patients undergo fullthickness skin grafting. However, this procedure is often burdensome, because it requires both stable fixation and appropriate tensioning of the skin piece. Furthermore, a skin piece may drop on the floor by accident during the defatting process To solve these problems, we present a unique method of full-thickness skin harvesting, which is easy and convenient, and does not require any special devices. The distal end of elliptical skin is not cut off but remains attached to the body like a pedicled flap. The surgeon pulls the end of the skin and puts his finger on the skin surface during the defatting procedure. This looks similar to a barber sharpening a razor using a strop belt. Our “razor strop” defatting method facilitates full-thickness skin harvesting without any need to purchase specialized equipment. We believe that this technique is an effective option for defatting in full-thickness skin grafting

Novel expansion techniques for skin grafts.

The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal–epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials.

Robust PLS models for soluble solids content and firmness determination in low chilling peach using near-infrared spectroscopy (NIR)

The objectives of this study was to develop partial least square (PLS) models using NIR spectroscopy for the determination of SSC and firmness in intact low chilling ‘Aurora-1’ peach fruit, and verify the influence of maturity stage and harvest season on the models to be developed (robustness). FT-NIR spectra were obtained as log 1/R with fruit harvested in 2013 at 3 maturity stages and in 2014. The spectra were collected on the background and blush colour skin areas of the each fruit. Model performance was evaluated based on the values of root mean square error for prediction (RMSEP) and coefficient of determination (RP2) obtained from validation fruit set (Kennard-Stone), and prediction fruit set (2014). PCA could not group the fruit based on blush and background skin colour, maturity stages, and harvest season. The model constructed using the external validation method obtained a RMSEVE of 1.08 % with 11 latent variables (LVS) and a RVE2 of 0.59. The prediction set, independent data, resulting in a less accurate model (RMSEP 1.04 %, Rp2 0.45 and 11 LVS). The same trend happened for determining firmness with the external validation resulting in better model with RMSEVE 9.51N and RVE2 of 0.40 and the prediction set with RMSEP of 13.2N, RP2 0.40 with 7 LVS. The NIR spectroscopy showed to be a potential analytical method to determine SSC and firmness of intact low chilling ‘Aurora 1’ cultivar. However, it is necessary to optimize the models in other to reduce the prediction errors.

Challenging the Conventional Therapy: Emerging Skin Graft Techniques for Wound Healing.

Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting. An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain. The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity. These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.

Novel Local Full-Thickness Skin Grafts for Closure of Free Fibular Osteocutaneous Flap Donor Sites

The fibular flap donor site after skin paddle harvest is usually covered with abdominal full-thickness skin grafts. However, this kind of skin graft creates an inevitable third operative area and additional esthetic damage. The aim of this report was to present a novel approach to manage fibular donor site defects using a full-thickness skin graft from the adjacent area and avoid further esthetic damage in a third area. Seventeen patients underwent mandibular and maxillary defect reconstruction using free fibular osteocutaneous flaps and the fibular donor-site defects were covered with full-thickness skin grafts from the adjacent area. The skin harvesting sites were closed primarily. The skin donor sites were closed without dehiscence in all cases. Fifteen full-thickness skin grafts survived completely, whereas 2 grafts were partial failures. There were no complete skin graft losses. All fibular osteocutaneous flaps were viable, and the recipient sites had no complications. This study shows that adjacent full-thickness skin grafts provide a straightforward and reliable technique for closure of the free fibular osteocutaneous flap donor site. The primary advantage of this technique is the avoidance of a third surgical site, an additional surgical scar, and subsequent additional esthetic impairment.