Split Skin Graft Research Articles

Negative pressure wound therapy: our experience of a polytrauma with degloving injury

Degloving injuries are uncommon serious conditions occurring in high-velocity traumas with high mortality and morbidity. The lack of standard guidelines for the diagnostic and therapeutic management of such injuries provides a challenge to the surgeon. We present a case of a 35-year-old male with an extensive degloving injury who underwent primary closure unsuccessfully. The necrotic area was debrided and negative pressure wound therapy was used for the management of the wound. The patient was managed with split skin grafting and post successful recovery on all fronts has been completely rehabilitated. Though primary suturing is always tried, the viability of the degloved skin remains questionable and might need extensive debridement. Negative Pressure Wound dressing is seen to be accelerating wound healing and improving the treatment outcome.

Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series.

Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.

A Comparison of Efficacy of Autologous Platelet-rich Plasma and Conventional Sutures in Anchoring Split Skin Graft on Wounds

Abstract Context: Split thickness skin grafting (STSG) restores cutaneous cover over wounds thus protecting the underlying surface from contamination, fluid loss and stimulates healing. Autologous platelet rich plasma (PRP) provides a large number of platelets and high concentration of growth factors which promote overall uptake of STSG. Aims: The aim of this study was to assess the immediate, subsequent adhesion and final take of STSG with application of PRP over recipient site. Methods and Material: 1 year Randomised Control Trial where 80 wounds of various aetiologies were randomised into intervention group (n=40) which received PRP before placing STSG on recipient site and control group (n=40) in which the graft was fixed in place with sutures alone. Immediate graft adhesion and subsequent graft uptake were compared between the two groups and statistical analysis was done with: SPSS Version 20. Results: Irrespective of aetiology, and size, among a total of 80 wounds 87.5% grafts had adhered by 1st minute of application in the intervention group compared to nil in control group (p< 0.0001). Graft uptake was assessed on first three consecutive dressings. There was significantly better graft uptake in intervention group compared to control group [third dressing uptake (98.29%, 93%, p< 0.0001) respectively].Difference in seroma and haematoma formation were also compared between the two groups and found to be not significant. (p>0.05) Conclusions: Application of topical PRP facilitates STSG uptake. It decreases operative time by decreasing mobility of graft over the wound bed. Thus, use of PRP improves outcome of split thickness skin graft in wounds of various aetiologies and we recommend use of the same at recipient site of STSG. CTRI/2021/06/034401

Three cases of pseudoepitheliomatous hyperplasia mimicking squamous cell carcinoma of the foot: A case series

Abstract Pseudoepitheliomatous hyperplasia (PEH) is a benign condition characterized by hyperplasia and proliferation of the epidermis and adnexal epithelium which can mimic squamous cell carcinoma (SCC). In our first case, a 55-year-old female with a prior history of split skin graft presented with dark verrucous growth over the graft site with a nonhealing ulcer of 3 cm × 2 cm seen over the ventral aspect of the left foot. Our second case, a 59-year-old male with a prior history of split skin grafting presented with dark verrucous growth and pain over the right forefoot for 3 months. The third case, a 58-year-old man with diabetic foot ulcer with verrucous growth over the toes. In all the cases, the biopsy was done and diagnosed to be PEH. We report this case series of PEH for the proper distinction from the SCC of the skin.

Surgical Outcome of Tumescent Versus Non Tumescent Technique for Harvesting Split Skin Graft: A Prospective Cohort Study

Introduction: The technique for harvesting Split-thickness Skin Grafts (STSG) varies among surgeons. To control bleeding from split-thickness skin graft donor sites, the use of several haemostatic agents has been reported. The tumescent technique involves injecting tumescent fluid into the subcutaneous fat, obtaining swelling and firmness (tumescence) of the surgical area. This creates regional anaesthesia of the skin and subcutaneous tissue, allowing painless cutaneous surgery, with adrenaline acts as a haemostatic agent. Aim: To compare the surgical outcomes in terms of blood loss during the harvesting of STSG, postoperative pain experienced by the patient, healing of the donor site, and graft take rate with tumescent versus non tumescent techniques of STSG. Materials and Methods: The present prospective cohort study was conducted in the Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India, from November 2017 to March 2019. A total of 56 patients were enrolled after applying inclusion and exclusion criteria. Patients were alternately assigned into the groups of tumescent or non tumescent technique groups. Intraoperative bleeding was assessed, postoperative pain was assessed using the Visual Analogue Score (VAS), and healing of the donor and recipient sites were assessed. Student’s t-test (two-tailed, independent) was used to find the significance of study parameters on a continuous scale between the two groups. The Chi-square/ Fisher’s-exact test was used to assess the significance of study parameters on a categorical scale between two or more groups. Results: The mean±Standard Deviation (SD) age of patients in the tumescent group was 48.25±12.79 years and in the non tumescent group was 52.79±12.91 years. Intraoperative bleeding ranged from 0-25% in all 28 patients in the tumescent group, while it ranged from 76-100% in all 28 patients in the control group (p-value<0.001). When the authors compared the pain on Postoperative Day (POD) 1 using VAS we observed that 32.1% of cases (n=9) had a score of 5-7 compared to 28.6% of controls (n=8). There was no significant difference in postoperative pain, and the technique used for harvesting STSG did not affect the healing of the donor site or the graft take at the recipient site. Conclusion: The tumescent technique is a safer and better alternative to the non tumescent technique, as intraoperative bleeding is significantly lower with the former. Additionally, the tumescent technique does not affect the healing of the donor or recipient site.

Efficacy of platelet-rich plasma in alleviating split skin graft morbidities.

Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.

Proximally based sural artery flap for the reconstruction of soft tissue defects around the knee and proximal third of the leg in India: a clinical study.

The reconstruction of defects around the knee and the proximal third of the leg necessitates thin, pliable skin with a stable and sensate soft tissue cover. This study analyzed the use of a proximally based sural artery flap for the coverage of such defects. This prospective clinical interventional study involved 10 patients who had soft tissue defects over the knee and the proximal third of the leg. These patients underwent reconstruction with a proximally based sural artery flap. The study analyzed various factors including age, sex, etiology, location and presentation of the defect, defect dimensions, flap particulars, postoperative complications, and follow-up. There were 10 cases, all of which involved men aged 20 to 65 years. The most common cause of injury was trauma resulting from road traffic accidents. The majority of defects were found in the proximal third of the leg, particularly on the anterolateral aspect. Defect dimensions varied from 6×3 to 15×13 cm2, and extensive defects as large as 16 cm × 14 cm could be covered using this flap. The size of the flaps ranged from 7×4 to 16×14 cm2, and the pedicle length was 10 to 15 cm. In all cases, donor site closure was achieved with split skin grafting. This flap consistently provided a thin, pliable, stable, and durable soft tissue cover over the defect with no functional deficit and minimal donor site morbidity. Complications, including distal flap necrosis and donor site graft loss, were observed in two cases. The proximally based sural fasciocutaneous flap serves as the primary method for reconstructing medium to large soft tissue defects around the knee and the proximal third of the leg. This technique offers thin, reliable, sensate, and stable soft tissue coverage, and can cover larger defects with minimal complications.

PLASTIC SURGERY OF WOUND DEFECTS WITH FREE GRAFTS AFTER MALIGNANT SKIN TUMORS EXCISION: A PILOT STUDY.

To evaluate the effectiveness of applying negative pressure bandages (VAC bandage) in patients with malignant skin tumors after closing defects with free skin grafts and to compare it with fixation of skin grafts by the ordinary ointment bandages. 61 patients with malignant skin tumors who underwent surgical treatment at the National Cancer Institute from 2019 to 2023 were included in the study. For the wound defects closure, the split skin grafts were applied in all patients. At the time of surgery, after closing a wound defect by a split skin graft, a negative pressure dressing (VAC bandage) was applied in 41 patients for 7 days (group 1). In 20 patients, a transplanted skin graft was fixed after surgery by an ordinary ointment pressure bandage (group 2). The immediate results were evaluated one week after surgery. Complete engraftment of the flap in group 1 was observed in 53.7 ± 7.8% cases, in group 2 this result was achieved in 5.0 ± 4.8% patients (p = 0.002). The complete graft necrosis occurred in 1 case in group 1 vs. 2 cases in group 2 (p = 0.496). The results of the engraftment in postoperative wounds were significantly better in the VAC-bandage group in terms of the number of the complete engraftments compared to the conventional pressure ointment bandage group.

Role of antimicrobial coated allogenic dried amniotic membrane in partial thickness burns

Objectives: Human amniotic membrane (HAM) is the biological scaffold for burn wound management. Allogenic HAM helps in promoting the healing of partial-thickness burn wounds. In this case study, we share our experience in using the antimicrobial-coated HAM. Material and Methods: The subject was an 8-year-old male child, who had accidental electrocution while playing near the electrical transformer and developed second-degree superficial and deep burns over the chest, abdomen, and bilateral lower limb. The child underwent tangential excision of the deep burns, and partial thickness burns are covered with dried allogenic HAM. Results: Intraoperative and postoperative periods were uneventful for the patient. The raw area took up the AM well, and burn wounds healed well in the second-degree superficial burns. A deep burns wound bed was prepared, and split skin grafting was done to the raw area. The wounds healed well after two weeks with minimal scarring. No complications or side effects were noted. Conclusion: Allogenic HAM plays a role in burn wound healing in burns. It helps in promoting the wound healing process.

Malignant proliferating trichilemmal tumor in male: A rare case entity with diagnostic dilemma

Abstract Trichilemmal tumor is a rare hair follicle tumor that is, thought to occur from a malignant transformation of a benign trichilemmoma. The tumor develops from the outer root sheath of the hair follicle. The patient underwent a wide local excision with 1 cm clear margin. The defect was covered by split thick skin graft harvested from ipsilateral thigh after consulting the plastic surgery department. Trichilemmal cyst can be misdiagnosed as other cutaneous lesions. Like in our case, initial FNAC was suggestive of a epidermoid cyst but post excision Histopathological examination gave us the real picture of a trichilemmal tumor. Recurrent tumors are very rare and can get misdiagnosed as squamous cell carcinoma. Malignant proliferating trichilemmal tumors are rare cutaneous tumors that are very rare in males. These tumors can be misdiagnosed as squamous cell carcinoma and require external stimuli for malignant conversion from benign counterparts. Wide local excision is sufficient for treatment.

Malignant appearance of trichilemmal cyst: a case report with review of the literature

69 years old male presented with one month history of non-tender, nodular, pinkish left neck swelling, measuring 10×20 mm. CECT revealed left neck dermatofibrosarcoma protuberans with submandibular vascular malformation. Surgical wide local excision of the lesion and split skin graft was done. Histopathology confirmed trichilemmal cyst (TC). TC is adnexal lesions, found in hair bearing areas. Pinkus pointed out that TC are keratin-filled cysts with a wall resembling the external root sheath of hair follicle. 2% can develop into proliferating trichilemmal tumours (PTTs) and malignant proliferating trichilemmal tumours (MPTTs). PTTs were originally described by Jones as benign but locally aggressive skin neoplasms. Female to male preponderance of 6% to 1%, with average age of 65 years at presentation. 90% are located on the scalp, while the residual 10% occur mainly on the back but they can develop any part of the body such as submandibular region. Proliferating TCs present as lobulated masses, soft in consistency. The masses may become exophytic, ulceration and may show malignant transformation. On imaging, these lesions can be either cystic or solid mass. Histopathological, it is characterised by absence of intercellular bridges between epithelial cells lining the cyst wall. Cyst cavity contains amorphous eosinophilic keratin. Satyaprakash et al report, complete surgical excision is warranted for TCs as if there is proliferative or malignant potential, it would affect the postoperative management and overall prognosis. TC, locally aggressive skin neoplasms and rarely, occurrence at submandibular region or become malignant and appropriately managed to prevent recurrence.

Traumatic degloving injuries: a prospective study to assess injury patterns, management, and outcomes at a single center in northern India.

This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

Comparison of Efficacy of Vacuum Dressing Versus Conventional Dressing Over Autologous Split Skin Grafts in Burn Wounds: A Single-Center Prospective Cohort Study.

This study was carried out to compare the efficacy of vacuum dressing and conventional dressing over split skin grafts in burn patients. It was a single-center prospective cohort study on patients, with less than 40% TBSA burn, undergoing skin grafting at 2 different sites simultaneously over the burn wounds. One site underwent conventional dressing following grafting, and the other underwent vacuum dressing. The primary objective was to compare the percentages of skin graft uptake on Day 5 and Day 14. The secondary objectives were to compare the duration of dressings, time for complete epithelization, need for regrafting, and wound swab culture positivity rates. Three independent examiners assessed the efficacy of dressings in terms of epithelization percentage, need for continued dressing, graft loss, wound swab culture positivity rate, and qualitative assessment of grafts. A total of 16 patients were included in the study. The graft loss, number of days of dressings, and complete epithelization time were statistically lower in the negative-pressure wound therapy (NPWT) group compared with the conventional group (P values .007, .006, and 0009, respectively). The percentage of epithelization was also found to be higher in the NPWT group (P = .006). The incidence of positive cultures and clinically significant graft loss was found to be lower in the NPWT group. However, this was not found to be statistically significant. NPWT dressings can be used in burn wounds following skin grafting and have been found to reduce the time for epithelization compared to conventional dressing.

First do no harm: A patient-reported survey of split skin graft donor site morbidities following thin and super-thin graft harvest

The split-thickness skin graft (STSG) donor site is the commonest used during burn surgery which has its own complications and as such the focus should be on minimizing it. Modifications to practice in our unit which we believe aid this include limiting the amount of STSG taken and the harvest of super-thin STSGs, with 0.003–0.005 in. (0.08–0.13 mm) being the commonest dermatome settings used. A patient-reported survey via a mobile phone link to a questionnaire was sent to 250 patients who had a STSG for an acute burn between 1st August 2020 and 31st July 2021. Patient demographics were collected from electronic records including the thickness of the FTSG taken when recorded. Patient responses were statistically analyzed and logistic regression with backwards elimination was performed to explore which contributing factors led to an improved experience of the donor site. Questionnaire responses were obtained from 107 patients (43%). These were between one and two and a half years after the injury. Concerning early donor site issues, itch was a problem for 52% of patients, pain was a problem for 48% of patients. Less common problems (fewer than 25% of patients) were leaking donor sites, wound breakdown, and over-granulation. Regarding long-term outcomes, increased, decreased or mixed pigmentation at the donor site was reported by 32% patients at the time of the survey. Hyper-vascular donor sites were reported by 24% patients. Raised or uneven feeling donor sites were reported by 19% patients, firm or stiff donor sites by 13% patients, and altered sensation by 10% patients. At the time of the survey, 70% responders reported their donor site looked “the same or about the same as my normal skin”. Of these, 62 reported how long it took for this to happen, and it equates to a third looking normal at 6 months and half looking normal at a year. For the 32 patients who reported their donor site looking abnormal, 72% were “not bothered” by it. Patients with super-thin grafts (0.003–0.005 in.) were significantly more likely to have normal sensation, normal stiffness, and be less raised at their donor sites than those who had thin grafts (0.006–0.008 in.). This survey gives important information on patients’ experiences of donor site morbidity that may form part of an informed consent process and allow tailored advice. Furthermore, it suggests that super-thin grafts may provide a superior donor site experience for patients.

Managing difficult airway in a post burn neck contracture: A case report

Post burns neck contracture is always considered a difficult airway and requires meticulous planning for proper management. Awake fiberoptic intubation (AFOI) have been gold standard for managing difficult airways [1]. Here we will discuss a case of difficult airway due to post burn contractures at the neck posted for debridement and Split Skin Grafting (SSG) for Marjolin’s ulcer at the nape of the neck. Internal changes in the airway due post inhalational injury fibrosis proved the major cause of difficulty and following traditional clinical teachings helped in successful management of airway.

Hybrid Regenerative Therapy for Successful Reconstruction of an Infected Traumatized Diabetic Foot Wound.

Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 mL sodium citrate and injected into the tendons, soft-tissues, and muscles. Next, the exposed bones and tendons were covered with platelet-rich fibrin and semi-occlusive membranes, and a Velnext negative pressure wound therapy device was applied over them. The wound improved progressively during the subsequent 6 weeks and was finally covered with a split-skin graft. The patient had a successful 18-month postoperative period until now with stable grafts, anatomical restoration, and excellent foot functionality. Thus, hybrid regenerative therapy, encompassing several prevalent methods for healing wounds, has excellent benefits for treating complex diabetic foot ulcers.

Comparative study of outcomes between application of negative pressure wound therapy to split skin graft versus split skin graft immobilized by traditional bolster dressing

Background: SSG is a versatile technique used for the reconstruction of wounds. The conventional techniques like traditional bolster dressing (TBD) to secure graft have been in use since the long time for the management of these wounds. NPWT is an effective advanced therapy which increase graft take by providing negative pressure to seal the space and provide persistent and uniform pressure. Methods: 60 patients were enrolled in the study. In the TBD group (30 patients) a bolster was placed on the graft which was made using a nonadherent dressing. In the NPWT group (30 patients) the SSG was secured using circumferential staples, followed by placement of VAC dressing with continuous negative pressure. Percentage of graft take assessed on 5th, 7th and 9th postop day. Results: Graft take on day 5th with NPWT group was 83.16±4.1% and in TBD group was 78.12±3.76%. On day 7th with NPWT group was 89.83±4.12% and in TBD group was 84.33±4.66%. On Day 9th with NPWT group was 96.33±5.3% and in TBD group was 92.67±5.24%. In NPWT group, mean Post SSG days were 9.9±0.61days. In TBD group, mean Post SSG days were 13.03±1.4 days. Conclusions: Our study suggest that Application of NPWT on SSG is beneficial in terms of better graft take, lesser infection, shortened post graft hospital stays and less no who needs for redo SSG and it is particularly useful anatomically challenging sites.

Use of MatriDerm® (skin substitute) and split skin graft in one stage in wound healing of exposed tibia without periosteum in two patients

Reporting two cases one of two centimetres breadth and the other of four centimetres breadth exposed tibia bone devoid of periosteum due to post debridement involving periosteum elevator to remove infective tissue which was successfully covered by a simple procedure with MatriDerm® and split skin graft in a single stage. Tibia bone was not drilled to sprout granulation tissue from bone marrow to create a granulated vascularised bed for second-stage skin grafting. It avoided local flap or microsurgical free flap surgery for small exposed bone devoid of periosteum. Both cases had a pleasing aesthetic outlook after a few months of follow-up. Difficult to find instances of more than two centimetres of exposed tibia devoid of periosteum covered successfully in a single stage by this procedure.

The use of Stimulan in bone and joint infections

AimsMusculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections.MethodsBetween January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30).ResultsOverall, six out of 106 patients (5.6%) presented with sepsis and poorly controlled comorbid conditions, and died in the hospital within few days of index surgery. Out of the remaining 100 patients, control of infection was achieved in 95 patients (95%). Persistence of infection was noted in five (5%) patients. Out of these 95 patients that had good control of infection, four patients (4.2%) with gap nonunion needed Masquelet procedure to achieve union.ConclusionOur multicentre experience confirmed that surgical debridement along with calcium sulphate bead insertion was effective in treating bone and joint infections without any side effects and complications.Cite this article: Bone Jt Open 2023;4(7):516–522.

Congenital Melanocytic Nevus: An Unusual Presentation

The overgrowth of melanocytes produces congenital melanocytic nevus. They are commonly present since birth, and the common terms used to describe them are called 'bathing trunk,' 'coat-sleeve,' or 'stocking naevi,' and they are usually found over thighs and back. The giant congenital nevus of size larger than twenty centimeters is highly pigmented and usually hairy. It is more commonly found in females compared to males. It is well recognized that the lesion's displeasing nature might have psychological and social ramifications, negatively affecting the patient's self-esteem, particularly females. Although congenital melanocytic nevus is mostly clinically diagnosed, the histological investigation is required to confirm the diagnosis and rule out malignant changes. The likelihood of transforming the giant nevus to malignant melanoma accounts for approximately five percent; fifty percent of melanomas develop before age two, and eighty percent develop before age seven. The risk of transformation to malignant melanoma is early in giant melanocytic nevus cases and adolescence in small and medium-sized nevi cases. Other complications like transformation to neurocutaneous melanosis consisting of the spread of melanoma to the central nervous system and leptomeninges are also dreadful. Hence, early removal is recommended. Here, we have reported a rare case of a six-year-old patient with a medium-sized nevus on their face with hairy tufts in between. On biopsy, the diagnosis was made as a junctional nevus. After which, the patient was managed with subsequent lesion excision and split skin grafting with an uneventful postoperative period. Our case report aims to report a rare case of congenital melanocytic nevus and to determine the importance of timely diagnosis and intervention. Keywords: , , , ,